{"id":5026,"date":"2025-12-15T10:08:47","date_gmt":"2025-12-15T10:08:47","guid":{"rendered":"https:\/\/www.chirurgiedelahanche.com\/blog\/implanter-prothese-hanche-primaire-sur-hanche-multioperee-enfance\/"},"modified":"2025-12-15T10:19:23","modified_gmt":"2025-12-15T10:19:23","slug":"primary-total-hip-replacement-patients-multiple-operations-during-childhood","status":"publish","type":"post","link":"https:\/\/www.chirurgiedelahanche.com\/en\/blog\/hip-surgery\/primary-total-hip-replacement-patients-multiple-operations-during-childhood\/","title":{"rendered":"Primary total hip replacement in patients presenting multiple operations during childhood"},"content":{"rendered":"<h2>The specific difficulties of multi-operated hips<\/h2>\n<p><strong>Primary total <\/strong><a href=\"https:\/\/www.chirurgiedelahanche.com\/en\/treatments\/custom-made-hip-prosthesis\/\"><strong>hip replacement<\/strong><\/a> <strong>on a non-operated <\/strong> hip is a common intervention, considered reliable and feasible in most centers.<\/p>\n<p>In contrast, certain <strong>childhood medical or surgical conditions<\/strong> make the procedure far more difficult and the outcomes more uncertain.<\/p>\n<p>We regularly treat patients, sometimes young adults, who have a <strong>multi-operated hip dating <\/strong> back to childhood due to :<\/p>\n<ul>\n<li aria-level=\"1\"><strong>developmental dysplasia of the hip (DDH)<\/strong><\/li>\n<li aria-level=\"1\"><strong>Legg\u2013Calv\u00e9\u2013Perthes disease<\/strong><\/li>\n<li aria-level=\"1\"><strong>childhood arthritis<\/strong><\/li>\n<li aria-level=\"1\"><strong>hip trauma<\/strong><\/li>\n<li>or <strong>multiple past surgeries:<\/strong> pelvic osteotomy, femoral osteotomy, shelf procedure, capsular release, tendon section, etc<\/li>\n<\/ul>\n<p>Often, no operative reports are available. Only several scars around the pelvis and femur, or even <strong>neurological sequelae<\/strong>, are observed.<\/p>\n<h2>A deeply altered anatomy<\/h2>\n<p>In these situations, patients present with highly <strong>atypical anatomy<\/strong>, including:<\/p>\n<ul>\n<li>pelvic tilt<\/li>\n<li>spinal deviation<\/li>\n<li>leg length discrepancy<\/li>\n<li>global atrophy of the gluteal and thigh musculature<\/li>\n<\/ul>\n<p>Radiographs frequently show sequelae of <strong>previous pelvic or femoral surgeries<\/strong>, along with a markedly asymmetric hip architecture.<\/p>\n<p>A thorough medical history, interview, and physical examination are therefore <strong>fundamental<\/strong>. They allow assessment of the spine, hips, lower limbs, passive and active mobility, and any muscular deficits (gluteus medius insufficiency or neurological involvement).<\/p>\n<h2>Which planning examinations are required?<\/h2>\n<p>When hip replacement is indicated, 2D planning is insufficient. It does not accurately reflect the true anatomy, particularly in the axial plane, nor the acetabular orientation, femoral anteversion, or retroversion.<\/p>\n<p><a href=\"https:\/\/www.chirurgiedelahanche.com\/en\/treatments\/custom-made-hip-prosthesis\/3d-scanner\/\"> A <strong>3D CT scan<\/strong><\/a><strong> is essential<\/strong>. It provides true-to-size analysis, three-dimensional reconstruction of the hip morphology, and evaluation of muscle trophicity (gluteal muscles, psoas). The presence of fatty degeneration is a poor prognostic factor for functional recovery.<\/p>\n<p>In addition, a standing <strong>EOS scan<\/strong> helps evaluate lumbopelvic\u2013femoral balance and lower-limb alignment abnormalities.<\/p>\n<p>Subsequently, 3D CT planning allows:<\/p>\n<ul>\n<li>determining the optimal position, orientation, and diameter of the acetabular cup<\/li>\n<li>designing a custom-made femoral stem adapted to the intramedullary canal<\/li>\n<li>optimizing the prosthetic neck to adjust neck\u2013shaft angle, anteversion, and medio-lateral offset<\/li>\n<\/ul>\n<h2>Objectives of hip prosthesis implantation in multi-operated hips<\/h2>\n<p>Implanting a hip prosthesis in this context must aim to :<\/p>\n<ul>\n<li>restore a functional anatomy<\/li>\n<li>remain realistic: a \u201cperfect\u201d hip is often a compromise<\/li>\n<li>minimize intraoperative complication risks<\/li>\n<\/ul>\n<h3>Choosing implants for multi-operated hips<\/h3>\n<p>These patients are often young, making it preferable to use a <strong>cementless implant,<\/strong>\u00a0<strong>titanium bone fixation<\/strong>, and a <strong>ceramic-on-ceramic bearing surfaces<\/strong>, ensuring long-term absence of wear.<\/p>\n<h3>The surgical approach: a major consideration<\/h3>\n<p>We favor the muscle sparing direct <strong>anterior approach<\/strong> that preserves muscular structures. In multi-operated patients, any additional muscle section must be avoided, unlike what occurs with posterior or transgluteal approaches.<\/p>\n<h2>A technically complex surgery<\/h2>\n<p>The procedure is often demanding and requires:<\/p>\n<ul>\n<li>wide exposure<\/li>\n<li>joint release<\/li>\n<li>cup implantation according to the planned alignment (sometimes with dysplasia or bone grafting)<\/li>\n<li>implantation of the custom-made stem in strict accordance with the preoperative plan<\/li>\n<\/ul>\n<p>At the end of surgery, the prosthetic ball is selected to properly balance the musculature.<\/p>\n<p>Postoperative recovery is longer than for a standard primary hip replacement. A rehabilitation program of <strong>4 to 6 months<\/strong> is required, focusing on restoring range of motion and lumbopelvic\u2013femoral balance.<\/p>\n<h2>A new life for patients operated on since childhood<\/h2>\n<p>For these patients, often treated surgically from a very young age, the successful implantation of a hip prosthesis opens new possibilities \u2014 both in daily activities and in sports practice.<\/p>\n<p><strong>3D planning and custom-made prostheses are key to reassuring the patient, optimizing the procedure, and achieving the best possible surgical outcome.<\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Implanting a hip prosthesis in a patient who underwent several operations during childhood represents a true surgical challenge. Unlike a primary hip replacement on a non-operated hip, often considered a reliable and standard procedure, the multi-operated hip presents a modified, sometimes severely altered anatomy, making both planning and execution significantly more complex. At Inside the Hip in Lyon and Paris, management relies on precise three-dimensional analysis and the use of custom-made implants, essential for restoring optimal function despite long-standing sequelae.<\/p>\n","protected":false},"author":35,"featured_media":5030,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[67],"tags":[],"class_list":["post-5026","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-hip-surgery"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Primary total hip replacement in patients presenting multiple operations during childhood | Paris and Lyon | Inside the Hip<\/title>\n<meta name=\"description\" content=\"Implanting a hip prosthesis in a patient who underwent several operations during childhood represents a true surgical challenge. 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