choice of surgical tactics for the treatment of children with destructive pathological dislocation of the hip after hematogenous osteomyelitis

A surgical approach to the treatment of destructive pathological dislocation of the hip in children has been substantiated, depending on age, the severity of destruction of the proximal femur and acetabulum. Reconstructive - restorative operations in most patients ensure the stability of the hip joint and thereby improve the patient's gait and statics, reduce the pelvic misalignment and eliminate the Trendelenburg symptom. The experience of surgical treatment of patients with pathological hip dislocations has shown that the most favorable outcomes are achieved with the use of open reduction of the stump of the head or neck of the femur with intertrochanteric detorsion shortening and varizing osteotomy with rotational pelvic osteotomy according to Salter and acetabular plasty according to Pemberton.

Comparing Hip Dysplasia in Dogs and Humans: A Review

Hip dysplasia (HD) is common in both humans and dogs. This interconnection is because humans and dogs descended from a common ancestor and therefore have a similar anatomy at micro- and macroscopic levels. Furthermore, dogs are the animals of choice for testing new treatments for human hip dysplasia and orthopedic surgery in general. However, little literature exists comparing HD between the two species. Therefore, the aim of this review is to describe the anatomy, etiology, pathogenesis, diagnostics, and treatment of HD in humans and dogs. HD as an orthopedic condition has many common characteristics in terms of etiology and pathogenesis and most of the differences can be explained by the evolutionary differences between dogs and humans. Likewise, the treatment of HD shows many commonalities between humans and dogs. Conservative treatment and surgical interventions such as femoral osteotomy, pelvic osteotomy and total hip arthroplasty are very similar between humans and dogs. Therefore, future integration of knowledge and experiences for HD between dogs and humans could be beneficial for both species.

Intraoperative Goal-Directed Therapies in Femoral and Pelvic Osteotomies in Children and In-Hospital Postoperative Outcomes

Background: Femoral and pelvic osteotomies are potential hemorrhagic interventions where transfusion requirements can be necessary.Objective: We undertook a secondary analysis of patients who underwent femoral and pelvic osteotomy in the initial cohort. The objective of this secondary analysis was to describe intraoperative and postoperative outcomes and to describe intraoperative management in these patients in terms of blood product management, fluid and hemodynamic therapy with the aim of implementing optimization management protocols for postoperative outcome improvement.Methods: A secondary analysis of patients who underwent femoral and pelvic osteotomy surgery was included in the initial retrospective study.Results: There were eighteen patients with a mean age of 104± 47.1 months. Four (22.2%) patients had intraoperative and/or postoperative complications. One patient (5.6%) had intraoperative hemorrhagic shock, two patients (11.1%) had postoperative neurologic failure, and one patient (5.6%) had postoperative wound sepsis. Transfusion rate was 50% in nine patients.Conclusion: Femoral and pelvic osteotomies are interventions where blood, transfusion and fluid requirements can be increased; thus, this implies the necessity of a global patient blood management protocol with point-of-care tests and fluid- and hemodynamic-guided protocols with validated tools in children for intraoperative and postoperative outcome optimization.

Triple Pelvic Osteotomy In The Treatment of Pincer Type Of Femoroacetabular Impingement Syndrome.

Purpose: Femoroacetabular impingement (FAI) syndrome is a dynamic cause of hip arthritis, and it is commonly diagnosed in young adults without any other causes of hip joint pain. Pincer type of FAI in this study, is typically present in active middle-aged females. Methods: Eighteen patients diagnosed only with pincer type FAI received triple pelvic osteotomy reverse in type between 2011 and 2020. The average age of the patients was 37.3 years (28.0-45.0). The joint preserving surgery consisted of open dislocation and trochanteric flip osteotomy. We chose to do in series of selected patients only a triple pelvic osteotomy reverse in type as a extraarticular procedure in order to safely address intraarticular arthritis. Results: After surgery, the Harris Hip Score increased from 55.1 to 91.4. The patients experienced a greater range of motion in the hip and less pain. Medium-term follow-up indicated that the surgeries were successful. In our series treated with triple pelvic osteotomy 22% (4 in 18 patients) after the operation appeared clinically rear pelvic FAI test. This result was not taken as significant due to small sample size (CI 95%). After the operation we used special guidelines and we postponed total hip replacement. We did no additional operation to selected patients.Conclusion: This technique is a safe procedure to restore hip mobility. This is an extraarticular operation, and therefore it helps this process inside the joint.

