Arthroscopically Assisted Reduction for Teratogenic Hip Dislocation in a Child with Multiple Congenital Malformations

Abstract

Teratogenic hip dislocation is a dysplastic musculoskeletal condition occurring in the context of multiple congenital malformations. Rigidity and pronounced anatomical changes result in the low effectiveness of conservative treatment; therefore, open surgical intervention remains the traditional method of choice, associated with procedure-related trauma and the risk of avascular necrosis of the femoral head. For the treatment of congenital hip dislocation in children, an alternative, less invasive method—arthroscopically assisted closed reduction of dislocation—has been developed; however, its use in teratogenic dislocations remains insufficiently studied. This article presents a case of arthroscopically assisted closed reduction of a high right-sided teratogenic hip dislocation in an 8-month-old child with spina bifida and multiple congenital anomalies. The patient had been under orthopedic supervision since birth and received conservative treatment using a splint, which proved ineffective. An unsuccessful attempt at closed reduction following overhead traction at 7.5 months of age resulted in persistent femoral head decentration. To eliminate intra-articular obstacles and achieve stable reduction in a minimally invasive manner, arthroscopy of the right hip joint was performed. Intraoperatively, hourglass-shaped capsular deformity, hypertrophy of lipofibrous granulation tissue in the acetabular floor, and abnormal transverse and ligamentum teres were identified. Arthroscopic capsular release, granulation tissue debridement, and ligament resection were carried out. After elimination of the obstacles, closed reduction was achieved, with stability confirmed by intraoperative fluoroscopy and ultrasound. Postoperative immobilization in a hip spica cast and orthosis lasted 9 months. Follow-up for 33 months revealed no recurrence of dislocation. The acetabular index on the right was 28.2°. A disruption of Shenton’s line indicated residual dysplasia. This clinical case illustrates the potential of arthroscopic techniques for removing intra-articular obstacles to closed reduction in patients with teratogenic hip dislocation, thereby potentially reducing procedure-related trauma.

Keywords

pediatric orthopedics / dysplasia of the hip / teratogenic hip dislocation / spina bifida / hip arthroscopy / case report

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