Hip reconstruction in patients with ischemic deformity of the proximal femur and associated acetabular dysplasia

Abstract

Introduction Acetabular dysplasia associated with ischemic deformity of the proximal femur leads to significant functional limitations and progressive hip osteoarthritis (OA). The best surgical approach, the timing and the volume of surgery are still controversial. Material and methods Outcomes of 32 patients with ischemic hip deformity were reviewed. The mean age at the time of surgery was 15.8 ± 0.7 (range, 12–24) years. The mean follow-up period was 4.2 ± 0.4 years. Clinical outcomes were measured using the Merle d'Aubigné-Postel, Tönnis, Severin scoring scales and the grading system developed at the National Ilizarov Medical Research Center for Trauma and Orthopedics (NIMRC TO). Extra-articular (n = 24) and intra-articular (n = 8) procedures were produced for hip reconstructions. Results The hip function score was 5.2 ± 0.1 after extra-articular interventions and 4.3 ± 0.14 after intra-articular procedures. Postoperatively, hip joints were+ graded as Severin IIa (n = 18), Severin IIb (n = 10) and Severin III (n = 4). No arthritic changes occurred in 25 hips. In the remaining cases, OA either progressed (n = 4) or improved (n = 3). Outcomes were rated as good with 2.6 ± 0.03 scores (n = 17), fair with 2 ± 0.1 scores (n = 13) and poor with 1.41 ± 0.05 scores (n = 2) measured on the NIMRC TO scale. Conclusion The technologies offered for the reconstruction of both articular components have been shown to be effective in treatment of patients with ischemic hip deformity and associated acetabular dysplasia.

Keywords

• perthes disease
• ischemic deformity
• acetabular dysplasia