On the occasion of the National Congress of the Italian Society of Orthopaedics and Traumatology, which took place in Bari from 9 to 12 November, Professor Nicola Portinaro – Head of the Paediatric Orthopaedics Unit at Humanitas – presented the results of two studies, never published before, on the prevention of hip dislocation, the first, and on the complete reconstruction of the hip in cases of infantile cerebral palsy (CP).
Progressive hip dislocation in the PCI
Progressive dislocation of the spastic hip – which is the most frequent deformity in infantile cerebral palsy – is a dislocation not present at birth, which develops progressively over the years. The triggering factors can be several, including inadequate muscle control, spasticity and retraction of muscles, or even lack of load and incorrect postures often taken by patients with this condition.
“These factors can trigger a process whereby the femur gradually moves away from its seat until complete dislocation, which occurs when the head of the femur is completely outside the acetabulum and the two heads of the joints are no longer in contact with each other,” explained the professor.
An operation to prevent and stop femoral dislocation
Thanks to the medial temporal hemiepiphysiodesis of the proximal femur (TMH-PF), it is possible to maintain or restore the correct ratio between the femur and the acetabulum. This is a surgical operation, performed in Humanitas by Prof. Portinaro and his team, which aims to stop or slow down the growth of a cartilage. “The surgical technique consists of inserting a cannulated screw into the neck of the femur to prevent the femoral head from progressively leaving its natural site,” explained the professor.
The operation is performed in day hospital, without hospitalization and with an average stay after the operation of about two hours.
The patient has no pain thanks to the minimally invasive percutaneous technique and the possibility of loading already in the first post-operative phase.
The results of the research
In the study carried out between 2007 and 2014 by Professor Portinaro and his team – presented in front of the audience of the 103rd National Congress of the Italian Society of Orthopaedics and Traumatology – it was found that “medial hemiepiphysiodesis of the proximal femur is an effective method of prevention and treatment for progressive dislocation of the hip in patients with PCI, avoiding or delaying major surgery,” explained Portinaro.
The research involved 28 patients (18 males and 17 females); the average age was 7.5 years, with a range between 4 and 11 years, and radiographic measurements were performed in 4 phases: preoperative and after 6, 12 and 60 months from surgery. The X-rays were aimed at measuring some indices that allow to establish the relationships between femoral head and acetabulum before surgery and after several years (the acetabular index (AI), the percentage of migration (MP) and the cervical diaphyseal angle (NSA), to demonstrate the effectiveness of the same in maintaining the femoral head within the acetabulum.
In all patients, the operation has allowed to perfectly achieve the goal of total containment of the hip within the acetabular cavity.
Complete hip reconstruction
This is one of the most important and demanding interventions in the field of paediatric orthopaedics, so the operation is carried out by a multidisciplinary team and a very close team. The technique used is to redirect the bones of the femur and pelvis after dissecting them, so that the hip joint is again of normal shape and function.
The results of the second research
The second research conducted by Prof. Portinaro and his team at Humanitas concerned the complete reconstruction of the hip for treatment in patients suffering from infantile cerebral palsy, where dislocation was not prevented.
In seven years of study and observation, between 2007 and 2015, the objective of the work was to evaluate the results of hip reconstruction as a surgical treatment in children, already affected by PCI, who had a mono or bilateral dislocation of the hip. The study involved 66 patients (45 males and 21 females); the average age of the patients was about 10 years and the follow-ups, with radiographic checks, were carried out over the next 37 months, after 6 and 12 months and every year thereafter.
“The results of our study show that this intervention allows an improvement in the conformation of the hips and also a functional improvement of the patient: personal hygiene in 61 patients (over 90%); sitting in 54 patients (over 80%) and 3 patients have even reached an upgrade of their GMFCS index (the classification of the Major Motor Function indicating the greater or lesser autonomy in movements by patients with infantile cerebral palsy, such as functional limitations and the need to use mobile devices such as walkers, crutches or wheelchairs)”, explained prof. Porter.
“This is the first study carried out on a statistically significant number of patients affected by PCI and operated with this technique and the results have shown that this type of surgery can allow these patients to achieve significant improvements in their daily activities, posture and gait – added the professor -. The risks and complications are always present when undergoing surgery, but as has been demonstrated in this work, these are limited and not serious cases, given the important results that can be achieved in terms of improving the living conditions of patients with PCI,” concluded the professor.