Management of recurrent hip dislocation in Down Syndrome using modified Ganz periacetabular osteotomy: Follow up after 5 years

Recurrent hip dislocation in a Down Syndrome patient with dysplastic hip is a very challenging case to treat even for an expert orthopaedic hip surgeon. Least compliant patient and family, lowly educated with low socioeconomic status and the dysplastic hip forces limited option as a treatment. This is the first case world wide reporting 4 year follow up of dysplastic hip with Down Syndrome treated successfully with PAO technique. Methods: An eighteen years old female with history of Down Syndrome had multiple posterior hip dislocation episodes since 3 years prior. Several attempts of close reduction and hip spica applications were performed upon dislocation despite no successful retaining of reduction. Acetabular index of right hip were 550 and epiphyseal plate hasclosed. PatientwasperformedopenreductionusingSouthern-Mooreposteriorapproachand osteotomy of ischium, continued with capsulorrhaphy followed with Smith-Peterson anterior approach and osteotomy of superior ramus pubis and iliac bone. Then, derotation maneuver was performed under image intensifier to obtain adequate coveragefollowedwithbonegraftandfixationusing2cannulatedscrewandhipspica castapplication. Results: Within four years after surgery, the hip has never been dislocated again, patient could sit without pain and walk with full weight bearing although Harris Hip Score could not be performed due to Down Syndrome. Leg length discrepancy was negligible,fracture has fully united and acetabularin dex was300. Conclusions: Ganz periacetabular osteotomy, although a technically demanding surgery, is a preferable treatment in recurrent hip dislocation for Down Syndrome patient with good to excellent clinical and radiological ou tcome

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Complications associated with combined surgical hip dislocation and periacetabular osteotomy for complex hip deformities

Journal of Hip Preservation Surgery ◽

10.1093/jhps/hnz014 ◽

2019 ◽

Vol 6 (2) ◽

pp. 117-123 ◽

Cited By ~ 3

Author(s):

Adam I Edelstein ◽

Stephen T Duncan ◽

Sean Akers ◽

Gail Pashos ◽

Perry L Schoenecker ◽

...

Keyword(s):

Perioperative Complications ◽

Periacetabular Osteotomy ◽

Hip Dislocation ◽

Labral Repair ◽

Harris Hip Score ◽

Surgical Hip Dislocation ◽

Level Of Evidence ◽

Permanent Disability ◽

Superior Pubic Ramus

AbstractSurgical hip dislocation (SD) and periacetabular osteotomy (PAO) are well-described treatments for femoroacetabular impingement (FAI) and acetabular dysplasia, respectively. Occasionally, complex deformities require a combined SD/PAO; the morbidity of performing both procedures in a single stage has not been fully investigated. We performed a retrospective review of a consecutive group of patients undergoing combined SD/PAO to investigate the incidence and character of perioperative complications. Forty-five patients (46 hips) were identified. Perioperative complications were graded by the modified Clindo-Davien complication scheme. Mean follow-up was 36 months (range 12–128), and no patients were lost to follow-up. Six complications occurred in six hips (13%). Four (8.7%) complications were minor (Grades I or II): one Brooker Grade III heterotopic ossification requiring no treatment, one superior pubic ramus nonunion requiring no treatment and two superficial wound infections requiring antibiotics. Two (4.3%) complications were major (Grades III or IV): one coxa saltans interna and labral tear requiring hip arthroscopy with labral repair and iliopsoas lengthening, and one deep surgical site infection requiring irrigation and debridement followed by development of arthritis requiring conversion to arthroplasty. The average Harris hip score improved from 62 ± 13 preoperatively to 80 ± 19 at final follow-up. Except for the single joint replacement, there were no long-term disabilities. There were no major neurovascular injuries, osteonecrosis, fractures or trochanteric nonunions. Combined SD/PAO for the treatment of complex, concomitant deformities of the proximal femur and acetabulum is associated with an acceptable risk of complications. The vast majority of complications that occurred were managed without permanent disability.Level of Evidence: IV

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Preliminary results of an anteverting triple periacetabular osteotomy for the treatment of hip instability in Down syndrome

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.12.170174 ◽

2018 ◽

Vol 12 (1) ◽

pp. 55-62

Author(s):

