The Medium-Term Results of Complex Treatment of the Children with I-II Stage Dysplastic Osteoarthritis

Abstract

Relevance. The frequency of hip dysplasia does not decrease and in different countries of the world ranges from 2 to 50 or more per 1000 newborns. The generally accepted standard for the treatment of children under 1 year of age with hip dysplasia is the functional method. At the same time, the number of patients with untimely revealed hip dysplasia, as well as with an unsatisfactory outcome of functional treatment, for example, according to the A. Lorenz technique, remains at a fairly high level. In this regard, the use of corrective surgical interventions remains relevant. The purpose of this study was to evaluate the medium-term results of the treatment of children with I–II stage dysplastic coxarthrosis using the authors’ rehabilitation algorithm based on the functional state of the hip. Materials and Methods. The study was based on the results of a comprehensive examination of 41 patients (48 hip joints) with stage I–IIa dysplastic coxarthrosis undergone the surgery and rehabilitation according to the authors’ algorithm in the period from 2016 to 2018. To compare the obtained results, we performed a retrospective analysis of the clinical records of 32 patients (39 hip joints) undergone the similar surgery, although with the routine rehabilitation. All patients underwent a clinical examination with a mandatory assessment of step cycle, periarticular muscles endurance, and filling out specialized questionnaires. Radiological evaluation included hip x-ray and multi-spiral computed tomography. To obtain the most objective information of the hip functional state and lower extremities, we used electrophysiological (EMG) and biomechanics (stabilometry) studies. Results. Clinical and functional results were evaluated no earlier than 24 months after the treatment. The patients undergone rehabilitation according to the authors’ algorithm demonstrated the significant (p<0.05) increase in the strength and endurance of their hip area muscles, as well as in their electromyographic indicators, resulting in the improvement of their clinical and biomechanical parameters. This did not observed in the patients undergone the routine rehabilitation. Conclusion. The analysis of the medium-term results of the complex treatment of children with stage I–II dysplastic coxarthrosis, including surgical stable fixation and the authors’ rehabilitation method, led to a significant (p<0.05) improvement in the static-dynamic function of the lower extremities. This was confirmed by the results of clinical, electrophysiological, biomechanical evaluation, as well as by the employment of specialized scales that took into account the hip function, quality of life, and social adaptation of the patient.

Keywords

• children
• dysplasia
• coxarthrosis
• triple pelvic osteotomy
• rehabilitation