Open reduction, Dega osteotomy and proximal femoral osteotomy in delayed diagnosis of developmental hip dislocation: outcome at 40-year follow-up.
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ABSTRACT: Purpose
Late-diagnosed dislocated hips underwent open reduction, Dega osteotomy, and proximal femoral osteotomy between 1968 and 1988. The objectives of this study are to assess the survival of hips into adulthood, clinical and radiological outcome, patients' life perspectives and the risk factors of failure.Methods
An assessment of 67 hips treated when younger than five years (Level of evidence
III.
SUBMITTER: Wozniak L
PROVIDER: S-EPMC8138783 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:ObjectiveTo evaluate the outcomes of total hip arthroplasty (THA) with subtrochanteric femoral shortening osteotomy for high hip dislocation.MethodsIn this retrospective study, the results of 24 primary THAs with acetabular reconstruction and subtrochanteric femoral shortening osteotomy in 21 patients with high hip dislocation were evaluated. The acetabula were reconstructed with cemented or uncemented cups and bone grafting. Transverse subtrochanteric femoral shortening osteotomies were applied and the osteotomy sites treated by bone grafting and cable fixation. Assessment was by Hip Harris scores and radiographic evaluation.ResultsThe mean follow-up time was 42 months (18-108 months), three cases being lost to follow-up 18-27 months postoperatively. The HHS improved from 47.5 ± 8.7 to 88.5 ± 3.1. The mean length of femoral segments removed was 2.5 ± 0.8 cm (range, 1.0-4.5 cm) and mean acetabular inclination 43° ± 5° (range, 31°-54°). Caudalization of the femoral head center was 3.2 ± 3.0 mm (range, -3 to 12 mm) and lateralization 4.0 ± 4.0 mm (range, -9 to 11 mm). Mean greater trochanter height relative to theoretical hip center was 5.2 ± 1.0 cm (range, 3.5-7.1 cm) preoperatively and 0.2 ± 0.6 cm (range, -0.9 to 1.2 cm) postoperatively. Intraoperative trochanteric fractures occurred in three cases and sciatic nerve palsy in one.ConclusionTHA with subtrochanteric femoral shortening osteotomy is an effective technique for treating high hip dislocation. Its advantages include improvement in limb imbalance and decreased risk of sciatic nerve injury.
| S-EPMC6583667 | biostudies-literature
Project description:BackgroundThe study was carried out based on the background that though proximal femoral varus osteotomy is one of the most effective methods in treating developmental dysplasia of the hip (DDH), its surgical efficiency and effect need to be improved.MethodsThe neck shaft angle and acetabular morphological parameters were measured before and after operation and during clinical follow-up. The Severin criteria and McKay criteria were both adopted to score the measurements. The distance from the center of the femoral head to the medial cutting bone (expressed as C value) and the shortened lengths of the proximal femur (expressed as Δ S) calculated by formula and obtained by actual measurement were compared.ResultsThe neck shaft angle and acetabular morphological parameters after operation and during clinical follow-up were significantly lower than those before operation (P<0.05). The proportion of children with McKay scores of I, II, III, and IV after operation was 50.00%, 41.67%, 8.33%, and 0.00%, respectively; while the proportion of children with Severin scores of I, II, III, and IV was 55.00%, 38.33%, 6.67%, and 0.00%, respectively. There were no significant differences in the C value and Δ S obtained after formula calculation and actual measurement (P>0.05).ConclusionsThe acetabular morphological parameters applied in proximal femoral varus osteotomy are of great value for the treatment of DDH in children.
| S-EPMC8193007 | biostudies-literature
Project description:PurposeProximal femoral excision is a salvage procedure for painful chronic hip dislocation in cerebral palsy (CP) patients. The primary objective of this article is to describe our experience of an amplified interposition myoplasty, with appropriate peri-operative pain and tone management strategies, in a cohort of non-ambulatory CP patients with painful chronic hip dislocation. Our secondary objective is to present the clinical outcomes of these patients.MethodsWe describe our experience in 20 CP patients (25 procedures) at mean 54-month (range 27-169) follow-up with a surgical technique that includes an augmented interposition myoplasty and tone management. The indications for surgery were pain (21 hips), poor sitting tolerance (11) and difficulty with perineal care (8).ResultsThe mean age was 22 years (range 10-40) with 11 patients Gross Motor Function Classification Scale (GMFCS) IV and 9 patients GMFCS V. Mean length of stay was 13 days (3-35). One procedure required revision at 12 months. Mean pain score improved from 7.8 (5-10) pre-operatively to 2.8 (1-5) post-operatively (p < 0.001). Sitting tolerance improved in all patients and in 75 % (15) perineal care was easier.ConclusionsOur interposition myoplasty technique with individualised pain/tone management has good outcomes in this cohort of patients with multiple co-morbidities.
