Long-term treatment results of congenital hip disease in adolescents

Abstract

Backgrоund. An analysis of modern literature reveals that presently, there are no algorithms for determining the correct method of surgical treatment for adolescents with high congenital hip dislocation; few publications are devoted to the treatment of adolescents with this pathology. Children are treated by podiatrists until the age of 18 before transferring to adult specialists. There remain debatable issues of total hip replacement in adolescents because there are time limits for hip preservation. The search for improved treatment methods for adolescents with this pathology by preserving their own bone structures continues to be relevant.
 Aim. To evaluate the long-term results of the treatment of adolescents with complete congenital hip dislocation after intertrochanteric osteotomy using the authors technique.
 Materials and methods. From 19902006, in the Republican Orthopedic and Traumatological Center of the Republic of Dagestan and the clinic of the Department of Traumatology and Orthopedics of the Dagestan State Medical University, 37 patients with high congenital dislocation of the hip underwent 49 operations using the method developed by the authors. The surgeries were performed by a single orthopedist and were presented as an angulatory lengthening by transtrochantiс osteotomy of the femur by fixation with a fingered plate. All patients underwent clinical, radiographical, biomechanical, and statistical evaluation before and after surgery using the Harris and VAS scales. The results of the study were processed using the Student, Pearson, and Kolmogorov coefficients and confidence intervals.
 Results. Over a long-term treatment period of up to 10 years, the average Harris score increased from 44.2 (95% CI 38.747.9) to 80.5 (95% CI 77.185.3). After the 10-year follow-up period (1015 years after surgery), the scores gradually dropped to 72.4 (95% CI 70.178.3). Unsatisfactory treatment results were found in 13.5% of cases and were mainly associated with an unsuccessful choice of support point under the pelvis and the preservation of uncompensated shortening of the limb. The alignment of the created degree of angulation of the hip in terms of adolescent age groups was not established. Differences in treatment results (depending on the inter-operation time for the bilateral dislocation of the hip) were not established. At follow-up periods of 1015 years after surgery, total hip replacement was performed in 21 joints (56.7%).
 Conclusions. The proposed method of surgical treatment of congenital hip dislocation in adolescents improves the staticdynamic capabilities of the hip joint and remains effective over the following 15 years of life. The duration of inpatient treatment is reduced and does not interfere with subsequent total hip arthroplasty.