Does Open Reduction of Arthrogrypotic Hips Cause Stiffness?

Area of Science:

• Orthopedic surgery
• Pediatric orthopedics
• Congenital hip dislocation

Background:

• Concerns persist regarding hip stiffness after open reduction for congenital hip dislocations in arthrogryposis multiplex congenita (arthrogryposis).
• Published outcomes suggest positive results, necessitating further evaluation of hip mobility and ambulatory function.

Purpose of the Study:

• To retrospectively compare preoperative and postoperative hip range of motion.
• To evaluate the ambulatory abilities of patients following open reduction for arthrogrypotic hip dislocations.

Main Methods:

• A 10-year retrospective review of 52 patients (75 hips) with arthrogryposis undergoing open hip reduction (minimum 2-year follow-up).
• Assessment of hip range of motion (flexion, abduction) and ambulatory status preoperatively, postoperatively, and at final follow-up.
• Radiographic evaluation for hip stability and avascular necrosis (AVN).

Main Results:

• Significant improvements observed in hip flexion contracture (22 degrees), frogleg abduction (11 degrees), and abduction (10 degrees) (P ≤0.001).
• Total flexion-extension arc of motion showed minimal change (-1 degree, P =0.733).
• At mean 68-month follow-up, 31 patients were independently ambulatory, 15 were walker-dependent, and 6 remained nonambulatory. AVN occurred in ~50% of hips but did not impact overall motion.

Conclusions:

• Open reduction for arthrogrypotic hip dislocations effectively maintains hip mobility without inducing significant stiffness.
• Improvements in hip extension and abduction enhance lower limb positioning and promote ambulation.
• The majority of patients achieved independent ambulation post-procedure.