Ilizarov Hip Reconstruction Research Articles

Is arthroplasty inevitable after Ilizarov hip reconstruction of unstable hip joints in adolescents and young adults? Long-Term Evaluation of 136 Cases

Introduction Whereas hip joint destroying trauma and diseases are difficult situations, the problem is more complex when it is complicated by hip instability. This could be a sequel of several hip affections such as trauma, septic or tuberculous arthritis, neglected developmental dysplasia of the hip, postoperative conditions, and neurologic pathologies (cerebral palsy, myelomeningocele, poliomyelitis). Purpose The purpose of this study is to evaluate long-term radiographic and clinical outcomes of the Ilizarov hip reconstruction for the treatment of painful and unstable hips in adolescents and young adults. Materials and methods The study included 136 patients with an average age of 18.3 years (range, 6 to 34 years); 75 patients were males (55.1%) and 61 females (44.9%). The primary causes of the hip instability were untreated or unsuccessfully treated cases of septic arthritis (40 cases; 29.4 %), congenital hip dislocation (28 cases; 20.6 %), paralytic hip dislocation (36 cases; 26.5 %), proximal femoral focal deficiency (14 cases; 10.3 %), neglected fracture of the femoral neck (10 cases; 7.4 %), osteoarthritis (6 cases; 4.4 %), and tuberculous hip arthritis (2 cases; 1.5 %). The intervention consisted in the performance of two osteotomies (proximal and distal) of the femur with pelviс support and placement of the Ilizarov apparatus of a specific assembly. Results The external fixation period ranged from 4 to 12 months (6.5 months on average). Patients were followed up for an average of 17.4 years (range, 5 to 27 years). Multiple clinical parameters at final follow-ups showed significant improvement, including pain relief, pain-free walking distance, lameness, hip flexion and abduction, hip contracture, and lumbar lordosis. Functionally, the mean Harris Hip Score improved with a statistically significant difference from 48 points (range, 35–65) before surgery to 83 points (range 70–90) after surgery. The pain disappeared in all patients, with the exception of six cases of pain in the early postoperative period. In all cases, supportive walking aids were no longer necessary, with the exception of two cases of persistent pain by physical activities. Walking ability and painless walking distance improved in all patients from an average of 35 m (range, 10 to 50 m) before surgery to 1,150 m (range, 1,000 to 1,500 m) after surgery, showing significant difference. Conclusion Ilizarov pelvic support osteotomy provided a multi-purpose solution to the complex challenging problem of hip instability in adolescents and young adults with variable primary etiologies. The improvements in the hip motion, mechanical axis, and correction of limb-length discrepancy lead to good functional outcomes over a long-term follow-up. This treatment modality might avoid or postpone the need for total hip arthroplasty for several years.

Development of modified Ilizarov hip reconstruction surgery for hip dysfunction treatment in adolescent and young adults

