Rehabilitation of adolescents after surgical treatment of dysplastic coxarthrosis

Abstract

Background. The prevalence and severity of stage II and III dysplastic coxarthrosis determine the medical and social importance of its prevention and treatment. For a practicing orthopedic surgeon, there are two established stages of orthopedic treatment: the surgical stage and the restorative stage. The domestic and foreign literature from the previous 25 years comprises few publications regarding the rehabilitation of young children after reconstructive hip joint surgeries. Thus, the issues regarding the rehabilitation of teenagers following extra-articular operations on the hip joint remain unexplored. Aim. To evaluate the effectiveness of the developed program of rehabilitation for children after the surgical treatment of dysplastic coxarthrosis stages I and II. Material and methods. We analyzed the results of the surgical and rehabilitative treatment of 40 children (100%) with dysplastic coxarthrosis stage I and II; the study population included 27 girls (67.5%) and 13 boys (32.5 per cent) aged 13–18 years (total 54 joints). The rehabilitation period was divided into the following 4 stages: I preoperative, II postoperative day 1–2, III postoperative day 3–21, IV outpatient treatment (after hospital discharge to 1 year postoperatively). Results. By the time of discharge, the range of motion in the hip joint was as follows: bending 950° ± 40°, withdrawal 150° ± 50°, and extension 100° ± 30°. According to the results of the electromyography performed 3 months postoperatively, there was an increase in the amplitude of biopotentials for the gluteal muscle. The long-term result was evaluated after 1 year. The average modified Harris Hip Score and a scale developed in the The Turner Scientific and Research Institute for Children’s Orthopedics, significantly (p < 0.05) differed from preoperative ones. Conclusion. Early rehabilitation allows an increase in the strength and tone of muscles and restores the amplitude of movements in conditions of altered anatomical and biomechanical relationships in the hip. The verticalization of patients with the learning of proper load distribution on the parts of the foot enables effective recovery of the correct gait pattern. Comprehensive treatment of adolescents with dysplastic coxarthrosis according to the proposed method not only improves the condition of the affected hip joint and lower limb as a whole, but also improves the child’s quality of life.