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 210 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 1020 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 patients tissues.

Quality of Life in Children With Achondroplasia Undergoing Paired Limb Lengthening With an External Fixator and Modified Distraction Control: Observational Nonrandomized Study

“…Furthermore, the optimal fixator compositions for different age groups of patients are not specified [ 9 ]. A high rate of complications persists, which may be due to noncompliance with age-specific aspects of surgical treatment [ 17 ]. Several postoperative management issues remain unresolved [ 16 ].…”

“…Surveys conducted among patients with achondroplasia and their family members, both before and after treatment, consistently answer in favor of the need for limb augmentation [ 8 , 17 ]. Currently, the primary method for addressing growth deficit in patients with achondroplasia involves surgical distraction osteosynthesis [ 9 , 10 ].…”

“…Traditionally, limb lengthening for patients in this nosological group has been performed using a multiaxial system, known as the Ilizarov system. While this system shows good results in reparative tissue regeneration processes, its complex design and cumbersomeness can impact patients’ quality of life, which is especially significant in pediatric practice [ 9 , 16 , 17 ]. To address this, rod fixators built on a semicircular frame with a simpler and lighter design are gaining popularity [ 20 , 21 ].…”

“…However, the complexity of the design, its excessively bulky nature, and its many parts can lead to long assembly times and require an increased time under anesthesia. In turn, these factors contribute to challenges during rehabilitation, limiting the use of this type of external fixator in pediatric practice [17]. Nevertheless, external fixators are the most common in the treatment of patients with achondroplasia in many countries [18][19][20].…”