Background/objectiveHip dysfunction in young population caused by developmental dysplasia of the hip, congenital hip deformity or femur head necrosis severely affect the quality of life of young patients, and total hip replacement is the current widely accepted standard therapy for hip function reconstruction in adults, but not for young patients. Alternative safe and effective surgical method for hip function preservation/reconstruction for young patients is lacking. Ilizarov hip reconstruction osteotomy was an alternative method for preserving hip function but the surgical procedures were rather complicated using discomforting ring fixation at the hip region that prevents its wider acceptance and application. Here we reported a modified Ilizarov hip reconstruction surgery for hip dysfunction/deformity correction in adolescent and young adults using femoral shaft osteotomy and simplified unilateral external fixation configuration at the hip region with satisfactory clinical outcomes.MethodsThis is a retrospective study with five male and twelve female patients aged from 10 to 34 years old (mean 20.6 years) including 11 developmental dislocations of the hip and 6 femoral head necrosis. Modified Ilizarov hip reconstruction y surgery was performed using single-arm triangular configuration, threaded half pins on the femur and multiple drill hole guide for osteotomy. The mechanical axis and limb length were corrected spontaneously during the subsequent limb lengthening process in all patients. Preoperative and postoperative gross appearance, radiography of the hip and hip function assessment scores were recorded and compared during the follow-up period.ResultsThe mean follow-up period was 64.3 months (12–87 months). Satisfactory hip appearance, hip and knee functions were achieved in all patients, none resulted in hip replacement surgery at the follow-up period. The mean preoperative and postoperative Harris hip scores were 45.92 ​± ​19.41 and 87.16 ​± ​5.31, respectively (p ​< ​0.01). Pin-track infections occurred in four patients, treated successfully with wound dressing care and oral antibiotics. Restricted range of motion of the knee was observed in eight patients, all gradually overcome by active functional exercises. Osteotomy site fracture of the middle femurs after removing external devices occurred in two patients due to unexpected fall, and complete healing was achieved after plaster fixation. Complications such as fixation device failure, knee dislocation, vessel or nerve impairments did not occur.ConclusionsModified Ilizarov hip reconstruction surgery significantly reduced the surgery time and discomforts to patients, avoided the disturbance of blood supply at the osteotomy sites. This modified method is a useful alternative for correction of hip deformities and reconstruction hip function in adolescent and young adults who are not suitable for conventional pelvis support surgery or hip replacement surgery.Translational potential statementThe modified Ilizarov hip reconstruction surgery provides an alternative for hip replacement surgery with satisfactory clinical outcomes. This procedure is minimally invasive, safe and simple, with few complications compared to conventional pelvis support surgery, and it may be the first choice of surgery for the management of hip dysfunction in adolescent and young adults.

Ilizarov hip reconstruction (hybrid transosseous Osteo-synthesis technique creating femoral support to acetabu-lum and correcting biomechanical limb axis in proximal femoral defect)

Ilizarov hip reconstruction (hybrid transosseous Osteo-synthesis technique creating femoral support to acetabu-lum and correcting biomechanical limb axis in proximal femoral defect)

Pelvic Support Hip Reconstruction with Internal Devices: An Alternative to Ilizarov Hip Reconstruction.

Aim and objectiveIlizarov hip reconstruction (IHR) is a traditional method of salvaging chronic adolescent problem hips but faces practical issues from external fixators leading to reduced compliance. We present the same reconstruction procedure using only internal devices with a modification in the technique and review early results.Materials and methodsWe retrospectively evaluated eight patients between 2014 and 2017 with chronic painful hips treated by two-stage reconstruction; stage I included femoral head resection and pelvic support osteotomy using double plating, whereas stage II comprised distal femoral osteotomy avoiding varus followed by the insertion of a retrograde magnetic nail for postoperative lengthening. Patients continued physiotherapy postoperatively while protecting from early weight-bearing.ResultsAt a mean follow-up of 19 months (range, 6–36), all osteotomies healed with a bone healing index of 47 days/cm (range, 30–72). Pain improved from 8.3 (range, 7–9) to 2 (range, 0–6) while the limb length discrepancy got corrected from 4.3 cm (range, 3–5) to 1.4 cm (range, 0–2.5) at the final follow-up. Trendelenburg sign was eliminated in three patients and delayed in five patients. No examples of infection or permanent knee stiffness were noted. One patient had plate breakage due to mechanical fall, and another patient had 35 mm of lateral mechanical axis deviation (MAD) requiring corrective osteotomy.ConclusionPelvic support hip reconstruction with exclusive internal devices is a technique in evolution with encouraging early results. It avoids common complications of external fixators and facilitates quick rehabilitation of joints. Refraining from distal varus can effectively eliminate Trendelenburg gait, although with some degree of lateral MAD. Unlike external fixation where there is a possibility of gradual correction, this staged procedure of internal fixation is technically demanding with a learning curve.Clinical significancePelvic support hip reconstruction performed by internal implants is a viable alternative to Ilizarov hip reconstruction with potential benefits.How to cite this articleMetikala S, Kurian BT, Madan SS, et al. Pelvic Support Hip Reconstruction with Internal Devices: An Alternative to Ilizarov Hip Reconstruction. Strategies Trauma Limb Reconstr 2020;15(1):34–40.

