title: [Characteristics in treatment of the hip in patients with Down syndrome].
abstract: BACKGROUND
  The treatment of hip instability in patients with Down syndrome is challenging. We have performed different pelvic osteotomies and corrections at the proximal femur for this indication. This retrospective study was conducted to evaluate the clinical and radiological outcome of each intervention.
  
  
  METHODS
  All in all, 166 patients with Down syndrome were treated at our orthopaedic department in the observation period. Problems related to the hip joint were diagnosed in 63 of those patients. Only patients who underwent surgery were included in this study. The charts and X-rays of these 31 patients were evaluated with respect to the following parameters: incidence of the hip problem, concomitant diseases, temporal progress, kind of operation method and date, duration of stay in the hospital, after-care, follow-on surgery related to complications, AC angle, CE angle, ACM angle, CCD angle, index of migration according to Reimers, classification of Bauer and Kerschbauer and general morphology of the femoral head. The group was compared with an age-matched group of 21 patients with hip dysplasia. Those patients underwent the same sort of operation in the same year.
  
  
  RESULTS
  In the Morbus Down group, we performed surgery for preservation of the hip in 49 cases. This included 13 osteotomies according to Chiari, 11 triple osteotomies according to Tönnis, 10 corrections by femoral varus derotation osteotomy, 8 pelvic osteotomies according to Pemberton, 5 pelvic osteotomies according to Salter and 2 open reductions of the hip. With respect to the moment of surgery, we detected three peaks of age. There was no difference in course of disease and quantity of complications between the groups. Satisfactory results concerning clinical and radiological outcome were achieved predominantly by complete redirectional acetabular osteotomies. Half of the patients who were solely treated by femoral varus derotation osteotomy needed follow-on surgery in the form of pelvic osteotomy. Comparison of preoperative and postoperative range of motion of the hip joint between groups detected capsular insufficiency, increased ligamentous laxity and muscular hypotonia in patients with Down syndrome. Comparison of pelvic radiographs demonstrated significant improvement concerning measured angles in both groups. Preoperative values with respect to AC angle and CE angle were demonstrated to be lower in the hip dysplasia group (p < 0.01); whereas values for ACM angle were comparable between groups.
  
  
  CONCLUSIONS
  Hypermobility and secondary dislocation of the hip joint is a common problem in patients with Down syndrome, which often requires surgical intervention at an early stage. According to our data and clinical results we suggest a complete redirectional acetabular osteotomy in combination with capsular plication for treatment of this challenging condition.
authors.affiliation: Klinik für Orthopädie und Rheumatologie, Universitätsklinikum Gießen und Marburg, Marburg.
authors.forename: C-D
authors.initials: CD
authors.lastname: Peterlein
authors.affiliation: Klinik für Orthopädie und Rheumatologie, Universitätsklinikum Gießen und Marburg, Marburg.
authors.forename: M
authors.initials: M
authors.lastname: Schiel
authors.affiliation: Institut für Medizinische Biometrie und Epidemiologie, Philipps-Universität Marburg.
authors.forename: N
authors.initials: N
authors.lastname: Timmesfeld
authors.affiliation: Klinik für Orthopädie und Rheumatologie, Universitätsklinikum Gießen und Marburg, Marburg.
authors.forename: M D
authors.initials: MD
authors.lastname: Schofer
authors.affiliation: Orthopädische Klinik, Klinikum Stuttgart - Olgahospital.
authors.forename: O
authors.initials: O
authors.lastname: Eberhardt
authors.affiliation: Orthopädische Klinik, Klinikum Stuttgart - Olgahospital.
authors.forename: T
authors.initials: T
authors.lastname: Wirth
authors.affiliation: Orthopädische Klinik, Klinikum Stuttgart - Olgahospital.
authors.forename: F F
authors.initials: FF
authors.lastname: Fernandez
mesh_terms: D000293:Adolescent; D000328:Adult; D001178:Arthroplasty / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D004314:Down Syndrome / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D005858:Germany; D006617:Hip Dislocation / Q000453:epidemiology / Q000601:surgery*; D006621:Hip Joint / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007223:Infant; D007593:Joint Instability / Q000453:epidemiology / Q000601:surgery*; D008297:Male; D010027:Osteotomy / Q000706:statistics & numerical data*; D019651:Plastic Surgery Procedures / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult