Reconstruction of Paralytic Hips in Children
10.4055/jkoa.1976.11.4.639
- Author:
Duk Yong LEE
;
In Kwon KIM
- Publication Type:Original Article
- MeSH:
Arthroplasty;
Braces;
Cerebral Palsy;
Child;
Congenital Abnormalities;
Crutches;
Dislocations;
Extremities;
Fascia;
Foot;
Hand;
Health Resorts;
Hip;
Humans;
Knee;
Meningomyelocele;
Mustard Plant;
Osteotomy;
Poliomyelitis;
Recurrence;
Seoul;
Steel;
Surgical Procedures, Operative;
Tendon Transfer;
Tendons;
Tenotomy
- From:The Journal of the Korean Orthopaedic Association
1976;11(4):639-655
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
The approach toward paralytic hips in children with subluxation or dislocation has been essentially conservative and palliative, frequently.accepting the subluxation or dislocation. Buster Brown belt, ischial seat brace, or crutches with non-weight bearing is frequently prescribed. For obvious reasons, both the patient and the surgeon are reluctant to resort to hip fusion, and muscle or tendon transfer about the hip cannot be expected to function in the presence of subluxation or dislocation. On the other hand, deformities about the hip are corrected successfully by standard procedures, such as adductor tenotomy, Soutters fasciotomy, and Campbells iliac crest transfer. In severe, fixed deformities in older children, the overall balance may be restored by varus or valgus osteotomy of Irwin, leaving the deformities uncorrected. Jones varus osteotomy is aimed at reduction of the hip, but it ignores the factor of remodeling and is of temporary benefit. More recently, Salters and Pembertons osteotomies have been suggested in the treatment of paralytic subluxation or dislocation, but the lack of remodeling remains unchallenged. During the period of 14 years, from October 1963 to May 1976, we operated on 132 hips in 108 cases of paralytic hips, mostly in children, at Seoul National University Hospital. Of the total cases, 104 cases were residual poliomyelitis, 3 cases cerebral palsy, and one case meningomyelocele, Operative procedures carried out on these hips were as follows: Soutters abductor fasciotomy; 35 Campbells iliac crest transfer; 22 Lumbodorsal fasciotomy; 20 Ober-Barrs erector spinae and tensor fasciae latae transfer; 29 Thomas-Thompson-Straubs external oblique transfer; 15 Sharrards iliopsoas transfer; 6 Mustards iliopsoas transfer; 20 Legg-Dicksons tensor fasciae latae transfer; 8 Blecks iliopsoas recession; 1 Hip fusion; 2 Pembertons pericapsular osteotomy; 28 Salters innominate osteomy; 26 Steels triple osteotomy; 1 Chiari's osteomy; 1 Soft tissue release operations were carried out whenever necessary, either prior to or at the time of reconstructive surgery. In 39 hips, osteotomies were either combined at the same time or were followed by muscle or tendon transfers, while in the earlier 4 hips osteotomy alone resulted in recurrence of subluxation or dislocation and required repeat osteotomy combined with muscle transfer, and in another hip, recently, osteotomy was complicated by infection and muscle transfer has been postponed to date. In our experience with paralytic hips, when subluxation or dislocation is present, either muscle or tendon transfer alone or osteotomy or arthroplasty alone will likely fail or, at best, will be ineffective. Most satisfactory and' permanent results were obtained when these hips were aggressively treated by maximum correction of deformities followed by combined mechanical(osteotomy or arthroplasty) and functional (muscle or tendon transfer) stabilizations. This often permits elimination of the brace and hip fusion is seldom necessary, thus resulting in functional salvage of a flail hip. Also, any surgery on the knee and the foot of the same limb is greatly enhanced by reconstruction of the hip.
