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[Results of surgical repositioning of congenital hip dislocation]
Insights
Surgical treatment of inborn hip dislocation in children yields best results when performed before 17 months of age. Early intervention and specific surgical techniques improve outcomes, while older age and prior surgeries decrease success rates.
Area of Science:
- Pediatric Orthopedics
- Surgical Treatment of Hip Dysplasia
- Congenital Hip Dislocation
Background:
- Congenital hip dislocation requires timely surgical intervention for optimal outcomes.
- Treatment strategies vary based on patient age and hip joint condition.
- Long-term results depend on surgical approach and patient-specific factors.
Purpose of the Study:
- To analyze the results of surgical treatment for inborn hip dislocation in children.
- To evaluate the impact of patient age at the time of operation on treatment outcomes.
- To compare the effectiveness of different surgical techniques and approaches.
Main Methods:
- Retrospective analysis of 96 children (103 hip joints) operated between 1978 and 1992.
- Patients categorized into three age groups: <17 months, 18-48 months, and >4 years.
- Clinical and radiological evaluations using Severin's classification and specific X-ray measurements.
Main Results:
- The youngest age group (<17 months) demonstrated the best clinical and radiological outcomes.
- Success rates declined with increasing age at operation and number of previous surgeries.
- Overall, 83% of patients achieved good radiological results, with 17% considered satisfactory. Avascular necrosis occurred in 8.5% of cases.
Conclusions:
- Early surgical intervention (before 17 months) is crucial for successful treatment of inborn hip dislocation.
- Age at operation and previous surgical history significantly influence treatment prognosis.
- Specific surgical techniques, including distraction and osteotomies, are vital components of successful management.
Abstract:
The authors submit an analysis of the results of surgical treatment of inborn dislocation of the hip joint in children from the age of one year to completed growth. Decisive for inclusion into this group was surgical reposition. The operated patients were divided into the following three groups by age at the time of operation: 1. first year up to 17 months; 2. 18 to 48 months; 3. patients older than 4 years up to 15 years. Between 1978 and 1992 96 children with inborn dislocation of the hip joint were operated (103 hip joints). Complete documentation was available for 59 hip joints of 54 patients. The follow up period varies between 1 and 14 years after operation. In the first group 24 hip joints of 21 patients were checked, the average age at the time of operation being 8 months. In 17 hip joints at the same time subtrochanteric osteotomy with abbreviation was performed. In these operated hip joints surgical reposition was preceded by distraction either using the "overhead" system or the Pavlanský's method. All hip joints in this group were operated from an anterolateral approach according to Scaglietti's principles. In the second group 19 hip joints of 16 patients were checked, the mean age at the time of operation being 28 months. A standard component of the operation was in addition to surgical reposition also pelvic osteotomy according to Salter's method, in 16 cases at the same time derotation varus osteotomy was performed. The third group comprises 16 hip joints of 15 patients operated at an average age of 9 years and 8 months. Fourteen of the hip joints had been operated previously at least once by different methods. In acetabular dysplasia different techniques were used, most frequently Chiari's osteotomy. The surgical reposition proper was preceded in four instances of high iliac dislocation by preoperative distraction by external fixation. For evaluation of the results clinical and radiological parameters were used, essentially identical with Severin's classification. X-ray evaluation was supplemented y values of the distance between the head and Köhler's protrusion. The best clinical and X-ray results were achieved in the first group; wih the number of previous operations and advancing age the perspective of excellent results declines. In the group as a whole five, i. e. 8.5%, avascular necroses were recorded. From the total number of operated patients good radiological results were achieved in 83%, 17% of the results are considered satisfactory.(ABSTRACT TRUNCATED AT 250 WORDS)