Arthrodiastasis followed by open reduction associated with pelvic and femoral osteotomies for the treatment of high inveterate congenital hip dislocation.

Abstract

Our purpose is to analyze results, following the use of arthrodiastasis for the treatment of inveterate congenital hip dislocations. The study included eight patients. The mean age was 6 years. Three (37.5%) were male patients, and five (62.5%) were female patients. The patients were followed-up for 46 months. Teratologic, neurologic, rheumatic, and syndrome-associated dislocations were excluded. The following scores were used: Harris Hip Score, displacement of femoral head with respect to Hilgenreiner's line, Acetabular index, Wiberg angle, Reimer's extrusion index, and leg length discrepancy. Statistical analysis was carried out using Wilcoxon's test and Fisher's test. P values less than 0.05 were considered significant. We performed surgical technique in two stages. First, arthrogram and an adductor and a psoas tenotomy through an inguinal approach were performed; two 3.2 mm hydroxiapatite-coated screws were positioned in the supra-acetabular region and femoral shaft, joined using monolateral LRS fixator with a proximal locking T clamp. Distraction began the day after the procedure at a rate of 1 mm/day until restoration of Shenton's arc. Second, we performedan arthrogram intraoperatively, which included the anterior approach to the hip with open reduction, capsulorrhaphy and Salter osteotomy, and proximal femoral varus derotational osteotomy. Harris Hip Score improved significantly. Acetabular index and Wiberg angle decreased significantly in an average time of 14 months. Reimer's index showed no difference with respect to a healthy hip. Final leg length discrepancy was 14.9 mm. The complications that occurred were superficial pin tract infections: 25% of patients. We believe that arthrodiastasis, compounded by monolateral external fixation and an adductor and psoas tenotomy, combined with open reduction and pelvic and femoral osteotomies, is an optional tool to resolve the treatment approach to high inveterate congenital dislocation of the hip.