Surgical Treatment of Posterosuperior Hip Dislocation in A Patient with Hereditary Sensory Autonomic Neuropathy Type IV: A Case Report

A 4-year old female patient with a diagnosis of hereditary sensory autonomic neuropathy type IV (congenital insensitivity to pain with anhidrosis) since the age of 1 year, sustained a posterior hip dislocation. During her initial stay at the hospital, an attempt at manual reduction failed. Open reduction, capsulorrhaphy, and Salter operation were done at 36 days after the index dislocation. After the operation there was a 23-degree acetabular index, and there were several abnormal round whitish gray fibrous nodules. There was also severe wound discharge, skin abrasion, and erythema on the patient's back and buttocks due to loss of protective sensation. After conservatively treating the wound and skin problems with prone positioning, we achieved a final acetabular index of 26 degrees. The patient did not have protective sensation in her hip joint. We were able to check for increasing instability after the index operation.

A New Innominate Osteotomy in Legg-Calve-Perthes' Disease / 대한정형외과학회잡지

Purpose: To evaluate the clinical and radiological results of a new innominate osteotomy in Legg-Calve-Perthes' disease (LCPD). Materials and Methods: This study examined 25 hips that were treated with a new innominate osteotomy for LCPD. The treatment involved the anterior half of the ilium being osteomized in a direction of 45degrees to the coronal plane and 30degrees to 45degrees to the sagittal plane, and the posterior half of the ilium being cut using a Gigli saw according to the conventional method. The mean follow-up duration was 5.5 years. Stable interposition of the bone block was achieved using a single biodegradable screw in 8 hips, and without any fixation device in 17 hips. Results: The clinical results according to the criteria of Robinson were good in 20 hips. Twelve hips was graded as good by the Mose method, according to the criteria of Stulberg, 8 hips were included in class I, 6 hips in class II, 8 hips in class III, and 3 hips in class IV. The mean center-edge angle improved from 19.4degrees to 30.2degrees. Conclusion: The new innominate osteotomy is simpler and easier to perform than a routine Salter osteotomy, and satisfactory clinical results can be obtained without fixing the Kirschner wire.

Femoral Varus Osteotomy Versus Salter Innominate Osteotomy in the Treatment of Legg - Calve - Perthes Disease / 대한정형외과학회잡지

We compared the clinical and radiographic outcomes between femoral varus osteotomy (23 hips) and Salter innominate osteotomy (18 hips) for treatment of Catteral is groups III and IV Perthes disease after 3-12 years follow-up. There were no statistically significant differences in the clinical outcomes using the lowa hip rating score and leg length discrepancy and in the final radiographic outcomes using the femoral head sphericity and Stulberg type between the two groups. However, neckshaft angle and center-edge angle were closer to normal value in the Salter innominate osteotomy group compared with the femoral varus osteotomy group. When the patients underwent femoral varus osteotomy at the older age (7 years), articulotrochanteric distance ratio and neck-shaft angle were significantly less than those of other patients. Salter innominate osteotomy may be better indi- cated as compared to femoral varus osteotomy, when physeal damage of proximal femur is obvious or highly suspicious particularly in the older children (7 years) with severe Perthes disease.

Innominate osteotomy for the treatment of Legg-Calve-Perthes disease

A retrospective study was performed in 37 patients who underwent innominate osteotomy for the treatment of Legg-Calve-Perthes disease. The majority of the patients (81%) were more than 6 years old, and the mean age was 7 years and 6 months. Thirty five hips were Catterall group III or IV, and 2 hips that had clinical and radiological "head at risk" signs were group II. The time interval between surgery and the final follow-up ranged from 2 to 6 years with a mean of 3 years and 10 months. Twenty five of 37 patients had good clinical results, and radiographs showed that the sphericity of the femoral head in the older age (> 8 years) group was poorer, which demonstrated a similar pattern to the clinical results in this age group. We conclude that innominate osteotomy is a safe and effective procedure in severe Legg-Calve-Perthes disease and this operation should be carefully selected as a treatment method in the appropriate age group.

The Innominate Osteotomy in Congenital Dislocation of the Hip / 대한정형외과학회잡지

Beyond the usual age of walking, the dysplasia of dislocated hip has become severe and its reversivility limited so that the reduced hip cannot maintained in stable position. The innominate osteotomy redirect cartilage of the hip and provide stability in the functional position of walking. The author have experienced 45 cases out of 42 patients with congenital dislocation of the hip who were treated by innominate osteotomy at Department of Orthopedic Surgery College of Medicine Yonsei University from Jan. 1979 to Dec. 1986. The analysis of result of operation has been Jan. 1979 at least 18 months follw-up study. 1. The mean age was 4.2 years ranging fron 18 months to 14 years.2. The mean value of parameters in preoperative evaluation, acetabular index was 37°, neck shaft angle 146°, CE angle −64° and leg length discrepency 1.5cm. After operation, actabular index was 20°, neck shaft angle 137° and CE angle 39° in average. And operated limb was longer as 0.5cm in average. 3. By anatomical assessment of NcKay, 17 cases were graded excellent, 19 cases good, 7 cases fair and 2 cases poor. Especially among the patients above 6 years old, only 6 cases were graded excellent or good. 4. As to the post-operative complication, limitation of motion was noted in 4 cases, redislocation in 2 cases, subluxation in 1 cases, avascular necrosis of femoral head in 1 case and infection in 1 case.

