Reorientational Proximal Femoral Osteotomies for Correction of Hip Contractures in Children with Arthrogryposis.

Abstract

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. Determine hip range of motion clinically and obtain radiographs to confirm that the hips are located and there are no unusual structural abnormalities. Position the patient supine with a bump at the sacrum, and drape to allow access to both hips simultaneously. Perform an initial anterior hip release for patients with a palpable soft-tissue flexion contracture. Make a standard approach to the lateral aspect of the proximal part of the femur. Position a guidewire for the appropriate correction; then cut a track for the blade plate with a seating chisel. Perform 2 intertrochanteric osteotomy cuts to provide cut surfaces that, when joined together, will position the lower extremity optimally. Impact the blade plate into the proximal fragment and secure it to the distal fragment. Apply a Petrie cast, and instruct the parents on how to maintain hip motion. 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. 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.