ABSTRACT
Purpose: Relative femoral neck lengthening (RNL) is a newer technique to correct coxa breva and coxa vara to relieve a femoro-acetabular impingement and improve hip abductor function without changing the position of the head on the shaft. Proximal femoral osteotomy (PFO) changes the position of the femoral head relative to the shaft. We studied the short-term complications of procedures that combined RNL with PFO. Methods: All hips that underwent RNL and PFO using a surgical dislocation and extended retinacular flap development were included. Hips that were treated only with intra-articular femoral osteotomies (IAFO) were excluded. Hips that underwent RNL and PFO, with IAFO and/or acetabular procedures were included. Intra-operative evaluation of the femoral head blood flow was performed with the drill hole technique. Clinical evaluation and hip radiographs were obtained at 1 week, 6 weeks, 3 months, 6 months, 12 months and 24 months. Results: Seventy two patients (31 males, 41 females, 6-52 years of age) underwent 79 combined RNL and PFO. 22 hips underwent additional procedures like head reduction osteotomy, femoral neck osteotomy, and acetabular osteotomies. There were 6 major and 5 minor complications noted. Two hips developed non-unions, both with basicervical varus-producing osteotomies. Four hips developed femoral head ischemia. Two of these hips avoided collapse with early intervention. One hip had persistent abductor weakness requiring hardware removal and three hips, all in boys developed symptomatic widening of the hip on the operated side from varus-producing osteotomy. One hip had asymptomatic trochanteric non-union. Conclusion: RNL is routinely performed by releasing the short external rotator muscle tendon insertion from the proximal femur to raise the posterior retinacular flap. Though this technique protects the blood supply from direct injury, it seems to stretch the vessels with major corrections in the proximal femur. We recommend evaluating the blood flow intraoperatively and postoperatively and taking necessary steps early to decrease the stretch on the flap. It may be safer to avoid raising the flap for major extra-articular proximal femur corrections. Significance: The results of this study suggest ways to improve the safety of procedures that combine RNL and PFO.
ABSTRACT
Septic arthritis of the pediatric hip is a surgical emergency that requires adequate lavage to decompress the hip, reduce degradative cartilage insult, and prevent coxarthrosis. In this report, we describe a simplified arthroscopic technique that may be performed using a single portal based on fluoroscopy and surface landmarks and without regular use of traction. We present results of a series of patients who underwent the simplified arthroscopic method for the management of pediatric septic hip. Data were obtained by a retrospective chart review of 13 consecutive patients (14 hips) with pediatric septic hip treated with arthroscopic lavage from 2010 to 2015. Age at the time of surgery ranged from 3 months to 8 years with three patients less than 1 year old. Ten hips (71%) returned for a routine follow-up with an average follow-up of 22 months. All 14 hips (100%) had complete resolution of symptoms. Two hips (14%) needed revision surgery due to inadequate response after the first lavage. One hip (7%) had transient femoral nerve palsy. Hip arthroscopy is an attractive and effective option for the management of pediatric septic hip. The limited equipment required and the ease of performing our simplified technique may broaden the application to the general orthopedist for the treatment of pediatric septic hip.
Subject(s)
Arthritis, Infectious/diagnostic imaging , Arthritis, Infectious/therapy , Arthroscopy/methods , Hip Joint/diagnostic imaging , Therapeutic Irrigation/methods , Adolescent , Child , Child, Preschool , Female , Hip Joint/surgery , Humans , MaleABSTRACT
BACKGROUND: Percutaneous in situ single screw fixation is the preferred treatment for stable and unstable slipped capital femoral epiphysis (SCFE). The recommended screw placement is in the center of the epiphysis and perpendicular to the physis, which necessitates an anterior starting point for most SCFEs. A recent clinical study has shown good clinical results with a laterally based screw for SCFE, which is oblique to the physis. We sought to biomechanically compare these 2 techniques for load to failure and hypothesized that the laterally based oblique screw is equivalent or superior to an anteriorly based perpendicular screw. METHODS: Twenty-two paired immature porcine femurs were used to compare the techniques. A SCFE model was created in all femurs using a previously published technique by performing a 30-degree posterior closing wedge osteotomy through the proximal physis. In the control group, a screw was placed perpendicular to the slip with an anterior starting point. In the experimental group, the screw was started as close to the mid-lateral cortex of the proximal femur as possible while maintaining the screw anterior to the posterior cortex of the femoral neck and ending at the apex of the epiphysis ignoring the resultant angle to the physis for the experimental group. The specimens were then potted and loaded in a physiologically relevant posteroinferior direction (30 degrees posterior from vertical) to determine load to failure (N) and stiffness (N/mm). RESULTS: No statistical difference was found between the 2 groups in maximum load to failure or stiffness (P>0.05). CONCLUSIONS: A laterally based screw oblique to the physis for in situ fixation in mild SCFE is not significantly different than an anteriorly based screw perpendicular to the physis in load to failure and stiffness in our study model. CLINICAL RELEVANCE: In light of no difference in load to failure of these 2 constructs, surgeons may be more comfortable with the traditional lateral entry point while still aiming for screw placement in the center of head.
