Bilateral femoral head reshaping and mosaicplasty in Legg–Calvé–Perthes disease residual deformity

Residual hip deformity secondary to Perthes disease may lead to early symptomatic joint degeneration. The altered anatomy results in biomechanical and biological problems that can be surgically addressed in adolescents or young adults with hip preservation procedures. This case report aims to demonstrate a customized surgical treatment performed on a 15-year-old male who developed painful hips with significant intra- and extra-articular impingement, secondary to bilateral Leg–Calvé–Perthes disease residual deformity. Intra-articular procedures were executed through a safe surgical dislocation of the hip, with a mosaicplasty using osteochondral autografts from the exceeding peripheral ipsilateral femoral head, a femoral head–neck osteochondroplasty and a labrum repair. A relative lengthening of the femoral neck was also carried out with a trochanteric advancement to solve the extra-articular issues. On follow-up, he referred to a substantial improvement in pain and function, being his radiographic studies satisfactory. At 4 and 5 years from surgery, the patient was able to exercise regularly with minimal complaints, with a Harris Hip Score of 85.85% and a Hip Outcome Score of 94.1% for activities of daily life and 86.1% for sports. In patients with hip deformity after healed Perthes disease, treatment strategies that address both the morphological disturbance of coxa magna, plana and breva, as well as the biological concerns arising from osteochondral injuries or labral tears, and mechanical dysfunctions lead to improvements in symptomatology, function and medium-term prognosis. Further procedures to address residual adaptative acetabular dysplasia would favor outcomes of conservative hip surgery in the sequelae of LCPD.

Pathological progress of traumatic femur head necrosis after femoral neck fracture in children and adolescents: a case series study

The pathological progression and prognosis of traumatic femur head necrosis (TFHN) after femoral neck fracture (FNF) in children and adolescent is relatively unknown and has never been specifically characterized. As we speculated, the prognosis in such population would be poor and characterized as the high risk of femoral head collapse, hip deformity and degeneration in a short term. This retrospective case series enrolled 64 children and adolescent with TFHN who treated with observational treatment from 2000.1 to 2018.1. The primary outcomes, the progression of femoral head collapse, hip deformity (Stulberg classification) and hip degeneration (Tönnis grade), and their prognostic factors were analysed. Sixty-four patients with a mean age of 13 years (6–16 years) were included. A total of 28 hips (44%) showed unsatisfactory outcome and 25 (39%) hips collapsed progressively during a mean follow-up of 48 months (24–203 months). Finally, 38 hips (59%) experienced hip deformity, 20 of them were Class IV/V. Thirty-four hips (53%) generally progressed to osteoarthritis, 14 of them were classified as Grades II/III. The location of the lesion and the presence of subluxation were found to be related to progression of collapse; however, the presence of subluxation was the only independent risk factor of severe hip deformity and degeneration. TFHN in children and adolescent is a rapidly progressing disease with a poor prognosis characterized by a high risk of femoral head collapse progression. If the subluxation emerged, collapsed cases showed increasingly tendency towards hip deformity and degeneration.

Direct Anterior Total Hip Arthroplasty with Fluoroscopy to Mitigate the Risk of Complications in Patients with Legg–Calve–Perthes Disease

A minority of adult patients with childhood Legg–Calve–Perthes disease (LCPD) will develop secondary arthritis with marked leg length discrepancy (LLD) and multiplanar hip deformity. During total hip arthroplasty (THA), these technical challenges increase the perioperative risks of nerve injury, leg length inequality, and implant malposition. The technique of direct anterior total hip arthroplasty (DA-THA) in combination with fluoroscopic imaging was evaluated to mitigate these risks. We performed a retrospective review of 11 DA-THA procedures performed for patients with LCPD. The mean preoperative LLD for the patient cohort was 17 mm (range, 2–54). The mean postoperative LLD was 6 mm (range, 0–28). Acetabular component orientation was precise and accurate with a mean abduction angle of 44 degrees (range, 42–46) and mean anteversion of 20 degrees (range, 16–24). Clinical outcomes demonstrated a mean hip disability and osteoarthritis outcome score for joint replacement (HOOS, Jr) of 94 points. No patients had leg lengthening more than 26 mm and no nerve palsies were identified. We conclude that DA-THA with fluoroscopic guidance may be a valuable method to improve component placement precision and procedural safety in this potentially high-risk patient group.

