Femoral Varus Derotation Osteotomy for the Treatment of Habitual Subluxation and Dislocation of the Pediatric Hip in Trisomy 21

Knight, Dominique; Alves, Cristina; Wedge, John H.

doi:10.1097/bpo.0b013e3182285fa5

Cited by 25 publications

(29 citation statements)

References 11 publications

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“…4,6,7 In some instances, there was a reliance on isolated soft tissue procedures, which are prone to failure in a condition characterized by soft tissue laxity, as the tissues tend to stretch out over time particularly on a background of bony structural deficiency. 12,13 ASSESSMENT Because of the range of anatomic abnormalities of the unstable hip that occur in Trisomy 21, a detailed clinical and radiographic assessment is necessary. Life expectancy at the time of writing of many of the key historical articles on the hip in Trisomy 21 was merely 25 years of age.…”

Section: Poor Historical Resultsmentioning

confidence: 99%

“…12 An alternative approach to the habitually dislocating hip has been proposed by Sankar et al, 13 whose recommendation is that of an isolated anteverting triple osteotomy of the acetabulum. Although primary acetabular retroversion may be present, features of secondary acetabular dysplasia are not usually present.…”

Section: Habitual Dislocationmentioning

confidence: 99%

“…Degenerative arthritis may occur secondary to hip instability with progressive subluxation or dislocation but may also occur secondary to the other hip pathologies associated with Trisomy 21, namely slipped capital femoral epiphysis and Perthes disease. 12,13 This is mainly due to a more complete understanding of the pathoanatomy of hip dysplasia in Trisomy 21 and its progression with age combined with a surgical algorithm that aims to systematically correct each of the important elements without exacerbating known deficiencies. Trisomy 21 per se should not be considered a contraindication to the use of THA despite concerns about postoperative dislocation related to intellectual disability or soft tissue laxity, nor from technical concerns regarding abnormal bony anatomy including severe acetabular dysplasia or the small dysplastic morphology of the proximal femur and acetabulum.…”

Section: Fixed Dislocationmentioning

confidence: 99%

“…21 The third complication of note is peri-implant fracture 12 (Fig. Infection rates of up to 20% have been quoted after hip reconstruction.…”

Section: Fixed Dislocationmentioning

confidence: 99%

“…21 The third complication of note is peri-implant fracture 12 (Fig. 12 The etiology of this complication may be multifactorial as although patients with Trisomy 21 have low areal bone mineral density (areal BMD), their values for volumetric bone mineral density (volBMD) are equivalent to normal subjects.…”

Section: Fixed Dislocationmentioning

confidence: 99%

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Management of Hip Instability in Trisomy 21

Kelley

Wedge²

2013

Journal of Pediatric Orthopaedics

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The unstable hip in Trisomy 21 presents with a spectrum of hip instability with different problems at different ages. What links this multiphase problem, in many patients, is the final common pathway of untreated instability, that of a stiff, dislocated, and often-painful hip, leading to significant functional disability. Historically, the results of treating hip instability in Trisomy 21 were variable with a notable frequency of poor results. With an improved understanding of the Trisomy 21 hip in terms of its pathoanatomy and a more contemporary surgical approach to hip reconstruction, much improved results can be expected and indeed have recently been shown. The mainstay of treatment for the habitual dislocation group presenting before 8 years of age is the femoral varus derotation osteotomy. The older group presenting with painful subluxation often show signs of secondary acetabular dysplasia and thus are best treated with redirectional acetabular osteotomy with or without the use of femoral varus derotation osteotomy. The presence of radiographic features of degenerative arthritis in the fixed dislocation group precludes the use of joint-preserving techniques for hip reconstruction, and these patients can achieve excellent results with total joint arthroplasty. The natural history, historical results, assessment, treatment, and management of complications of hip instability in Trisomy 21 are addressed in this paper.

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