SURGICAL MANAGEMENT OF NEUROLOGICAL PARA-OSTEO-ARTHROPLATHIES OF THE HIP

Abstract

Purpose: We report an retrospective analysis of 33 patients with neurological para-osteo-arthroplathy of the hip who underwent surgery between 1985 and 1999.

Material and methods: Forty-three hips were operated in 33 patients aged 14 to 50 years at the time of the accident. Twenty-two patients had head trauma, two had spinal cord injury and three both. The causal mechanism was: trauma 27 patients, rupture of an inta-cranial aneurysm in five patients, widespread burns one patient. Localisations were inferome-dial 14 patients, anterior 10 patients, posterior two patients, circumferential five patients. Surgical care included complete resection in 30 cases, resection of the head and neck in six, and implantation of a total hip arthroplasty in seven. There were several perioperative accidents: two vessel injuries, two persistent bleedings, one haematoma, eight superficial infections, six recurrences, one ankylosis and one death. Functional outcome was assessed on the basis of gain in amplitude of hip flexion.

Results: Analysis was possible for 37 of the 43 hips. Outcome was good in 18 (flexion gain greater than 90°), fair in nine (flexion gain from 60 to 90°), poor in ten (flexion gain less than 60°). Complete resection gave better results (61.5%). Total hip arthroplasty gave mediocre results. The best results were obtained with resection for the inferomedial and anterior localisations.

Discussion: The decision for surgery should be discussed in light of the objectives to be achieved. We present our surgical strategy as a function of the localisation. We advocate systematic verification of the vascularisation and prefer the obturator approach for inferomedial localisations. The risk of recurrence depends on the delay from the accident to surgery.

Conclusion: Based on this retrospective series, we prefer surgical resection after the first year. We emphasise the importance of peroperative verification of the vascularisation.