D. A. Maranho ◽

Y.-J. Kim ◽

K. A. Williams ◽

E. N. Novais

Keyword(s):

Down Syndrome ◽

Periacetabular Osteotomy ◽

Deformity Correction ◽

Major Complication ◽

Radiographic Evaluation ◽

Level Of Evidence ◽

Hip Instability ◽

Hip Stability ◽

One Year

Purpose To investigate the outcomes of an anteverting triple periacetabular osteotomy for the treatment of hip instability in skeletally immature patients with Down syndrome. Methods We evaluated 16 patients (21 hips) with Down syndrome and hip instability who underwent an anteverting triple periacetabular osteotomy between 2007 and 2016. There were nine females and seven males with an average age of 7.4 years SD 2.0. We assessed the level of hip pain, gait ability and clinical stability at a minimum of one year after surgery. Radiographic evaluation included pre- and postoperative lateral centre-edge angle (LCEA), Tönnis acetabular angle and extrusion index. Result After an average follow-up of 4.1 years SD 2.6, 20 of 21 hips (95%) remained clinically stable. In all, 12 of 16 (75%) patients had a full gait without a major limp, but three patients (19%) had a persistent limp. Of the 21 procedures, one hip (5%) was considered a failure due to persistent instability. There was a mean increase of 18.3º SD 15.3º of the LCEA (p < 0.001); a mean decrease of 15.2º SD 11.6º (p < 0.001) for the Tönnis angle and the extrusion index had a mean decrease of 0.27 SD 0.20 (p < 0.001). The most common complications were minor and included nonunion of the pubis or ischium (24%) and stress fractures of the pubis and ischium (14%). Only one patient required unplanned surgery for the treatment of an infection; which was considered a major complication. Conclusion The anteverting triple periacetabular osteotomy provided global deformity correction and achieved hip stability in 95% of the hips after a mean follow-up of 4.1 years. Level of Evidence Therapeutic level IV.

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Fourth Ventricle Outlet Obstruction and Diverticular Enlargement of Luschka Foramina in a Child with Down Syndrome

Pediatric Neurosurgery ◽

10.1159/000511088 ◽

2020 ◽

pp. 1-4

Author(s):

Valentina Orlando ◽

Pietro Spennato ◽

Maria De Liso ◽

Vincenzo Trischitta ◽

Alessia Imperato ◽

...

Keyword(s):

Down Syndrome ◽

Fourth Ventricle ◽

Endoscopic Third Ventriculostomy ◽

Obstructive Hydrocephalus ◽

Radiological Finding ◽

Outlet Obstruction ◽

Third Ventriculostomy ◽

Viable Option ◽

Case Presentation

Introduction: Hydrocephalus is not usually part of Down syndrome (DS). Fourth ventricle outlet obstruction is a rare cause of obstructive hydrocephalus, difficult to diagnose, because tetraventricular dilatation may suggest a communicant/nonobstructive hydrocephalus. Case Presentation: We describe the case of a 6-year-old boy with obstructive tetraventricular hydrocephalus, caused by Luschka and Magendie foramina obstruction and diverticular enlargement of Luschka foramina (the so-called fourth ventricle outlet obstruction) associated with DS. He was treated with endoscopic third ventriculostomy (ETV) without complications, and a follow-up MRI revealed reduction of the ventricles, disappearance of the diverticula, and patency of the ventriculostomy. Conclusion: Diverticular enlargement of Luschka foramina is an important radiological finding for obstructive tetraventricular hydrocephalus. ETV is a viable option in tetraventricular obstructive hydrocephalus in DS.

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Porous tantalum acetabular cups for reconstructions after peri-acetabular resections of primary bone tumours

Hip International ◽

10.1177/11207000211001552 ◽

2021 ◽

pp. 112070002110015

Author(s):

Riccardo Zucchini ◽

Andrea Sambri ◽

Claudio Giannini ◽

Michele Fiore ◽

Carlotta Calamelli ◽

...

