The use of new technologies in the functional treatment of children with congenital dislocation of the hip before the age of 3 years 
 

Kutsenok Ya.B. 
SI «Institute of Traumatology and Orthopedics of National Academy of Medical Sciences of Ukraine», Kyiv

Objective: to reduce the invasiveness and to extend the scope of the functional treatment in congenital dislocation of the hip (CDH) through the use of ultrasound (US) monitoring and navigation, as well as arthroscopic techniques.

Materials and methods. Author has an experience of active functional treatment using Pavlik harness in 1,000 children with CDH who started treatment before the age of 6 months, and more than 500 children with CDH aged 6 months to 3 years. In approximately half of these children, we have used US-navigation to select the optimal position of hips. US-topographic anatomy of the hip joint (HJ) at the stages of functional treatment has been studied by the author in the 1990s together with A.Ya. Vovchenko. Treatment of children has been carried out using active functional method under UScontrol in 5 stages (periods): preparation, reduction, control, full development, early rehabilitation, under the age of 6 months — using Pavlik harness, in older children — by vertical traction with gradual abduction of the legs.

Results and discussion. Functional treatment was carried out at the position of flexion, abduction and rotation of the hips out, in children up to 6 months — using Pavlik harness, and from 6 months to 3 years — by traction in the vertical plane, with a gradual increase in the abduction of the hips. Selecting the position of the hips was justified by an analysis of topographic anatomy of HJ studied by us together with A.Ya. Ravytska in the early 1960s when developing intrapelvic access to HJ and Ludloff approach analysis. Treatment of children was performed by means of active and functional method using US-monitoring, in 5 stages. Spontaneous reduction was observed in 93% of children in youn ger age group, and in 55% of older children. Reduction was achieved in 3% of children in younger age group, and in 12% — the older one. It should be emphasized that about a quarter of the children we observed before admission were treated without achieving reduction. In the case of conservatively irreducible dislocations, a surgical treatment should be applied. With the modern development of surgical technique, arthroscopic technology (AST) may be a golden key of Pinocchio for the treatment of children with irreducible CDH allowing to eliminate the blockade and to open the access to the acetabulum without open surgery. We believe that through the use of AST with US-navigation, invasiveness of reposition substantially reduced that increases the ability of HJ tissues to the full development and the formation of a full-fledged joint.

Conclusions. The use of multipositional and functional US made it possible to distinguish three types of CDH: reducible dislocations (90–55%), with no obstacles to the free penetration of the femoral head in the acetabulum; conditionally reducible (6–36%) — there are obstacles blocking the entrance to the acetabulum, which can be eliminated under the influence of preparatory treatment and/or changes in the hip position, under US guidance; irreducible dislocations (4–9%) — there are obstacles for head penetration in the acetabulum or the head diameter is greater than the diameter of the acetabulum by more than 15%. Percentage of conditionally reducible and irreducible dislocations increases with patient’s age. In the case of irreducible dislocation, to remove obstacles it is re commended the use of arthroscopic techniques for repositioning the articulart lip, resection of tissues filling the acetabulum, dissection of the capsule of the isthmus, dissection of the transverse ligament of the acetabulum. The operation is performed under the control and US-navigation in online mode, which provides a minimal invasiveness and radicality. Further stages of the treatment carried out in the same way, as after the elimination of dislocation conservatively.

Key words: congenital dislocation of the hip, hip joint, ultrasound navigation, arthroscopic techniques.

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