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      Transposition of the apophysis of the greater trochanter for reconstruction of the femoral head after septic hip arthritis in children : 4 children followed for more than 15 years

      Acta Orthopaedica

      Informa Healthcare

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          Abstract

          Background and purpose

          Total necrosis of the femoral head after infection in children during their first months of life gives a dislocated hip with severe leg shortening. A new femoral head can be achieved with subtrochanteric osteotomy and transposition of the apophysis of the greater trochanter into the acetabulum. Previous reports have dealt with short-term results (up to 12 years). Here I present some results of this procedure 15–24 years after operation.

          Patients and methods

          4 children aged 1–6 years with complete necrosis of the femoral head were operated on with transposition of the greater trochanter. Secondary shelf plasty was performed later in 1 child, distal femoral epiphysiodesis in another, and femoral bone lengthening in 1 child. The mean follow-up period was 19 (15–24) years.

          Results

          A new femoral head developed in all hips. 2 of them had a spherical head with a good acetabular cover, and without any osteoarthritis except for slight reduction of cartilage height. These hips were painless, with a mobility that allowed good walking function after 16 and 24 years, respectively. In the other 2 patients, in which there was a severe acetabular dysplasia at the primary operation, the new femoral head was somewhat flattened; painful osteoarthritis led to hip replacement 15 and 21 years after trochanter arthroplasty. Even these patients had a relatively good walking function until the last couple of years before hip replacement. Maximum leg length discrepancy was 7 cm.

          Interpretation

          Trochanter arthroplasty with subtrochanteric osteotomy in total femoral head necrosis after septic arthritis in children may give satisfactory long-term results provided adequate acetabular cover is obtained. Although the method cannot provide a normal hip, it can contribute to less length discrepancy, less pain, improved gait, and more favorable conditions for later hip replacement.

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          Most cited references 13

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          Classification and surgical management of the severe sequelae of septic hips in children.

          The treatment of the acute state of septic arthritis of the hip in children has been clearly outlined in the current literature. The treatment of residual anatomic deformity is less well understood; no classification or comprehensive treatment program has been documented. The following classification of the sequelae of septic hips in children is based on the presence or absence of a capital femoral epiphysis and hip stability. This classification defines the case material and outlines the anatomic problem requiring solution. Of ten patients with severe destruction of the femoral head followed for an average period of 11.2 years, there were eight satisfactory and two unsatisfactory results. Both unsatisfactory results were Type III hips with pseudarthrosis of the neck. Both had an average of five surgical procedures, compared with 2.2 procedures for patients with satisfactory results. The complications were leg-length discrepancy, hip instability, and scoliosis.
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            On the acute arthritis of infants

             T. SMITH,  T Smith (1874)
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              Greater trochanteric hip arthroplasty in children with loss of the femoral head.

              In seventeen children with catastrophic loss of the femoral head, the hip was salvaged by greater trochanteric arthroplasty. The average follow-up of these patients was eleven years, and fourteen patients were followed to skeletal maturity or longer. In Group I, consisting of four patients with greater trochanteric arthroplasty alone, good initial stability gradually deteriorated as subluxation occurred, accompanied by a proportionate return of abductor limp, loss of hip motion, and an increased rate of degenerative changes in the joint. Group II, consisting of eight patients who had either acetabuloplasty or innominate osteotomy in addition to greater trochanteric arthroplasty, had only slightly improved hip containment and results similar to those in Group I. Spontaneous ankylosis of the hip occurred in six of the patients in those two groups. The best results were obtained in five patients in Groups III and IV who had the procedure supplemented by proximal femoral varus osteotomy.
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                Author and article information

                Journal
                Acta Orthop
                ORT
                Acta Orthopaedica
                Informa Healthcare
                1745-3674
                1745-3682
                February 2011
                10 February 2011
                : 82
                : 1
                : 64-68
                Affiliations
                Department of Orthpaedics, St. Olav's University Hospital and Department of Neuroscience, Norwegian University of Science and Technology , Trondheim, Norway
                Author notes
                Article
                ORT_A_548030_O
                10.3109/17453674.2010.548030
                3229999
                21189111
                Copyright: © Nordic Orthopaedic Federation

                This is an open-access article distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the source is credited.

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                Orthopedics

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