PRAGUE A team from the Medical University of
South Carolina, in Charleston, U.S.A., found that performing a
proximal femoral extension osteotomy was effective in cases
hip flexion contracture in pediatric patients due to spastic
arthrogryposis and other conditions.
Yuehuei H. An, BMed, MMed, presented the clinical
results of the retrospective study of eight patients with a mean age 14 years
who had hip flexion contractures with lumbar lordosis averaging more than
46º and discussed a new surgical technique for treating this condition
SICOT XXV Triennial World Congress 2011.
An noted that all of the cases were carried out by
Richard Gross, MD.
Blade plate stabilization
All patients were doing well at an average 14
months follow-up with improved standing posture and gait, An said. The
mean follow-up ranged from 3 months to 40 months, according to the
Two patients in series were diagnosed with spastic
cerebral palsy and arthrogryposis, and one patient each was diagnosed with
metaphyseal dysplasia, neuromuscular scoliosis, sequelae of a septic hip and
For the posteriorly-based closing wedge osteotomy done
at the intertrochanteric level in these cases, surgeons made a lateral incision
and a straight osteotome and a blade plate fixed with screws to stabilize the
osteotomy were typically used.
The postoperative care was patients getting
[physical therapy] PT the next day and weightbearing as tolerated with the aid
of a walker or crutches, An said.
Sacrofemoral angle identified
An and colleagues evaluated several factors
postoperatively, including correction of the sacrofemoral angle
radiographically, which is normally 45° to 65°, assessment of the
patients gait and standing posture, and identification of
most osteotomies, the chisel is placed perpendicular to the long axis of the
femur. For this one it is angled from anterior distal to posterior proximal.
The angle between the chisel placement and a line perpendicular to the long
axis of the femur will dictate the amount of extension achieved when the
instrumentation is placed.
Image: Gross R
At the patients last follow-up examination at 14
months, investigators found that the improvement in sacrofemoral angles
the radiographic angle between the upper surface of the sacrum and the shaft of
the femur averaged about 33°, An noted.
Despite these good results, he cited the few cases in
the series and the lack of family/patient functional outcome scoring among the
During the papers discussion, Gross noted that he
uses the Tönnis test to check the sacrofemoral angle while the patient is
under anesthesia. He has successfully corrected hips with up to 60º
contracture using this method. by Susan M. Rapp
- An Y, Gross R. Proximal femur extension osteotomy for treatment of
flexion contracture of the hip. Paper #29304. Presented at the SICOT XXV
Triennial World Congress 2011. Sept. 6-9. Prague.
- Yuehuei H. An, BMed, MMed, can be reached at North Short LIF
Southside Hospital, 301 E. Main St., Bay Shore, NY 11706, USA; +1-631-968-3777;
- Disclosure: An has no relevant financial disclosures.
The hip flexion deformity is a condition that interferes
greatly in the function of the patient. In a nonambulator patient, the sitting
position becomes abnormal creating points of hyper-pressure; and in an
ambulatory patient it increases the lumbar lordosis and the gait becomes less
effective with more energy cost.
The indication for surgical treatment is individualized
as in almost all neuromuscular conditions.
The group of patients presented in this study varies in
the etiology of the clinical condition and could have an effect in the results,
but it is a not common deformity to surgically treat.
Before the surgical indication, there is the need to
check if the excessive lumbar lordosis is still flexible otherwise approaching
the hip only could not be as effective.
The surgical treatment starts with soft tissue release
over the hip joint but rarely has the power to correct deformities greater than
The surgical technique presented is probably the only
way to correct the deformity because of the age of the patients and the
severity of it. The osteotomy shown is very effective with low complications.
The only point that should be taken is that the follow-up period was not long
enough; time until the skeletal maturity is needed to assess the final outcome
of these patients.
Patricia Fucs, MD, PhD
Immediate past Treasurer, SICOT
Disclosure: Fucs has no
relevant financial disclosures.