Hip Arthroscopy as Part of a Salvage Procedure for Avascular Necrosis (AVN) in a 7-Year-Old Child

Patient: Female, 7 Final Diagnosis: Femoroacetabular (CAM) impingement Symptoms: Hip pain • limitation of movement of the hip Medication: — Clinical Procedure: Femoral osteotomy and acetabuloplasty – hip arthroscopy Specialty: Orthopedics and Traumatology OBJECTIVE: Unusual setting of medical care BACKGROUND: Avascular necrosis of the femoral head (AVN) is one of the most serious complications following developmental dysplasia of the hip (DDH). Treatment options focus mainly on improving the biomechanics and kinematics of the affected hip joint. In the past, femoral and pelvic osteotomies were the mainstay of treatment. Over the last years, the use of hip arthroscopy has also grown and allows reconstructive treatments in pediatric hip disorders. CASE REPORT: We present a 7-year old patient with AVN of the proximal femoral head after open reduction of her dislocated hip (DDH). The patient presented to our department with limb length discrepancy, limited internal rotation of the right hip and groin pain. We performed a two-stage procedure including a) valgus proximal femur osteotomy combined with Dega acetabuloplasty and b) hip arthroscopy to address the formation of CAM impingement that was the result of excessive femoral head necrosis and our re-orientation procedure. CONCLUSIONS: AVN following closed or open reduction for DDH is a potentially devastating complication. Hip arthroscopy can be an extremely useful tool that can be used in addition to the well-known osteotomy procedures to improve joint congruency. Hip arthroscopy in the pediatric population is a new growing field that can be used in managing disorders of the pediatric hip, as the indications will continue to evolve.