Charles E Johnston1. 1. Texas Scottish Rite Hospital for Children, Dallas, TX 75219, USA. charles.johnston@tsrh.org
Abstract
BACKGROUND: Congenital dislocation of the hip (CDH) and congenital dislocation of the knee (CDK) occurring in the same extremity is a rare condition. Traditional treatment usually involves staged procedures, obtaining knee reduction first, and then addressing the hip once the knee can be flexed adequately. Simultaneous surgical reduction of both dislocations assisted by femoral shortening is a logical treatment option not previously reported. METHODS: A retrospective radiographic and clinical review of surgically treated patients was performed, with a minimum 5-year follow-up. Outcome of CDK treatment was graded according to a scale consisting of radiographic congruity, clinical stability, function, and gait. Outcome of CDH treatment was graded according to Severin classification. RESULTS: Eight patients (11 limbs) were identified, with follow-up of 5 to 16 years. Four patients (5 limbs) underwent simultaneous open reduction of both dislocations stabilized by capsulorrhaphy and femoral shortening, with 3 patients operated at age 1 year. Subsequent procedures included 2 physeal-sparing anterior cruciate ligament reconstructions, and 1 high tibial osteotomy to correct angular deformity. Additional procedures for hip dysplasia included 2 pelvic osteotomies in the same patient. Four patients (6 limbs) underwent staged treatment: open reduction of the knee using quadricepsplasty at age 4 to 11 months, followed by open reduction of the hip by either medial approach 3 months later, or anterior approach 12 to 24 months later. No additional knee procedures were performed in this group. Additional hip procedures included 1 repeat open reduction and 1 pelvic/femoral osteotomy. At follow-up in the simultaneous group, knees were 3 excellent, 1 good, and 1 fair, whereas hips had 3 Severin grade 1 to 2 results, 1 grade 3, and 1 grade 4. Outcomes for the staged group knees were 2 fair and 4 poor results, whereas hips had 5 grade 1 to 2 results and 1 grade 3. CONCLUSIONS: Outcome for CDK treated simultaneously seems better than staged treatment due to improved retained quadriceps function and attention to teratologic instability. Outcomes for CDH were essentially equal regardless of simultaneous or staged treatment. LEVEL OF EVIDENCE: : III.
BACKGROUND:Congenital dislocation of the hip (CDH) and congenital dislocation of the knee (CDK) occurring in the same extremity is a rare condition. Traditional treatment usually involves staged procedures, obtaining knee reduction first, and then addressing the hip once the knee can be flexed adequately. Simultaneous surgical reduction of both dislocations assisted by femoral shortening is a logical treatment option not previously reported. METHODS: A retrospective radiographic and clinical review of surgically treated patients was performed, with a minimum 5-year follow-up. Outcome of CDK treatment was graded according to a scale consisting of radiographic congruity, clinical stability, function, and gait. Outcome of CDH treatment was graded according to Severin classification. RESULTS: Eight patients (11 limbs) were identified, with follow-up of 5 to 16 years. Four patients (5 limbs) underwent simultaneous open reduction of both dislocations stabilized by capsulorrhaphy and femoral shortening, with 3 patients operated at age 1 year. Subsequent procedures included 2 physeal-sparing anterior cruciate ligament reconstructions, and 1 high tibial osteotomy to correct angular deformity. Additional procedures for hip dysplasia included 2 pelvic osteotomies in the same patient. Four patients (6 limbs) underwent staged treatment: open reduction of the knee using quadricepsplasty at age 4 to 11 months, followed by open reduction of the hip by either medial approach 3 months later, or anterior approach 12 to 24 months later. No additional knee procedures were performed in this group. Additional hip procedures included 1 repeat open reduction and 1 pelvic/femoral osteotomy. At follow-up in the simultaneous group, knees were 3 excellent, 1 good, and 1 fair, whereas hips had 3 Severin grade 1 to 2 results, 1 grade 3, and 1 grade 4. Outcomes for the staged group knees were 2 fair and 4 poor results, whereas hips had 5 grade 1 to 2 results and 1 grade 3. CONCLUSIONS: Outcome for CDK treated simultaneously seems better than staged treatment due to improved retained quadriceps function and attention to teratologic instability. Outcomes for CDH were essentially equal regardless of simultaneous or staged treatment. LEVEL OF EVIDENCE: : III.