Email this article Fibrous hip ankylosis in adolescents: non-standard approach to treatment (clinical observation)
- Authors: Kozhevnikov O.V.1, Kralina S.E.1, Ivanov A.V.1
-
Affiliations:
- N.N. P riorov Central Research Institute of Traumatology and Orthopedics
- Issue: Vol 6, No 3 (2018)
- Pages: 70-77
- Section: Clinical cases
- URL: https://bakhtiniada.ru/turner/article/view/10230
- DOI: https://doi.org/10.17816/PTORS6370-77
- ID: 10230
Cite item
Abstract
The development of secondary deforming coxarthrosis in childhood and adolescence, as a rule, is accompanied by the formation of a pronounced deformity of the hip joint, up to ankylosis, which significantly limits the function of the lower limb and leads to early disability. In most patients, hip ankylosis develops in a vicious position with the resulting flexion-intracavity installation of the lower limb. If such a condition is encountered in childhood and adolescence, treatment currently remains debatable. Various methods are used, ranging from arthroplastic organ-preserving interventions and corrective osteotomies to joint replacement. In this report, we present a clinical case of children treated with post-infectious secondary deforming coxarthrosis with fibrous ankylosis of the hip joint in a vicious position. We applied a coherent combination of modern treatment methods: distraction in the apparatus, arthroscopy, intra-articular injections, physiotherapy, and other rehabilitation. The treatment results were evaluated over a two-year period. In this case, the rational use of a consistent set of remedial measures helped to improve joint function, socialize the patient, and postpone surgery for joint replacement for at least 2 years.
Full Text
##article.viewOnOriginalSite##About the authors
Oleg V. Kozhevnikov
N.N. P riorov Central Research Institute of Traumatology and Orthopedics
Author for correspondence.
Email: 10otdcito@mail.ru
PhD, Head of the 10th Traumatological and Orthopedic Children’s Department
Russian Federation, 10, Priorova str., Moscow, 125299Svetlana E. Kralina
N.N. P riorov Central Research Institute of Traumatology and Orthopedics
Email: 10otdcito@mail.ru
ORCID iD: 0000-0001-6956-6801
MD, Senior Researcher of the 10th Traumatological and Orthopedic Children’s Department
Russian Federation, 10, Priorova str., Moscow, 125299Alexey V. Ivanov
N.N. P riorov Central Research Institute of Traumatology and Orthopedics
Email: 10otdcito@mail.ru
MD, Leading Researcher of the 10th Traumatological and Orthopedic Children’s Department
Russian Federation, 10, Priorova str., Moscow, 125299References
- Танькут В.А., Хвисюк А.Н., Гращенкова Т.Н., и др. Артропластика тазобедренного сустава (обзор литературы) // Ортопедия, травматология и протезирование. – 1989. – № 8. – С. 60–64. [Tan’kut VA, Khvisyuk AN, Grashchenkova TM, et al. Artroplastika tazobedrennogo sustava (obzor literatury). Orthopaedics, traumatology and prosthetics. 1989;(8):60-64. (In Russ.)]
- Кулиш Н.И, Гращенкова Г.Н., Мезенцева P.M., и др. Методика функционального ведения больных после артропластики тазобедренного сустава // Ортопедия, травматология и протезирование. – 1989. – № 8. – С. 31–35. [Kulish NI, Grashchenkova GN, Mezentseva PM, et al. Metodika funktsional’nogo vedeniya bol’nykh posle artroplastiki tazobedrennogo sustava. Orthopaedics, traumatology and prosthetics. 1989;(8):31-35. (In Russ.)]
- Крисюк А.П. Постинфекционный коксартроз у детей и подростков, его профилактика и лечение // Ортопедия, травматология и протезирование. – 1979. – № 8. – С. 36–40. [Krisyuk AP. Postinfektsionnyy koksartroz u detey i podrostkov, ego profilaktika i lechenie. Orthopaedics, traumatology and prosthetics. 1979;(8):36-40. (In Russ.)]
- Гаркавенко Ю.Е. Двусторонние патологические вывихи бедер у детей. // Ортопедия, травматология и восстановительная хирургия детского возраста. – 2017. – Т. 5. – № 1. – С. 21–27. [Garkavenko YE. Bilateral pathological hip dislocation in children. Pediatric traumatology, orthopaedics and reconstructive surgery. 2017;5(1):12-27. (In Russ.)]. doi: 10.17816/PTORS515-12.
