PubMed1993
The authors submit an analysis of the results of surgical treatment of inborn dislocation of the hip joint in children from the age of one year to completed growth. Decisive for inclusion into this group was surgical reposition. The operated patients were divided into the following three groups by age at the time of operation: 1. first year up to 17 months; 2. 18 to 48 months; 3. patients older than 4 years up to 15 years. Between 1978 and 1992 96 children with inborn dislocation of the hip joint were operated (103 hip joints). Complete documentation was available for 59 hip joints of 54 patients. The follow up period varies between 1 and 14 years after operation. In the first group 24 hip joints of 21 patients were checked, the average age at the time of operation being 8 months. In 17 hip joints at the same time subtrochanteric osteotomy with abbreviation was performed. In these operated hip joints surgical reposition was preceded by distraction either using the "overhead" system or the Pavlanský's method. All hip joints in this group were operated from an anterolateral approach according to Scaglietti's principles. In the second group 19 hip joints of 16 patients were checked, the mean age at the time of operation being 28 months. A standard component of the operation was in addition to surgical reposition also pelvic osteotomy according to Salter's method, in 16 cases at the same time derotation varus osteotomy was performed. The third group comprises 16 hip joints of 15 patients operated at an average age of 9 years and 8 months. Fourteen of the hip joints had been operated previously at least once by different methods. In acetabular dysplasia different techniques were used, most frequently Chiari's osteotomy. The surgical reposition proper was preceded in four instances of high iliac dislocation by preoperative distraction by external fixation. For evaluation of the results clinical and radiological parameters were used, essentially identical with Severin's classification. X-ray evaluation was supplemented y values of the distance between the head and Köhler's protrusion. The best clinical and X-ray results were achieved in the first group; wih the number of previous operations and advancing age the perspective of excellent results declines. In the group as a whole five, i. e. 8.5%, avascular necroses were recorded. From the total number of operated patients good radiological results were achieved in 83%, 17% of the results are considered satisfactory.(ABSTRACT TRUNCATED AT 250 WORDS)