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Development of modified Ilizarov hip reconstruction surgery for hip dysfunction treatment in adolescent and young adults

BACKGROUND/OBJECTIVE: Hip dysfunction in young population caused by developmental dysplasia of the hip, congenital hip deformity or femur head necrosis severely affect the quality of life of young patients, and total hip replacement is the current widely accepted standard therapy for hip function re...

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Autores principales: Luo, Suhong, Kong, Lingchi, Wang, Jihui, Nie, Hongying, Luan, Bo, Li, Gang
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Chinese Speaking Orthopaedic Society 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7779533/
https://www.ncbi.nlm.nih.gov/pubmed/33437641
http://dx.doi.org/10.1016/j.jot.2020.11.002
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author Luo, Suhong
Kong, Lingchi
Wang, Jihui
Nie, Hongying
Luan, Bo
Li, Gang
author_facet Luo, Suhong
Kong, Lingchi
Wang, Jihui
Nie, Hongying
Luan, Bo
Li, Gang
author_sort Luo, Suhong
collection PubMed
description BACKGROUND/OBJECTIVE: Hip dysfunction in young population caused by developmental dysplasia of the hip, congenital hip deformity or femur head necrosis severely affect the quality of life of young patients, and total hip replacement is the current widely accepted standard therapy for hip function reconstruction in adults, but not for young patients. Alternative safe and effective surgical method for hip function preservation/reconstruction for young patients is lacking. Ilizarov hip reconstruction osteotomy was an alternative method for preserving hip function but the surgical procedures were rather complicated using discomforting ring fixation at the hip region that prevents its wider acceptance and application. Here we reported a modified Ilizarov hip reconstruction surgery for hip dysfunction/deformity correction in adolescent and young adults using femoral shaft osteotomy and simplified unilateral external fixation configuration at the hip region with satisfactory clinical outcomes. METHODS: This is a retrospective study with five male and twelve female patients aged from 10 to 34 years old (mean 20.6 years) including 11 developmental dislocations of the hip and 6 femoral head necrosis. Modified Ilizarov hip reconstruction y surgery was performed using single-arm triangular configuration, threaded half pins on the femur and multiple drill hole guide for osteotomy. The mechanical axis and limb length were corrected spontaneously during the subsequent limb lengthening process in all patients. Preoperative and postoperative gross appearance, radiography of the hip and hip function assessment scores were recorded and compared during the follow-up period. RESULTS: The mean follow-up period was 64.3 months (12–87 months). Satisfactory hip appearance, hip and knee functions were achieved in all patients, none resulted in hip replacement surgery at the follow-up period. The mean preoperative and postoperative Harris hip scores were 45.92 ​± ​19.41 and 87.16 ​± ​5.31, respectively (p ​< ​0.01). Pin-track infections occurred in four patients, treated successfully with wound dressing care and oral antibiotics. Restricted range of motion of the knee was observed in eight patients, all gradually overcome by active functional exercises. Osteotomy site fracture of the middle femurs after removing external devices occurred in two patients due to unexpected fall, and complete healing was achieved after plaster fixation. Complications such as fixation device failure, knee dislocation, vessel or nerve impairments did not occur. CONCLUSIONS: Modified Ilizarov hip reconstruction surgery significantly reduced the surgery time and discomforts to patients, avoided the disturbance of blood supply at the osteotomy sites. This modified method is a useful alternative for correction of hip deformities and reconstruction hip function in adolescent and young adults who are not suitable for conventional pelvis support surgery or hip replacement surgery. TRANSLATIONAL POTENTIAL STATEMENT: The modified Ilizarov hip reconstruction surgery provides an alternative for hip replacement surgery with satisfactory clinical outcomes. This procedure is minimally invasive, safe and simple, with few complications compared to conventional pelvis support surgery, and it may be the first choice of surgery for the management of hip dysfunction in adolescent and young adults.
