Surgical treatment of children with hip dysplasia complicated with avascular necrosis of the femoral head

Abstract

Introduction. Avascular necrosis of the femoral head complicates the surgical treatment of hip dysplasia and aggravates the prognosis. Aim. We studied the immediate and medium-term results of reconstructive treatment in 18 children with hip dysplasia complicated by avascular femoral head necrosis, which developed after closed repositioning of a congenitally dislocated femur. Material and methods. Average age at the time of operation was 4.2 0.2 years. The patients were divided into two groups. Group 1 included 12 children with hip subluxation who underwent extra-articular reconstructions on articular components, spinal tunneling of the neck and head, and hardware unloading of the joint and group 2 included six patients with hip dislocation in whom an additional open reduction was performed. Functional results were estimated using DAubigne-Postel classification, whereas X-ray results were evaluated using Kruczynski classification. Results. Duration of observation was 37 years (average, 4.2 0.3 years). Functional results were good (1518 points) in nine joints in group 1, satisfactory (1214 points) in three joints in group 1 and five in group 2, and unsatisfactory (11 points) in one joint in group 2. X-ray results were good in six joints in group 1, satisfactory in six joints in group 1 and five in group 2, and unsatisfactory in one joint in group 2. Conclusions. Extra-articular reconstructive and stimulatory interventions combined with hardware decompression helps improve the shape and structure of the femoral head, and formation of congruent articular surfaces in children with subluxation of the thigh complicated by avascular necrosis.