Content
Abstract of the article: Dodds MK et al. Transarticular
stabilization of the immature femoral head: assessment of a novel surgical
approach to the dislocating pediatric hip in a porcine model (2008). The
article describes an experiment of reconstruction of ligamentum capitis femoris
(LCF) in pigs with the formation of a femoral tunnel. The text in Russian is
available at the following link: 2008DoddsMK_McCormackD.
Abstract
Background: Acetabular dysplasia and hip instability are common
in neuromuscular diseases such as spina bifida and cerebral palsy due to deranged
muscle function around the hip. Occasionally
in developmental dysplasia of the hip, persistent instability may be difficult
to manage by standard treatments. It is in these contexts that we wished to
investigate whether a dislocatable hip could be stabilized by means of a
transarticular suture acting as a reconstructed ligamentum teres. The aim of
this study was to investigate and assess the iatrogenic damage caused by such a
procedure on the immature proximal femoral physis, epiphysis, and hip joint.
Methods: Four- to 6-week-old mixed breed European pigs (n = 18) were used in the
study. Six animals with normal hips
underwent the stabilization procedure to the right hip joint, the left hips
serving as controls. The remaining 12 pigs were subjected to a model of hip
dysplasia on the right hip. After 6 weeks, the dysplasia stimulus was removed,
and half of the animals underwent the hip stabilization procedure, the
remaining 6 animals served as a control for "untreated dysplasia."
Animals underwent serial pelvic radiography until euthanasia at 18 weeks of
age. Postoperative, morphometric, radiographic, and histological analyses were
performed.
Results: The dysplasia model consistently produced an increase in the acetabular
index, femoral head subluxation, and growth retardation of the capital
epiphysis. We observed no detrimental
effect on the capital ossific nucleus, proximal femoral physis, or acetabular
development in terms of radiographic, morphometric, or histological findings
after the transarticular suture procedure.
Conclusions: The surgical technique of drilling across the immature
porcine hip did not result in avascular necrosis of the femoral head, osseous
bar formation across the proximal femoral physis, proximal femoral metaphyseal
growth disturbance, chondrolysis, or disturbance in normal acetabular
development.
Clinical relevance: The described technique may be a useful augment to the
definitive stabilization of the recalcitrant dysplastic or unstable hip where
standard operative measures alone are likely to be unsuccessful.
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Dodds MK, Lee J, McCormack D. Transarticular stabilization of the immature femoral head: assessment of a novel surgical approach to the dislocating pediatric hip in a porcine model. Journal of Pediatric Orthopaedics. 2008;28(1)36-42. DOI: 10.1097/BPO.0b013e31815ff350 journals.lww.com , pubmed.ncbi.nlm.nih.gov
Experimental LCF Reconstruction Procedure.
The hip was held in a neutral position. From a point on the lateral aspect of the femur, 4 cm distal to the tip of the greater trochanter, we drilled a 4.5-mm-diameter drill tunnel in a retrograde direction across the proximal femoral physis and capital epiphysis, through the hip joint and acetabulum until the medial wall of the pelvis was breeched. The transarticular tunnel was protected with a 4-mm-diameter steel sheath through which we passed a suture anchor (Panalok RC QuickAnchor, Depuy Mitek, Johnson and Johnson, Norwood, Mass). Having engaged the anchor, we removed the sheath and secured the suture snuggly to the lateral femur using a polyethylene button.
Michael K Dodds – Department of
Surgery, University College Dublin, Dublin, Ireland. michaeldodds200@hotmail.com
James Lee – Department of Surgery,
University College Dublin, Dublin, Ireland.
Damian McCormack – Department
of Surgery, University College Dublin, Dublin, Ireland.
ligamentum capitis femoris, ligamentum teres, ligament of head of femur, plastic surgery, reconstruction, open plastic surgery, pigs, animals, experiment
NB! Fair practice / use: copied for the purposes of criticism, review, comment, research and private study in accordance with Copyright Laws of the US: 17 U.S.C. §107; Copyright Law of the EU: Dir. 2001/29/EC, art.5/3a,d; Copyright Law of the RU: ГК РФ ст.1274/1.1-2,7
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