Pelvic Support Hip Reconstruction with Internal Devices: An Alternative to Ilizarov Hip Reconstruction.

Aim and objectiveIlizarov hip reconstruction (IHR) is a traditional method of salvaging chronic adolescent problem hips but faces practical problems from external fixators leading to reduced compliance. We present the same reconstruction utilising only internal devices with a modification in technique and aim to review early results.Materials and methodsWe retrospectively evaluated eight patients between 2014 and 2017 with chronic painful hips treated by a two-stage reconstruction; stage 1 included femoral head resection and pelvic support osteotomy using double plating, while stage 2 comprised distal femoral osteotomy avoiding varus followed by insertion of retrograde magnetic nail for postoperative lengthening. Patients continued physiotherapy postoperatively while protecting from early weight-bearing.ResultsAt mean follow-up of 19 months (range 6–36), all osteotomies healed with bone healing index of 47 days/cm (range 30–72). Pain improved from 8.3 (range 7–9) to 2 (range 0–6), while limb length discrepancy got corrected from 4.3 cm (range 3–5) to 1.4 cm (range 0–2.5) at final follow-up. Trendelenburg sign was eliminated in three and delayed in five. No examples of infection or permanent knee stiffness were noted. One patient had plates breakage due to mechanical fall and one had 35 mm of lateral mechanical axis deviation requiring corrective osteotomy.ConclusionPelvic support hip reconstruction with exclusive internal devices is a technique in evolution with encouraging early results. It avoids common complications of external fixators and facilitates quick rehabilitation of joints. Refraining from distal varus can effectively eliminate Trendelenburg gait, albeit with some degree of lateral mechanical axis deviation. Unlike external fixation where there is a possibility of gradual correction, this staged procedure of internal fixation is technically demanding with a learning curve.Clinical significancePelvic support hip reconstruction performed by internal implants is a viable alternative to IHR with potential benefits.How to cite this articleMetikala S, Kurian BT, Madan SS, et al. Pelvic Support Hip Reconstruction with Internal Devices: An Alternative to Ilizarov Hip Reconstruction. Strategies Trauma Limb Reconstr 2020;15(2):91–97.

Modified Ilizarov hip reconstruction in treatment of adolescent hip instability

To evaluate the effectiveness of modified Ilizarov hip reconstruction in the treatment of hip instability. The clinical data of 13 young patients with hip diseases treated with modified Ilizarov hip reconstruction between January 2010 and March 2018 were retrospectively analyzed. There were 2 males and 11 females, aged from 14 to 34 years, with an average age of 24.2 years. There were 1 case of hip dysplasia and dislocation due to spinal bifida, 3 cases of hip dysplasia after pyogenic arthritis of the hip, 2 cases of developmental dysplasiaof the hip (DDH) accompanying femoral head necrosis who rejected hip replacement, 6 cases of young DDH refused to undergo hip replacement, and 1 case of bilateral hip dysplasia with dislocation due to sputum cerebral palsy. The disease duration was 2-20 years, with an average of 8.5 years. Preoperative Trendelenburg sign was positive in 12 cases and negative in 1 case. The preoperative Harris score of hip joint was 53.5±8.9 and the unequal length of lower limbs was (46.08±15.73) mm. Postoperative Harris hip score and patients' satisfaction with effectiveness evaluated according to their self scoring were used to assess the effectiveness. All 13 patients were followed up 1-5 years, with an average of 2.6 years. Five patients developed postoperative needle infection, which improved after dressing change; 7 patients had limited knee joint activity and improved after knee joint function training. The Trendelenburg sign was negative at 1 year after operation, and the patient's hip pain symptoms were relieved or disappeared. The Harris hip score of patients at 1 year after operation was 84.5±6.1, which was significantly improved when compared with preoperative one ( t=－10.538, P=0.000). According to Harris hip score, the effectiveness results were excellent in 4 cases, good in 5 cases, and fair in 4 cases, with an excellent and good rate of 69.2%. The unequal length of lower limbs was (15.38±7.27) mm, which was significantly better than that before operation ( t=11.826, P=0.000). At last follow-up, the patients' satisfaction score was 80%-95%, with an average of 88%. Modified Ilizarov hip reconstruction can be used to treat young patients with hip disease who are unsuitable or refuse to undergo artificial hip replacement. Its effectiveness is reliable, and it has unique advantages in limb limp improvement and limb shortening correction.

