Passive manipulation under general anesthesia for treating postoperative hip stiffness in 193 children

Ying LIU; Enbo WANG; Liwei SHI; Qun ZHAO

ABSTRACT

OBJECTIVE:

To present our experience of manipulation under general anesthesia for treating postoperative hip joint stiffness in children.

METHODS:

193 children (226 hips) with postoperative joint stiffness were retrospectively studied at the Department of Pediatric Orthopaedics, Shengjing Hospital, China Medical University from January 1978 to December 2005, comprising 53 males and 140 females, aged 1-14 years old. 226 hips with postoperative stiffness from open reduction of developmental dysplasia of the hip (DDH) (155 cases with 188 hips) and capsulotomy for hip sepsis or tuberculosis (38 cases with 38 hips) were retrospectively reviewed. All patients laid on the surgical table supinately under general anesthesia. The assistant fixed the pelvic with palms. The operator manipulated the hip joint with 3

steps:

flexed hip joint slowly and gently to 110°-120° or more; then abducted and externally rotated hip joint; adducted and internally rotated the hip. Then 3-step passive manipulation was repeated for once at least. As soon as the patient waked from general anesthesia, Continuous passive motion was applied for the affected hip with the range of motion increasing daily for 1-2 weeks. They were followed averagely 15 months (6-24 months) to evaluate the promoted range of motion in flextion-extension and adduction-abdduction.

RESULTS:

186 hips (82.3%) succeeded in manipulation in addition to 34 failure hips (15%) and 6 hips (2.7%) with femoral neck fracture. The successful rate, promoted range of motion in group of ≤6-year-old and group of ≤12-month-duration from primary surgery were significantly higher, femoral neck fracture rate was less than those in group of >6 years of age and group of >12-month-duration from primary surgery.

CONCLUSION:

Passive manipulation under general anesthesia is a safe, uninvasive and effective method in treating postoperative hip stiffness in children. Younger age (≤6 years) and less duration from the primary surgery (≤12 months) would yield better result.