Surgical Dislocation in the Management of Pediatric and Adolescent Hip Deformity

Rebello, Gleeson; Spencer, Samantha A.; Millis, Michael B.; Kim, Young-Jo

doi:10.1007/s11999-008-0591-y

Cited by 86 publications

(78 citation statements)

References 17 publications

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“…Our results are comparable to those after open 3,23 or arthroscopic 9,24 hip surgery. The open dislocation method achieved good-to-excellent short-to midterm results in 70 to 80% of patients.…”

Section: Discussionsupporting

confidence: 79%

Conservative Treatment for Mild Femoroacetabular Impingement

Emara

Samir

Khan

2011

J Orthop Surg (Hong Kong)

144

167

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Purpose. To report early results of conservative treatments (including modifications in activities of daily living) for mild femoroacetabular impingement. Methods. 27 male and 10 female athletic patients aged 23 to 47 years presented with unilateral hip pain secondary to femoroacetabular impingement and an alpha angle of <60º. Patients were instructed to adapt to their safe range of movement and perform activities of daily living with minimal friction. The Harris Hip Score and non-arthritic hip score before and after treatment were compared. Open or arthroscopic hip surgery to remove the impinging bone was indicated when conservative treatment failed. Results. Patients were followed up for 25 to 28 months. Of the 37 patients, 4 underwent surgical treatment after conservative management failed. For the remaining 33 patients, the mean Harris Hip Score improved significantly from 72 before treatment to 91 at the 24-month follow-up. The mean non-arthritic hip scores improved from 72 to 91, and the mean visual analogue scores for hip pain from 6 to 2. Six of the 33 patients had recurrent hip pain and discomfort but not severe enough for surgical treatment. Conclusion. Conservative treatment did not improve the range of hip movement, despite improvement in function and symptoms. Yet it achieved good early results, as long as the patients could modify activities of daily living to adapt to their hip morphology.

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Section: Discussionsupporting

confidence: 79%

Conservative Treatment for Mild Femoroacetabular Impingement

Emara

Samir

Khan

2011

J Orthop Surg (Hong Kong)

144

167

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“…The other potential advantage is the prevention of femoroacetabular impingement (FAI) by achieving an anatomical reduction of the epiphysis [9,10,12]. Adolfsen and Sucato [9] reported a series of 15 patients with unstable SCFEs, treated with open reduction and fixation of the slipped capital epiphysis by means of surgical hip dislocation, where 1 of 15 patients (6.7 %) had AVN.…”

Section: Discussionmentioning

confidence: 99%

Open reduction and internal fixation of unstable slipped capital femoral epiphysis by means of surgical dislocation does not decrease the rate of avascular necrosis: A preliminary study

Alves

Steele

Narayanan

et al. 2012

Journal of Children's Orthopaedics

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Purpose The treatment of unstable slipped capital femoral epiphysis (SCFE) remains controversial. Surgical dislocation and open reduction has the potential to significantly reduce the rate of avascular necrosis (AVN) by allowing direct preservation of the femoral head blood supply. The purpose of this study was to determine if open reduction of the unstable SCFE by means of surgical hip dislocation reduced the risk of AVN compared with closed reduction and percutaneous pinning. Methods We reviewed the medical records and radiographs of patients treated at our institution between the years 2000 and 2008. Sex, age, side of slip, precipitating event, pre-and post-operative anterior physeal separation (APS) and slip angle, slip severity, time between inciting event and surgical treatment, number of screws used, development of AVN, and need for subsequent surgery were evaluated. Statistical analysis was performed to compare risk factors and occurrence of AVN. Results From 2004 to 2008, we treated 12 patients with unstable SCFEs: six had closed reduction and percutaneous pinning and six underwent open reduction by means of surgical hip dislocation. There were no statistically significant differences between the two groups regarding sex, age, slip angle, APS, time to surgery, and AVN rate. At follow-up, 4 (66.7 %) patients had AVN in the group which had open reduction, while 2 (33.3 %) patients had AVN in the group which underwent closed reduction. (p = 0.57). Conclusions Open reduction of the unstable SCFE by means of surgical dislocation of the hip does not decrease the rate of AVN when compared to closed reduction.

