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Background. Patients with amyoplasia-type arthrogryposis and hip dislocation have different variants of hip contractures and deformities, but there is no difference in the selection of the type of surgery. The study aimed to justify and evaluate the effectiveness of the original algorithm of the rational selection of surgical approaches in children aged 3 years with hip dislocation in amyoplasia. Material and Methods. Level of evidence II. Seventy patients were examined, including 21 children aged 1 year (main group) who underwent 25 hip open reductions; 19 children aged 1.53 years (main group) who underwent hip open reductions, Salter innominate osteotomy, and femoral osteotomy; and 30 patients aged 37 years (control group) who had not previously received conservative and surgical treatment. All patients were divided into two subgroups depending on the variant of hip contracture: flexionextensionabductionexternal rotation (frog-like) (subgroup 1) and flexionextensionadductionexternal rotation (subgroup 2). Clinical, radiological, and statistical methods were used. Results. In subgroup 1, after hip open reduction, good results were noted in 17% of cases, satisfactory in 50%, and unsatisfactory in 33%. Severe complications, i.e., classes III and IV according to the modified ClavienDindoSink classification, were noted in 83% of the cases. After hip open reduction, Salter innominate osteotomy, and femoral osteotomy in subgroup 1, good results were noted in 50% of cases and satisfactory and unsatisfactory each in 25%, and 50% had less severe complications (p = 0.041). In subgroup 2, after hip open reduction, good results were obtained in 90% of cases and satisfactory in 10%, and 10% had severe complications When this surgery was combined with Salter innominate osteotomy and femoral osteotomy, good results were noted in 75% of cases, satisfactory in 19%, and unsatisfactory in 6%, and 25% had severe complications (p = 0.05). Conclusion. A differentiated treatment approach of children with hip dislocation in amyoplasia-type arthrogryposis will increase the effectiveness of treatment methods, and its introduction into clinical practice will help to improve outcomes.

Introduction The article is a literature review focusing on reconstruction surgery for dislocated hips in children with cerebral palsy (CP). Material and methods Publications in Scopus, PubMed, RSCI indexed journals over the past 20 years were reviewed for hip dislocation in children with CP. Results and discussion The article discusses the prevalence of the orthopaedic complication of cerebral palsy, pathogenesis, diagnosis, indications to surgery, choice of surgical technique, early rehabilitation and long-term outcomes. A report made for the first educational meeting of the European Pediatric Orthopaedic Society held in Russia at the Ilizarov Center in 2021 was used for the contribution. Conclusion Surgical treatment is indicated for hip dislocation in children with CP using holistic approach and principles of single-event multilevel surgery that suggest hip reconstruction, addressing contractures and deformities of the subjacent segments and creating conditions for postoperative postural management. Standardized indications, patient selection and optimal time for intervention are to be carefully considered for the procedure with the use of customized orthopaedic implants and techniques.

Introduction Hip joint arthroplasty combined with shortening osteotomy is a technically difficult surgical intervention. Transection of the femur is possible both with the free-hand method and with the use of special devices. Purpose To evaluate the efficiency of using a special device for shortening osteotomy in total hip arthroplasty in comparison with the operations performed without an osteotomy guide. Materials and methods There were 16 hip replacement surgeries that included shortening osteotomy performed in patients with high dislocation of the femur. The group was divided into 2 subgroups: the study subgroup (8 cases), in which a special device was used for osteotomy, and the control subgroup (8 cases). We used clinical and radiographic study methods, and assesssed the Harris Hip Score (HHS) before and after treatment. Results Duration of the intervention and intraoperative blood loss in the first subgroup were shorter than in the control group but the difference was not statistically significant. The mean HHS increased significantly in the whole group. The midterm HHS in the study subgroup was 85.4 ± 1.9 points, which slightly differed from the control (81.9 ± 1.2 points). The mean follow-up period was 40 ± 8 months. There were two cases of nonunion in the osteotomy site and one case of transient sciatic neuropathy. Two patients with nonunion of the femoral fragments were treated by plating and bone grafting. Conclusion The use of a special device for subtrochanteric osteotomy technically simplifies the arthroplasty procedure in patients with high dislocation of the femur, shortens the operation time and reduces blood loss.