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spelling pubmed-77795332021-01-11 Development of modified Ilizarov hip reconstruction surgery for hip dysfunction treatment in adolescent and young adults Luo, Suhong Kong, Lingchi Wang, Jihui Nie, Hongying Luan, Bo Li, Gang J Orthop Translat Original Article BACKGROUND/OBJECTIVE: Hip dysfunction in young population caused by developmental dysplasia of the hip, congenital hip deformity or femur head necrosis severely affect the quality of life of young patients, and total hip replacement is the current widely accepted standard therapy for hip function reconstruction in adults, but not for young patients. Alternative safe and effective surgical method for hip function preservation/reconstruction for young patients is lacking. Ilizarov hip reconstruction osteotomy was an alternative method for preserving hip function but the surgical procedures were rather complicated using discomforting ring fixation at the hip region that prevents its wider acceptance and application. Here we reported a modified Ilizarov hip reconstruction surgery for hip dysfunction/deformity correction in adolescent and young adults using femoral shaft osteotomy and simplified unilateral external fixation configuration at the hip region with satisfactory clinical outcomes. METHODS: This is a retrospective study with five male and twelve female patients aged from 10 to 34 years old (mean 20.6 years) including 11 developmental dislocations of the hip and 6 femoral head necrosis. Modified Ilizarov hip reconstruction y surgery was performed using single-arm triangular configuration, threaded half pins on the femur and multiple drill hole guide for osteotomy. The mechanical axis and limb length were corrected spontaneously during the subsequent limb lengthening process in all patients. Preoperative and postoperative gross appearance, radiography of the hip and hip function assessment scores were recorded and compared during the follow-up period. RESULTS: The mean follow-up period was 64.3 months (12–87 months). Satisfactory hip appearance, hip and knee functions were achieved in all patients, none resulted in hip replacement surgery at the follow-up period. The mean preoperative and postoperative Harris hip scores were 45.92 ​± ​19.41 and 87.16 ​± ​5.31, respectively (p ​< ​0.01). Pin-track infections occurred in four patients, treated successfully with wound dressing care and oral antibiotics. Restricted range of motion of the knee was observed in eight patients, all gradually overcome by active functional exercises. Osteotomy site fracture of the middle femurs after removing external devices occurred in two patients due to unexpected fall, and complete healing was achieved after plaster fixation. Complications such as fixation device failure, knee dislocation, vessel or nerve impairments did not occur. CONCLUSIONS: Modified Ilizarov hip reconstruction surgery significantly reduced the surgery time and discomforts to patients, avoided the disturbance of blood supply at the osteotomy sites. This modified method is a useful alternative for correction of hip deformities and reconstruction hip function in adolescent and young adults who are not suitable for conventional pelvis support surgery or hip replacement surgery. TRANSLATIONAL POTENTIAL STATEMENT: The modified Ilizarov hip reconstruction surgery provides an alternative for hip replacement surgery with satisfactory clinical outcomes. This procedure is minimally invasive, safe and simple, with few complications compared to conventional pelvis support surgery, and it may be the first choice of surgery for the management of hip dysfunction in adolescent and young adults. Chinese Speaking Orthopaedic Society 2020-12-29 /pmc/articles/PMC7779533/ /pubmed/33437641 http://dx.doi.org/10.1016/j.jot.2020.11.002 Text en © 2020 The Authors http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Article
Luo, Suhong
Kong, Lingchi
Wang, Jihui
Nie, Hongying
Luan, Bo
Li, Gang
Development of modified Ilizarov hip reconstruction surgery for hip dysfunction treatment in adolescent and young adults
title Development of modified Ilizarov hip reconstruction surgery for hip dysfunction treatment in adolescent and young adults
title_full Development of modified Ilizarov hip reconstruction surgery for hip dysfunction treatment in adolescent and young adults
title_fullStr Development of modified Ilizarov hip reconstruction surgery for hip dysfunction treatment in adolescent and young adults
title_full_unstemmed Development of modified Ilizarov hip reconstruction surgery for hip dysfunction treatment in adolescent and young adults
title_short Development of modified Ilizarov hip reconstruction surgery for hip dysfunction treatment in adolescent and young adults
title_sort development of modified ilizarov hip reconstruction surgery for hip dysfunction treatment in adolescent and young adults
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7779533/
https://www.ncbi.nlm.nih.gov/pubmed/33437641
http://dx.doi.org/10.1016/j.jot.2020.11.002
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