- Басков В.Е., Неверов В.А., Бортулев П.И., и др. Особенности тотального эндопротезирования тазобедренного сустава у детей после артропластики деминерализированными костно-хрящевыми аллоколпачками // Ортопедия, травматология и восстановительная хирургия детского возраста. – 2017. – Т. 5. – № 1. – С. 13–20. [Baskov VE, Neverov VA, Bortulev PI, et al. Total hip arthroplasty in children who have undergone arthroplasty with demineralized bone-cartilage allocups. Pediatric traumatology, orthopaedics and reconstructive surgery. 2017;5(1):13-20. (In Russ.)]. doi: 10.17816/PTORS5113-20.
- Тепленький М.П., Олейников Е.В., Бунов В.С. Реконструкция тазобедренного сустава у детей с последствиями септического коксита // Ортопедия, травматология и восстановительная хирургия детского возраста. – 2016. – Т. 4. – № 2. – С. 19–23. [Teplenkiy MP, Oleinikov EV, Bunov VS. Reconstruction of the hip joint in children after septic coxitis. Pediatric traumatology, orthopaedics and reconstructive surgery. 2016;4(2):16-23. (In Russ.)]. doi: 10.17816/PTORS4216-23.
- Скворцов А.П., Андреев П.С., Ягудин Р.Х. Лечение больных с анкилозом тазобедренного сустава в функционально невыгодном (порочном) положении после перенесенного острого гематогенного метаэпифизарного остеомиелита / Материалы Междисциплинарной научно-практической конференции с международным участием «Лечение артрозов. Всё, кроме замены сустава»; Казань, 13–14 мая 2016 г. – Казань, 2016. – С. 169–170. [Skvortsov AP, Andreev PS, Yagudin RK. Lechenie bol’nykh s ankilozom tazobedrennogo sustava v funktsional’no nevygodnom (porochnom) polozhenii posle perenesennogo ostrogo gematogennogo metaepifizarnogo osteomielita. In: Proceedigs of the Interdisciplinary scientific and practical conference with international participation “Lechenie artrozov. Vse, krome zameny sustava”; Kazan’, 13-14 May 2016. Kazan’; 2016. P. 169-171. (In Russ.)]
- Близнюков В.В. Эндопротезирование тазобедренного сустава у пациентов с деформациями бедренной кости: Дис. ... канд. мед. наук. – СПб., 2014. [Bliznyukov VV. Endoprotezirovanie tazobedrennogo sustava u patsientov s deformatsiyami bedrennoy kosti. [dissertation] Saint Petersburg; 2014. (In Russ.)]
- Нуждин В.И., Кудинов О.А., Ерохин П.А., Кузьмин Ф.А. Тотальное эндопротезирование тазобедренного сустава у пациентов, перенесших остеотомию проксимального отдела бедренной кости / Материалы Всероссийской конференции «Эндопротезирование крупных суставов»; Москва, 21–22 апреля 2009 г. – М., 2009. – С. 103. [Nuzhdin VI, Kudinov OA, Erokhin PA, Kuz’min FA. Total’noe endoprotezirovanie tazobedrennogo sustava u patsientov, perenesshikh osteotomiyu proksimal’nogo otdela bedrennoi kosti. In: Proceedings of the All-Russian Conference “Endoprotezirovanie krupnykh sustavov”; Moscow, 21-22 Apr 2009. Moscow; 2009. P. 103. (In Russ.)]
- Волокитина, Е.А., Колотыгин Д.А., Камшинов Б.В. Особенности эндопротезирования при угловых деформациях бедренной кости после опорных остеотомий // Материалы Всероссийской конференции «Эндопротезирование крупных суставов»; Москва, 21–22 апреля 2009 г. – М., 2009. – С. 21–22. [Volokitina, EA, Kolotygin DA, Kamshinov BV. Osobennosti endoprotezirovaniya pri uglovykh deformatsiyakh bedrennoy kosti posle opornykh osteotomii. In: Proceedings of the All-Russian Conference “Endoprotezirovanie krupnykh sustavov”; Moscow, 21-22 Apr 2009. Moscow; 2009. P. 21-22. (In Russ.)]
