Hip stability during lengthening in children with congenital femoral deficiency.
Congenital femoral deficiency (CFD) is one of the most challenging and complex conditions for limb lengthening. We focused on the problem of hip instability during femoral lengthening because subluxation and dislocation are potentially catastrophic for hip function.



We assessed for hip stability in 69 children (91 femoral lengthenings) who had CFD Paley type 1a (43 children) and 1b (26 children). The mean age at first lengthening was 6.4 years.



Hip subluxation/dislocation occurred during 14 (15 %) of 91 lengthenings. Thirty-three pelvic osteotomies were performed before lengthening in an attempt to stabilize hips. Thirteen patients (type 1a, eight; type 1b, five) had acetabular dysplasia at initiation of lengthening. One of the eight with type 1a experienced mild femoral head subluxation; four of the five with type 1b experienced three dislocations and one subluxation. Eight patients (type 1b) experienced hip instability although they had pelvic osteotomies. Proximal femoral lengthening was a significant factor for hip subluxation. Patients with hip subluxation more likely underwent monolateral fixation and the original superhip procedure. Age ±six years was not a contributing factor for hip instability.



Important risk factors for hip instability during femoral lengthening are severity of CFD, residual acetabular dysplasia, and proximal femoral lengthening. We recommend routine performance of pelvic osteotomy for patients with Paley type 1b CFD and distal lengthening.



Therapeutic Level IV.
Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel.
Mark
M
Eidelman
Department of Orthopaedics, University of Maryland Medical Center, 110 S. Paca, Street 6th Floor, Suite 300, Baltimore, MD, 21201, USA.
Julio J
JJ
Jauregui
International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA.
Shawn C
SC
Standard
Paley Advanced Limb Lengthening Institute, St. Mary's Hospital, West Palm Beach, FL, USA.
Dror
D
Paley
International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA. jherzenberg@lifebridgehealth.org.
John E
JE
Herzenberg
D000293:Adolescent; D001852:Bone Lengthening / Q000009:adverse effects / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005269:Femur / Q000002:abnormalities* / Q000601:surgery; D006617:Hip Dislocation / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D006621:Hip Joint / Q000601:surgery*; D006801:Humans; D008297:Male; D010027:Osteotomy / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies
Congenital femoral deficiency; Hip stability; Limb lengthening; Pelvic osteotomy; Superhip procedure
Clin Orthop Relat Res. 1994 Apr;(301):10-8
8156659
J Bone Joint Surg Am. 2000 Oct;82-A(10):1432-46
11057472
Chir Narzadow Ruchu Ortop Pol. 1974;39(5):601-13
4422569
Clin Orthop Relat Res. 1993 Jun;(291):236-45
8504606
Early Hum Dev. 2013 Nov;89(11):915-8
24094457
J R Coll Surg Edinb. 1996 Aug;41(4):258-64
8772079
J Bone Joint Surg Br. 1991 May;73(3):439-47
1670446
J Pediatr Orthop. 1985 Mar-Apr;5(2):129-34
3988912
J Pediatr Orthop B. 2012 May;21(3):240-7
22186706
Clin Orthop Relat Res. 2014 Dec;472(12 ):3860-8
24664194
J Pediatr Orthop. 1992 May-Jun;12 (3):315-23
1572994
J Bone Joint Surg Am. 1979 Dec;61(8):1182-94
389929
Clin Orthop Relat Res. 1990 Jan;(250):81-104
2403498
J Pediatr Orthop. 1985 Nov-Dec;5(6):642-4
4066934
J Pediatr Orthop. 1994 May-Jun;14 (3):343-6
8006166
J Bone Joint Surg Br. 1979 May;61-B(2):133-7
438260
J Bone Joint Surg Am. 1953 Jan;35-A(1):65-80
13022708
J Pediatr Orthop. 2017 Sep;37(6):416-423
26650581
J Pediatr Orthop. 2001 May-Jun;21(3):354-9
11371820
J Bone Joint Surg Br. 2009 Jul;91(7):962-7
19567864
J Bone Joint Surg Am. 1997 Oct;79(10):1464-80
9378732