Objective Explore changes in roentgenoanatomical parameters of the pediatric hip joint following multilevel reconstructive surgeries performed for CP patients in combination with derotation varus osteotomy (DVO) alone or DVO and acetabuloplasty (AP). Material and methods The study included 49 children (30 GMFCS level IV and 19 GMFCS level V patients). Either DVO (n = 28, 44 joints, mean age 6.98 ± 2.2 years) or DVO and AP (n = 21, 38 oints, mean age 7.0 ± 2.04 years) were produced in combination with multilevel reconstructive surgeries to eliminate contractures of the knee and ankle joints and correct foot deformities. The acetabular angle, the Reimers' index, the acetabular depth ratio (ADR), the Wiberg center-edge angle were measured preoperatively, straight after surgery and at 1, 2, 3 years postsurgery. Results Normal relationship between the femoral head and acetabulum persisted at a long-term follow-up. The parameters evaluating acetabular morphology (Wiberg angle, AI and ADR) were shown to improve or remain stable. The mean annual increase in the Reimers' index was not more than 3 % after DVO and not more than 2% following DVO and AP. A reverse statistically significant correlation was detected between the AI and Wiberg angle after DVO alone or DVO combined with AP throughout the observation period. This sort of correlation facilitated beneficial development of the operated hips at a long term following reconstructive interventions. Moderate correlation was observed in changed AI values after DVO at 3 years postsurgery and changes in the Wiberg angle at three-year observation comparing relative measurement changes and the age when surgery was performed. Age appeared to have a minor effect on the development of the hip following multilevel procedures produced for the cohort of patients. Conclusion Appropriate conditions should be provided for normal development of the hip to address hip dislocation using growth-remaining potential and remodeling the articular ends. Single-event multilevel surgery involving hip reconstruction and addressing knee and ankle contractures is practical for providing favorable conditions for postural management and passive verticalization of patients to maintain axial loading on the limbs.

Abstract Purpose of the study: to find a correlation between radiological and biomechanical parameters of a hip joint (HJ) in case of dysplastic instability for dystrophic process in the joint study. Materials and methods. Clinical and radiological data of 154 patients aged from 2 to 13 years with dysplastic instability of a HJ the development of which was being observed from 2 to 5 years (189 joints) were studied. The following parameters of a HJ were determined: acetabular index, cervico-diaphyseal angle, centration of the femoral head. All the measurements were performed by plain pelvis radiographs without special positioning the patient. The stress and strain state in the acetabulum and proximal part of the femur was studied using the finite element method. The stress intensity (stress of von Mises, measured in MPa) was chosen as a basic characteristic, which is one of the most informative one for the stress and strain state evaluation. Results. The study has shown that of the three types of decentration such as coaxial, non-coaxial with downward and lateral acetabular center displacement from a HJ center, non-coaxial with downward and medial acetabular center displacement, the last-mentioned has turned out to be less favorable. Moreover, an increased angle of deviation corresponded to greater width and sclerosis intensity of a HJ subchondral surface and also fragmentation of the femoral head was observed in the majority of cases. Studied stress and strain state in a HJ has revealed that decentration in a joint is a key factor, which leads to osteartrosis development. The large decentration, the more severe stress intensity at the lower part of the femoral head and at the upper border of the acetabulum was. Thus, the value of stress intensity at the upper part of the femoral head decreased and was 2.3 MPa comparing with the normal one 2.5 MPa; at the lower part it increased to 2.3 MPa, that was twice higher than the normal one. On the front edge of the acetabulum the stress state level was about 2.3 MPa, which was almost four times more than the normal one (0,6 MPa) in this region. Increase in acetabulum curvature didn’t change the pattern of stress and strain state distribution, but it led to increase in strain level especially at the posterior superior part of the acetabulum and, respectively, at the contact region of the femoral head. Conclusions. The femoral head rotational center shift changes the pattern of stress and strain state distribution in a HJ in comparison with the norms, increases the stress at its lower part and also increases stress state at the upper acetabular edge. Increase in acetabulum curvature doesn’t change the pattern of stress and strain state distribution, but it leads to increase in strain level especially at the acetabular posterior superior part and, respectively, at the contact region of the femoral head. Decentration of HJ elements is the main etiological factor of its instability leading to the further dystrophic transformation of the joint. Biomechanic modeling of decentration in a HJ using the finite element method has proved the fact of complex changes in HJ structures at the early stages of the pathological process development, revealed understanding of the decentration process in a joint, contributed to working out the dystrophic process early prevention and treatment tactics.

