Application of Ganz surgical hip dislocation approach in pediatric hip diseases.
BACKGROUND
Ganz surgical hip dislocation is useful in the management of severe hip diseases, providing an unobstructed view of the femoral head and acetabulum. We present our early experience with this approach in pediatric hip diseases.


METHODS
Twenty-three hips of 21 patients with pediatric hip diseases treated using the Ganz surgical hip dislocation approach were the subjects of this study. The average age at the time of surgery was 15.7 years. There were 15 male and 6 female patients who were followed for an average of 15.1 months (range, 6 to 29 months). Diagnoses included hereditary multiple exostoses in 9 hips, slipped capital femoral epiphysis in 7, Legg-Calvé-Perthes disease in 4, osteoid osteoma in 1, pigmented villonodular synovitis in 1, and neonatal septic hip sequelae in 1. Medical records were reviewed to record diagnoses, principal surgical procedures, operative time, blood loss, postoperative rehabilitation, changes in the range of hip joint motion, and complications.


RESULTS
Femoral head-neck osteochondroplasty was performed in 17 patients, proximal femoral realignment osteotomy in 6, open reduction and subcapital osteotomy for slipped capital femoral epiphysis (SCFE) in 2, core decompression and bone grafting in 2, hip distraction arthroplasty in 2, and synovectomy in 2. Operative time averaged 168.6 minutes when only osteochondroplasty and/or synovectomy were performed. Hip flexion range improved from a preoperative mean of 84.7 degrees to a mean of 115.0 degrees at the latest follow-up visit. Early continuous passive motion and ambulation were stressed in rehabilitation. No avascular necrosis of the femoral head was noted up to the time of the latest follow-up visit, except for in one SCFE patient whose surgical intervention was delayed for medical reasons.


CONCLUSIONS
Ganz surgical hip dislocation provides wide exposure of the femoral head and neck, which enables complete and precise evaluation of the femoral head and neck contour. Hence, the extensive impinging bump can be excised meticulously, and the circulation of the femoral head can be monitored during surgery. The Ganz procedure was useful in severe pediatric hip diseases and allowed for quick rehabilitation with fewer complications.
Shin
Sung Jin
SJ
Department of Orthopaedic Surgery, Jeju National University College of Medicine, Jeju, Korea.
Kwak
Hong-Seok
HS
Cho
Tae-Joon
TJ
Park
Moon Seok
MS
Yoo
Won Joon
WJ
Chung
Chin Youb
CY
Choi
In Ho
IH
D000077:Acetabulum / Q000601:surgery; D000293:Adolescent; D000328:Adult; D002358:Cartilage, Articular / Q000601:surgery; D002648:Child; D005260:Female; D005270:Femur Head / Q000601:surgery; D006617:Hip Dislocation / Q000601:surgery; D006621:Hip Joint / Q000002:abnormalities / Q000601:surgery*; D006801:Humans; D008297:Male; D010027:Osteotomy / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult