Preoperative planning of hip joint arthroplasty in terminal stage degenerative diseases in adolescents

Abstract

The modern aspects of diagnosis, preoperative planning, and indications for total hip arthroplasty in adolescents are reviewed in the article. The aim of the article is the systematization of the tactics of preoperative planning of total hip arthroplasty in the terminal stage degenerative diseases in adolescents. Preoperative planning is very challenging in total hip arthroplasty in adolescents because in all cases on hip radiographs severe anatomical hypoplasia or destruction of both the pelvic and femoral components is visualized. Before the surgery, patients undergo a complex multifactorial examination: orthopedic status specification, X-ray and radio-functional diagnostics, computed tomography and magnetic resonance imaging. Examination results allow us to determine the anatomy of the acetabulum, the path of the femoral head within it, the defect type and the diameter of brim of the acetabulum area, its depth, the integrity of the walls and roof. The authors performed total hip arthroplasty in 32 patients aged 15-18 years (11 boys and 21 girls) with terminal stages degenerative-dystrophic diseases of the hip joint with the implementation of preoperative planning in accordance with described methods. Comparison of preoperative planning results with the clinical results of total hip arthroplasty in most cases showed the agreement of calculations with the intraoperative analysis data. After total arthroplasty, evaluation of patients’ hip joint function was from 92 to 100 points. Preoperative planning is one of the most important stages of total hip arthroplasty in adolescent orthopedics. It allows to obtain reliable information about the needed model of the endoprosthesis, the optimal size of its components, the depth of the acetabulum reaming, the level of the femoral neck resection, placement and orientation of the implant cup and the stem, the possibility of correction of the lower limbs length and to achieve good results in the treatment of patients with severe congenital or acquired hip defects and progressive thigh non-weight bearing.