Temporary coxofemoral suspension as an adjuvant in the surgical treatment of recurrent, unstable or late congenital dislocations: case series and description of surgical technique
Keywords:
Hip dislocation, congenital, Osteotomy, MethodsAbstract
Introduction: Recurrent hip dysplasia or re-dislocation after successful open reduction and osteotomy is a feared complication, more often seeing in older children. Causes have been attributed to biological, technical, or post-operative factors. A procedure so-called temporary coxo-femoral suspension was developed to deal with prevention and treatment of this difficult situation.
Methods: We present a case series of patients with high riding hips who were submitted to this procedure associated to open reduction and pelvic and/or femoral osteotomies. A device known as TightRope® (Arthrex), was used in all hips. Pemberton acetabuloplasties were performed in all patients. Patients have been followed from a minimum of 8 months to a maximum of three years after the procedure.
Results: We treated 6 patients (9 hips) between 3 and 7 years old. The implants were removed after 4 to 6 months in 7 hips. Up to-date, no cases of avascular necrosis, condrolysis, infection or subluxation were noticed. A limitation of range of movement was apparent initially, but returned to normal 3 to 6 months after implant removal. Tonnis migration level, acetabular index, Wiberg CE angle and clinical & radiographic parameters according to Ponseti’s modification of Severin scale improved in all patients.
Discussion: Coxo-femoral suspension, also called “teresitation”, associated to formal open reduction, capsuloplasty and osteotomy, may be a useful method in treating unstable, recalcitrant congenital hip dislocations, but more clinical work is needed to support its recommendation
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