GKD Tedavisinde Femoral Kısaltma ve/veya Derotasyon için Uygulanan Farklı Seviyelerdeki Femoral Osteotomi Radyolojik ve Klinik Sonuçları Nasıl Etkiler?

Abstract

Introduction: In the present study, different femoral osteotomy levels applied in the combined surgical treatment of the patients aged over 2 years with developmental dysplasia of hip (DDH) were compared. It was aimed to determine the advantages and disadvantages of the osteotomies performed at the shaft and subtrochanteric regions of the femur and to evaluate the radiological and clinical impact on hip development. Materials and Method: The study included the patients aged over 2 years with DDH who were applied open reduction, Pemberton pericapsular osteotomy and femoral osteotomy (PPO). The demographic information, clinical evaluations and radiographic results of the patients were applied from the medical records. In addition, radiation exposure (the number of fluoroscopic images), operation duration and present of complications were evaluated. The patients were divided into two groups based on the level of femoral osteotomy as shaft (group 1) and subtrochanteric (group 2) groups. The Tönnis Classification System was used to assess the grade of preoperative hip dysplasia. Radiological evaluation was performed according to Severin’s criteria while modified McKay’s criteria was applied for clinical evaluation. Kalamachi and MacEwen’s criteria were preferred for evaluation of avascular necrosis (AVN). Results: 46 hips of 31 patients were included in the study. 21 hips were in the shaft group and 25 hips were in the subtrochanteric group. No statistically significant difference was present between the groups in terms of age, Tönnis type of hip, preoperative acetabular index, postoperative acetabular index, preoperative collo-diaphyseal angle, postoperative collo-diaphyseal angle and degree of derotation. The difference between the follow-up durations of the groups was statistically significant. The follow-up duration of the group 1 was shorter than the group 2. Although, clinical results in the group 1 were proportionally better than the group 2, no statistically significant difference was determined between the groups. A statistically significant difference was detected between the groups in terms of radiological results. AVN was found in none of the hips in the group 1 whereas 8 hips were detected with AVN in the group 2. The difference between the groups regarding femoral head AVN was statistically significant. There was a statistically significant difference between the groups in terms of operation duration and radiation exposure. Subluxation or redislocation developed in none of the cases. Conclusion: Femoral osteotomy performed for femoral shortening and/or derotation at the region of femoral shaft can be used as an alternative surgical procedure without increasing the risk for AVN in the pediatric patients aged over 2 years with DDH. © 2023, Yuzuncu Yil Universitesi Tip Fakultesi. All rights reserved.