Keyword(s):

Bone Tumour ◽

Hip Dislocation ◽

Functional Results ◽

Bone Tumours ◽

Harris Hip Score ◽

Porous Tantalum ◽

Term Survival ◽

Primary Bone ◽

Primary Bone Tumours

Introduction: Periacetabular reconstruction after resection of primary bone tumour is a very demanding procedure. They are frequently associated with scarce functional results and a high rate of complications. We report a series of patients with periacetabular resections for primary bone tumours and reconstruction with a porous tantalum (PT) acetabular cup (AC). Materials and methods: 27 patients (median age 30 years) were included, being affected by primary bone tumours of the pelvis and treated with peri-acetabular resection and reconstruction with a PT AC. The diagnoses were 13 osteosarcomas, 7 chondrosarcomas and 7 Ewing sarcomas. Function was assessed with the Harris Hip Score and complications were classified according to Zeifang. Results: The median follow-up was 70 months. 1 patient required removal of the PT AC because of implant associated infection 55 months after surgery. There was 1 hip dislocation and no case of aseptic loosening. At final follow-up, the median HHS was 81 points (range 48–92). Conclusions: The used PT AC had good medium-term survival rates and good functional results. This technique is a viable reconstructive option after resections of periacetabular primary bone sarcomas.

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A case report of femoral head fracture with osteochondral lesion treated by osteosynthesis and biomimetic scaffold: 2-year clinical and radiological follow-up

Journal of Experimental Orthopaedics ◽

10.1186/s40634-021-00362-x ◽

2021 ◽

Vol 8 (1) ◽

Author(s):

Alessandro Casiraghi ◽

Claudio Galante ◽

Marco Domenicucci ◽

Stefano Cattaneo ◽

Andrea Achille Spreafico ◽

...

Keyword(s):

Case Report ◽

Femoral Head ◽

Articular Surface ◽

Osteochondral Lesion ◽

Hip Dislocation ◽

Fracture Dislocation ◽

Osteochondral Lesions ◽

Femoral Head Fracture ◽

Osteochondral Scaffold

AbstractThe aim of the present study was to present clinical and radiological outcome of a hip fracture-dislocation of the femoral head treated with biomimetic osteochondral scaffold.An 18-year-old male was admitted to the hospital after a motorcycle-accident. He presented with an obturator hip dislocation with a type IVA femoral head fracture according to Brumback classification system. The patient underwent surgery 5 days after accident. The largest osteochondral fragment was reduced and stabilized with 2 screws, and the small fragments were removed. The residual osteochondral area was replaced by a biomimetic nanostructured osteochondral scaffold. At 1-year follow-up the patient did not complain of hip pain and could walk without limp. At 2-year follow-up he was able to run with no pain and he returned to practice sports. Repeated radiographs and magnetic resonance imaging studies of the hip showed no signs of osteoarthritis or evidence of avascular necrosis. A hyaline-like signal on the surface of the scaffold was observed with restoration of the articular surface and progressive decrease of the subchondral edema.The results of the present study showed that the biomimetic nanostructured osteochondral scaffold could be a promising and safe option for the treatment of traumatic osteochondral lesions of the femoral head.Study Design: Case report.

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Hip Dislocation and Subluxation in Athletes: A Systematic Review

The American Journal of Sports Medicine ◽

10.1177/03635465211036104 ◽

2021 ◽

pp. 036354652110361

Author(s):

Deepak V. Chona ◽

Paul D. Minetos ◽

Christopher M. LaPrade ◽

Mark E. Cinque ◽

Geoffrey D. Abrams ◽

...

Keyword(s):

