1 - Congenital Femoral Deficiency

Abstract

Femoral dysplasia is a maldevelopment of broad spectrum including not only deficiencies of the femur ranging from minor shortening to total absence but also modifications in form such as coxa vara, pseudarthrosis, and hip dislocation. This chapter discusses the role of surgery in preventing some predictable complications that emerge because of congenital femoral deficiency. The management of congenital femoral deficiency is dominated by the ability to predict the outcome in the type of dysplasia with which one is dealing. Surgical and prosthetic modes are used concurrently and are at all times complementary. The surgeon should restrain the enthusiasm to undertake a challenging operation until the prosthetist has assured him that the success of the proposed procedure will in no way compromise the surgeon's future program. The decision for or against early operation should be taken at about one year of age to anticipate independent walking and the consequent risk of displacement at a point of instability. Children with defects of the proximal femur are not unduly delayed in walking for at this age shortening is compensated for by a tip-toe gait.