Ilizarov hip reconstruction for late sequelae of childhood septic arthritis

Background The management of hip instability because of septic arthritis in childhood is difficult. Ilizarov hip reconstruction (IHR) is a double-level femoral osteotomy with the objective of eliminating hip instability, through a proximal valgus extension–derotation osteotomy, and a distal varization-lengthening osteotomy for mechanical axis correction and equalization limb length.Patients and methods IHR was performed for 16 adult patients with complaints of hip pain, leg-length discrepancy, limping, reduced activity, and limited abduction of the hip as a result of childhood septic arthritis. Their ages ranged from 19 to 32 years (mean 23.2±4.2 years).Results Ilizarov external fixator was used in all cases. At the time of last follow-up, which ranged from 60 to 132 months (mean 85.6±23.5 months), the Harris hip score showed excellent functional outcome in two (12.50%) cases, good in 13 (81.25%) cases, and fair in one (6.25%) case. There was no poor functional outcome in any case. Preoperatively, the mean Harris hip score was 56.18 points, and at the time of last follow-up, it improved to a mean of 84.62 points. Pain subsided in all patients, the Trendelenburg sign became negative in all but three (19%) patients, no patient had limb-length discrepancy, and the alignment of the extremity was reestablished in all cases. No additional operations were required.Conclusion IHR is a valuable and durable solution for the late sequelae of childhood septic arthritis of the hip presenting in adult patients.

Treatment of unstable hips in children with Ilizarov hip reconstruction: A retrospective analysis of six cases

Introduction: Hip instability in older children and adolescents is mainly because of the loss of bone in the proximal femur or conditions that cause loss of the fulcrum. These may be related to infantile septic hip sequelae or neglected developmental dysplasia of the hip. Materials and Methods: We retrospectively analyzed six patients with hip instability treated by Ilizarov hip reconstruction from 2004 to 2007 at our institute. The mean age of the patients was 10 years (range 7–14 years). Results: The etiology was septic hip sequelae (Choi type IV) in four patients and neglected developmental dysplasia of hip in two patients. The fixator was kept for an average of 7 months (range 6–8 months). The average follow-up was 3 years. The visual analog score for pain improved from a preoperative mean of 8 to 2 postoperatively. The gait improved in all the patients and the leg length discrepancy improved from a preoperative mean of 5 to 1 cm postoperatively. All the limbs were aligned to a satisfactory level with the mean mechanical axis deviation of 3 mm (laterally) and pelvic mechanical axis of 90°. The Harris hip score improved from 41 preoperatively to 84 postoperatively ( P Conclusion: Ilizarov Hip Reconstruction is an excellent salvage procedure for adolescent patients with unstable hips, giving good results in the short-term.

Ilizarov hip reconstruction osteotomy for neglected dislocation of the hip in young adults

Background Neglected dislocation of the hip joint in young adults is a difficult problem. Patients with an unstable hip secondary to any aetiology usually have loss of bone from the proximal femur or shortening of the limb or both. Objective In the present study we report our results in the treatment of the neglected dislocation of the hip joint in young adults by pelvic support osteotomy using the Ilizarov method. Patients and methods From 2007 to 2014, 30 patients (20 women and 10 men) with neglected dislocation of the hip joint were treated in the Orthopaedic Department of Al-Azhar University Hospital, Damietta, Egypt. Their mean age was 22.5 years (range: 19–35 years). The main complaints were pain, leg length discrepancy, limping and limited abduction of the hip. All patients underwent valgus extension osteotomy in the proximal femur and distal femoral osteotomy for lengthening. The average follow-up ranged from 2 to 7 years. Results All hips were pain free at follow-up. The Trendelenburg sign became negative in 25 patients. There was no limb length discrepancy and alignments of the extremity were re-established. Five patients had a lurch gait. Valgus extension osteotomy provided stability of the hip joint and maintained some motion of the hip joint. By using the Ilizarov technique we could prevent the valgus effects created by the valgus extension osteotomy while achieving lengthening of the femur through distal osteotomy in the femur. Conclusion Pelvic support osteotomy with Ilizarov modification can provide an alternative to other techniques in managing patients having excision arthroplasty who are severely disabled as a result of abductor weakness, instability and limb length discrepancy.

