Congenital dislocation of the knee: prenatal diagnostics and treatment at an early age

Abstract

Background. Congenital dislocation of the knee (CDK) is a rare abnormality of the musculoskeletal system, with an incidence of 1 per 100,000 liveborn infants. Timely prenatal diagnostics and treatment during the initial days of life can help avoid the development of disabilities in a child. Aim of the study. We aimed to study the possible prenatal ultrasound diagnostics and to assess the efficacy of early orthopedic alignment using conservative methods of treatment. Materials and methods. From January 1988 to February 2016, 37 newborns (50 lower limbs) with CDK were treated. The initial assessment of the affected limbs was performed immediately after birth. To determine the severity of dislocation, the Seringe and Tarek classifications were used. Conservative treatment was performed for all the patients. The age of pediatric patients at the time of treatment onset ranged from 2 hours to 5 days. Various methods were used, such as stage plaster bandages (10 lower limbs) and correction using the von Rosen splint (8 lower limbs). Since 2003, a single treatment protocol, developed by the authors of this study, has been applied. Results. The prenatal ultrasound screening enabled the detection of CDK before birth in 21% of cases. Long-term results (catamnesis from 3 to 28 years) were evaluated by the Seringe scale and were excellent in 60%, good in 32%, and satisfactory in 8% of cases. Bad results were not registered. All the pediatric patients included in the study began to walk independently at the age of 9–18 months. Conclusion. Prenatal ultrasound diagnosis enables the detection of CDK. Treatment of newborns, started in the first hours of life, according to the protocol developed by the authors, enables the alignment of the dislocated lower leg in a short time, without using prolonged stage plaster bandages. Long-term results demonstrate the efficiency of the proposed methodology.