Hip Arthritis After Developmental Dysplasia (DDH): When to Consider Total Hip Replacement and How It’s Done

Developmental dysplasia of the hip (DDH) (often known as congenital hip dysplasia/dislocation) is one of the most common reasons for early hip arthritis in adults. Even if DDH was treated in childhood, the hip may still have a different shape and load pattern. Over time, this can lead to cartilage wear, pain, limping, and loss of motion.

This guide explains, in plain language, why hip replacement in DDH is not the same as “standard” arthritis, how we decide the right timing, and which modern surgical strategies are used to rebuild a stable, well-functioning hip.

1) Why DDH-related arthritis is more complex

In typical age-related arthritis, the hip anatomy is usually close to normal. In DDH, the problem is often both cartilage wear and structural mismatch in the ball-and-socket.

• Socket (acetabulum): The socket may be shallow, steep, and provide limited bone support. In higher dislocations, the femoral head may have formed a “false socket” higher up.
• Femur (thigh bone): The canal can be narrow, and the femoral neck may have increased rotation (version) that affects implant placement.

That’s why DDH hip replacement is often a reconstruction procedure—designed to restore anatomy and biomechanics, not just replace worn cartilage.

2) When is the “right time” for hip replacement?

Many DDH patients develop symptoms in their 30s, 40s, or 50s—so timing matters. The decision is not based on X-ray appearance alone.

• Pain: Persistent pain, night pain, rest pain, and pain that limits walking are key signals.
• Function: Difficulty with stairs, putting on shoes/socks, getting in/out of a car, and reduced walking endurance are common triggers to consider surgery.
• Daily life impact: If you can still manage well with simple measures, surgery may not be urgent. If your quality of life is clearly reduced, delaying too long can lead to more stiffness and weakness.

Practical rule: We recommend surgery when pain and function have become the main problem—not just because the imaging looks “bad.”

3) Why pre-operative planning is essential

Successful DDH hip replacement starts with excellent planning:

• Standing X-rays + often CT/3D planning: Helps evaluate bone stock, socket position, and femoral anatomy in detail.
• Leg length and pelvic balance: Many DDH patients have leg-length difference and altered gait. The plan aims for the safest and most functional correction.
• Spine–hip relationship: Low-back stiffness or deformity can influence hip stability and cup positioning in some patients.

4) The critical question: where should the new socket go?

In DDH, one of the most important technical decisions is cup placement (the new socket component).

• True (anatomic) acetabulum: Whenever possible, placing the cup in the true socket restores biomechanics and helps the hip muscles work more efficiently.
• High hip center: If bone coverage in the true socket is not adequate, a slightly higher placement may be considered in selected cases, but it may affect muscle leverage and long-term mechanics.

What if bone support is limited? Surgeons may use one or more strategies depending on the case:

• Medialization (cotyloplasty concept): Carefully shaping the inner wall to seat the cup deeper for better support.
• Bone graft: Using the patient’s femoral head to build coverage when appropriate.
• Metal augments: Porous metal support in more advanced bone deficiency.

5) In high dislocations: why a femoral shortening osteotomy may be needed

In severe DDH, the femur can sit very high. Bringing the hip down into the true socket may lengthen the leg significantly. If lengthening is excessive, nerves—especially the sciatic nerve—can be overstretched.

To reduce this risk, surgeons may perform a subtrochanteric femoral shortening osteotomy. In simple terms: a controlled segment of bone is removed to shorten the femur, allowing the hip to be safely relocated without dangerous nerve tension. Modern implants help stabilize the bone while it heals.

6) Risks and possible complications

DDH hip replacement can carry higher technical demands than standard cases. With experienced hands and correct planning, outcomes are often excellent—yet patients should understand the main risks:

• Nerve irritation or injury: Risk increases in cases requiring major leg-length correction.
• Dislocation: Muscle imbalance and altered anatomy can raise dislocation risk in some DDH patients.
• Non-union (rare): In osteotomy cases, bone healing issues can occasionally occur.

Conclusion

Hip replacement for DDH-related arthritis can dramatically reduce pain and restore walking ability. However, it is not a “routine” arthritis operation in many cases. The best results come from individualized planning—true socket reconstruction when possible, smart management of bone coverage, and femoral shortening osteotomy in carefully selected severe dislocations.