Comparative Study on the Results of Femoral Osteotomy and Innominate Osteotomy in LCPD / 대한정형외과학회잡지

Methods of treatment of Legg-Calve-Perthes' disease, (L.C.P.D.) are at present generally defined, and the individual approach is now more precise than before. But it is still controversial, particularly in older age groups. We analized the result of intertrochanteric varus osteotomy in 44 hips and innominate osteotomy in 23 hips of L.C.P.D., and compared the former with the later. To find out the influence of the both osteotomies on the femoral head (coxa magna), the relations between the stage and degree of involvement at operation and reult, and the postoperative progression of disease, the cases were analyzed and classified by Elizabethtown's stage and Catterall group. And also the duration of fragmentation stage after osteotomy was observed. Results were as follows: l. At the time of operation 45 hips were in avascular stage, 18 hips in fragmentation stage, and 4 hips in healing stage. 20 hips(29.8%) were classified as group II, 29(43. 3%) group III, and 18(23.1%) group IV. 2. After the osteotmy in case of avasculsr necrosis stage, average duration of fragmentation stage was 6.3 months after femoral osteotomy and 1 year 6 months after innominate osteotomy. 12 among 20 hips were skipped the fragmentation stage, and got into healing stage in case of femoral osteotomy. 3. After the osteotomy at the fragmentation stage, average duration of the fragmentation stage was 9.8 months after femoral osteotomy and 1 year 3 months in case of innominate osteotomy. 4. Regardless of the type of osteotomy, coxa magna was observed more frequently in the case who had surgery at the late stage and severely involoved head at the time of osteotomy. 5. In the case of femoral osteotomy, average preoperative neck shaft angle was 138.5°, and postoperative one was 113.5°. During the follow-up study, 12.0° of revalgarisation took place. 6. The result obtained by femoral osteotomy gave better results than those by innominate osteotomy. Regardless of the type of osteotomy, good results were obtained in case who had surgery at the early stage such as avascular stage, and had mild involvement as such group II.

Our Experience with Steel's Triple Innominate Osteotomy On Paralytic Hips and Septic Hip Residua / 대한정형외과학회잡지

In 1973, Steel described triple innominate osteotomy in which the ischium, the superior pubic ramus and ilium superior to the acetabulum are divided and the acetabulum is repositioned anterolaterally and is stabilized by a bone graft and metal pins. Its goal is to establish a stable hip for dislocation or subluxation of the hips in older children and adults on whom it is impossible to correct effectively the instability by any one of the more conventional osteotomies, i.e. Salter's, Pemberton's or Chiari's, or by the capsular arthroplasty of Colonna. During the eleven years and eight months, from December 1973 to August 1985, at the Department of Orthopedic Surgery, Seoul National University Hospital, we performed Steel's triple innominate osteotomy on 41 cases, of which 37 were residual poliomyelitis and 4 septic hip residua. 4 cases of residual poliomyelitis were lost during follow up. The remaining 37 cases were reviewed for the efficacy and limitations of triple innominate osteotomy. We observed following conclusions: 1. Aside from congenital dislocation and dysplasia of the hip, paralytic conditions, such as residual poliomyelitis, are good indications of Steel's triple innominate osteotomy in older children, adolescents and young adults. Acetabular acclivity is adequately reduced and stability is improved. 2. Septic hip residua, including healed tuberculosis, is another indication of triple innominate osteotomy, particularly when total hip arthroplasty is contemplated. 3. When abductors are partially paralyzed, triple innominate osteotomy alone results in appreciable increase in abductor power, by providing a better muscle tension. 4. Substantial gain in leg length is an added advantage of triple innominate osteotomy. An average of 1.74 cm was gained at osteotomy site in our series. In adults, when limb shortening is relatively m i nor, triple innominate osteotomy alone can be a more convenient alternative to conventional, more formidable method of leg length equalization, such as femoral lengthening. This is particularly true when there is some instability or when abductors are weak. 5. Following improvement in mechanical stability by triple innominate osteotomy, weak abductors and extensors may be augmented by appropriate muscle transfer, resulting in more stable hip functionally. 6. In a hypermobile paralytic hip, iliopsoas tenotomy is neither necessary nor desirable at the time of osteotomy. When the hip is dislocated, or when the hip has marked flexion deformity, iliopsoas tenotomy fascillitates adequate correction, but this greatly increases the risk of neurological complication.

Congenital Dislocation of the Hip / 대한정형외과학회잡지

It is well known that early diagnosis and early treatment is very important for the patient with congenital dislocation of the hip joint to have favorable function in the whole life. The goal of treatment is to replace the hip restored in containment with anatomical position. There have been various treatments in both conservative and surgical methods. In the past, conservative treatment has been prevalled, and since Salter has advocated innominate osteotomy, this surgical method could be successively replaced the treatment of congenital dislocation of the hip in the older age group. We have experienced 40 congenital dislocation of the hips out of 35 patients at the Department of Orthopaedic Surgery in National Medical Center. Clinical analysis has been performed, with average 3 years and 9 months follow-up study and the resuits are as follows. 1. Majority of the case was treated primarily at age between 12-24 months. 2. The preponderence of girl to boys was 33:2. 3. The affection ratio of left to right side was nearly equal as 16:14. Five out of 35 cases were involved at both sides. 4. The chief complaints were almost limping and limb shortening. 5. In 40 hips from 35 patients, 12 hips were treated by closed reduction, 3 hips by open reduction and 18 hips by Salters innominate osteotomy in the age group under 7 years old. By Seddon's classification, we obtained 11 excellent and good results out of 12 cases treated by closed reduction, 2 out of 3 hips by open reduction and 15 out of 18 hips by Saiters innominate osteotomy. 6. We performed femoral derotation osteotomy in 2 cases, 9 and 11-year-old patients. Steels operation with femoral shortening in 9-year-old girl and bilateral THR on 2 hips in 44-year-old patient. Result of derotation osteotomy belonged to clinical failure and THR belonged to excellent group by Seddons classification. 7. We experienced one case of avascular necrosis transiently, but finally healed delaying weight bearing.