Hip arthroplasty using the cartilaginous part of the greater trochanter in the treatment of the sequelae of epiphysal osteomyelitis in children

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Abstract

BACKGROUND: Alternative methods of hip arthroplasty as a result of the complete destruction of the epiphysis and femoral neck using the preserved part of the apophysis of this segment are not widely reported, which may be useful for specialists who are faced with the choice of providing such assistance.

AIM: To present the long-term results of treating children with the hip joint reconstruction method developed in the clinic using trochanteric arthroplasty by utilizing the intact cartilaginous part of the greater trochanter apophysis for the treatment of defects resulting from osteolysis of the femoral head and neck after epiphyseal osteomyelitis.

MATERIALS AND METHODS: The results of the surgical treatment of seven children (two of them had a bilateral process) who underwent reconstruction of nine hip joints according to the proposed method were analyzed. The procedures were performed at the age of 2–10 years. The intervention involved the surgical preparation of the acetabulum with repositioning of the greater trochanter after proximal angulation osteotomy of the hip at the metadiaphyseal level. In four patients with a unilateral process, Salter innominate osteotomy was additionally performed in one or two stages. In five patients with a unilateral process with further growth, limb lengthening was performed. The efficiency index was evaluated using both anatomical and functional results. In a bilateral process, the assessment considered the function of the worst operated joints.

RESULTS: In six children, good and, in one child with a bilateral process, satisfactory long-term clinical and functional results were obtained (assessed 10–20 years after the first reconstructive surgery). All of them had restored limb support without pain, with a sufficient range of motion. The method was organ-preserving, which enabled an opportunity for walking, and an anatomically favorable situation for further arthroplasty has been created, the timing of which has been postponed to a mature period.

CONCLUSIONS: The method developed in the clinic for the surgical use of the greater trochanter for the reconstruction of the hip joint after infectious osteolysis of the head and neck of the femur is effective, allowing for a long time to maintain leg support using the patient’s tissues.

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About the authors

Nikolay M. Belokrylov

Regional Children’s Clinical Hospital, Perm; Perm State Medical University named after acad. E.A. Wagner

Author for correspondence.
Email: belokrylov1958@mail.ru
ORCID iD: 0000-0002-9359-034X
SPIN-code: 7649-8548

MD, PhD, Dr. Sci. (Med.), Assistant Professor, Honored Doctor of Russian Federation

Russian Federation, Perm; Perm

Natalia V. Polyakova

Regional Children’s Clinical Hospital, Perm

Email: polyakovanatalia19@mail.ru
ORCID iD: 0000-0003-0087-6830

MD, PhD, Cand. Sci. (Med.)

Russian Federation, Perm

Aleksei N. Belokrylov

Regional Children’s Clinical Hospital, Perm

Email: leksab@mail.ru
ORCID iD: 0000-0002-3283-2069

MD, PhD, Cand. Sci. (Med.)

Russian Federation, Perm

Dmitrii V. Antonov

Regional Children’s Clinical Hospital, Perm; Perm State Medical University named after acad. E.A. Wagner

Email: permkdkb@mail.ru
ORCID iD: 0000-0002-3392-0044

MD, PhD, Dr. Sci. (Med.)

Russian Federation, Perm; Perm

Evgeniy A. Zhuzhgov

Regional Children’s Clinical Hospital, Perm

Email: zhuzhgov.evgeniy@gmail.com
ORCID iD: 0000-0002-6689-2123

MD, Pediatric Surgeon

Russian Federation, Perm

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Supplementary files

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2. Fig. 1. Radiographs of the hip joints of patient D: a, b, c, stages of osteomyelitis with the formation of pathological dislocation at the age of 2.5 years; d, e, immediately after surgery and 6 months after surgical treatment by trochanteric arthroplasty

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3. Fig. 2. Radiographs of patient D. Dynamics of development of the left hip joint after trochanteric arthroplasty: a, after 3 years; b, after 5 years; c, 8 years after reconstruction before lengthening. The sphericity of the newly created femoral “head” and its centering are preserved. The apophysis fragment with a growth zone is traced

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4. Fig. 3. Radiographs of patient D.: a, b, stages of lengthening in the Ilizarov apparatus; c, after 1 year; d–f, 5 years after dismantling the apparatus. The articular cavity with congruent articular surfaces is traced (e)

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5. Fig. 4. Radiographs of the hip joints of patient K.: a, pathological hip dislocation; b, after trochanteric arthroplasty at the age of 2 years; c, after hardware removal from the thigh and supra-acetabular osteotomy at the age of 3 years; d, 5 years of age; e, f, 7 years old

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6. Fig. 5. Patient K., 12 years old. Appearance after trochanteric arthroplasty of the left hip joint

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7. Fig. 6. Radiographs of patient K., 23 years old, taken 6 years after left femur lengthening and limb-length alignment. The apophysis head of the greater trochanter partially retains its support, and there is contact with the outer edge of the acetabulum with ossification of its bottom, as well as cartilaginous contact of the femur and pelvis

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