Anterior hip dislocation in children with neurological disorders. A retrospective study of ten operated hips - 16/01/15

Doi : 10.1016/j.otsr.2014.11.004

L. Gatin ^a, N. Khouri ^a,^⁎,^b
^a Service de chirurgie orthopédique pédiatrique, hôpital d’Enfants Armand Trousseau, 26, avenue du Docteur-Netter, 75012 Paris, France
^b Service de chirurgie orthopédique pédiatrique, hôpital universitaire Necker Enfants Malades, rue de Sèvres, 75015 Paris, France

^⁎Corresponding author.

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Abstract

Introduction

Patients with neurological disorders often exhibit dislocation or subluxation of the hip. Anterior dislocation is rare, little known, and often associated with deformities. Its surgical treatment has rarely been studied.

Hypothesis

Hip surgery (with open reduction, femoral and pelvic osteotomy, and adapted tenotomies) could provide a centered hip that is supple and painless.

Materials and methods

Ten hips (seven dislocated, three subluxated) in six patients with a mean age of 8.3 years were operated between 1995 and 2009 and revised with a mean follow-up of 6.5 years. The deformities comprised four cases of abduction, extension, and external rotation and six cases of adduction, extension, and external rotation. Four patients had lost the ability to walk or maintain the sitting position. Intraoperative findings were an increased neck-shaft angle, anterosuperior acetabular dysplasia, and in only one case increased femoral anteversion. In all cases of dislocation, open reduction was necessary, and all hips underwent pelvic and femoral osteotomy.

Results

At the longest follow-up, hips were centered on X-rays. Five patients could walk or sit as they had done before and hips were supple, with no deformities.

Discussion

The study of deformities and intraoperative findings is mandatory for surgical management, whose mid-term results are encouraging. Femoral anteversion does not seem to be excessive, but the increase of femoral valgus is constant, as is anterosuperior acetabular dysplasia. We propose a decision tree for the management of these patients.