Effects of arthroscopic-assisted surgery on irreducible developmental dislocation of hip by mid-term follow-up: An observational study

Abstract

The purpose of this study was to investigate the indications, surgical technique, and the clinical effects of arthroscopic-assisted treatment of irreducible developmental dislocation of the hip by mid-term follow-up. Arthroscopic-assisted surgeries were performed on 40 children (52 hips) between January 2005 and December 2009. Anterior and antero-superior greater trochanter portals were used in these treatments. Spica cast and abduction splint were applied for 3 months postoperatively. The follow-up was conducted on every 3 months postoperatively. During 12-month follow-up, a secondary treatment such as acetabuloplasty and/or femoral osteotomy (shortening, varus, and derotation) was applied if the acetabular angle was greater than 25°. The pelvic acetabular angle, Mckay and Severin score were evaluated every 6 months in all children. With 36 to 96 months (average 71 months) follow-up, 35 children (44 hips) were successfully followed up with complete case data while 5 children unsuccessfully. According to Tönnis classification, there were 5 grade 1 hips, 14 grade 2 hips, 14 grade 3 hips, 11 grade 4 hips, in which 3 children (4 hips) were failed in arthroscopic reduction and femoral head avascular necrosis occurred in 2 children (4 hips). According to Mckay standard, the good rate is 100%. According to Severin standard, the good rate is 84.1%. Arthroscopic assisted treatment is an effective way of reduction of the irreducible hip. Compared with the open reduction, arthroscopic treatment combined with acetabuloplasty and/or femoral osteotomy has advantages of less trauma and better function preservation.

Figure 1

A, The puncture point of anterior portal was at the intersection of the anterior superior iliac spine perpendicular and the pubic symphysis horizontal line. B, A cannula was inserted with the sagittal plane of 45° upward and coronal plane of 45° inward.

Figure 2

A, Ligamentum teres connected with femoral head were confirmed. B, Ligamentum teres were excised by arthroscopy planning tool. C, All pulvinars in acetabulum were removed. D, The transverse acetabular ligament was cut off. E, The labrum was incised by hooked blade radially. F, Reduction of the femoral head.

Figure 3

A, 11 months, L: Tönnis II, AC angle: 42°/25°. B, Plaster cast after excision and reduction. C, Plaster cast: 30° in abduction position. D, Abduction brace afterwards. E, Continuous Shenton line with AC angle: 25°/20° after 1 year. F, AC angle: 20°/18° in 42 months. G–I, Excellent (Mckay standard).

Figure 4

A, 22 months; Tönnis III bilaterally; AC angle: 45°/40°. B, Plaster cast after reduction. C, Good reduction (1 year); AC angle: 28°/27°. D, Pemberton acetabuloplasty. E, Abduction brace (the 6th week). F, Good relationship of femoral head, and acetabulum. G, AC angle: 18°/15° (the 42th month). H–K, Excellent (Mckay standard).

Figure 5

A, 28 months, Tönnis IV bilaterally; AC angle: 45°/46°. B, Plaster cast after reduction. C, Poor reduction (1 year): AC angle: 34°/38°. D, Pemberton acetabuloplasty (1 year). AVN grade I. bilaterally (the 66th month). E–G, Good (Mckay standard).