EVALUATION OF EARLY OPEN REDUCTION OF THE HIP IN CHILDREN WITH AMYOPLASIA
Open reduction of the hip is the method of choice for children under 1 year with amyoplasia, however, it is accompanied by a high rate of complications such as reluxation, subluxation (11-46%) and avascular necrosis of the femoral head (AVN) (5-63%). To evaluate results of open reduction of the hip with different contractures in children with amyoplasia. We evaluated the results of 25 open reduction of the hip performed in 21 children with amyoplasia; follow-up periods ranged from 2.6 to 6 years. We used clinical, radiological and statistical methods. In children with abduction contractures of the hip after surgery, good results were noted in 1 case (17%), satisfactory in 3 cases (50%), and poor in 2 cases (33%). The reasons of poor outcomes (reluxation, subluxation, III group AVN of the femoral head according to Kalamchi-MacEwen classification) in 4 cases (83%) were irreparable external rotation contracture and retrotorsion of the femur, which did not allow to achieve a stable concentric reduction, as well as underdevelopment of the external and anterior edges of the acetabulum. After surgery, performed in patients with adduction contractures, noted development of the external and anterior edges and decrease in its anteversion, which led to good results in 17 cases (90%), satisfactory - in 2 cases (10%). Complications observed in 2 cases (10%) (subluxation, III group AVN of the femoral head). Open reduction of the hip with adduction contractures in amyoplasia is significantly more effective than in patients with abduction contractures.