Justification of a new method of alternative treatment of high congenital hip dislocations in adolescents and adults

Abstract

Aim. Justofocation of a new method of hip joint stabilization in adolescents and adults with congenital hip dislocation by preserving its own bone structures. Methods. The biomechanical substantiation of a new method of surgical correction of the proximal femur is presented. A primary analysis of the surgical treatment of congenital hip dislocation was performed on 101 patients (116 joints) aged 14 to 30 years (average age 21.3 ± 3.5 years) by creating an additional point of support for the pelvis according to the authors' method with 10 to 15-year follow up. The technique includes angulating elongating squamous oblique osteotomy of the thigh, which allows extending the limb simultaneously to 4 cm and restoring its biomechanical axis. All patients were evaluated clinically, radiologically and using Harris scale before and after the surgery. Results. At the analysis of the treatment results 10-15 years after the operation in 56 patients, the average Harris score increased from 42.7 (from 40.1 to 45.3) to 81.1 (77.2-86.7). Valgus proximal hip and oblique intertrochanteric osteotomy allowed elongating the limb in one-side hip dislocation by 3.2 ± 0.8 (95 % CI 2.8-4.0 cm), shortening of the limb by 3 cm persisted in all patients with one-side hip dislocation. In 37 patients (43 joints) podographic examination revealed restoration of rhythmic walking and longer single-support time. Conclusion. The suggested method of treatment of high congenital hip dislocation is an effective and minimally invasive method of stabilization of the hip joint in adolescents and adults. We discuss the question of possible reconstructive surgeries with preserved own bone structures in young patients aged 14 to 30 years, creating of bone mass in hip joint area for further joint replacement.