Abstract
BackgroundThe aim of this study is to evaluate the clinical outcome of various surgery methods in children suffering pathological dislocation of the hip joint due to coxotuberculosis.Patients and methodsFrom January 2006 to January 2011, 29 children with coxotuberculosis hip dislocation were treated with open reduction (4 children) and acetabular reconstruction (25 children). According to degree of dislocation and age, acetabular reconstructions included Salter osteotomy (nine children), Pemberton operation (six children), Dega operation (seven children), the hip shelf arthroplasty (two children), and Chiari operation (one child). During acetabular reconstruction, 16 children underwent upper femoral rotational shortening osteotomies simultaneously, 6 children underwent the femoral head and neck reconstruction simultaneously, and 3 children were underwent corrective osteotomy. After operation, children were immobilized with plaster external fixation for 1–3 months and treated with routine anti-infective therapy for 3 days. During follow-up study (12–18 months), the hip stability was examined via X-ray. The recovery was evaluated via acetabular index (AI) and Harris hip score.ResultsPostoperative X-ray films of 29 children showed concentric reduction of all hips. Total 25 children healed I incision surgery, while 4 children with skin antrum of incision were further treated leading to 1–3 months delay of healing. Total 24 children were followed up for 2–5 years. X-ray examination revealed no redislocation after 2 years postoperative. The postoperative AI was normal (15°–20°) in 22 children and increased to 25°– 30° in 2 children. After 2 years postoperative, 8 children had normal function of hip joint, 13 children had mild limitation of flexion and rotation, and 3 children had fibrous ankylosis. The average of Harris hip score was 83 (ranged, 62–90).ConclusionIn our study, pathological hip dislocations of children attributed to coxotuberculosis were treated via open reduction and acetabular reconstruction and the outcomes were both excellent. Individual characteristic should be taken into consideration during treatment, and proper surgery approach should be adopted according to pathological changes of the hip.
Highlights
Pathological dislocation of the hip joint in children is relatively rare occurrence and may cause lifelong disability when missed or ill-treated
According to the development of hip dislocation, pathological dislocation of the hip is frequently associated with heavy bone destructive defect of acetabulum and femoral heads and necks as well as the residual anatomic deformity
The disease once occurred in the hip may lead to progressive destruction of the joint if untreated at an early stage, and many even proceed to pathological dislocation
Summary
Pathological dislocation of the hip joint in children is relatively rare occurrence and may cause lifelong disability when missed or ill-treated. The disease once occurred in the hip may lead to progressive destruction of the joint if untreated at an early stage, and many even proceed to pathological dislocation. Dislocated hips with infection are difficult to be managed to obtain a stable, mobile, congruous, and concentric joint. Diagnosis and effective treatment at an early stage are vital to treat the disease and save the joint [3]. The reports on the management of residual anatomic deformity of hip dislocation due to tuberculosis in children have rarely been documented. The aim of this study is to evaluate the clinical outcome of various surgery methods in children suffering pathological dislocation of the hip joint due to coxotuberculosis
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