Surgical Treatment of Children with Hip Dislocation in Amyoplasia-Type Arthrogryposis: A Rational Approach to Treatment Selection

Abstract

Background. Patients with amyoplasia and hip dislocation have different variants of hip contractures and deformities, but there is no difference in the selection of the method.
 Aim. To justify the algorithm of rational selection of surgery methods in children under 3 years of age with hip dislocation in amyoplasia
 Materials and methods. Level of Evidence II. 70 patients were examined, including 21 children under the age of 12 months (main group) after 25 hip open reduction, 19 children under the age of 3 years (main group) after hip open reduction, Salter innominate osteotomy, femoral osteotomy and 30 patients aged 3 to 7 years (control group) who had not previously received conservative and surgical treatment. All patients were divided into two subgroups depending on the variant of hip contracture: flexion-extension-abduction-external rotation (frog-like) (subgroup 1) and flexion-extension-adduction-external rotation (subgroup 2). We used clinical, radiological and statistical methods.
 Results. In children of subgroup 1, after hip open reduction, good results were noted in 17% of cases, satisfactory in 50%, unsatisfactory in 33%, severe complications class III, IV according to the modified Clavien-Dindo-Sink classification were obtained in 83%. After hip open reduction, Salter innominate osteotomy, and femoral osteotomy performed in patients of subgroup 1 under the age of 3 years, good results were noted in 50% of cases, satisfactory and unsatisfactory in 25% with less severe complications (50%) (p=0.041). In children of subgroup 2, after hip open reduction, good results were obtained in 90% of cases, satisfactory in 10% with a rate of severe complications of 10%, and when this surgery was combined with Salter innominate osteotomy, femoral osteotomy, good results were noted in 75% of cases, satisfactory in 19% and unsatisfactory in 6%, with a rate of severe complications of 25% (p=0.05).
 Conclusion. A differentiated approach to the treatment of children with hip dislocation in amyoplasia, in our opinion, will increase the effectiveness of the treatment methods, and its introduction into clinical practice will help to improve the outcomes