RESUMO
Arthrogryposis multiplex congenital [AMC] is a rare disease with multiple joint contractures. In unilateral hip dislocation surgical treatment to reduce the hip is recommended to prevent pelvic obliquity and scoliosis. It is commonly believed that bilaterally dislocated hips should not be reduced because movement is satisfactory and open reduction leads to poor results. The purpose of this study is to report our clinical and radiological outcome of the surgical treatment of unilateral and bilateral hip dislocation in 5 patients [8 hips] having AMC. During the period 2006 to 2010, we operated on 8 hips of 5 children with AMC [3 patients had bilateral hip dislocation and 2 patients had unilateral hip dislocation]. Open reduction with capsular plication without any bony procedure was performed on 2 hips. Open reduction combined with Salter osteotomy of innominate bone was performed on 2 hips. Open reduction combined with Salter osteotomy of innominate bone and femoral shortening with varus derotational osteotomy was performed on 5 hips. In addition to that, open adductor tenotomy was done in all cases through a separate medial incision. The mean age at surgery was 16.6 months [range: 9-22 months] and the average follow up period was 2.3 years [range: 1-3 years]. At the final follow up, two children were able to walk independently. One child had a unilateral dislocation and required a long leg brace and support for walking. One child had a unilateral dislocation and required a short leg brace for walking. One child was unable to walk because of severe contractures in all four limbs, and one child required revision surgery for a re-dislocation of the hip joint. The clinical results were good in 5 hips, fair in 1 hip, and poor in 2 hips. According to the Severin classification, all 8 hips were rated as good [5 hips in class I and 3 hips in class II]. There was a low incidence of avascular necrosis where only one hip was in grade 1 according to Kalamchi classification, while 7 hips did not show any evidence of avascular necrosis. We believe that open reduction combined with bony procedures should be performed for unilateral and bilateral dislocation of the hip in children with AMC, and it should be done at an earlier age to achieve the best functional outcome