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Treatment of late neglected adultTreatment of late neglected adult

congenital dislocation of the hip withcongenital dislocation of the hip withhybrid Ilizarov/monolateralhybrid Ilizarov/monolateral distractordistractor

and total hip replacementand total hip replacement

A new methodologyA new methodology

oo Nuno Craveiro LopesNuno Craveiro Lopes

oo Joo JacintoJoo Jacintooo Carolina EscadaCarolina Escadaoo MMrio Tapadinhasrio Tapadinhasoo CarloCarlo VillacresesVillacreses

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Treatment of neglected congenitally dislocated hip in adults is

a challenging problem with a very demanding and problematic

surgical technique

Treatment of neglected congenitally dislocated hip in adults isTreatment of neglected congenitally dislocated hip in adults is

a challenging problem with a very demandinga challenging problem with a very demanding and problematicand problematic

surgical techniquesurgical technique

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o Age of patiento Limb length discrepancy

o Cup on true acetabulumo Distortion of proximal femur

o Small & adapted implant

oo Age of patientAge of patient

oo Limb length discrepancyLimb length discrepancy

oo Cup on true acetabulumCup on true acetabulumoo Distortion of proximal femurDistortion of proximal femur

oo SmallSmall && adaptedadapted implantimplant

ProblemsProblemsProblems

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Classic TechniqueClassicClassic TechniqueTechnique

Paavilainen et al (1990)Paavilainen et al (1990)

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Classic TechniquePaavilainen et al (1990)ClassicClassic TechniqueTechniquePaavilainen et al (1990)

103 patients with FW of 10 yearsParalisis 10%

Fractures 10%

Dislocation 2%

Discrepancy 0-7cm (1.9cm)

Revision acetabular 48%

Revision Femoral 10%

103 patients with FW of 10 yearsParalisis 10%

Fractures 10%

Dislocation 2%

Discrepancy 0-7cm (1.9cm)

Revision acetabular 48%Revision Femoral 10%

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o Resection of femoral neck and head

o Hybrid external distractor

o Distal femoral transport 2 months

o Distractor removal

o Skin traction 2 weeks

o Small THR covered with HA (Corail@,S-Rom@ )

o Cer-Cer, Met-Met or Cer-Met joint

oo Resection of femoral neck and headResection of femoral neck and head

oo Hybrid externalHybrid external distractordistractor

oo Distal femoral transportDistal femoral transport 2 months2 months

oo DistractorDistractor removalremoval

oo Skin tractionSkin traction 2 weeks2 weeks

oo SmallSmall THRTHR covered with HA (covered with HA (CorailCorail@@,S,S--RomRom@@ ))

oo CerCer--CerCer, Met, Met--Met orMet or CerCer--Met jointMet joint

MethodologyMethodologyMethodology

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o More robust and stable

o 4 supra acetabular pins

o 4 femoral pins

o Immediate ambulation

o Weight bearing

oo More robustMore robust andand stablestable

oo 4 supra acetabular pins4 supra acetabular pins

oo 4 femoral pins4 femoral pins

oo Immediate ambulationImmediate ambulation

oo WWeight bearingeight bearing

Advantage of hybrid distractorAdvantageAdvantage ofof hybridhybrid distractordistractor

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o 7 female patients

o Mean age 36 yo (22 to 51)

o Mean overriding 5.3cm (4 to 6.8)

o Mean follow-up 5.5 years (3 to 8)

o 5 CDH sequel

o 1 Septic sequel

o 1 AVN sequel

oo 77 femalefemale patientspatients

oo MeanMean age 36age 36 yoyo (22 to 51)(22 to 51)

oo MeanMean overridingoverriding 5.3cm (4 to 6.8)5.3cm (4 to 6.8)

oo Mean followMean follow--up 5.5 years (3 to 8)up 5.5 years (3 to 8)

oo 5 CDH5 CDH sequelsequel

oo 11 SepticSeptic sequelsequel

oo 1 AVN1 AVN sequelsequel

Clinical DataClinicalClinical DataData

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M.M. 51 yo female

Untreated CDH

6.3 cm overriding

M.M. 51M.M. 51 yoyo femalefemale UntreatedUntreated CDHCDH

6.3 cm overriding6.3 cm overriding

8 years of follow-up8 years of follow8 years of follow--upup

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03-20020303--2002200203-20020303--20022002 03-20100303--20102010

