Reconstruction of Paralytic Hips in Children: Report of 61 Hips on 45 Cases
10.4055/jkoa.1971.6.1.11
- Author:
Keun Woo KIM
;
Jin Ho KIM
;
Duk Yong LEE
- Publication Type:Original Article
- MeSH:
Arthroplasty;
Braces;
Child;
Congenital Abnormalities;
Dislocations;
Follow-Up Studies;
Hip;
Humans;
Meningomyelocele;
Osteotomy;
Poliomyelitis;
Rehabilitation;
Seoul;
Tendon Transfer;
Tendons
- From:The Journal of the Korean Orthopaedic Association
1971;6(1):11-26
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
A Paralytic hip with subluxation or dislocation may be treated by any of the ischial seat brace, hip fusion, muscle or tendon transfer, and more recently Pembertons or Salters osteotomy. 61 hips on 45 cases have been reconstructed, by one or combination of various procedures at Seoul National University Hospital during the 7 year period from October 1963 to October 1970. Follow-up results of these hips were evaluated by the reporters' according to the criteria of both functional and mechanical stability. Of the 43 cases with known results 9 rated Undetermined, 2 Fair, 5 Good, and 27 Excellent. Analysis of the 27 Excellent cases suggests that the most satisfactoy results can be obtained when the hips are attacked by concomitant functional(muscle or tendon transfer) and mechanical (Pembertons or Salters osteomy) stabilizations. In our experience, a combination of muscle or tendon transfer and an arthroplasty of Pemberton or Salter type can be carried out at the same setting, and at the same time results in better and more permanent rehabilitation of the hip than either muscle or tendon transfer or arthroplaty alone and often eliminates braces and the need for hip fusion, and thus a flail hip can be functionally salvaged. Our approach has become more aggressive in recent years, and we sometimes do not hesitate radical operations in children below 5 years of age or in convalescent stage of poliomyelitis in order to prevent further progression of hip deformities. More recently, Sharrards posterior transplantation of the iliopsoas tendon, originally described for reconstruction of paralytic hips in meningomyelocele, was carried out in 4 cases of residual poliomyelitis and we are satisfied with the initial results.