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“…They believed that the complication rate was related to the complexity of the reconstruction at the time of dislocation. 32 Sink et al 33 recently described the complications after surgical dislocation in a multicentre study of 334 hips in 302 patients with a mean age of 26 years at a mean followup of 5.8 months. The overall incidence of complications was 9%, but no cases of osteonecrosis or femoral neck fracture were encountered.…”

Section: Figmentioning

confidence: 99%

“…In a study of 29 patients with SCFE by Rebello et al, 32 of whom 17 had prior pinning in situ, the surgical procedures performed were femoral head-neck osteochondroplasty (n = 7), intertrochanteric osteotomy (n = 5), femoral head-neck osteochondroplasty with intertrochanteric osteotomy (n = 8), femoral neck osteotomy (n = 4) and open reduction and internal fixation (n = 5). Improvement in the mean WOMAC score for pain, stiffness and function was reported at a mean follow-up of 41.6 months.…”

Section: Figmentioning

confidence: 99%

Surgical treatment of femoroacetabular impingement in patients with slipped capital femoral epiphysis

Azegami

Kosuge

Ramachandran

2013

The Bone & Joint Journal

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Slipped capital femoral epiphysis (SCFE) is relatively common in adolescents and results in a complex deformity of the hip that can lead to femoroacetabular impingement (FAI). FAI may be symptomatic and lead to the premature development of osteoarthritis (OA) of the hip. Current techniques for managing the deformity include arthroscopic femoral neck osteochondroplasty, an arthroscopically assisted limited anterior approach to the hip, surgical dislocation, and proximal femoral osteotomy. Although not a routine procedure to treat FAI secondary to SCFE deformity, peri-acetabular osteotomy has been successfully used to treat FAI caused by acetabular over-coverage. These procedures should be considered for patients with symptoms due to a deformity of the hip secondary to SCFE. Slipped capital femoral epiphysis (SCFE) is the most common adolescent disorder of the hip and the incidence is likely to increase, given the current epidemic of obesity in childhood. 1,2 It has been reported that the age at onset decreases with increasing obesity. 3 SCFE creates a complex deformity of the hip that can result in femoroacetabular impingement (FAI), which may lead to the early development of osteoarthritis (OA) of the hip. 4 Retrospective studies of patients with untreated SCFE and of pinning in situ without realignment suggest that the severity of the slip correlates with the subsequent radiological evidence of OA and poor clinical outcome scores, but is not necessarily predictive of FAI. 5,6 In a retrospective study by Dodds et al, 6 32% of patients (16 of 49) who previously presented to their institution with SCFE were found to have clinical signs of FAI.In situ pinning is commonly undertaken and is a relatively low risk procedure relying on remodelling of the proximal femur. However, it may still result in radiological osteoarthritic changes and a poor clinical outcome. Surgical management of FAI is aimed at restoring a more normal femoral head-neck offset in order to increase clearance and prevent femoral abutment against the acetabular edge. Various management strategies have been described, including arthroscopic osteochondroplasty, arthroscopically assisted osteochondroplasty via arthrotomy, surgical dislocation osteochondroplasty, proximal femoral osteotomy and peri-acetabular osteotomy. PathophysiologyBased on the type of abnormal morphology, FAI can be divided into three types: cam, pincer, and mixed-type. 4 In cam-type impingement the prominent area, typically on the anterolateral femoral neck, abuts the acetabular rim during forceful movement, especially in flexion and internal rotation, leading to damage of the labral-chondral complex. 7 In pincertype impingement the abnormality is on the acetabular side, involving focal or global overcoverage of the femoral head leading to damage of the femoral head-neck region and labrum. 8,9 FAI can also be classified as primary and secondary (Fig. 1).In SCFE, the relative positioning of the femoral head leads to prominence of the anterolateral femoral metaphysis (Fig. 2). 10 Th...

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Surgical Dislocation in the Management of Pediatric and Adolescent Hip Deformity

Cited by 86 publications

References 17 publications

Conservative Treatment for Mild Femoroacetabular Impingement

Conservative Treatment for Mild Femoroacetabular Impingement

Open reduction and internal fixation of unstable slipped capital femoral epiphysis by means of surgical dislocation does not decrease the rate of avascular necrosis: A preliminary study

Surgical treatment of femoroacetabular impingement in patients with slipped capital femoral epiphysis

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