الفهرس 
: Biomechanics of the hip jointOnly 14 pages are availabe for public view
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Abstract
The management of the adult patient with DDH is a challenge, and joint-preserving procedures should be considered in young adults with no or minimal osteoarthritic changes, whereas in the older patient joint preservation is associated with inferior results, albeit still an option.
Cross-sectional imaging, including CT and MRI, afford improved detection and characterization by providing morphologic information about acetabular deficiency. MRI also allows evaluation of potential associated injuries to the articular cartilage, the labrum, and the ligamentum teres. Familiarity with the radiographic and cross-sectional imaging findings of mild hip dysplasia in adults may allow a timely diagnosis and implementation of treatment strategies.
In young adults with moderate or severe hip dysplasia, treatment generally is surgical with the goal of restoring joint stability and proper hip biomechanics to ultimately delay the onset of OA.
The Bernese PAO is one of the most frequently used osteotomy procedures for dysplastic hips in skeletally mature patients and has been shown to maintain a native hip for many years. The shelf acetabuloplasty is a salvage procedure and cannot cover the femoral head concentrically, but it is an effective procedure for a young patient in postponing the progression of the hip OA once it starts in order to perform reconstructive surgeries later when justified.
The femoral varus osteotomy remains one of the most reliable conservative operations in OA due to DDH. However to achieve these good results, a clear understanding of the indications and biomechanical demands of this operation is required. In seldom and selected cases of severe arthritis, a palliative valgus osteotomy can achieve a decade of pain relief. However, patients over 35 year of age who have advanced hip arthritis and joint incongruity are less likely to benefit from osteotomies and will require THA.
Joint arthroplasty is the more attractive option in the older patient with established OA, and anatomical difficulties of acetabular and femoral reconstruction must be recognized to allow the appropriate choice of technique and implants. Unfortunately, the complication rates remain high and variable, despite efforts over the past 30 years to create the best technique or to find the best combination of implants to perform an ultimately successful THA on a patient with DDH.
Orthopaedic surgeons who treat adult patients with congenital hip disease should be familiar with its terminology, be able to recognise the different anatomical abnormalities, be able to carry out thorough pre-operative planning, reconstruct the hip using the appropriate surgical technique and implants and finally be able to anticipate the clinical outcome and avoid complications.