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Hip stability during lengthening in children with congenital femoral deficiency
Mark Eidelman1, Julio J Jauregui2, Shawn C Standard3
1Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel.
Insights
Hip instability, including subluxation and dislocation, is a significant risk during femoral lengthening for congenital femoral deficiency (CFD). Proximal femoral lengthening and acetabular dysplasia are key risk factors, necessitating careful management strategies.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Limb reconstruction
Background:
- Congenital femoral deficiency (CFD) presents complex challenges in limb lengthening procedures.
- Hip instability, specifically subluxation and dislocation, poses a severe risk to hip function during femoral lengthening.
Purpose of the Study:
- To assess hip stability during femoral lengthening in children with Congenital Femoral Deficiency (CFD).
- To identify risk factors contributing to hip subluxation and dislocation in CFD patients undergoing limb lengthening.
Main Methods:
- Hip stability was evaluated in 69 children undergoing 91 femoral lengthenings for CFD (Paley types 1a and 1b).
- Pelvic osteotomies were performed in 33 patients prior to lengthening.
- Data on hip subluxation/dislocation, acetabular dysplasia, fixation methods, and surgical procedures were collected.
Main Results:
- Hip subluxation or dislocation occurred in 15% of lengthenings.
- Proximal femoral lengthening was a significant factor associated with hip subluxation.
- Patients with hip subluxation were more likely to have undergone monolateral fixation and the superhip procedure.
Conclusions:
- Key risk factors for hip instability include CFD severity, acetabular dysplasia, and proximal femoral lengthening.
- Routine pelvic osteotomy is recommended for Paley type 1b CFD patients, especially with distal lengthening, to mitigate hip instability risks.
Background:
Congenital femoral deficiency (CFD) is one of the most challenging and complex conditions for limb lengthening. We focused on the problem of hip instability during femoral lengthening because subluxation and dislocation are potentially catastrophic for hip function.
Methods:
We assessed for hip stability in 69 children (91 femoral lengthenings) who had CFD Paley type 1a (43 children) and 1b (26 children). The mean age at first lengthening was 6.4 years.
Results:
Hip subluxation/dislocation occurred during 14 (15 %) of 91 lengthenings. Thirty-three pelvic osteotomies were performed before lengthening in an attempt to stabilize hips. Thirteen patients (type 1a, eight; type 1b, five) had acetabular dysplasia at initiation of lengthening. One of the eight with type 1a experienced mild femoral head subluxation; four of the five with type 1b experienced three dislocations and one subluxation. Eight patients (type 1b) experienced hip instability although they had pelvic osteotomies. Proximal femoral lengthening was a significant factor for hip subluxation. Patients with hip subluxation more likely underwent monolateral fixation and the original superhip procedure. Age ±six years was not a contributing factor for hip instability.
Conclusions:
Important risk factors for hip instability during femoral lengthening are severity of CFD, residual acetabular dysplasia, and proximal femoral lengthening. We recommend routine performance of pelvic osteotomy for patients with Paley type 1b CFD and distal lengthening.
Level Of Evidence:
Therapeutic Level IV.
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