Clin Orthop Surg.  2009 Sep;1(3):132-137. 10.4055/cios.2009.1.3.132.

Application of Ganz Surgical Hip Dislocation Approach in Pediatric Hip Diseases

• Shin SJ
• Kwak HS
• Cho TJ
• Park MS
• Yoo WJ
• Chung CY
• Choi IH

• KMID: 999391
• DOI: http://doi.org/10.4055/cios.2009.1.3.132

Abstract

BACKGROUND
Ganz surgical hip dislocation is useful in the management of severe hip diseases, providing an unobstructed view of the femoral head and acetabulum. We present our early experience with this approach in pediatric hip diseases. METHODS: Twenty-three hips of 21 patients with pediatric hip diseases treated using the Ganz surgical hip dislocation approach were the subjects of this study. The average age at the time of surgery was 15.7 years. There were 15 male and 6 female patients who were followed for an average of 15.1 months (range, 6 to 29 months). Diagnoses included hereditary multiple exostoses in 9 hips, slipped capital femoral epiphysis in 7, Legg-Calve-Perthes disease in 4, osteoid osteoma in 1, pigmented villonodular synovitis in 1, and neonatal septic hip sequelae in 1. Medical records were reviewed to record diagnoses, principal surgical procedures, operative time, blood loss, postoperative rehabilitation, changes in the range of hip joint motion, and complications. RESULTS: Femoral head-neck osteochondroplasty was performed in 17 patients, proximal femoral realignment osteotomy in 6, open reduction and subcapital osteotomy for slipped capital femoral epiphysis (SCFE) in 2, core decompression and bone grafting in 2, hip distraction arthroplasty in 2, and synovectomy in 2. Operative time averaged 168.6 minutes when only osteochondroplasty and/or synovectomy were performed. Hip flexion range improved from a preoperative mean of 84.7degrees to a mean of 115.0degrees at the latest follow-up visit. Early continuous passive motion and ambulation were stressed in rehabilitation. No avascular necrosis of the femoral head was noted up to the time of the latest follow-up visit, except for in one SCFE patient whose surgical intervention was delayed for medical reasons. CONCLUSIONS: Ganz surgical hip dislocation provides wide exposure of the femoral head and neck, which enables complete and precise evaluation of the femoral head and neck contour. Hence, the extensive impinging bump can be excised meticulously, and the circulation of the femoral head can be monitored during surgery. The Ganz procedure was useful in severe pediatric hip diseases and allowed for quick rehabilitation with fewer complications.

Keyword

Surgical hip dislocation; Femoroacetabular impingement; Pediatric hip disease

MeSH Terms

Acetabulum/surgery
Adolescent
Adult
Cartilage, Articular/surgery
Child
Female
Femur Head/surgery
Hip Dislocation/surgery
Hip Joint/abnormalities/*surgery
Humans
Male
Osteotomy/methods
Treatment Outcome
Young Adult

Figure

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  Fig. 1 A 16-year-old boy with Legg-Calvé-Perthes disease of the left hip was treated with femoral valgization osteotomy 6 years ago and shelf acetabuloplasty 3 years ago. He had limited left hip flexion and a positive impingement test (A). Lauenstein view (B), 3D-CT (C), and sagittal reconstruction view (D) revealed an anterior hump of the femoral head causing cam-type femoroacetabular impingement, which was also confirmed in the subluxated femoral head using the Ganz surgical hip dislocation approach (E). Osteochondroplasty relieved the impingement (F). Plain radiographs taken 1.5 years later showed a well-formed head-neck offset (white arrow) (G, H). Hip flexion range improved from 95° in the preoperative period to 130° at 1.5 years follow-up.

Reference

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