PAPER 051: ARTICULATED HIP DISTRACTION ARTHROPLASTY: A TREATMENT OPTION FOR AVASCULAR NECROSIS AND CHONDROLYSIS OF THE CHILD AND ADOLESCENT FEMORAL HEAD

Abstract

Purpose: To describe the clinical outcomes of adolescent patients, treated with hip distraction arthroplasty for avascular necrosis (AVN) of the femoral head. Outcomes were examined in order to better understand the usefulness and indications of performing hip arthrodia-stasis in this patient population.

Method: Retrospective review was performed on thirty-one hips with femoral head AVN treated with hip distraction arthroplasty. Mean age at treatment was 14.2 years. Preoperative and follow-up pain, and physical limitations, as well as follow-up range of motion (ROM) were assessed.

Results: Follow up assessment was obtained at 18.3 years of age. Time of follow up was 55.3 months after distraction. The etiologies of AVN were: 11 Slipped Capital Femoral Epyphysis (SCFE); 5 Idiopathic AVN; 3 with hip dysplasia; and 12 others. There was a significant difference in pain preoperatively and postoperatively (p< .001), the majority of patients (79.5%, n=23) had less pain after the treatment. Multivariate regression model demonstrated that patients with SCFE were likely to have less improvement in pain than patients with other etiologies (odds ratio: 24.8; p=.035). All patients had activity limitations before the treatment; at the postoperative assessment more than half of our patients (n=15) reported no limitations in their activities. Nine patients had minor complications with the fixator. At follow up, 5 (16.1 %) patients converted to total hip replacement or arthrodesis.

Conclusion: Hip distraction arthroplasty in adolescent patients with symptomatic AVN reduces the amount of pain and limitation in daily activities, at a follow up of 4.6 years. Arthrodiastasis is not the final solution to AVN, with longer follow up patient’s symptomatology increases. Patients with AVN secondary to SCFE do not beneficiate of this procedure as much as other patients do. Hip distraction is a safe and appropriate procedure to perform in these patients. The procedure might be able to delay definitive surgical procedures at an early age, restoring function and improving the patient s quality of life.