| S-EPMC4549349 | biostudies-literature
Project description:Background: Typical sequelae of Perthes disease and Perthes-like deformities comprise a short femoral neck, aspherical femoral head, and greater trochanteric overgrowth. Morscher’s osteotomy aims at restoring the normal extra-articular anatomy, but incapable of restoring a normal head-neck contour with residual impingement. Femoral neck lengthening osteotomy combined with osteochondroplasty through surgical hip dislocation approach was not previously described in the literature. We hypothesized that this technique is capable of near-normal restoration of the proximal femoral anatomy, increasing limb length, restoring abductor power, and simultaneous management of intra-articular chondro-labral disease. Methods: A prospective series of 21 consecutive patients with sequelae of Perthes disease and Perthes-like deformity (Stulberg II and III) were treated by Morscher’s osteotomy through surgical hip dislocation approach. The mean age was 14.9 years (9–30 years) and the mean follow-up was 4.5 years (2–8 years). Results: The mean Harris hip score improved significantly from 66.5 to 89.5 points (p < 0.001), and the mean limb length discrepancy improved from 2.5 to 0.6 cm (p < 0.001). The mean alpha angle improved from 81.8° to 49.5°, the mean neck-shaft angle increased from 117.8° to 129.8°, and the articulo-trochanteric distance has improved from −6.7 to 20.8 mm. Six out of 21 patients required staged periacetabular osteotomy for residual acetabular dysplasia. No cases of chondrolysis or osteonecrosis were identified. Conclusion: Femoral neck lengthening osteotomy through surgical hip dislocation appraoch has proven to be safe and effective for preservation of symptomatic hips with Perthes and Perthes-like deformities and mild to moderate femoral head deformities (Stulberg II and III). A staged periacetabular osteotomy may be required in those patients with significant acetabular dysplasia. Level of evidence: Level IV.
| S-EPMC9124916 | biostudies-literature
Project description:A 77-year-old man sustained an acetabular fracture after falling from a staircase and landing on his right side. He fractured the anterior column of his acetabulum and the quadrilateral plate. He underwent a single-stage open reduction and internal fixation of the fracture combined with a dual mobility total hip arthroplasty (THA). He sustained a traumatic hip dislocation 1?month postoperatively. Closed reduction was attempted at another hospital, and the femoral stem was pulled out. We believe this was caused by the polyliner being hitched either to the acetabular cup or in the soft tissues around the ilium. We present this case to caution orthopaedic surgeons that dual mobility THA dislocations are difficult to diagnose as the polyliner is not clearly seen on X-rays, and reduction attempts may lead to worsening of an already difficult situation.
| S-EPMC5786971 | biostudies-literature
Project description:Recurrent hip dislocation in a Down Syndrome patient with dysplastic hip is a very rare and challenging case to treat even for an expert orthopaedic hip surgeon. Least compliant patient and family, lowly educated with low socioeconomic status, young age and several anatomical variations forces limited option as a treatment. Several literatures mentioned Despite requiring only minimal implant, this technically demanding surgery requires a thorough understanding of the hip anatomy. This is the first case worldwide reporting 5 year follow up of dysplastic hip with DS treated successfully with periacetabular osteotomy (PAO) technique. An eighteen years old female with DS had multiple posterior hip dislocation episodes since 3 years prior our hospital admission. A modified Ganz PAO was performed under image intensifier guide. Patient was able to talk and hip was never dislocated again within 5 years follow up. Ganz periacetabular osteotomy, although a technically demanding surgery, is a preferable treatment in recurrent hip dislocation for Down Syndrome patient with good to excellent clinical and radiological outcome.