Postoperative Complications of Double Pelvic Osteotomy Using Specific Plates in 305 Dogs

Objective The aim of this clinical retrospective study was to describe the postoperative complications and associated factors of double pelvic osteotomy (DPO) using DPO plates. Materials and Methods Medical records were searched for dogs that underwent unilateral or bilateral DPO using DPO plates from February 2009 to October 2018 and were re-evaluated for a minimum of 1 to 2 months postoperatively. A variety of commercially available, specific DPO plates were used. Complications were determined during the immediate postoperative period and at the time of the clinical and radiographic re-evaluations done 1 and/or 2 months postoperatively. Results A total of 458 DPO (226 right, 232 left) performed in 305 dogs satisfied the inclusion criteria. Double pelvic osteotomy plates from eight different manufacturers were used: Fixin (n = 160), Kyon (n = 154), New Generation Device (n = 63), Hofmann (n = 61), Veterinary Instrumentation (n = 12), DePuy Synthes (n = 4), Porte (n = 3) and Koenigsee (n = 1). Mean age of the dogs was 6.2 months (range: 5–8 months), and the body weight ranged from 10 to 47 kg. Overall, a total of 42 complications occurred in 38 DPO (8.2%). Complications included greenstick fracture of the ischium in 14 DPO (3%), isolated screw loosening in 13 DPO involving 16 of a total of 2,947 screws (0.5%), isolated screw breakage in 4 DPO involving 5 of 2,947 screws (0.1%), incomplete ilium fracture in 3 DPO (0.6%), partial caudal plate avulsion in 3 DPO (0.6%), iatrogenic sciatic neuropraxia in two DPO (0.4%), suspected surgical site infection (SSI) in 1 DPO (0.2%) and persistent pain and lameness caused by the implant in 2 DPO (0.4%). The case of suspected SSI and the two cases of persistent pain were classified as major complications (3 DPO, 0.6%), requiring medical and surgical intervention, respectively, whereas other 39 complications in 35 DPO were classified as minor, not requiring treatment (7.6%). Conclusion Double pelvic osteotomy using DPO plates appears to be a safe surgical option for the treatment of hip dysplasia in growing dogs; no catastrophic complications were reported and the incidence of complications (0.6% major complications and 7.6% minor complications) was low. This study showed that DPO using DPO plates and proper technique was safe in 92% of cases. The only two factors found to be significantly associated with the development of complications after DPO were the laterality (left-sided or right-sided) and body weight.

A COMPREHENSIVE PELVIC AND FEMORAL OSTEOTOMY REVISION TO TREAT A FAILED PELVIC AND FEMORAL OSTEOTOMY: A CASE REPORT

Hip’s open reduction combined with Salter innominate osteotomy and femoral osteotomy is the treatment of choice when treating Developmental Dislocation of the Hip (DDH) at walking age. We report a case of a five-year-old girl who underwent a failed surgical procedure of hip’s open reduction, Salter innominate osteotomy, and the femoral osteotomy. One year later, one-stage surgical procedure of hip’s open reduction, Dega pelvic osteotomy, and femoral de-rotation varus shortening osteotomy was performed. During the five-year follow-up, the clinical outcome was evaluated as excellent. The Dega pelvic osteotomy is an effective pelvic osteotomy for DDH, in a case of a failed Salter osteotomy.