Pelvic Support Hip Reconstruction with Internal Devices: An Alternative to Ilizarov Hip Reconstruction

Abstract

Aim and objective: Ilizarov hip reconstruction (IHR) is a traditional method of salvaging chronic adolescent problem hips but faces practical problems from external fixators leading to reduced compliance. We present the same reconstruction utilising only internal devices with a modification in technique and aim to review early results.

Materials and methods: We retrospectively evaluated eight patients between 2014 and 2017 with chronic painful hips treated by a two-stage reconstruction; stage 1 included femoral head resection and pelvic support osteotomy using double plating, while stage 2 comprised distal femoral osteotomy avoiding varus followed by insertion of retrograde magnetic nail for postoperative lengthening. Patients continued physiotherapy postoperatively while protecting from early weight-bearing.

Results: At mean follow-up of 19 months (range 6-36), all osteotomies healed with bone healing index of 47 days/cm (range 30-72). Pain improved from 8.3 (range 7-9) to 2 (range 0-6), while limb length discrepancy got corrected from 4.3 cm (range 3-5) to 1.4 cm (range 0-2.5) at final follow-up. Trendelenburg sign was eliminated in three and delayed in five. No examples of infection or permanent knee stiffness were noted. One patient had plates breakage due to mechanical fall and one had 35 mm of lateral mechanical axis deviation requiring corrective osteotomy.

Conclusion: Pelvic support hip reconstruction with exclusive internal devices is a technique in evolution with encouraging early results. It avoids common complications of external fixators and facilitates quick rehabilitation of joints. Refraining from distal varus can effectively eliminate Trendelenburg gait, albeit with some degree of lateral mechanical axis deviation. Unlike external fixation where there is a possibility of gradual correction, this staged procedure of internal fixation is technically demanding with a learning curve.

Clinical significance: Pelvic support hip reconstruction performed by internal implants is a viable alternative to IHR with potential benefits.

How to cite this article: Metikala S, Kurian BT, Madan SS, et al. Pelvic Support Hip Reconstruction with Internal Devices: An Alternative to Ilizarov Hip Reconstruction. Strategies Trauma Limb Reconstr 2020;15(2):91-97.

Keywords: Ilizarov hip reconstruction; Internal lengthening nail; Limb lengthening; Pelvic support osteotomy.

Fig. 1

Pelvic radiograph of an adolescent with secondary osteoarthritis due to avascular necrosis following slipped capital femoral epiphysis and surgical intervention

Fig. 2

Fluoroscopic perioperative images showing the valgus extension osteotomy stabilized with double plating internal fixation technique

Fig. 3

Standing mechanical axis view with distraction in progress with the intramedullary lengthening nail

Fig. 4

Final mechanical axis view standing with consolidated regenerated and realigned axis in slight valgus MAD