Introduction The purpose of this work was to study the results of orthopedic correction performed according to the principles of one-stage multilevel surgical intervention in cerebral palsy patients with hip dislocation. Material and methods We studied the results of operative orthopedic treatment in 50 children suffering from cerebral palsy (GMFCS levels IV and V, mean age 6.2 ± 1.4 years at the beginning of treatment) who underwent multilevel interventions with the purpose of hip joint reconstruction and correction of other orthopedic complications of cerebral palsy in the knee and foot. The parameters of the orthopedic status were studied as well as such radiographic data as the Reimers index, acetabular index, acetabular frontal depth index, projection neck-to-shaft angle, Wiberg index, tibiotalar angle, angle of the talocalcaneal divergence in the sagittal and frontal planes, coverage of the head of the talus with the navicular bone. The mean follow-up period was 2.8 ± 1.7 years. Results Patients underwent 91 reconstructive interventions during the study period involving 461 surgical elements (5.07 per operation on average). The goals of the pathology correction were achieved in all cases. In all patients, by the end of the first year after the operation, hip abduction was more than 30 degrees and flexion was more than 100 degrees. Comfortable sitting posture and correct passive symmetrical verticalization, pain relief in everyday life were reported in all cases. The shape and position of the foot made it possible to use comfortable regular footwear during verticalization, as well as during walking. By the end of the second follow-up year, a decrease in hip abduction to 20 ° was detected in only two patients. In two cases, a partial recurrence of foot valgus was observed which occurred by axial limb loading and required the use of an orthotic appliance. All radiological indicators examined after the treatment remained within the limits of normal values during the follow-up period. But there was a mild tendency to reduction of hypercorrection achieved which was within the normal boundaries. Conclusion Multilevel operations in children with severe types of cerebral palsy and hip dislocation as the leading pathology are aimed at achieving correction of all orthopedic problems in the lower limbs. The result of such interventions is not only normal anatomical parameters but also the creation of conditions for rehabilitation measures, especially postural management, which is extremely important for normal hip joint development and prevention of hip subluxation and dislocation recurrence in children.

Introduction. Hip dislocation is the key problem in patients with severe cerebral palsy (GMFCS IV, V) older than 10 years that affects life quality and limits functional capabilities. In the present study the authors evaluated the efficiency of the proximal femoral resection arthroplasty (pfra) and valgus proximal osteotomy of the femur (VPOF) associated with femoral head resection for pain control, improvement of postural management, hygiene and verticalization with total weight-bearing and correction of accompanying orthopaedic deformities. Material and мethods. A retrospective study compared two groups of patients where PFRA (7 cases, 13 hips) or VPOF (14 patients, 23 hips) were performed. Level V of GMFCS was reported in 10 patients, and level IV of GMFCS – in 11 patients. The mean age at time of surgery was 15.3±3.9 y.o. PFRA was performed in 7 cases (13 joints) and VPOF – in 14 patients (23 joints). Results. The authors did not observe any difference between the methods in respect of pain control, postural management, comfortable sitting position and hygiene. The verticalization with total weight-bearing and life quality improvement was achieved only after PVOF with femoral head resection associated with simultaneous knee and foot deformity correction performed according to the principles of Single-Event Multilevel Orthopedic Surgery. Conclusion. Both palliative methods allow to control pain syndrome, to achieve satisfactory postural management, comfortable sitting position and hygiene. But only VPOF with simultaneous knee and foot deformity correction provides possibility to verticalize the patient with weight-bearing using different orthopedic devices.

More and more people use baby slings and wraps instead of wheelchairs. The child is in front of the person who wears them. The baby weight is distributed evenly and symmetrically. Carrying a baby in a sling is safe, doesn’t damage a locomotor system if the binding in a sling is good. Carrying a baby in a sling helps in treatment hip dysplasia and has a good outflow on the hip joints in infants.