Surgical Treatment of Children with Hip Dislocation in Amyoplasia-Type Arthrogryposis: A Rational Approach to Treatment Selection

Abstract

Background. Patients with amyoplasia-type arthrogryposis and hip dislocation have different variants of hip contractures and deformities, but there is no difference in the selection of the type of surgery.
 The study aimed to justify and evaluate the effectiveness of the original algorithm of the rational selection of surgical approaches in children aged 3 years with hip dislocation in amyoplasia.
 Material and Methods. Level of evidence II. Seventy patients were examined, including 21 children aged 1 year (main group) who underwent 25 hip open reductions; 19 children aged 1.53 years (main group) who underwent hip open reductions, Salter innominate osteotomy, and femoral osteotomy; and 30 patients aged 37 years (control group) who had not previously received conservative and surgical treatment. All patients were divided into two subgroups depending on the variant of hip contracture: flexionextensionabductionexternal rotation (frog-like) (subgroup 1) and flexionextensionadductionexternal rotation (subgroup 2). Clinical, radiological, and statistical methods were used.
 Results. In subgroup 1, after hip open reduction, good results were noted in 17% of cases, satisfactory in 50%, and unsatisfactory in 33%. Severe complications, i.e., classes III and IV according to the modified ClavienDindoSink classification, were noted in 83% of the cases. After hip open reduction, Salter innominate osteotomy, and femoral osteotomy in subgroup 1, good results were noted in 50% of cases and satisfactory and unsatisfactory each in 25%, and 50% had less severe complications (p = 0.041). In subgroup 2, after hip open reduction, good results were obtained in 90% of cases and satisfactory in 10%, and 10% had severe complications When this surgery was combined with Salter innominate osteotomy and femoral osteotomy, good results were noted in 75% of cases, satisfactory in 19%, and unsatisfactory in 6%, and 25% had severe complications (p = 0.05).
 Conclusion. A differentiated treatment approach of children with hip dislocation in amyoplasia-type arthrogryposis will increase the effectiveness of treatment methods, and its introduction into clinical practice will help to improve outcomes.