- Ахтямов И.Ф. К вопросу о преемственности в хирургическом лечении диспластического коксартроза // Вестник травматологии и ортопедии им. Н.Н. Приорова. – 2005. – № 2. – С. 70–75. [Akhatyamov IF. About Succession in Surgical Treatment of Dysplastic Coxarthrosis. Vestnik travmatologii i ortopedii im. N.N. Priorova. 2005;(2):70-75. (In Russ.)]
- Кожевников О.В., Горохов В.Ю., Кралина С.Э. Опыт тотального эндопротезирования тазобедренного сустава у подростков // Российский вестник детской хирургии, анестезиологии и реаниматологии. – 2012. – Т. 2. – № 3. – С. 72–84. [Kozhevnikov ОV, Gorochov VY, Kralina SE. Experience in total hip replacement in adolescents. Rossiiskiy vestnik detskoy khirurgii, anesteziologii i reanimatologii. 2012;2(3):72-84. (In Russ.)]
- Басков В.Е., Неверов В.А. Результат двустороннего тотального эндопротезирования тазобедренных суставов при лечении ребенка с ДЦП // Ортопедия, травматология и восстановительная хирургия детского возраста. – 2015. – Т. 3. – № 4. – С. 44–47. [Baskov VE, Neverov VA. Result of bilateral total hip replacement in the treatment of a child with cerebral palsy. Pediatric traumatology, orthopaedics and reconstructive surgery. 2015;3(4):44-47. (In Russ.)]. doi: 10.17816/PTORS3444-47.
- Хрыпов С.В., Красавина Д.А., Веселов А.Г., и др. Особенности тотального эндопротезирования при лечении вторичного коксартроза различного генеза у детей старшего возраста // Педиатр. – 2017. – Т. 8. – № 4. – С. 43–47. [Khrypov SV, Krasavina DA, Veselov AG, et al. Features of total hip arthroplasty in the treatment of secondary coxarthrosis of different genesis in older children. Pediatrician (St. Petersburg). 2017;8(4):43-47. (In Russ.)]. doi: 10.17816/PED8443-47.
- Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969;51(4):737-755.
Supplementary files
Supplementary Files
Action
1.
JATS XML
2.
Fig. 1. Patient V., 13 years old. Diagnosis: “The consequence of septic coxitis. Secondary deforming coxatrosis on the left. Fibrous ankylosis of the left hip joint”. Clinical picture at admission: flexion-adductive-intrarotational contracture of the left hip joint, pelvic distortion, increased lordosis, and lower limb length inequality
Download (165KB)
3.
Fig. 2. Radiograph and computed tomography (CT) scan of the hip joints. Deforming coxatrosis. The femoral head is deformed, has an irregular shape, and has an uneven contour. The cotyloid cavity also has an uneven contour. Joint space is sharply narrowed and is wavy because of the closure of the articular surfaces of the head and cavity of “puzzle” type. Degenerative-dystrophic changes in the form of areas of subchondral sclerosis, cystic changes, and marginal bone growths. Adduction contracture at an angle of 40°
Download (177KB)
4.
Fig. 3. Radiography image and patient appearance after the first stage of treatment. The distraction wire and rod apparatus is placed on the pelvis and the left hip; due to the distraction, the joint space of the left hip joint is stretched to 1.5 cm. The patient is activated in the apparatus
Download (98KB)
5.
Fig. 4. Treatment and diagnostic arthroscopy of the hip joint: a — the joint cavity is absent, filled with scar tissues; b — after excision of scars, a joint cavity is formed
Download (122KB)
6.
Fig. 5. The range of movements in the hip joint after arthroscopic joint lavage
Download (175KB)
7.
Fig. 6. The distraction apparatus was reassembled, and the lower limb was removed from the vicious position
Download (163KB)
8.
Fig. 7. Passive working out of movements in the hip joint in the apparatus
Download (84KB)
9.
Fig. 8. After apparatus dismantling, the cuff extension was continued on a plane using therapeutic gymnastics and other methods of rehabilitation
Download (195KB)
10.
Fig. 9. Learning to walk with graduated weight bearing on the left lower extremity on the Lokomat robotic complex
Download (102KB)
11.
Fig. 10. Clinical and radiological results after 2 years of treatment (described in the text)
Download (248KB)
