Combined Bony and Soft Tissue Stabilisation of the Hip in Congenital Femoral Deficiency

This is a review of 23 patients with congenital femoral deficiency treated between 1999 and 2016 using a strategy of hip and femoral reconstruction before planned limb lengthening.

Standard radiological parameters describing proximal femoral and acetabular shape were used to record the preoperative and postoperative status. The neck-shaft angle, acetabular index, the Sharp-Ullmann index, and the Centre-Edge Angle of Wiberg were used. These results were analysed with regard to hip subluxations and other complications that had occurred during lengthening. All patients had completed their treatment cycles with no further lengthening procedures planned.

The neck shaft angles (NSAs) had a preoperative mean value of 89.3°, which, after reconstruction, was increased to a mean of 119.5° (p < 0.0001). The mean acetabular index of the affected limbs was 31.2° pre-operatively and improved to 17.1° post-reconstruction (p = 0.0003). The Sharp-Ullmann Index was reduced from 50.0° to 44.9° post-operatively (p = 0.0005). The mean CEA on the affected limbs of the patients was 25.9° post-operatively. There were no hip subluxations recorded during the subsequent lengthening procedures. Three patients required revision surgery to the hip and two cases of implant failure.

These results suggest that addressing the pathoanatomy of the hip joint, via bony and soft tissue reconstruction, is of paramount importance in avoiding hip subluxation and dislocation during subsequent limb lengthening.