Reconstruction of the hip in congenital femoral defciency: a three year follow-up.

BACKGROUND: Congenital femoral deficiency (CFD) has many anatomical variations. A management-oriented classification offers greater clinical value. The SUPERhip reconstruction procedure was developed based on Paley's classification, though reports on its outcome remain limited. PURPOSE: Our aim in this study was to evaluate the radiographic and range of motion outcomes after hip reconstruction in CFD using the SUPERhip technique. METHODS: This is a prospective case series that included 12 patients with unilateral CFD type one who underwent hip reconstruction using the SUPERhip 1 procedure, with at least a three-year follow-up. Bilateral cases, neck pseudarthrosis, diaphyseal deficiency, and cases with previous hip surgery were excluded. Average follow-up was 41.5 months. Radiographs were used for evaluation of the neck shaft angle (NSA), acetabular index (AI), and lateral centre edge angle. Range of motion (ROM) was evaluated using Children's Hospital Oakland Hip Evaluation Scale (CHOES). Non-parametric tests were used for statistical analysis. RESULTS: The postoperative range of motion scores were excellent in four cases, good in seven cases, and fair in one case. Eight cases underwent pelvic osteotomy, post-operative AI and LCEA were within the accepted degrees for all cases. Neck shaft angle regressed toward varus in four cases (average 13°) after plate removal. One case developed a deep infection requiring debridement. Persistent hip flexion was present in two cases (15°, 25°). Five cases underwent lengthening; no hip dislocations or changes in AI or LCEA were encountered during or after lengthening. Age, sex, and CFD type did not influence the final clinical outcome or the varus recurrence. CONCLUSION: The radiographic outcome and range of motion after the SUPERhip 1 technique for type 1 CFD yielded good to excellent results in 91.6%. The procedure was found to be reliable and reproducible with an acceptable complication rate. The varus recurrence remains a problem.