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Management of post septic sequelae of hips with dislocation in children
Prateek Rastogi1, Anil Agarwal2
1Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, 110031, India.
Insights
Open reduction surgery for pediatric hip dislocation sequelae improves hip function and mechanics. While residual dysplasia may persist, the procedure offers a better natural history for affected children.
Area of Science:
- Pediatric Orthopedics
- Pediatric Hip Surgery
- Septic Hip Sequelae Management
Background:
- Limited literature exists on managing post-septic sequelae of hip dislocation in children.
- This study focuses on the functional and radiological outcomes of open reduction for these specific hip conditions.
Purpose of the Study:
- To evaluate the functional and radiological outcomes of open reduction in children with post-septic hip dislocation sequelae.
- To determine the influence of surgical correction and hip relocation on these outcomes.
Main Methods:
- Compared preoperative acetabular index (AI) to quantify dysplasia.
- Assessed radiological parameters (AI, CEA, Reimer's index, CHDD, NSA) and compared with the contralateral hip.
- Evaluated outcomes using modified Severin classification (radiological) and Moon's criterion (clinical).
Main Results:
- Open reduction in 20.6-month-olds showed significant AI improvement (35° to 26.5°) but residual dysplasia.
- Follow-up revealed improved radiological parameters, though some hips showed triradiate cartilage fusion.
- Functional outcomes were excellent to good in 9/11 patients, with 7/11 showing good to fair radiological outcomes.
Conclusions:
- Open reduction can alter the natural history of post-septic hip dislocation sequelae.
- The surgical correction contributes to improved hip mechanics and function in pediatric patients.
Background:
Limited literature guide management of post septic sequelae of hips with dislocation in children. We studied the functional and radiological outcome of open reduction of such sequelae in 11 children. Special emphasis was given to determine the influence of surgical correction and relocation of these hips.
Methods:
Preoperative acetabular index (AI) on both sides was compared to quantify acetabular dysplasia. Radiological parameters like AI, centre edge angle (CEA), Reimer's index, centre head distance discrepancy (CHDD) and neck shaft angle (NSA) were calculated and compared with the unintervened side at follow-up. Outcome was assessed radiologically by modified Severin classification and clinically by Moon's criterion.
Results:
Average age at open reduction was 20.6 months and further follow-up was 48.8 months. The mean pre-operative AI on intervened side (35 degrees) differed significantly from unintervened side (22.5 degrees). The follow-up AI on intervened side (26.5 degrees) improved significantly from the pre-operative values but residual dysplasia persisted. Mean values for other radiological parameters on intervened side at follow-up were CEA 16.1 degrees, Reimer's index 31.5%, CHDD 18.6% and NSA 119 degrees. Mean shortening of 2.3 cm was documented in ten patients at final follow-up. Triradiate cartilage fused in four out of 11 hips at follow-up. Radiological outcome according to modified Severin classification was good to fair in seven patients (types II and III) whereas poor in four patients (types IV and V). Functional outcome as per Moon's criterion was excellent to good in nine patients, fair and poor in one patient each.
Conclusions:
Open reduction potentially alters the natural history of post septic sequelae of hips with dislocation and contributes to better hip mechanics and function.