Reconstruction of Unstable Hips with Ilizarov Technique. Role of Pelvic Support and Distal Lengthening Realignment Osteotomy.

Hips can suffer severe damage due to untreated developmental dysplasia, septic arthritis, tuberculosis, a neglected fracture of the neck of femur and neglected hip dislocation. The Ilizarov technique offers an effective treatment by providing a stable hip with abolished Trendelenburg lurch and equalizing limb length discrepancy through distal lengthening realignment osteotomy. 20 patients with hip instabilities due to various etiologies were treated with the Ilizarov technique of pelvic support osteotomy and distal lengthening realignment osteotomy. There were 12 females and 8 males in the study group and the age range was 13 to 30 years. Average limb length discrepancy was 5.95 cms (range 4-8.5 cms).The pre-operative and post-operative range of motion and Harris hip score was collected and data analyzed by Student's paired t test. A p value of < 0.05 was taken to be statistically significant Results. The functional Harris hip score improved in all the patients at final follow-up. The mean Harris hip score was 56.95 (range 33-71) pre-operatively, which improved to 83.25 (range 73-85) at final follow up and was statistically significant (P-value < 0.05). The mean length achieved was 5.53 cms (4-8 cms). The mean external fixation time was 8.6 months and the mean healing index was 1.54 months /cm. 1. Ilizarov hip reconstruction is an excellent method of salvage in patients with unstable hips diverse etiologies especially in this part of the world, where patients demand unrestricted range of motion at hip, and in the younger age group, where other procedures do not offer a long term solution. 2. It provides an excellent functional outcome in hips of different etiologies. 3. However, for an excellent outcome, surgical expertise, patient compliance and meticulous follow-up are mandatory.

A case of late sequela of infantile hip infection treated by Ilizarov hip reconstruction using monolateral fixator

A 13-year-old female presented with chronic instability of her left hip due to late sequela of infantile hip infection. Instability of hip causes significant problems due to pain, limp, and shortening. Such a case is rare and difficult to treat. We performed a subtrochanteric valgus extension pelvic support osteotomy, along with distal varization and lengthening osteotomy utilizing a monolateral fixator. The patient was clinically and radiologically followed up for 24 months after her operation. The fixator was removed after 12 months once radiological union and adequate lengthening was achieved. Pre- and postoperative assessments were done using the Harris Hip Score, which showed a significant improvement. Long duration of usage of the fixator, knee stiffness, and pin tract infections are a few of the limitations observed.

Midterm results of Ilizarov hip reconstruction for late sequelae of childhood septic arthritis.

The management of hip instability as a consequence of septic arthritis in childhood is difficult. Ilizarov hip reconstruction is a double-level femoral osteotomy with the objective of eliminating hip instability, through a proximal valgus–extension–derotation osteotomy and a distal varization–lengthening osteotomy for mechanical axis correction and equalization limb length. Ilizarov hip reconstruction was performed for 16 adult patients with complaints of hip pain, leg-length discrepancy, limping, reduced activity and limited abduction of the hip as a result of childhood septic arthritis. Their ages ranged from 19 to 32 years (mean 23.2 ± 4.2). Ilizarov external fixator was used in all cases. At the time of last follow-up that ranged from 60 to 132 months (mean 85.6 ± 23.5), the Harris hip score (HHS) showed excellent functional outcome in two cases (12.50 %), good in 13 cases (81.25 %) and fair in one case (6.25 %). There was no poor functional outcome in any case. Preoperatively, the mean HHS was 56.18 points, and at the time of last follow-up, it improved to a mean of 84.62 points. Pain subsided in all patients, the Trendelenburg sign became negative in all but three (19 %) patients, no patient had limb-length discrepancy, and the alignment of the extremity was reestablished in all cases. No additional operations were required. Ilizarov hip reconstruction is a valuable and durable solution for the late sequelae of childhood septic arthritis of the hip presenting in adult patients.

