Abstract
To evaluate the clinical and radiographic correction obtained by distal and lateral advancement of the greater trochanter in patients with a positive Trendelenburg’s sign and a “gluteus medius lurch” kind of limp due to avascular necrosis of the capital femoral epiphysis following treatment of developmental dysplasia of the hip (DDH) or septic arthritis (SA).
The results of trochanteric advancement were evaluated in 24 hips of 18 patients with relative overgrowth of the greater trochanter because of avascular necrosis of the femoral head. There were 10 girls and eight boys with a mean age of 12 years (range 8 to 18 years). The deformity was bilateral in six and unilateral in 12 patients. Etiology was DDH in 20 hips of 15 patients and SA in four hips of three patients. The mean follow-up period was four years and two months (range 1 to 7 years). Radiographically, the articulotrochanteric distance (ATD) is used to assess the position of the greater trochanter in relation to the femoral head. All patients showed both clinical and radiographic improvement postoperatively. The Trendelenburg’s sign, which was positive in all patients preoperatively, became negative in 18 hips of 14 patients and Delayed positive in six hips of four patients. Abduction increased a mean of 25 degrees in 15 hips of 13 patients. On clinical evaluation, the results were excellent in 17 hips, good in five hips, and moderate in two hips. Radiographically, the ATD which was −10,5 mm (range −24 to +8 mm) preoperatively, became 22 mm (range −5 to +42 mm) postoperatively Trochanteric advancement leads to satisfactory clinical results in patients with a positive Trendelenburg’s sign and a gluteus medius lurch.
Although this operation does not affect the degenerative process in the hip joint. It improves the patients’ gait and the problem of getting tired easily are overcome. Furthermore, it provides a good understructure for future reconstructive operations of adult age
Local Host: British Society for Children’s Orthopaedic Surgery. Conference Theme: Congenital Deficiencies of the Lower Limb. These abstracts were prepared by A.Catterall.