Systematic Review ◽

Arthroscopic Surgery ◽

Treatment Strategies ◽

Hip Dislocation ◽

Return To Play ◽

Exclusion Criteria ◽

Level Of Evidence ◽

Radiographic Outcomes ◽

Center Edge

Background: Hip dislocation is a rare occurrence during sports but carries serious implications for athletes. Purpose: To systematically review treatment strategies and outcomes for hip dislocation in athletes, with the ultimate goal of providing sports medicine physicians with the information necessary to appropriately treat and counsel patients sustaining this injury. Study Design: Systematic review; Level of evidence, 4. Methods: PubMed, MEDLINE, and Embase were searched for studies relating to hip instability and athletics from January 1, 1989 to October 1, 2019. Abstracts and articles were evaluated on the basis of predefined inclusion and exclusion criteria. Inclusion criteria were the following: (1) data from ≥1 patients, (2) native hip dislocation or subluxation occurring during sports, (3) patients aged at least 10 years, and (4) written in English. Exclusion criteria were (1) patients younger than 10 years; (2) nonnative or postoperative hip dislocation or subluxation; (3) a native hip injury without dislocation or subluxation; (4) patients with dislocation or subluxation secondary to neuromuscular, developmental, or syndromic causes; (5) dislocation or subluxation not occurring during sports; (6) patients with physeal fractures; or (7) review articles or meta-analyses. Data were recorded on patient demographics, injury mechanism, treatment strategies, and clinical and radiographic outcomes. Where possible, pooled analysis was performed. Studies were grouped based on reported outcomes. Meta-analysis was then performed on these pooled subsets. Results: A total of 602 articles were initially identified, and after screening by 2 reviewers, 27 articles reporting on 145 patients were included in the final review. There were 2 studies that identified morphological differences between patients with posterior dislocation and controls, including decreased acetabular anteversion ( P = .015 and .068, respectively), increased prevalence of a cam deformity ( P < .0035), higher alpha angles ( P≤ .0213), and decreased posterior acetabular coverage ( P < .001). No differences were identified for the lateral center edge angle or Tonnis angle. Protected postreduction weightbearing was most commonly prescribed for 2 to 6 weeks, with 65% of reporting authors recommending touchdown, toe-touch, or crutch-assisted weightbearing. Recurrence was reported in 3% of cases. Overall, 4 studies reported on findings at hip arthroscopic surgery, including a 100% incidence of labral tears (n = 27; 4 studies), 92% incidence of chondral injuries, 20% incidence of capsular tears, and 84% incidence of ligamentum teres tears (n = 25; 2 studies). At final follow-up, 86% of patients reported no pain (n = 14; 12 studies), 87% reported a successful return to play (n = 39; 10 studies), and 11% had radiographic evidence of osteonecrosis (n = 38; 10 studies). Conclusion: Various treatment strategies have been described in the literature, and multiple methods have yielded promising clinical and radiographic outcomes in patients with native hip dislocation sustained during sporting activity. Data support nonoperative treatment with protected weightbearing for hips with concentric reduction and without significant fractures and an operative intervention to obtain concentric reduction if unachievable by closed means alone. Imaging for osteonecrosis is recommended, with evidence suggesting 4- to 6-week magnetic resonance imaging and follow-up at 3 months for those with suspicious findings in the femoral head.

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Ligamentum teres reconstruction with labrum and capsule repair after posterior acetabular wall fracture: a case report

Journal of Hip Preservation Surgery ◽

10.1093/jhps/hnab029 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. i41-i45

Author(s):

Jacek Mazek ◽

Maciej Gnatowski ◽

Antonio Porthos Salas ◽

Marcin Domżalski ◽

Rafał Wójcicki ◽

...

Keyword(s):

Hip Joint ◽

Hip Dislocation ◽

Ligamentum Teres ◽

Hip Instability ◽

Post Traumatic ◽

The Right ◽

Capsule Repair ◽

Acetabular Wall

Abstract The aim of this case study is to present arthroscopic treatment of recurrent hip instability after acute post-traumatic posterior hip dislocation with a fracture of the posterior acetabular wall. A male patient aged 35 suffered a dislocation of the right hip joint with a fracture of the posterior acetabular wall due to an accident. The fracture was stabilized during emergency surgery with a locking compression plate, and the patient was released home in a hip brace. Multiple dislocations of the hip joint followed with the implant being confirmed as stable. Decision was made to qualify the patient for a right hip arthroscopy. During the surgery, ligamentum teres was reconstructed using gracilis and semitendinous muscle grafts, followed by the labrum and joint capsule repair, where the surgery that stabilized the acetabular wall fracture had damaged them. There were no complications following the procedure. Short-term follow-up of 3 months demonstrates the patient has a stable hip, reduced pain and has returned to pre-injury activities.

