Hip arthroplasty using the cartilaginous part of the greater trochanter in the treatment of the sequelae of epiphysal osteomyelitis in children

Abstract

BACKGROUND: Alternative methods of hip arthroplasty as a result of the complete destruction of the epiphysis and femoral neck using the preserved part of the apophysis of this segment are not widely reported, which may be useful for specialists who are faced with the choice of providing such assistance.

AIM: To present the long-term results of treating children with the hip joint reconstruction method developed in the clinic using trochanteric arthroplasty by utilizing the intact cartilaginous part of the greater trochanter apophysis for the treatment of defects resulting from osteolysis of the femoral head and neck after epiphyseal osteomyelitis.

MATERIALS AND METHODS: The results of the surgical treatment of seven children (two of them had a bilateral process) who underwent reconstruction of nine hip joints according to the proposed method were analyzed. The procedures were performed at the age of 2–10 years. The intervention involved the surgical preparation of the acetabulum with repositioning of the greater trochanter after proximal angulation osteotomy of the hip at the metadiaphyseal level. In four patients with a unilateral process, Salter innominate osteotomy was additionally performed in one or two stages. In five patients with a unilateral process with further growth, limb lengthening was performed. The efficiency index was evaluated using both anatomical and functional results. In a bilateral process, the assessment considered the function of the worst operated joints.

RESULTS: In six children, good and, in one child with a bilateral process, satisfactory long-term clinical and functional results were obtained (assessed 10–20 years after the first reconstructive surgery). All of them had restored limb support without pain, with a sufficient range of motion. The method was organ-preserving, which enabled an opportunity for walking, and an anatomically favorable situation for further arthroplasty has been created, the timing of which has been postponed to a mature period.

CONCLUSIONS: The method developed in the clinic for the surgical use of the greater trochanter for the reconstruction of the hip joint after infectious osteolysis of the head and neck of the femur is effective, allowing for a long time to maintain leg support using the patient’s tissues.

Keywords

osteomyelitis / septic arthritis of the hip joint / trochanteric arthroplasty / hip joint reconstruction / supporting osteotomy / corrective osteotomy

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