Die offene Reposition des luxierten Hüftgelenks im Kindesalter

ArticleinOperative Orthopädie und Traumatologie 8(4):262-270 · November 1996
Impact Factor: 0.72 · 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.