|Beitragstitel||Proximal femoral osteotomies in adult patients with combined surgical hip dislocation: First results with the LCP Pediatric Hip Plate (TM)|
Introduction: Torsional deformities, valgus and varus deformities and focal osteonecrosis of the femoral head are indications for proximal femur osteotomies (PFO) in adults. We often combine PFO with surgical hip dislocations (SHD) to address concomitant intraarticular problems. Blade plates have been routinely used for PFO, but refixation of the trochanteric osteotomy (TO) in the setup of SHD is challenging. The LCP Pediatric Hip Plate TM allows fixation with locking screws in the femoral neck facilitating refixation of the TO. Various plates with different shaft-neck angles allow basically any correction. We report our first experiences for PFO using the Pediatric Hip Plate (TM) with concomitant surgical hip dislocation.
Methods: We retrospectively analyzed radiological and clinical outcome of 21 patients (21 hips) with PFO using the Pediatric Hip Plate (TM) and SHD with TO between 12/2008 and 01/2016. Adult patients (>16 years) with a minimum followup period of 1 year were included. Indications for PFO included combined valgus and high femoral antetorsion (7 hips), isolated high femoral antetorsion (5 hips), hip dysplasia (3 hips) and avascular necrosis of the femoral head (6 hips). Mean age was 28 years +/- 9 (18-51years). Indications for SHD included inspection of cartilage damage, offset correction and intraoperative testing of impingement.
Results: Twenty-one patients (21 hips) were included. Isolated deformity correction was performed in 12 hips (57%), combined varisation and derotation or flexion in 9 hips (43%). Mean corrective angle for varisation was 16° +/- 4 (10-20) and 22° +/- 7 (15-40°) for derotation. Time to union was 5 ± 3 months (2 – 12 months) for the PFO and 2 +/- 0.5 months (2-3 months) for the TO. Mean followup time was 2 ± 1 years (1 – 6 years). Complications were observed in 4 hips (22%) including revision osteosynthesis due to non-union of the PFO in 2 hips (10%) and implant failure due to loosening of one screw without revision surgery in 2 hips (10%). Non-union of the TO after one year was observed in one hip (5%). No deep wound infection occurred.
Conclusion: The LCP Pediatric Hip Plate (TM) is an implant with acceptable complication rate for PFO in adult patients. It allows corrections in all planes and stable fixation of the head-neck fragment as well as the trochanteric fragment with conventional screws when a concomitant surgical hip dislocation is performed. It represents an alternative to the traditional blade plate.