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Surgical Dislocation in the Management of Pediatric and Adolescent Hip Deformity

  • Symposium: Femoracetabular Impingement: Current Status of Diagnosis and Treatment
  • Published:
Clinical Orthopaedics and Related Research

Abstract

The surgical dislocation approach is useful in assessing and treating proximal femoral hip deformities commonly due to pediatric conditions. We sought to demonstrate the efficacy and problems associated with this technique. Diagnoses included slipped capital femoral epiphysis, Perthes disease, developmental dysplasia of the hip, osteonecrosis, and exostoses. Through this approach, femoral head-neck osteoplasty (22), intertrochanteric osteotomy (eight), femoral head-neck osteoplasty plus intertrochanteric osteotomy (15), femoral neck osteotomy (five), open reduction and internal fixation of an acute slipped capital femoral epiphysis with callus resection (five), open reduction and internal fixation of an acetabular fracture (one), trapdoor procedure (one), and acetabular rim osteoplasty (one) were performed. The average patient age was 16 years. The minimum followup was 12 months (average, 41.6 months; range, 12–73 months). Patients with Perthes disease and SCFE had preoperative and postoperative WOMAC scores of 9.6 and 5.1, and 7.9 and 3.5 respectively. In patients with unstable SCFEs, the average postoperative WOMAC score was 1.2. Seven patients underwent THAs and two patients underwent hip fusion. Complications in the 58 procedures included four cases of osteonecrosis: three after femoral neck osteotomy and one after intertrochanteric osteotomy. The surgical dislocation technique can be utilized to effectively treat these deformities and improve short-term symptoms. Although the technique is demanding, we believe surgical dislocation offers sufficient advantages in assessing and treating these complex deformities that it justifies judicious application.

Level of Evidence: Level IV, retrospective study, case series. See the Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgment

We thank Cathy Matero for her assistance in performing the study.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Children’s Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA

    Gleeson Rebello MD, Samantha Spencer MD, Michael B. Millis MD & Young-Jo Kim MD, PhD

Authors
  1. Gleeson Rebello MD
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  2. Samantha Spencer MD
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  3. Michael B. Millis MD
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  4. Young-Jo Kim MD, PhD
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Corresponding author

Correspondence to Young-Jo Kim MD, PhD.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Rebello, G., Spencer, S., Millis, M.B. et al. Surgical Dislocation in the Management of Pediatric and Adolescent Hip Deformity. Clin Orthop Relat Res 467, 724–731 (2009). https://doi.org/10.1007/s11999-008-0591-y

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  • DOI: https://doi.org/10.1007/s11999-008-0591-y

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