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  • Title: Reorientational Proximal Femoral Osteotomies for Correction of Hip Contractures in Children with Arthrogryposis.
    Author: van Bosse HJP.
    Journal: JBJS Essent Surg Tech; 2017 Jun 28; 7(2):e11. PubMed ID: 30233946.
    Abstract:
    INTRODUCTION: Reorientational osteotomy of the proximal part of the femur for children with arthrogryposis repositions the various arcs of hip motion into a more functional sphere of motion, addressing the hip contractures that otherwise are the main mechanical impediments to ambulation. STEP 1 PREOPERATIVE ASSESSMENT: Determine hip range of motion clinically and obtain radiographs to confirm that the hips are located and there are no unusual structural abnormalities. STEP 2 PATIENT POSITIONING AND DRAPING: Position the patient supine with a bump at the sacrum, and drape to allow access to both hips simultaneously. STEP 3 INITIAL PERCUTANEOUS ANTERIOR HIP RELEASE: Perform an initial anterior hip release for patients with a palpable soft-tissue flexion contracture. STEP 4 SURGICAL APPROACH TO THE PROXIMAL PART OF THE FEMUR: Make a standard approach to the lateral aspect of the proximal part of the femur. STEP 5 BLADE-PLATE POSITIONING: Position a guidewire for the appropriate correction; then cut a track for the blade plate with a seating chisel. STEP 6 WEDGE-SHAPED INTERTROCHANTERIC OSTEOTOMY: Perform 2 intertrochanteric osteotomy cuts to provide cut surfaces that, when joined together, will position the lower extremity optimally. STEP 7 APPLYING THE BLADE PLATE AND CLOSURE: Impact the blade plate into the proximal fragment and secure it to the distal fragment. STEP 8 POSTOPERATIVE MANAGEMENT: Apply a Petrie cast, and instruct the parents on how to maintain hip motion. STEP 9 PLATE REMOVAL: Remove the blade plate on an outpatient basis 12 to 18 months after the osteotomy, through the smallest incision possible to allow a quicker recovery. RESULTS: We performed reorientational osteotomies on 68 consecutive children with arthrogrypotic multiplanar hip contractures over a 5-year span, and 65 were followed for at least 2 years; 54 of these patients had a bilateral hip contracture, for a total of 119 reorientational osteotomies.
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