Soft tissue balancing in total hip arthroplasty for
patients with adult dysplasia of the hipos4_034212..215
Xing Wu MD, Lie-ming Lou MD, Shao-hua Li MD, Wei-ping Wu MD, Zheng-dong Cai MD
Department of Orthopaedics, Shanghai Tenth People’s Hospital, Tongji University, Shanghai, China
Objective: To summarize our surgical experience of release and balance of soft tissues around the hip in total hip
arthroplasty (THA) for patients with adult dysplasia of the hip (ADH).
Methods: From January 2001 to January 2006, 29 adult patients with dysplastic hips (31 hips) were included in this
study. Among them, there were 19 women and 10 men, aged from 38 to 65 years. According to the Crowe classification
system,there were 8 type I,12 type II,6 type III and 5 type IV.THA was performed via a lateral approach.All acetabular
cups were reconstructed at the original anatomic location through soft tissue releasing around the hip to restore limb
length, and techniques of balance of soft tissue were applied to extend the strength of the hip abductor and improve its
Results: All patients had restoration of limb length (range, 1.5–4.5 cm). One postoperative dislocation occurred due
to slight enlargement of the angle of abduction of the acetabulum.At 1.5-year follow-up (mean,3.2 years) in 29 patients,
the Harris score had increased from 42.6 preoperatively to 85.4. All hips were pain free with good function.
Conclusion: In order to restore the anatomic structure and physiologic function of the affected hip, the technique of
release and balance of soft tissues around the hip should be applied cautiously in arthroplasty of ADH.
Key words: Arthroplasty, replacement, hip; Hip dislocation, congenital; Orthopedic procedures
Adult dysplasia of the hip (ADH) is a common joint
disease, the symptoms of which often include arthralgia,
an effective procedure for hip dysplasia, but it is some-
times difficult to complete because of femoral head dis-
location, dysplasia of the acetabulum and the femur,
disparity in limb length, soft tissue contraction, and mus-
cular atrophy1. For the past few years, we have obtained
good results with THA in ADH using techniques of effec-
tive release and balance of soft tissue in order to recon-
struct the true socket, partly recover the abductor and
prevent resection of the femur.
Materials and methods
From January 2001 to January 2006, 29 adult patients
with dysplastic hips (31 hips) were included in this study.
Among them, there were 19 women and 10 men, aged
from 38 to 65 years. Preoperative anteroposterior radio-
graphs of the pelvis and anteroposterior and lateral radio-
graphs of the affected hip joint were taken to assess the
severity of hip dysplasia and anatomic variations of the
acetabulum and proximal femur. A computed tomogra-
phy (CT) scan was routinely taken to identify the quality
of bone around the true and the fake sockets and the
shape of the proximal femoral cavity. According to the
Crowe classification system2, there were 8 type I, 12 type
II, 6 type III and 5 type IV hips.
Initial surgical technique
approach began from 5 cm proximal to the apex of the
greater trochanter and paralleled the longitudinal axis of
the thigh. Skin and subcutaneous tissue were slit and the
fascia lata incised lengthwise slightly posteriorly.Then the
gluteus medius was exposed and separated from its one
third anterior–middle parts. Parts of the sheath of the
vastus lateralis were incised distally. Continuity of the
aponeurosis of the gluteus medius and the sheath of
the vastus lateralis were retained and repaired afterwards.
The gluteus minimus was dissected from its attachment
Address for correspondence Lie-ming Lou, MD, Department of
Orthopaedics, Shanghai Tenth People’s Hospital, Tongji University,
Shanghai 200072, China Tel: 0086-21-66307308; Fax: 0086-21-
66307308; Email: email@example.com
Received 24 January 2009; accepted 24 February 2009.
Orthopaedic Surgery (2009), Volume 1, No. 3, 212–215
© 2009 Tianjin Hospital and Blackwell Publishing Asia Pty Ltd