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Surgical Hip Dislocation is Safe and Effective Following Acute Traumatic Hip Instability in the Adolescent

Podeszwa, David A. MD*; Rocha, Adriana De La MS*; Larson, Annalise N. MD; Sucato, Daniel J. MD, MS*

Journal of Pediatric Orthopaedics: July/August 2015 - Volume 35 - Issue 5 - p 435–442
doi: 10.1097/BPO.0000000000000316
Trauma
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Background: A traumatic hip dislocation in the pediatric patient is a rare but potentially catastrophic injury. The purpose of this study was to review our early clinical results and radiographic morphology of hips treated with a surgical hip dislocation (SHD) approach for intra-articular hip pathology resulting from traumatic instability in pediatric and adolescent patients.

Methods: This is a retrospective analysis of a consecutive series of patients presenting with nonconcentric reduction after traumatic hip instability. All patients were treated with a transtrochanteric SHD with concomitant procedures based on intra-articular findings. Radiographic evaluations and Harris Hip Scores were completed at final follow-up.

Results: Eleven male patients, mean age of 12.3 years (range, 9.3 to 16.1 y) and mean body mass index 19.6 kg/m2 (range, 15.4 to 28.0 kg/m2). Intraoperative findings included: labral tear (8), femoral cartilage injury (5), acetabular rim fracture (4), acetabular cartilage delamination (3), loose body (2), and femoral head osteochondral fracture (1). Postoperatively, 1 patient developed a transient peroneal nerve palsy. At a mean 24.5 months (range, 12.0 to 48.1 mo) postoperatively, no hips have radiographic evidence of osteonecrosis. The mean lateral center edge angle was 20 degrees (range, 9 to 38 degrees) with 6 hips of <20 degrees; mean acetabular index 9 degrees (range, −2 to 23 degrees) with 5 hips of >10 degrees; mean α-angle 56 degrees (range, 48 to 62 degrees) with 6 hips of >55 degrees; mean acetabular version 12 degrees (range, 8 to 16 degrees) with 8 hips of <15 degrees. At 1-year follow-up, the mean Harris Hip Score was 95.8 (range, 84.7 to 100).

Conclusions: Early results suggest that SHD is a safe approach to treat an incomplete reduction following posterior hip instability and is effective for identification and treatment of acute intra-articular pathology. Acetabular dysplasia, relative acetabular retroversion, and/or decreased femoral offset may be risk factors for posterior hip instability in adolescents.

Level of Evidence: Level IV.

*Department of Orthopaedic Surgery, Texas Scottish Rite Hospital for Children, Dallas, TX

Mayo Clinic, Rochester, MN

Study performed at Children’s Medical Center Dallas and Texas Scottish Rite Hospital for Children.

The authors declare no conflicts of interest.

Reprints: David A. Podeszwa, MD, Department of Orthopaedic Surgery, Texas Scottish Rite Hospital for Children, 2222 Welborn St., Dallas, TX 75219. E-mail: david.podeszwa@tsrh.org.

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