Congenital Hip Disease

Overview

  • Persisting DDH causes abnormal loading and early arthritis
  • Spectrum from mild dysplasia with labral overload to high dislocation with a false acetabulum
  • Crowe and Hartofilakidis describe subluxation
  • Lateral centre edge angle under 20° and a high Tönnis angle
  • Periacetabular osteotomy for young patients without significant arthritis
  • THR is demanding, with shallow acetabulum, excess femoral anteversion and shortening
  • May need shortening osteotomy or augmentation

Reviewed by Dr Marc Friso MBBS | Unaccredited Orthopaedic Registrar

Pathology

  • Shallow, anteverted acetabulum deficient anterolaterally, with a hypertrophic labrum prone to tearing
  • Femur has excess anteversion, valgus neck, small head and narrow straight canal
  • High dislocation shortens the abductors, hamstrings and sciatic nerve

Classification

Crowe

TypeSubluxation
IUnder 50%
II50 to 75%
III75 to 100%
IVOver 100%

Original publication Crowe JF, Mani VJ, Ranawat CS. Total hip replacement in congenital dislocation and dysplasia of the hip. J Bone Joint Surg Am. 1979;61(1):15-23.

Hartofilakidis

TypeDescription
AHead within the true acetabulum
BLow dislocation, false acetabulum overlapping the true
CHigh dislocation, no contact with the true acetabulum

Original publication Hartofilakidis G, Stamos K, Karachalios T, Ioannidis TT, Zacharakis N. Congenital hip disease in adults. Classification of acetabular deficiencies and operative treatment with acetabuloplasty combined with total hip arthroplasty. J Bone Joint Surg Am. 1996;78(5):683-92.

Investigations

Congenital Hip Disease, radiograph of a neglected developmental dysplasia of the hip in an adult
Radiograph of a neglected developmental dysplasia of the hip in an adult. Image by Surgeon and radiographer of the patient., Wikimedia Commons, CC BY-SA 3.0.
  • LCEA below 20 degrees dysplastic, 20 to 25 borderline
  • Tönnis angle above 10 degrees
  • Anterior centre edge angle on false profile below 20 degrees
  • Crossover and posterior wall signs indicate retroversion

Management

  • Bernese PAO (Ganz) for younger patients with congruent joints and Tönnis 0 to 1
  • PAO preserves the posterior column, keeping the ring stable and allowing early mobilisation
  • PAO risks LFCN injury, overcorrection, pubic non-union and sciatic injury
  • In THR, a cup at the true acetabulum restores centre of rotation and abductor lever arm
  • Small, modular or cemented stems allow independent version setting
  • Crowe IV needs subtrochanteric shortening osteotomy, as sciatic palsy rises beyond about 4 cm lengthening

Prognosis

  • THR outcomes are inferior to primary OA, with more dislocation, nerve palsy and revision

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.