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Subchondral drilling for chondral flaps reduces the risk of total hip arthroplasty in femoroacetabular impingement surgery at minimum five years follow-up

Hip International ◽

10.1177/1120700018781807 ◽

2018 ◽

Vol 29 (2) ◽

pp. 191-197 ◽

Cited By ~ 2

Author(s):

Pascal C Haefeli ◽

Moritz Tannast ◽

Martin Beck ◽

Klaus A Siebenrock ◽

Lorenz Büchler

Keyword(s):

Los Angeles ◽

Total Hip Arthroplasty ◽

Femoroacetabular Impingement ◽

Hip Arthroplasty ◽

Hip Dislocation ◽

Harris Hip Score ◽

Control Group ◽

Total Hip ◽

Tönnis Grade

Introduction: The best treatment of acetabular chondral flaps during surgery for femoroacetabular impingement (FAI) is unknown. We asked if subchondral drilling improves clinical and radiographic outcome and if there are factors predicting failure. Methods: We treated 79 patients with symptomatic FAI and acetabular chondral flaps with surgical hip dislocation between January 2000 and December 2007. Exclusion of all patients with previous hip pathology or trauma resulted in 62 patients (80 hips). The chondral flap was slightly debrided in 43 patients/51 hips (control group). In 28 patients/29 hips (study group), additional osseous drilling was performed. 4 patients (5 hips, 6%) were lost to follow-up. Mean follow-up was 9 years (5–13 years). The groups did not differ in demographic data, radiographic parameters or follow-up. Clinical outcome was assessed with the Merle d’Aubigné score, modified Harris Hip Score and University of California Los Angeles activity score and progression of osteoarthritis with the Tönnis grade. Results: No patient underwent conversion to total hip arthroplasty (THA) in the drilling group compared to 7 patients (8 hips, 16%) in the control group ( p = 0.005); in the remaining hips, clinical scores and progression of Tönnis grade did not differ. Increased acetabular coverage, age and body mass index were univariate predictive factors for conversion to THA. No drilling was as an independent predictive factor for conversion to THA (hazard ratio 58.07, p = 0.009). Conclusion: Subchondral drilling under acetabular chondral flaps during surgical treatment of FAI is an effective procedure to reduce the rate of conversion to THA.

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FUNCTIONAL OUTCOME OF PIRIFORMIS MUSCLE SPARING POSTEROLATERAL APPROACH IN BIPOLAR HEMIARTHROPLASTY: A RETROSPECTIVE STUDY.

10.36106/ijsr/6003850 ◽

2021 ◽

pp. 30-32

Author(s):

Nadeem A. Lil ◽

Vipul R. Makwana ◽

Arjav R. Patel ◽

Aakrut S. Modi ◽

Tirth D. Patel ◽

...

Keyword(s):

Functional Outcome ◽

Single Case ◽

Tertiary Care ◽

Hip Dislocation ◽

Posterolateral Approach ◽

Harris Hip Score ◽

Bipolar Hemiarthroplasty ◽

Care Hospital ◽

Piriformis Muscle

INTRODUCTION: Hemiarthroplasty for hip fracture is a common surgical procedure and is the treatment of choice for displaced intracapsular neck of femur fracture. Numerous approaches are used to access the hip joint. The standard posterior approach is used by many surgeons to preserve the abductor complex but is associated with higher dislocation rate. In this study we assess functional outcomes of piriformis sparing posterolateral approach for hemiarthroplasty of hip. MATERIAL AND METHODOLOGY: We retrospectively reviewed 96 patients who underwent bipolar hemiarthroplasty of hip performed by chief surgeon between May 2018 to September 2020. All the database was retrieved from institutional database of tertiary care hospital. Functional outcome was measured by modied HARRIS HIP SCORE. RESULTS: Till minimum 1 year follow up we noticed that there was no single case of hip dislocation. Joint proprioception was preserved. In the nal follow up average Harris hip score was 92.2. No infection, nerve injury, implant migration occurred in our study. DISCUSSION: The main aim of the arthroplasty procedure is to decrease pain, to achieve mobility and restore anatomy. The piriformis sparing approach not only preserves abductor complex but also piriformis muscle. The muscle works like cradle, at the posterosuperior part of the joint, an area with a high risk of dislocation. The only disadvantage was noted in this approach was increased exposure difculty in obese patients CONCLUSION: From this study we conclude that Piriformis sparing posterolateral approach is safe, demands some technical aspects and should be used by surgeons using posterolateral approach.

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