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8 years follow-up88 yearsyears followfollow--upup

01-20020101--20022002

03-20100303--20102010

HHS 59.3HHSHHS 59.359.3 HHS 89 (+29,7)HHSHHS 89 (+29,7)89 (+29,7)

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J.F., 24 years old female

Neonate septic arthritis

5.3 cm overriding

J.F., 24J.F., 24 yearsyears oldold femalefemale

NeonateNeonate septicseptic arthritisarthritis

5.3 cm5.3 cm overridingoverriding

7,5 years of follow-up7,5 years of follow7,5 years of follow--upup

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07-20020707--20022002 01-20100101--20102010

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7,5 years follow-up7,57,5 yearsyears followfollow--upup

01-20100101--20102010

11-20011111--20012001

HHS 64.4HHSHHS 64.464.4 HHS 93 (+29,6)HHSHHS 93 (+29,6)93 (+29,6)

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F.M. 47 years old female

Untreated CDH

6.8 cm overriding

F.M. 47F.M. 47 yearsyears oldold femalefemale

UntreatedUntreated CDHCDH

6.8 cm6.8 cm overridingoverriding

6,5 year of follow-up6,56,5 yearyear of followof follow--upup

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FM01.10

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6,5 year of follow-up6,56,5 yearyear of followof follow--upup

HS - 60HSHS -- 6060 HHS 93.6 (+33,6)HHSHHS 93.6 (+33,6)93.6 (+33,6)

10-20031010--20032003

01-20100101--20102010

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T.N. 35 years old female

Untreated bilateral CDH

4 cm overriding

T.N. 35T.N. 35 yearsyears oldold femalefemale

UntreatedUntreated bilateral CDHbilateral CDH

4 cm4 cm overridingoverriding

3 years follow-up3 years follow3 years follow--upup

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TN01.10

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3 years of follow-up3 years of follow3 years of follow--upup

TN01.10

HHS 62.7HHSHHS 62.762.7 HHS 93 (30,3)HHSHHS 93 (30,3)93 (30,3)

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ProblemsFemoral fissure during THR 2Transient paresis after THR 1

Peri-Articular Calcifications 1

Pin fracture 1Pin infection 1

ProblemsProblemsFemoralFemoral fissurefissure duringduring THRTHR 22TransientTransient paresisparesis afterafter THRTHR 11

PeriPeri--ArticularArticular CalcificationsCalcifications 11

PinPin fracturefracture 11PinPin infectioninfection 11

ObstaclesTHR dislocation 1ObstaclesObstacles

THR dislocationTHR dislocation 11

ComplicationsTHR Infection 0

THR loosening 0

ComplicationsComplications

THRTHR InfectionInfection 00

THRTHR looseningloosening 00

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70,4

93,6

57,4

89

62,3

92,5

50

60

70

80

90

100

Before After

Harris Hip ScoreHarrisHarris HipHip ScoreScore

62.3 92.562.3 92.562.3 92.5

Very significant difference (p

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ConclusionConclusionConclusiono Comprehensive approach

o Stable fixation

o Well tolerated

o No complications

o Excelent end results

oo ComprehensiveComprehensive approachapproach

oo StableStable fixationfixation

oo WellWell toleratedtolerated

oo NoNo complicationscomplications

oo ExcelentExcelent endend resultsresults

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GARCIA DE ORTA HOSPITAL, EPEGARCIA DE ORTA HOSPITAL, EPEOrthopedic & TraumaOrthopedic & TraumaDptDpt

Director:Director:CraveiroCraveiroLopes, M.D.Lopes, M.D.