Joint-sparing surgery in patients with acetabular dysplasia complicated by sphericity of the femoral head

Abstract

BACKGROUND: Acetabular dysplasia combined with ischaemic deformity of the femoral head contributes to rapid progression of coxarthrosis in young adults. The issues of treatment tactics for this pathology remain unresolved.
 AIM: Analysis of the immediate and mid-term results of extra-articular and intra-articular combined reconstructive interventions performed in patients with acetabular dysplasia combined with femoral head sphericity disorder.
 MATERIALS AND METHODS: Treatment outcomes were studied in 23 patients with acetabular dysplasia associated with femoral head deformity. The average age at the operation was 19.0±1.2 years (14–34). The mean follow-up period was 3.4±0.4 years. Anatomical and functional results were evaluated according to the criteria of D’Aubigne-Postel, Tonnis and according to the Russian Scientific Center “Restorative Traumatology and Orthopedics” system. Extra-articular reconstructive interventions on both articular components were performed in 14 patients. In 9 cases, intra-articular operations were performed.
 RESULTS: Functional results after extra-articular interventions: good (15–17 points) — 8 joints, satisfactory (12–14 points) — 6 joints. The average score was 5.05±0.06 points. Functional results after intra-articular interventions: good (15 points) — 3 joints, satisfactory (13–14 points) — 5 joints, unsatisfactory (7 points) — 1 joint. The average score is 4.3±0.07 points. Rapid progression of arthrosis was noted in one case. In other cases, the degree of arthrosis did not change. Anatomical results of treatment after extra-articular interventions: good (2.6±0.03) — 8 joints, satisfactory (1.95±0.06) — 6 joints. Anatomical results of treatment after intra-articular interventions: good (2.55±0.01) — 2 joints, satisfactory (2.1±0.04) –— 6 joints, unsatisfactory (1.6) — 1 joint.
 CONCLUSION: Differential application of extra-articular and intra-articular joint-saving interventions makes it possible to slow down the progression of the pathological process in the joint in conditions of sphericity disturbance of the articular surfaces, which makes it possible to consider them as a temporary alternative to endoprosthesis in adolescents and young adults.