Colonna arthroplasty with concomitant femoral shortening and rotational osteotomy. Long-term results.
The results of Colonna capsular arthroplasty in twenty-two hips in twenty patients were reviewed. All twenty patients were at least five years old at the time of the operation, which was performed for either complete dislocation or marked subluxation of the hip. None were candidates for reconstructive procedures designed to preserve articular cartilage. The mean age at the time of the Colonna arthroplasty was nine years and three months (range, five years to fifteen years and two months), and the mean duration of follow-up was sixteen years (range, six to thirty-two years). At the most recent follow-up examination, the mean Harris hip score, for the twenty-one hips for which it was available, was 82 points (range, 52 to 98 points), the patients had improved gait, and there was marked improvement in the radiographic appearance of the hip according to the classification system of Severin. Thirteen hips in twelve patients had concomitant femoral shortening and rotational osteotomy at the time of the Colonna arthroplasty, and none of these patients who did not have evidence of avascular necrosis of the capital femoral epiphysis preoperatively had it postoperatively. Three hips that did not have concomitant femoral shortening had evidence of new-onset avascular necrosis after the Colonna arthroplasty. Concomitant femoral shortening and rotational osteotomy allowed the operation to be performed without preoperative traction, dramatically reduced the need for a subsequent rotational femoral osteotomy, and reduced the prevalence of postoperative avascular necrosis of the capital femoral epiphysis.
Stans
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Division of Pediatric Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
Coleman
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D000293:Adolescent; D001178:Arthroplasty / Q000379:methods*; D002547:Cerebral Palsy / Q000150:complications; D002648:Child; D002675:Child, Preschool; D005260:Female; D005269:Femur / Q000601:surgery*; D005271:Femur Head Necrosis / Q000209:etiology; D006618:Hip Dislocation, Congenital / Q000000981:diagnostic imaging / Q000601:surgery*; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D010027:Osteotomy; D011183:Postoperative Complications; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome