Document Detail


Simultaneous open reduction of ipsilateral congenital dislocation of the hip and knee assisted by femoral diaphyseal shortening.
MedLine Citation:
PMID:  21926869     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
BACKGROUND: : Congenital dislocation of the hip (CDH) and congenital dislocation of the knee (CDK) occurring in the same extremity is a rare condition. Traditional treatment usually involves staged procedures, obtaining knee reduction first, and then addressing the hip once the knee can be flexed adequately. Simultaneous surgical reduction of both dislocations assisted by femoral shortening is a logical treatment option not previously reported.
METHODS: : A retrospective radiographic and clinical review of surgically treated patients was performed, with a minimum 5-year follow-up. Outcome of CDK treatment was graded according to a scale consisting of radiographic congruity, clinical stability, function, and gait. Outcome of CDH treatment was graded according to Severin classification.
RESULTS: : Eight patients (11 limbs) were identified, with follow-up of 5 to 16 years. Four patients (5 limbs) underwent simultaneous open reduction of both dislocations stabilized by capsulorrhaphy and femoral shortening, with 3 patients operated at age 1 year. Subsequent procedures included 2 physeal-sparing anterior cruciate ligament reconstructions, and 1 high tibial osteotomy to correct angular deformity. Additional procedures for hip dysplasia included 2 pelvic osteotomies in the same patient. Four patients (6 limbs) underwent staged treatment: open reduction of the knee using quadricepsplasty at age 4 to 11 months, followed by open reduction of the hip by either medial approach 3 months later, or anterior approach 12 to 24 months later. No additional knee procedures were performed in this group. Additional hip procedures included 1 repeat open reduction and 1 pelvic/femoral osteotomy. At follow-up in the simultaneous group, knees were 3 excellent, 1 good, and 1 fair, whereas hips had 3 Severin grade 1 to 2 results, 1 grade 3, and 1 grade 4. Outcomes for the staged group knees were 2 fair and 4 poor results, whereas hips had 5 grade 1 to 2 results and 1 grade 3.
CONCLUSIONS: : Outcome for CDK treated simultaneously seems better than staged treatment due to improved retained quadriceps function and attention to teratologic instability. Outcomes for CDH were essentially equal regardless of simultaneous or staged treatment.
LEVEL OF EVIDENCE: : III.
Authors:
Charles E Johnston
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of pediatric orthopedics     Volume:  31     ISSN:  1539-2570     ISO Abbreviation:  J Pediatr Orthop     Publication Date:    2011 Oct-Nov
Date Detail:
Created Date:  2011-09-19     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8109053     Medline TA:  J Pediatr Orthop     Country:  United States    
Other Details:
Languages:  eng     Pagination:  732-40     Citation Subset:  IM    
Affiliation:
Texas Scottish Rite Hospital for Children, Dallas, TX.
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