Recurrent Dislocations and Complete Necrosis

The basic concepts and goals of pelvic support osteotomy (PSO) are to enhance femoro-pelvic stability by proximal femoral valgus osteotomy and to improve hip biomechanics by displacing the center of gravity medially, which results in an improvement in the mechanical efficiencies of abductor muscles. However, the clinical application of traditional PSO is limited due to its intrinsic shortcomings. Ilizarov designed a modified PSO, so called "Ilizarov hip reconstruction (IHR)," which incorporated a second distal femoral osteotomy, to realign the knee joint and to correct limb-length discrepancy and proximal femoral valgus osteotomy for pelvic support. IHR remains as a viable option for the salvage of severely damaged hips in the adolescents and young adults in whom arthrodesis or hip arthroplasty is not suitable. The purpose of this article is to briefly review the evolution of PSO and to concentrate on the technical considerations and outcomes of IHR.

Ilizarov hip reconstruction for the management of advanced osteonecrosis in an adolescent with leukemia

With advances in chemotherapy, long-term survival for childhood leukemia is improving. However, chemotherapy-induced osteonecrosis of the proximal femur remains a challenging problem. We present a case of an adolescent female with advanced osteonecrosis of the proximal femur after chemotherapy for acute lymphoblastic leukemia. She underwent an Ilizarov hip reconstruction with a subtrochanteric valgus extension osteotomy and distal femoral lengthening with varus angulation using an external fixator. At a 3-year follow-up, her symptoms and gait had markedly improved. On the basis of this preliminary report, Ilizarov hip reconstruction is a viable alternative for advanced osteonecrosis of the proximal femur in an adolescent.

Pelvic support osteotomy for unstable hips using hybrid external fixator: case series and review of literature

BackgroundInstability of the hip joint is a source of great discomfort to the patient due to pain, limp and leg-length discrepancy. Pelvic support osteotomy with Ilizarov hip reconstruction, along with its various modifications, has emerged as a standard treatment modality for this difficult problem. We present a series of patients with unstable hips treated with a modification of the monolateral fixator-the hybrid external fixator. Materials and methodsA retrospective review of a series of 23 patients (38 hips) with unstable hips treated at our institute with the hybrid external fixator was performed. The mean age of the patients was 19.1years (range 7–49years). The outcomes were evaluated radiologically and clinically using the Harris hip score. ResultsAfter a mean follow-up period of 30.5months (range 10–91months), the range of motion of the hip had improved, pain had decreased, and the Harris hip score had improved from 63.43 to 75.17, which was statistically significant. The pre-operative knee range of motion was achieved in all patients by the last follow-up. Trendelenburg gait disappeared in all patients except for 3, limb length discrepancy improved from a pre-operative mean of 43mm to a post-operative mean of 5mm at final follow-up, and the mechanical axis was regained in all patients. Pin-tract infections were the commonest complications, occurring in 12 patients (52%). ConclusionsThis study shows that pelvic support osteotomy using the new hybrid external fixator, which combines the versatility and modularity of the Ilizarov frame with the compactness of the monolateral fixator, is a useful treatment modality in individuals with unstable hips.

Ilizarov hip reconstruction in skeletally mature young patients with chronic unstable hip joints

