[Surgical treatment of hip dislocations in children and damages caused by conservative treatment methods]
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Reconstructive hip surgery can improve outcomes for children with developmental dysplasia of the hip (CHD) previously treated conservatively. Early surgical intervention leads to better long-term results compared to prolonged conservative management.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Hip Dysplasia Research
Background:
- Developmental Dysplasia of the Hip (CHD) often requires complex management.
- Previous conservative treatments can lead to significant hip damage, necessitating reconstructive surgery.
- Reoperations and reconstructive procedures are crucial for managing advanced hip damage.
Purpose of the Study:
- To evaluate the outcomes of reconstructive surgery for hips with severe damage from prior conservative treatment for CHD.
- To compare the results of reconstructive surgery with outcomes following primary surgical intervention for CHD.
- To assess the long-term efficacy of surgical hip reconstruction in pediatric patients.
Main Methods:
- Analysis of 19 pediatric cases (average age 4.8 years) undergoing hip reconstructive surgery.
- Average follow-up period of 6.3 years (range 3-12 years).
- Surgical techniques included hip reduction, femoral osteotomy, and acetabular correction, sometimes in staged procedures. Radiological assessment using Severin's classification.
Main Results:
- All hip dislocations were reducible, often requiring additional femoral osteotomy and acetabular correction.
- Initial post-operative results consistently reached Severin's radiological degree II.
- Severe cases with ischaemic necrosis showed deterioration to degrees III-IV (mediocre/poor) at follow-up.
- Patients with prior early surgery fared better than those with prolonged conservative treatment.
Conclusions:
- Circulatory damage during early treatment significantly impacts long-term outcomes in CHD.
- Reconstructive surgery offers substantial improvement for severely damaged hips, preventing severe disability.
- Surgical outcomes in this cohort were inferior to primary CHD surgery but provided significant functional improvement pending Total Hip Replacement (TEP).
Abstract:
For the major requirements of the operative technique and other special problems of operation it is reasonable to discuss among the questions of the reduction of CHD the reoperations and the reconstructive surgery of hips, badly damaged by the conservative treatment, separately. We have analysed the results of 19 own cases with an average follow up of 6.3 years (3-12 years). The average age of the patients was 4.8 years. In 7 patients only conservative treatment was carried out previously, the others were also operated. The Roentgenogram revealed severe ischaemic necrosis in 10 hips. The dislocation could be reduced in every case, to the reduction however it was obligatory to add femoral osteotomy and correction of the acetabulum. The later operation was performed frequently in the second sitting. As a direct result of the operation a state, corresponding to the II. degree of Severin's radiological classification was always reached, in cases of severe ischaemic necrosis however the result later grew worse and at the follow up it corresponded only to the degrees III. and IV. (mediocre, poor). Thus the circulatory damage, suffered during the early treatment determined the late results. This was the reason that the result of the follow up examinations were better in patients in whom early surgery was performed than in patients with forced conservative treatment. The results summarized fall far behind the results of the group with primary surgery of the CHD. Without the operations described these patients would live as limping cripples, with these operations however we have improved their state significantly for the time until TEP can be performed.