One-stage treatment of congenital severely dislocated hips in older children through various acetabuloplasty techniques

Figures & data

Figure 1 Case 10. A girl who was 6 years old at the index operation for bilateral hip dislocation. A. At the initial examination (bilateral hip dislocation). B. 1 year after open reduction, capsulorrhaphy, femoral shortening, and Salter innominate osteotomy, showing adequate reduction. C. After removal of implant.

Figure 2 Case 2. A 12.5-year-old girl at the index operation (A) for dislocation of the right hip and postoperatively (B) after open reduction, capsulorhaphy, extraarticular grafting arthroplasty and femoral shortening, showing adequate reduction.

Figure 3 Case 7. A 12-year-old girl at the index operation (A) for dislocation of the right hip and after open reduction, capsulorrhaphy, extraarticular grafting arthroplasty and femoral shortening (B), showing adequate reduction.

Table 1. Detailed information about he patients

A	B	C	D	E	F	G	H	I	J	K	L	M
1 ^a	F, 3 + 0	60	1998, 1	Salter	Y	-35/25	35/20	I	0		99	Y
	F, 3 + 2	58	1998, 3	Salter	Y	-35/45	40/20	I	0		97	Y
2	F, 12 + 7	47	1998, 11	EAGA	Y	-35/45	55/25	I	0		97	Y
3	M, 4 + 9	15	2002, 11	Salter	Y	-30/40	55/25	II	I		84	Y
4 ^a	F, 12 + 8	51	1998, 9	EAGA	Y	-30/40	60/25	I	I		96	Y
	F, 12 + 9	50	1998, 10	EAGA	N	-35/40	60/55	I	I		88	Y
5 ^a	F, 3 + 0	18	2002, 7	Salter	Y	-25/50	40/15	I	II		96	Y
	F, 3 + 2	16	2002, 9	Salter	Y	-20/40	40/15	I	I		97	Y
6 ^a	F, 9 + 2	30	2000, 11	Dega	Y	-30/45	60/20	I	0		77	Y
	F, 9 + 3	29	2000, 12	EAGA	N	-35/50	60/30	IV	II	III	77	N
7	F, 12 + 3	57	1998, 6	EAGA	Y	0/40	50/25	I	I		91	Y
8	F, 7 + 5	24	2001, 9	EAGA	N	-25/25	60/42	II	0		91	Y
9	F, 9 + 10	36	1999, 10	EAGA	N	-30/20	55/50	II	I	II	88	Y
10 ^a	F, 5 + 11	37	1999, 6	Salter	Y	-10/30	55/25	I	I		93	Y
	F, 5 + 12	36	1999, 7	Salter	Y	-15/40	55/25	I	0		97	Y
11	F, 13 + 9	44	1999, 1	EAGA	N	-10/20	60/55	IV	II		75	N
12	F, 14 + 8	39	1999, 4	EAGA	Y	0/60	40/20	I	0		97	Y
13 ^a	F, 3 + 11	18	2002, 1	Salter	N	-10/25	60/50	II	0	I	88	Y
	F, 4 + 0	16	2002, 3	Salter	N	0/35	50/36	I	0		91	Y
14	F, 11 + 7	36	1999, 12	EAGA	N	-10/20	65/40	I	0		88	Y
15	F, 9 + 11	12	2002, 12	Salter	Y	0/40	50/25	I	0		96	Y
16 ^a	F, 14 + 5	43	1999, 12	EAGA	N	0/35	60/55	VI	II		88	N
	F, 14 + 7	41	2000, 1	Chiari	N	-5/30	50/50	I	0	I	91	Y
17	F, 5 + 5	32	2001, 2	EAGA	Y	-30/30	60/25	I	0		97	Y
18	F, 6 + 11	33	2001, 6	Salter	Y	-10/35	50/25	I	0		99	Y
19	F, 6 + 1	52	1998, 8	Dega	Y	0/35	55/25	I	0		97	Y
20	M, 6 + 9	60	1998, 3	Salter	Y	0/30	50/25	I	0		97	Y
21	M, 5 + 5	53	1998, 11	Dega	Y	0/30	50/20	I	0		97	Y
22	F, 5 + 1	59	1998, 5	Dega	Y	0/25	45/20	I	0		99	Y

^a Bilateral cases.

A Case

B Gender, age at operation (years + months)

C Follow-up time (months)

D Operation time (year, month)

E Pelvic osteotomy EAGA: Extraarticular grafting acetabuloplasty.

F Postoperatively adequate reduction^b Y: Yes, N: No.

G CE angle pre-/postoperatively

H Acetabular index pre-/postoperatively

I Severin grade (postoperative)

J Boyer degenerative change (postoperative)

K Osteonecrosis (postoperative)

L Iowa score (postoperative) ^c

M Shenton line (postoperative)

^b A reduction was considered to be adequate when the center-edge angle was more than 15°, the asetabular index was less than 28°, and the Shenton line was intact.

^c A score of 90–100 points indicated an excellent result; 80–89 points, a good result; 70–79 points, a fair result; and less than 70 points, a poor result.

Figure 4 Case 12. A 15-year-old girl at the index operation (A) for dislocation of the right hip and after open reduction (B), capsulorrhaphy, extraarticular grafting arthroplasty and femoral shortening, showing adequate reduction at 28 months of follow-up.

Figure 5 Case 11. A 14-year-old girl at the index operation (A) for dislocation of the right hip and at follow-up (B) after 32 months: dislocation of the hip and heterotopic ossification.

Table 2. Complications in the patients

	Case no.
Complication	4L	6L	9	10R	11	13R	16R	16L
Subluxation/dislocation		+			+		+
Osteonecrosis		+	+			+		+
Implant failure				+
Heterotopic ossification		+			+
Excessive derotation	+	+	+
Joint stiffness	+	+	+
Limb discrepancy					+			+