Article

Die offene Reposition des luxierten Hüftgelenks im Kindesalter

Operative Orthopädie und Traumatologie (Impact Factor: 0.47). 11/1996; 8(4):262-270. DOI: 10.1007/BF02510187

ABSTRACT Goal of surgeryRestoration of joint anatomy to ensure normal development and function of the hip.

IndicationsAfter failed closed reduction of hip dislocation in instances of congenital hip dysplasia or neurologic disorders in children
such as cerebral palsy, myelomeningocele.

ContraindicationsUntreated superior hip dislocation in adolescents or adults with deformities of the femoral head and acetabulum resulting
in joint incongruity.

Preoperative work upRadiographs of both hips (Rippstein I and II), arthrography. In the presence of deformities or joint incongruities CT-scan
with 3-D-reconstruction.

Positioning and anaesthesiaSupine, affected side of pelvis elevated with a roll of towels. General anaesthesia.

Surgical techniqueOpen reduction of the dislocated femoral head through an anterolateral approach and T-shaped opening of the capsule and removal
of any intraarticular obstacles preventing anatomic reduction. Optional tenotomy of iliopsoas muscle and/or adductor muscles.
Capsulorraphy.

Postoperative managementIn children less than 2 years old: 6 weeks of immobilization in a spica cast.

In children who did not walk preoperatively: Pavlik harness and physiotherapy.

In children who have been able to walk preoperatively: night abduction splint and physiotherapy for 6 months.

In older children or when open reduction was combined with acetabular and femoral osteotomy: spica cast for 1 week, gentle
passive exercises during the 2nd week, and abduction splint for another 4 weeks.

Possible complicationsPersistence of superior dislocation.

Too extensive incision of the capsule.

Redislocation.

Contracture.

Results63 patients were operated between 1974 and 1993. Average age at surgery: 1 year, 10 months. Using the classification of Tönnis:
21 patients had a grade II, 23 a grade III and 43 a grade IV dislocation. In 5% of patients a neurologic disorder was present.

Based on the surgical technique used the patients were subdivided into 3 groups: in 26 patients: open reduction only (average
age: 20.5 months); in 22 patients: open reduction followed by acetabular and femoral osteotomies at a later date (average
age 20 months); in 15 patients: open reduction combined with corrective acetabular and femoral osteotomies (average age: 34
months).

Average follow-up time: 5 years, 10 months, excluding 6 patients, who were operated on within the last year.

Out of 57 patients 45 presented a well centred hip, full range of motion and a normal development of the ossific nucleus (Tönnis
grade I).

In 14% of patients avascular necrosis of different degrees was observed.

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    ABSTRACT: Objective Stable, mobile and resilient hip. Indications Untreated, dislocated hips in infants older than 6 months. Infants younger than 6 months with persistence of an unstable hip after 8 weeks of unsuccessful attempts at reduction and retention. Contraindications Bilateral dislocation in infants with arthrogryposis multiplex. High riding femoral heads in adolescents and adults with incongruity of opposing joint surfaces. Surgical Technique Anterolateral approach and exposure of the intertrochanteric area. Window-like opening of the joint capsule, resection of the ligamentum teres and the fatty tissue in the acetabular fossa, partial resection of the transverse ligament and of the iliopsoas tendon. Reduction under internal rotation and abduction. Temporary stabilization of the femoral head using a Kirschner wire introduced through the femoral neck into the acetabulum. Intertrochanteric osteotomy and fixation with 2 Kirschner wires in neutral position of the limb. Hip spica including the foot in neutral position of the leg for 6 weeks. All Kirschner wires are taken out then. No orthosis. Acetabuloplasty of acetabular dysplasia persists. Results Between 1981 and 1995 surgery of 48 hips; average follow-up: 8.3 years (6 months to 18 years). Assessment of all patients according to the criteria of Barrett et a.. No redislocation. Excellent and good results in 32, satisfactory results in 7, poor results in 7 patients. No head necrosis if the operation was performed before 6 months of age, 2 necroses between 6 and 12 months, and 4 beyond the age of 12 months. Best overall clinical and radiological results: infants operated before 6 months. Beyond this age, progressive worsening.
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