Hip reconstruction with subtrochanteric valgus extension pelvic support osteotomy and distal femoral osteotomy for lengthening and varus correction is one of the options available for salvage of chronic unstable hips and is also known as Ilizarov hip reconstruction (IHR). This study evaluated the outcomes and complications associated with IHR in skeletally mature young patients. Twelve patients (7 males, 5 females) with a mean age of 23 years underwent IHR for chronically dislocated hips due to various causes. Preoperative clinical and radiological evaluations were used to determine the site of osteotomies and the required angulations. Postoperatively the patients were followed up clinically and radiologically for a minimum of 36 months. Ilizarov fixator was removed when adequate lengthening was achieved and there was radiological evidence of union. Harris Hip Score was used to document hip function preoperatively and at final evaluation. Significant improvements occurred in limb length discrepancy (LLD) 5.11 cm preoperatively to 0.9 cm at final evaluation, Harris Hip Score 44.33 points preoperatively to 70.83 points (p < 0.0001) at final evaluation. Trendelenberg sign disappeared completely in nine patients and was delayed in three at final evaluation. The abduction at the hip increased from the preoperative mean of 12.08° (range 0°-25°) to 22.5° (range 15°-35°) postoperatively. The fixed flexion deformity at the hip decreased from 22° (range 10°-35°) preoperatively to 3° postoperatively (range 0°-10°). The amount of free flexion at the operated hips decreased from the preoperative mean of 88.33° (range 70°-120°) to 70.42° (range 45°-105°) at final follow up. The mean fixator interval was 7.33 months (5-12 months) and the mean follow up duration was 59.4 months (38-86 months). IHR is effective in improving the hip biomechanics, correcting the LLD and eliminating the Trendelenberg sign. Lengthy period of fixator wear, knee stiffness and pin tract infections, though minor are known limitations of this procedure.

Ilizarov hip reconstruction without external fixation: A new technique

The Ilizarov hip reconstruction is a well accepted but complication-prone operative salvage procedure in chronically dislocated hips, not least due to the long-term application of external fixation. Although the advantages of fully implantable devices are well known in limb lengthening and are described consistently, until now, external fixation has been used exclusively to perform the Ilizarov hip reconstruction procedure. We present a new technique of Ilizarov hip reconstruction with purely internal implants. A 14-year-old girl with a history of spina bifida presented with a 4-cm-short right leg, a Trendelenburg gait and a complex neurological disease expression. Because of refusal of external fixation by the patient and significantly lower complication rates, an Ilizarov hip reconstruction without external fixation was performed. A locking compression plate was applied to fix the proximal femoral valgus-extension osteotomy and a motorised intramedullary distraction nail was used for the distal, lengthening-varisation osteotomy. A healing index of 33days/cm and full weight bearing after 6months were noted. At the 1year follow-up, the patient showed an improvement of the Trendelenburg gait, as well as successful leg equalisation. Satisfaction to a high degree was additionally noted by factors such as reduced pain, the ability to wear workaday clothes and cosmetically appealing scars. No complications were recorded. The exclusive use of internal implants for Ilizarov hip reconstruction is a feasible and patient-friendly alternative to traditional methods. Their use, however, may be restricted by geometric preconditions.

Limb lengthening over a nail can safely reduce the duration of external fixation

Background:Limb lengthening using Ilizarov external fixation is safe, but the consolidation phase tends to take too long. A method that can safely reduce the time spent in external fixation would help increase patient tolerance and comfort. We report our results of lengthening over nails (LON) method in which an interlocking nail was used along with an Ilizarov external fixator to reduce external fixation duration in limb lengthening. This is a retrospective study.Materials and Methods:Twenty-seven lengthening surgeries were done with the LON method in 23 patients with 22 tibiae and five femora during the last 12 years. Length gain ranged from 1.5 cm to a maximum of 9.8 cm with a mean of 4.6 cm. The mean modified Paley difficulty score was 7.6 points. Fourteen associated procedures were performed in these patients, including equinus contracture releases, supracondylar osteotomies, ilizarov hip reonstruction and ankle fusion. We had a 29% rate of complications which included one problem, three obstacles and four complications with no serious deep intramedullary infections. Our rate of complications compares favorably with series reported in the literature. External fixation duration was reduced significantly to a mean of 17.8 days per cm.Conclusions:A combination of intramedullary nailing along with external fixation significantly reduces external fixation time while maintaining low rate of complications. Great care needs to be taken to prevent pin track infection and deep intramedullary sepsis.

