Transposition of the apophysis of the greater trochanter for reconstruction of the femoral head after septic hip arthritis in children

Figures & data

Table 1. Age at primary disease, type of infection, age at trochanter arthroplasty, and secondary operations

Patient	Age at primary disease	Reason for sepsis	Bacteriology	Affected joints	Age at arthroplasty (years)	Secondary operation
1, F	3 weeks	Intravenous infusion	S. aureus	Both hips	6	None
2, F	10 days	Intravenous infusion	S. aureus	Both hips, left ankle	1	Epiphysiodesis
3, M	6 months	Unknown	Unknown	Right hip	3	Lengthening osteotomy
4, M	2 months	Unknown	Unknown	Right hip	6	Shelf operation

Figure 1. Patient no. 1. A. Preoperatively, showing no femoral head on the right side and the femur positioned considerably more proximally than normal. A valgization osteotomy had been performed previously. A valgization osteotomy had also been performed in the left hip. B. Postoperatively, following transposition of the greater trochanter into the acetabulum on the right side. The subtrochanteric osteotomy was fixated with a Steinman pin. C. 24 years postoperatively, showing a spherical femoral head well covered by a congruent acetabular roof. The cartilage thickness seems adequate. Note the steep femoral neck and the low medial femoral head offset. Severe osteoarthritic changes can be seen in the left hip.

Figure 2. Patient no 2. A. Preoperatively, showing a luxated hip without any signs of a femoral neck and femoral head in the left hip. B. After trochanter arthroplasty and subtrochanteric osteotomy fixated with Steinman pins. Note severe acetabular dysplasia. C. 21 years after trochanter arthroplasty. The femoral head is flattended and poorly covered by the acetabulum. Osteoarthritic changes are present.

Figure 3. Patient no 3. A. Preoperatively, showing a totally luxated hip. B. 18 months after arthroplasty, the osteotomy had been fixated with a plate. The arrow points to a tiny ossification center in the new femoral head. C. 6 years after arthroplasty. Note the growth plate below the transposed greater trochanter. D. 6 years postoperatively. The new head is nearly spherical and well covered by a congruent acetabular roof.

Figure 4. Patient no 4. A. Preoperatively, showing a luxated hip without any signs of a femoral head. Note the severe dysplasia of the acetabulum. B. 15 years after operation, showing that the new femoral head, which is nearly spherical, is poorly covered by a neoacetabulum above a severely dysplastic acetabulum. Osteoarthritis has developed. C. After insertion of a total hip prosthesis.

Table 2. Findings at the final follow-up examination

Patient	Obs. period (years)	Radiographic findings			Pain ^c	Clinical findings at final follow-up							Limp ^d
		Evaluation of the joint		Leg length difference ^b		Range of motion
		shape	OA ^a	(cm)		Ext.	Flex.	Abd.	Add.	Int. rot.	Ext. rot.	Total
1, F	24	Spherical	no	0 (+2.0) ^e	None	–5	75	10	10	10	5	105	Slight
2, F	21	Dysplastic	yes	–1.3 (–2.4)	Moderate	0	80	15	20	10	10	135	Marked
3, M	16	Spherical	no	–2.0	None	0	90	20	10	10	5	135	Slight
4, M	15	Dysplastic	yes	–5.0 (–7.0)	Moderate	0	90	15	0	0	0	105	Marked

^a No OA means no osteoarthritic changes except slight reduction in cartilage height.

^b Values in parentheses indicate leg length difference including the difference due to subluxation.

^c Moderate pain indicates pain during activity.

^d Slight limp indicates limp that does not significantly influence the walking capacity, in contrast to marked limp.

^e In patient no. 1, the hip on the opposite side was subluxated.