Volume 4 | Issue 1 | January-June 2018 | Page: 23-28 | Bipin Ghanghurde, Mandar Agashe, Tarush Rustagi , Chasanal Rathod , Rujuta Mehta, Dominic D’Silva, Alaric Aroojis
Authors: Bipin Ghanghurde, Mandar Agashe, Tarush Rustagi , Chasanal Rathod , Rujuta Mehta, Dominic D’Silva, Alaric Aroojis
Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, 1Indian Spinal Injuries Centre, New Delhi, 2Seven Hills Hospital, Mumbai, Maharashtra, India
Address of Correspondence
Dr. Alaric Aroojis, Bai Jerbai Wadia Hospital for Children, Parel, Mumbai – 400 012, Maharashtra, India.
Introduction: Hip instability in older children and adolescents is mainly because of the loss of bone in the proximal femur or conditions that cause loss of the fulcrum. These may be related to infantile septic hip sequelae or neglected developmental dysplasia of the hip.
Materials and Methods: We retrospectively analyzed six patients with hip instability treated by Ilizarov hip reconstruction from 2004 to 2007 at our institute. The mean age of the patients was 10 years (range 7–14 years). Results: The etiology was septic hip sequelae (Choi type IV) in four patients and neglected developmental dysplasia of hip in two patients. The fixator was kept for an average of 7 months (range 6–8 months). The average follow-up was 3 years. The visual analog score for pain improved from a preoperative mean of 8 to 2 postoperatively. The gait improved in all the patients and the leg length discrepancy improved from a preoperative mean of 5 to 1 cm postoperatively. All the limbs were aligned to a satisfactory level with the mean mechanical axis deviation of 3 mm (laterally) and pelvic mechanical axis of 90°. The Harris hip score improved from 41 preoperatively to 84 postoperatively (P < 0.0001).
Conclusion: Ilizarov Hip Reconstruction is an excellent salvage procedure for adolescent patients with unstable hips, giving good results in the short-term.
Keywords: Ilizarov hip reconstruction, Neglected developmental dysplasia of the hip, Postseptic sequelae, Unstable hip
1. Hass J. A subtrochanteric osteotomy for pelvic support. J Bone Joint Surg Am 1943;25:281-91.
2. Hass J. Congenital dislocation of the hip. Palliative procedures. Springfield, IL: Thomas; 1951. p. 289-307.
3. Milch H. The pelvic support osteotomy. J Bone Joint Surg Am 1941;23:581-95.
4. Milch H. The “pelvic support” osteotomy. 1941. Clin Orthop Relat Res 1989;(249):4-11.
5. Schiltenwolf M, Carstens C, Bernd L, Lukoschek M. Late results after subtrochanteric angulation osteotomy in young patients. J Pediatr Orthop B 1996;5:259-67.
6. Samchukov ML, Birch JG. Pelvic support femoral reconstruction using the method of Ilizarov: A case report. Bull Hosp Jt Dis 1992;52:7-11.
7. Rozbruch SR, Paley D, Bhave A, Herzenberg JE. Ilizarov hip reconstruction for the late sequelae of infantile hip infection. J Bone Joint Surg Am 2005;87:1007-18.
8. Ilizarov GA. Transosseous osteosynthesis: Theoretical and clinical aspects of regeneration and growth of tissue. In: Hip dislocations. Berlin: Springer 1992. p. 701-5.
9. Ilizarov GA, Samchukov ML. Reconstruction of the femur by the Ilizarov method in the treatment of arthrosis deformans of the hip joint [in Russian]. Ortop Travmatol Protez 1988;(6):10-3.
10. Lai KA, Lin CJ, Su FC. Gait analysis of adult patients with complete congenital dislocation of the hip. J Formos Med Assoc 1997;96:740-4.
11. Choi IH, Pizzutillo PD, Bowen JR, Dragann R, Malhis T. Sequelae and reconstruction after septic arthiritis of the hips in infants. J Bone Joint Surg Am 1990;72:1150-65.
12. Lord BA, Parsell B. Measurement of pain in the prehospital setting using a visual analogue scale. Prehosp Disaster Med 2003;18:353-58.
13. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: Treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am 1969;51:737-55.
14. Paley D. Hip joint consideration. In: Paley D, editor. Principles of deformity correction. Springer-Verlag: Heidelberg; 2002.
15. Bombelli R. Structure and function in normal and abnormal hips. 3rd ed. Springer-Verlag: Berlin; 1993. p. 1-55.
16. Fabry G, Meire E. Septic arthritis of the hip in children: Poor results after late and inadequate treatment. J Pediatr Orthop 1983;3:461-6.
17. Wopperer JM, White JJ, Gillespie R, Obletz BE. Long-term follow-up of infantile hip sepsis. J Pediatr Orthop 1988;8:322-5.
18. Betz RR, Cooperman DR, Wopperer JM, Sutherland RD, White JJ Jr, Schaaf HW et al. Late sequelae of septic arthritis of the hip in infancy and childhood. J Pediatr Orthop 1990;10:365-72.
19. Schanz A. ZurBehandlung der veraltetenangeborenen Huftverrenkung. Munchen Med Wschr 1922;69:930-41.
20. Pafilas D, Nayagam S. The pelvic support osteotomy: Indications and preoperative planning. Strategies Trauma Limb Reconstr 2008;3:83-92.
21. E l-Mowafi H. Outcome of pelvic support osteotomy with the Ilizarov method in the treatment of the unstable hip joint. Acta Orthop Belg 2005;71:686-91.
|How to Cite this Article: Ghanghurde B, Agashe M, Rustagi T, Rathod C, Mehta R, D’Silva D, Aroojis | A Treatment of unstable hips in children with Ilizarov hip reconstruction: A retrospective analysis of six cases | January-June 2018; 4(1): 23-28.