| S-EPMC7218225 | biostudies-literature
Project description:BackgroundSubtrochanteric femoral shortening osteotomy is a crucial procedure to prevent nerve injury in total hip arthroplasty for severe developmental dysplasia of the hip. Transverse osteotomy was first applied, and other modified methods have also been reported. Each has its own advantages and limitations, but no definitive conclusions regarding differences in outcomes have been reached to date.MethodsWe therefore performed a comprehensive meta-analysis to compare the outcomes of different approaches. 37 studies (795 hips) were included in the final analysis. Meta-analysis, subgroup analysis and meta-regression were performed.ResultsMeta-analysis and subgroup analysis showed no significant difference between transverse and modified method. This is further confirmed by meta-regression. Method of osteotomy was found to be not associated with nonunion rate (P = 0.472), as well as other post-operative outcomes including nerve palsy (P = 0.240), dislocation (P = 0.735), revision (P = 0.653) and Harris hip score improvement (P = 0.562). In addition, western countries (P = 0.010) and duration of follow-up more than 5 years (P = 0.014) were associated with higher revision rate.ConclusionsTransverse osteotomy and modified osteotomy appear to be equivalent in terms of nonunion, safety and efficacy. Transverse osteotomy may be recommended, due to its simplicity and convenience in adjusting the anteversion angle. Well-designed and large-sample-size randomized controlled trials are expected to confirm and update the findings of this analysis.
| S-EPMC4201680 | biostudies-literature
Project description:OBJECTIVE:To introduce a modified osteotomy method for proximal femur reconstruction (PFR) in total hip arthroplasty (THA) for high developmental dysplasia of the hip (DDH). METHOD:A retrospective study was performed in a series of 24 patients (26 hips) with Crowe III/IV DDH who underwent THA and simultaneous PFR. We used an animated video to illustrate and help understand the procedure for this technique. Patients were reviewed clinically and radiographically with an average follow-up of 31?months. The Harris hip score (HHS) was recorded preoperatively and at 3 and 12?months postoperatively. RESULTS:All patients achieved primary bone union. No revision was needed up to the latest follow-up. One patient had a dislocation due to self-fall and received manual reduction under general anesthesia. No patient had intraoperative femoral fractures, sciatic nerve injury, or infection. The mean HHS improved from 33.48?±?9.06 preoperatively to 84.61?±?4.78 immediately after surgery and 90.84?±?4.96 at 12?months. CONCLUSION:Proximal femur reconstruction is a simple and practical technique for femoral remolding during THA in patients with high DDH.
| S-EPMC7031569 | biostudies-literature
Project description:Distal femoral varus osteotomy is a well-established procedure for the treatment of lateral compartment cartilage lesions and degenerative disease, correcting limb alignment and decreasing the progression of the pathology. Surgical techniques can be performed with a lateral opening-wedge or medial closing-wedge correction of the deformity. Fixation methods for lateral opening-wedge osteotomies are widely available, and there are various types of implants that can be used for fixation. However, there are currently only a few options of implants for fixation of a medial closing-wedge osteotomy on the market. This report describes a medial, supracondylar, V-shaped, closing-wedge distal femoral osteotomy using a locked anterolateral proximal tibial locking plate that fits anatomically to the medial side of the distal femur. This is a great option as a stable implant for a medial closing-wedge distal femoral osteotomy.
| S-EPMC4738638 | biostudies-literature
Project description:BackgroundThere are a range of implants for fixation of proximal femoral osteotomies (PFOs) in children. We investigated the training experiences and preferences of orthopaedic residents and fellows who were learning PFO, using a fixed angled blade plate (ABP) or a locking, cannulated blade plate (LCBP). We also studied short-term technical and radiographic outcomes.MethodsThis was a prospective, parallel-group, cohort study of 90 consecutive children and adolescents with cerebral palsy who underwent bilateral PFOs with ABP or LCBP. Surgical trainees completed a questionnaire to document the ease or difficulty of each operative step.ResultsThere were 48 boys and 42 girls, with a mean age of eight years and a mean follow-up of 25 months. Trainees preferred the LCBP system for: insertion of the guidewire, the seating chisel and the blade plate, as well as overall technical ease of use (p < 0.001). Radiographic outcomes were similar with no between-group differences for migration percentage (p = 0.996) or neck shaft angle (p = 0.849), but there was a higher prevalence of technical errors in the ABP group.ConclusionsTrainee surgeons expressed a preference for LCBPs when learning PFO in children with cerebral palsy. Radiographic outcomes were similar in both groups, with close attending surgeon supervision.
| S-EPMC5382338 | biostudies-literature