Abstract
Background
Congenital femoral deficiency (CFD) is one of the most challenging and complex conditions for limb lengthening. We focused on the problem of hip instability during femoral lengthening because subluxation and dislocation are potentially catastrophic for hip function.
Methods
We assessed for hip stability in 69 children (91 femoral lengthenings) who had CFD Paley type 1a (43 children) and 1b (26 children). The mean age at first lengthening was 6.4 years.
Results
Hip subluxation/dislocation occurred during 14 (15 %) of 91 lengthenings. Thirty-three pelvic osteotomies were performed before lengthening in an attempt to stabilize hips. Thirteen patients (type 1a, eight; type 1b, five) had acetabular dysplasia at initiation of lengthening. One of the eight with type 1a experienced mild femoral head subluxation; four of the five with type 1b experienced three dislocations and one subluxation. Eight patients (type 1b) experienced hip instability although they had pelvic osteotomies. Proximal femoral lengthening was a significant factor for hip subluxation. Patients with hip subluxation more likely underwent monolateral fixation and the original superhip procedure. Age ±six years was not a contributing factor for hip instability.
Conclusions
Important risk factors for hip instability during femoral lengthening are severity of CFD, residual acetabular dysplasia, and proximal femoral lengthening. We recommend routine performance of pelvic osteotomy for patients with Paley type 1b CFD and distal lengthening.
Level of evidence
Therapeutic Level IV
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Conflict of interest
Mark Eidelman: Nothing to disclose
Julio J. Jauregui:Nothing to disclose
Shawn C. Standard: Research support from NuVasive Specialized Orthopedics. Royalties from NuVasive Specialized Orthopedics and Pega Medical. The following companies supported my institution’s annual course for orthopedic surgeons: Smith & Nephew; BrainLab; Orthofix; Synthes; Stryker; Wright Medical Technology; Biomet; and The MHE Coalition. The following companies supported my institution’s non-profit organization, which provides financial assistance to our patients: Stryker; Orthocare Solutions; Medevations; Bay Scribe; Nations Healthcare; and Chesapeake Surgical.
Dror Paley: Consultant for NuVasive Specialized Orthopedics; IP royalties from Smith & Nephew, NuVasive Specialized Orthopedics, Pega Medical; and Publishing royalties, financial or material support from Springer.
John E. Herzenberg: Consultant for Orthopediatrics, Orthofix, and NuVasive Specialized Orthopedics. Research support from NuVasive Specialized Orthopedics. The following companies supported my institution’s non-profit organization, which provides financial assistance to our patients: Stryker; Orthocare Solutions; Medevations; Bay Scribe; Nations Healthcare; and Chesapeake Surgical. The following companies supported my institution’s annual course for orthopedic surgeons: Smith & Nephew; BrainLab; Orthofix; Synthes; Stryker; Wright Medical Technology; Biomet; and The MHE Coalition.
Funding
This study was performed without external funding.
Ethical approval
Proper Institutional Review Board (IRB) approval obtained prior to starting this study. Since this study was retrospectively performed and all data was de-identified, no informed consent was required.
Additional information
Study conducted at the Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
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Eidelman, M., Jauregui, J.J., Standard, S.C. et al. Hip stability during lengthening in children with congenital femoral deficiency. International Orthopaedics (SICOT) 40, 2619–2625 (2016). https://doi.org/10.1007/s00264-016-3289-x
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DOI: https://doi.org/10.1007/s00264-016-3289-x