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

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.

Pathological progress and prognosis of traumatic femur head necrosis after femoral neck fracture in children and adolescent: a retrospective case series of 64 patients

Background: The pathological progression and prognosis of traumatic femur head necrosis (TFHN) after femoral neck fracture (FNF) in children and adolescent is relatively unknown and has never been specifically characterized. As we speculated, the prognosis in such population would be poor and characterized as the high risk of femoral head collapse, hip deformity and degeneration in a short term.Methods: This retrospective case series enrolled 64 children and adolescent with TFHN who treated with observational treatment from 2000.1 to 2018.1. The primary outcomes, such as the progression of femoral head collapse, hip deformity (Stulberg classification) and hip degeneration (Tönnis grade), and their prognostic factors were analysed.Results: 42 males and 22 females with a mean age of 13 years (6-16 years), were included. A total of 28 hips (44%) showed unsatisfactory outcome and Twenty-five (39%) hips collapsed progressively during a mean follow-up of 48 months (24-203 months). Finally, 38 hips (59%) experienced hip deformity, 20 of them were class IV/V. 34 hips (53%) generally progressed to osteoarthritis, 14 of them were classified as grades II/III. The location of the lesion and the presence of lateral subluxation were found to be independently related to progression of femoral head collapse; however, the presence of lateral subluxation was the only independent risk factor of severe hip deformity and degeneration.Conclusion: TFHN in children and adolescent is a rapidly progressing disease with a poor prognosis characterized by a high risk of femoral head collapse progression. If the lateral subluxation emerged, collapsed cases showed increasingly tendency towards severe hip deformity and degeneration.

Rare manifestations of Potter Sequence: A Case Report

Potter sequence is a rare congenital malformation that primarily affects male fetuses and is characterized by pulmonary hypoplasia, skeletal malformation, and kidney abnormalities. The pressure of the uterine wall due to oligohydramnios leads to an unusual facial appearance, abnormal limbsor limbs in abnormal positions or contractures. The fetus generally dies soon after birth due to respiratory insufficiency. We presented a male baby of 35 wks gestation with birth weight 1200gms delivered by primi mother. She had severe oligohydramnios and virtually there was no liquor during birth. The baby had severe perinatal depression at birth requiring resuscitation. Multiple congenital anomalies like absence of left eye, congenital cataract on the right eye, right-sided choanal atresia, micrognathia, low set ears, beaked nose, bilateral clubbed foot with hip deformity were noted. After 2 hours of life,baby developed fast breathing and cyanosis and died due to respiratory failure.

The natural history of traumatic femur head necrosis after femoral neck fracture in children and adolescent: a retrospective case series of 64 patients

Background: The natural history of traumatic femur head necrosis (TFHN) after femoral neck fracture (FNF) in children and adolescent is relatively unknown and has never been specifically characterized. As we speculated, the natural history in such population would be poor and characterized as the high risk of femoral head collapse, hip deformity and degeneration in a short term. Methods: This retrospective case series enrolled 64 children and adolescent with TFHN who treated with observational treatment from 2000.1 to 2018.1. The primary outcomes, such as the progression of femoral head collapse, hip deformity (Stulberg classification) and hip degeneration (Tönnis grade), and their prognostic factors were analysed. Results: 42 males and 22 females with a mean age of 13 years (6-16 years), were included. A total of 28 hips (44%) showed unsatisfactory outcome and Twenty-five (39%) hips collapsed progressively during a mean follow-up of 48 months (24-203 months). Finally, 38 hips (59%) experienced hip deformity, 20 of them were class IV/V. 34 hips (53%) generally progressed to osteoarthritis, 14 of them were classified as grades II/III. The location of the lesion and the presence of lateral subluxation were found to be independently related to progression of femoral head collapse; however, the presence of lateral subluxation was the only independent risk factor of severe hip deformity and degeneration. Conclusion: TFHN in children and adolescent is a rapidly progressing disease with a poor natural history characterized by a high risk of femoral head collapse progression. If the lateral subluxation emerged, collapsed cases showed increasingly tendency towards severe hip deformity and degeneration.