The decision to undertake total hip replacement (THA) in a child is complex and daunting. This is augmented by the paucity of data on potential quality of life (QoL) improvement and functional outcomes. Therefore, the aim of this study was to ascertain whether outcomes after surgery are influenced by the nature of the primary diagnosis. This was a prospective, consecutive cohort study of patients under the age of 18 years undergoing THA by a single arthroplasty surgeon in collaboration with colleagues at a regional paediatric hospital. Patient electronic notes, radiographs and PROMS (EQ5D-Y, Oxford Hip Score (OHS) and modified Harris Hip Score(mHHS)) were reviewed. Twenty-two THAs were performed in patients less than 18 years (median 15 (range 10.7–17.9), with 7 patients undergoing bilateral surgery. Mean follow-up was 2 years. Thirteen of the THAs were undertaken for systemic conditions effecting multiple joints (Mucopolysaccharidoses, Mucolipidosis and Scwachman-Diamond syndrome) with the hip the worst affected joint and 9 for single joint disease (AVN, Perthes, dysplasia and idiopathic chondrolysis). PROMS scores showed reliable improvements with no differences between the two groups. Health related QoL was calculated from EQ5D-Y and indicated an overall improvement of 1.06(0.879–1.25). 6 patients were wheelchair users preop. All patients were independent walkers at follow-up. One patient underwent successful revision surgery for aseptic acetabular loosening. There were no other complications. THA in children leads to a significant positive impact on QoL as measured with validated PROMS scores. Patients with systemic conditions can benefit just as much as those with single joint disease. Further follow-up is required to understand the long-term outcomes.
The decision to undertake THA in a child is complex and surgery challenging. Pre-operatively patients' typically have significant pain and mobility restriction. Little is published on the functional gains after THA in this group. The aim of this study was therefore to measure the impact THA had on the PROMS in our young patients undergoing THA, to determine QoL improvement. This was a prospective, consecutive cohort study of patients under the age of 17 years undergoing THA by a single surgeon in a tertiary referral centre. Patient electronic notes, radiographs, and PROMS (EQ5D-Y, Oxford Hip Score (OHS) and modified Harris Hip Score (mHHS)) were reviewed. 12 children (8 females and 4 males) underwent THA before their 17th birthday, with 5 undergoing bilateral operations (17 THA total). The mean age was 14.6 years (10.75–16.9) and mean follow-up 1.5 years. Nine of the THA were undertaken for congenital syndromes, 4 for AVN, 2 for Perthe's disease and 1 for dysplasia and idiopathic chondrolysis. The mean pre-operative OHS was 15 (1–33) improving to 31 (19–39) at 6-weeks, 44 (42–46) at a year and 48 (47–48) at 3 years. mHHS improved from a pre-operative mean of 25 (0–56) to 60 (37–92) at 6-weeks, 65 (38–84) at a year and 91 (91) at 3 years. The EQ-VAS mean score pre-operatively was 35 (8–100) improving at 6-weeks to 73 (55–96), 84 (76–96) at a year and 92 (76–100) at 3 years. All patients achieved MCID or higher for OHS. 6 patients were wheelchair users preop. All patients were independent walkers at follow-up. There were no complications. THA in children is safe and leads to a significant positive impact on QoL as measured with validated PROMS scores. Wheelchair users can reliably gain independent walking. Further follow-up is required understand the long-term outcomes.
Unstable pelvic injuries in young children with
an immature pelvis have different modes of failure from those in adolescents
and adults. We describe the pathoanatomy of unstable pelvic injuries
in these children, and the incidence of associated avulsion of the
iliac apophysis and fracture of the ipsilateral fifth lumbar transverse
process (L5-TP). We retrospectively reviewed the medical records
of 33 children with Tile types B and C pelvic injuries admitted
between 2007 and 2014; their mean age was 12.6 years (2 to 18) and
12 had an immature pelvis. Those with an immature pelvis commonly
sustained symphyseal injuries anteriorly with diastasis, rather
than the fractures of the pubic rami seen in adolescents. Posteriorly,
transsacral fractures were more commonly encountered in mature children,
whereas sacroiliac dislocations and fracture-dislocations were seen
in both age groups. Avulsion of the iliac apophysis was identified
in eight children, all of whom had an immature pelvis with an intact
ipsilateral L5-TP. Young children with an immature pelvis are more
susceptible to pubic symphysis and sacroiliac diastasis, whereas
bony failures are more common in adolescents. Unstable pelvic injuries
in young children are commonly associated with avulsion of the iliac
apophysis, particularly with displaced SI joint dislocation and
an intact ipsilateral L5-TP. Cite this article:
