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RECONSTRUCTION OF

THE HIP JOINT IN


CHILDREN AFTER
SEPTIC COXITIS

S U P E R V I S O R : D R . W I S N U M U R T I , S P. O T

B Y : G I TA S U R I A N G G R A E N I
30101206631
JOURNAL IDENTITY

• RECONSTRUCTION OF THE HIP JOINT


Title IN CHILDREN AFTER SEPTIC COXITIS

Authors • M.P. Teplenkiy, E.V. Oleinikov,V.S. Bunov

Published • May 2015


Date
ABSTRACT
Background.
Surgical treatment of destructive dislocations is
problematic, and controversial. Treatment options range
from active monitoring to complex multistage
reconstruction protocols.
Patients and Methods:
• The results of treatment of 17 children with disruptive
dislocation of the hip (class IV according to the Choi classifi
cation) are presented.
• Clinical results were assessed using Colton’s criteria.
• The patients were divided into two groups, according to age,
for data analysis.
RESULTS

• Th e majority (88%) of the children had positive anatomical and


functional outcomes
CONCLUSION

• The use of reconstructive surgery using the


Ilizarov apparatus in children with a defect of
the proximal femur creates conditions for the
adaptation of incongruent articular
components without causing decompensation
of the joint.
INTRODUCTION
Septic coxitis is a relatively rare condition that
requires urgent attention owing to its severe
complications.
The complications are quite diverse and may
manifest as growth plate injury, deformity, and
destruction of articular components, and incorrect
joint relations
• aimed at analyzing the immediate and
midterm results of treatment of preschool
and early school-age children with defects of
the femoral head and neck secondary to
septic coxitis.
MATERIALS AND METHODS
• informed consent form to participate in the study and
undergo surgery
• Patients were treated at the Ilizarov Center between
2002 and 2011.
• Treatment outcomes of 17 children with septic coxitis
complications were analyzed
Inclusion criteria were as follows:
• destructive hip dislocation corresponding to
class IV according to the Choi classification,
• aged less than 10 years, and
• undergoing at least 2 years of follow-up.
• Patients with distention dislocation of the hip
joint were excluded from this study.
• Treatment outcomes were analyzed from 2 to
11 years.
• Clinical results were evaluated according to
the Colton criteria
• Joint pathology severity was determined
according to the Choi classifi cation,
CHOI’S CLASSIFICATION
• the radiographs taken after treatment, the following
indicators of the joint relations were determined
1. Lateral displacement angle (LDA): (normal range
20°-25°)
2. Degree of acetabular coverage (acetabular head
index, AHI)
3. Joint surface congruence according to Coleman
COLEMAN
CLASSIFICATION
Type I, spherical congruent;
Type II, spherical incongruent;
Type III, aspherical congruent; and
Type IV, aspherical incongruent)
PARAMETERS OF THE RESULT

LDA AHI TYPE OF COLEMAN

Good ≤ 25° ≥ 80%, was Type I or III congruence.

Satisfactory ≤ 30 ≥ 70%, Type III or IV congruence

Unsatisfactory > 30°, < 70%, Type IV congruence


THREE VARIATIONS OF THE
TECHNIQUE WERE USED FOR THE
FEMUR RECONSTRUCTION

• a C-shaped osteotomy through the base of the femoral neck and gradual
transposition of fragments to form the femoral neck-shaft inclination angle
 In six cases with Type IVa congruence
• double transtrochanteric osteotomy, and lateral transposition of the tip of
the greater trochanter and the distal fragment of the femur  In eight
cases with Iva nd Type IVb in children older than 4 years,
• joint reconstruction was accomplished with valgus lateral intertrochanteric
osteotomy  In three younger children with Type IVa,
DISTRIBUTION BY THE TYPE OF
JOINT DEFORMITY
(CHOI)
Group 1 (aged Group 2 ( aged
2-6 years) 7-9 years)

6 type 5 type
IV a IV a

3 Type 3 Type
IV b IV b
THE DISTRIBUTION OF FUNCTIONAL
RESULTS IN GROUP 1 ACCORDING TO
COLTON CRITERIA

Good : 3 joints

Satisfactory : 5 joints

Unsatisfactory : 1
joint
THE DISTRIBUTION OF FUNCTIONAL
RESULTS IN GROUP 2

Good : 2 joints

Satisfactory : 6
joints
The distribution of joints by the types
of congruence in group 1 :

Type I : Type III : Type IV :


2 joints 4 joints 3 joints
The distribution of joints by the types
of congruence in group 2 :

Type I : Type III : Type IV :


1 joint 6 joints 1 joints
TH E DISTRIBUTION OF RADIOGRAPHIC
RESULTS IN GROUP 1 (INCLUDING TWO
REOPERATIONS)

Good : 4 joints

Satisfactory : 4 joints

Unsatisfactory : 1
joint
TH E DISTRIBUTION OF
RADIOGRAPHIC RESULTS IN
GROUP 2
Good : 3 joints

Satisfactory : 3 joints

Unsatisfactory : 1
joint
CASE STUDY
CASE STUDY
DISCUSSION

• Almost 75% of complications from septic arthritis in children are hip lesions
• There are indirect and direct consequences of septic coxitis.
• Indirect consequences  include growth plate lesions and aseptic necrosis
of the femoral head,
• while direct consequences include  cartilage lesions and destruction of
the proximal femur.
• These changes are frequently accompanied by the disruption of articular
relations
• In this paper, we present the technique of progressive hip
extension, which should be considered similar to the well-
known technique by Krumins et al., involving a double
transtrochanteric osteotomy and repositioning of the
intermediate fragment in the direction towards the bottom of
the acetabulum
• The presented results give reason to assert that the use of
reconstructive surgery in school-age children does not result in the
decompensation and loss of the joint function.
• We agree with most other authors in that the reconstruction of
articular components not only improves the function of the limb, but
also makes hip joint replacement less complicated.
CONCLUSION

• Reconstructive surgery using the Ilizarov external fixation device in


children with defects in the proximal femur allows for the correction of
incongruent articular surfaces, without causing decompensation of the
joint. These interventions may be considered as alternatives to palliative
femur osteotomy in primary school-age children.
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