Treatment of high congenital dislocated hips by gradual distraction with an Ilizarov fixator, followed by cementless total hip arthroplasty

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Abstract

Background

The treatment of complete congenital dislocation of the hip with total hip arthroplasty (THA) in adults is a challenging surgical procedure. The successful placement of the acetabular component demands an anatomic reduction without causing excessive compressive loads across the hip joint. To accomplish this, several maneuvers have been introduced. Bone grafting, cotyloplasty, or a high hip center have been proposed. In this study, the authors report a combination of slow continuous iliofemoral distraction in patients requiring a distraction distance over 40 mm, followed by a oft-tissue release and cementless THA.

Patients and methods

Between 2004 and 2010, 12 adult patients (eight women, four men), 12 hips, with high congenital dislocation hip (Crowe type IV) were studied. All patients had constant pain despite nonoperative treatment, consisting of activity modification, physical therapy, and the use of nonsteroidal anti-inflammatory drugs. All patients had a limping gait because of limb-length discrepancy before the surgery that averaged 5.5 cm (range 4.5–7.0 cm). We used an Ilizarov fixator with iliofemoral distraction to treat high congenital dislocation of the hips before performing cementless THA. The patients ranged in age from 19 to 48 years (average 32.4 years). At an average follow-up period of 3.3 years (average 2–5.5 years), clinical and radiological data were collected. No patient was lost to follow-up. An average distraction distance of 5.5 cm (range 4.5–7.0 cm) was performed over 31.5 days (range 26–40 days). Clinical data were collected including the Harris hip score. All patients underwent THA on the day the external fixator was removed.

Results

All the patients had undergone an average effective iliofemoral distraction of 1.7 mm/day (1.5–1.8 mm/day), monitored clinically, although the distraction of the external fixator was much higher. The distraction period ranged from 26 to 40 days. The limb-length inequality at the time of the latest follow-up ranged from 0 to 2.0 cm (average 0.5 cm). There was no overlengthening on the side of the index surgery. All patients underwent THA on the day the external fixator was removed. The mean Harris hip score improved from an average 42.5 points preoperatively (range 28–60 points) to an average 89 points (range 76–98 points) at the time of the latest follow-up.

Conclusion

This study shows that a closed technique utilizing an Ilizarov fixator for iliofemoral distraction, followed by cementless THA might be a good alternative compared with shortening osteotomies in one-stage THA for patients with a high congenital hip dislocation over 40 mm.

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