Ilizarov Hip Reconstruction for the Late Sequelae of Infantile Hip Infection

The late sequelae of infantile hip infection include absence of the femoral head and neck, proximal migration of the femur, lower-extremity length discrepancy, abnormal gait, and pain. The Ilizarov hip reconstruction includes an acute valgus and extension osteotomy at the proximal part of the femur combined with gradual distraction for realignment and lengthening at a second, more distal, femoral osteotomy. The purpose of this study was to determine whether this technique can successfully treat the sequelae of infantile hip infection. We performed a retrospective review of a series of eight consecutive patients with a Type-IV or V hip deformity, according to the classification system of Hunka et al., after an infantile hip infection. The patients' mean age at surgery was 11.2 years. All hips were unstable, with a mean of 3.8 cm of proximal migration. A mean valgus angulation of 44 degrees and a mean extension angulation of 19 degrees were created with the proximal osteotomies. Distal femoral lengthening averaged 5.7 cm, and distal femoral varus angular correction averaged 10 degrees. The mean time in the Ilizarov frame was 4.7 months. Outcomes were evaluated clinically and radiographically. The clinical evaluation included gait analysis and the use of a modified Harris hip score. At the time of follow-up, at a mean of five years, the mean lower-extremity length discrepancy had improved from 4.6 cm preoperatively to 0.7 cm. The mean modified Harris hip score had improved from 51 points to 73 points (p = 0.007). All extremities were well aligned, with a mean pelvic mechanical axis angle of 89 degrees. The mean deviation of the mechanical axis was 2 mm in a lateral direction. The mean stance-time asymmetry improved from 16% to 5.4% (p = 0.0037), and the mean ground-reaction force (second peak) improved from 102% of body weight to 122% of body weight (p = 0.0005). The Ilizarov hip reconstruction can successfully correct a Trendelenburg gait and simultaneously restore knee alignment and correct lower-extremity length discrepancy. When the procedure is performed on a young patient, remodeling of the proximal osteotomy site and development of lower-extremity length discrepancy should be expected and the procedure may need to be repeated.

ILIZAROV HIP RECONSTRUCTION FOR THE LATE SEQUELAE OF INFANTILE HIP INFECTION

Background: The late sequelae of infantile hip infection include absence of the femoral head and neck, proximal migration of the femur, lower-extremity length discrepancy, abnormal gait, and pain. The Ilizarov hip reconstruction includes an acute valgus and extension osteotomy at the proximal part of the femur combined with gradual distraction for realignment and lengthening at a second, more distal, femoral osteotomy. The purpose of this study was to determine whether this technique can successfully treat the sequelae of infantile hip infection. Methods: We performed a retrospective review of a series of eight consecutive patients with a Type-IV or V hip deformity, according to the classification system of Hunka et al., after an infantile hip infection. The patients' mean age at surgery was 11.2 years. All hips were unstable, with a mean of 3.8 cm of proximal migration. A mean valgus angulation of 44° and a mean extension angulation of 19° were created with the proximal osteotomies. Distal femoral lengthening averaged 5.7 cm, and distal femoral varus angular correction averaged 10°. The mean time in the Ilizarov frame was 4.7 months. Outcomes were evaluated clinically and radiographically. The clinical evaluation included gait analysis and the use of a modified Harris hip score. Results: At the time of follow-up, at a mean of five years, the mean lower-extremity length discrepancy had improved from 4.6 cm preoperatively to 0.7 cm. The mean modified Harris hip score had improved from 51 points to 73 points (p = 0.007). All extremities were well aligned, with a mean pelvic mechanical axis angle of 89°. The mean deviation of the mechanical axis was 2 mm in a lateral direction. The mean stance-time asymmetry improved from 16% to 5.4% (p = 0.0037), and the mean ground-reaction force (second peak) improved from 102% of body weight to 122% of body weight (p = 0.0005). Conclusions: The Ilizarov hip reconstruction can successfully correct a Trendelenburg gait and simultaneously restore knee alignment and correct lower-extremity length discrepancy. When the procedure is performed on a young patient, remodeling of the proximal osteotomy site and development of lower-extremity length discrepancy should be expected and the procedure may need to be repeated. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.