SUPERHip procedure: hip reconstruction for congenital hypoplasia

The SUPER-Hip surgery is a complex procedure to correct deformities in the hips of patients with congenital hypoplasia (fibular hemimelia, tibial hemimelia, femoral hypoplasia, Congenital Femoral Deficiency CFD). This is a complex procedure for a rather rare condition, requiring specific knowledge and experience in this field.

SUPERHip Intervention: our experience

OrthoChildren (Bologna, Italy) is among the international centers with experience in the treatment of congenital hypoplasias.

Dr. Lampasi has been specializing in congenital hypoplasia and joint reconstruction for years. He worked first at the Rizzoli Orthopedic Institute (Bologna, Italy), where many of the first scientific studies on this type of procedure and congenital hypoplasia were conducted (Prof. Dal Monte, Dr. Donzelli). He then served as Head of Pediatric Orthopedics at Meyer Hospital in Florence, where he performed several complex procedures in this field for the first time at that hospital. Finally, he performed numerous cases of joint reconstruction (SUPER procedures, etc.) at various public and private Italian hospitals, also providing consulting and training to other pediatric orthopedic surgeons.

Dr. Lucchesi has been dedicated to the treatment of congenital hypoplasia for years, has attended numerous courses and conferences held by Professor Dror Paley, who systematized many of the procedures in this field, and has undertaken extended training periods with Dr. Alexander Kirienko, a luminary in external fixation with the Ilizarov apparatus.

SUPERHip surgery: What does SUPER mean?

The SUPERHip procedure belongs to a series of procedures with the prefix SUPER, an acronym that stands for Systematic Utilitarian Procedure for Extremity Reconstruction, conceived and systematized by Professor Dror Paley.

In congenital hypoplasia (fibular hemimelia, tibial hemimelia, femoral hypoplasia, Congenital Femoral Deficiency CFD), the affected limbs are not only more or less significantly shorter, but also show associated deformities at the level of the main joints: hip, knee, ankle, foot.

In the past, these deformities were given less importance and the goal was exclusively to lengthen the limbs. However, this often resulted in limbs of adequate length but stiff or poorly functional.

Over the years, it has been understood that before lengthening a limb, it is essential to restore good joint morphology to optimize functionality and limit lengthening complications.

This is why the SUPER- procedures were developed.

SUPERHip surgery: what does it involve?

The SUPER-Hip procedure aims to correct hip deformities in patients with congenital hypoplasia, which involve:

• Soft tissues: some structures (muscles, tendons, etc.) in these cases are retracted and cause a contracture; these structures must be loosened
• Bone deformities: there are deformities affecting the femur and pelvis. Osteotomies of the femur and pelvis are therefore required to restore correct joint relationships

SUPERHip surgery: why do it?

In congenital hypoplasias, especially in hypoplasias of the femur (Congenital Femoral Deficiency, CFD), there are various malformations that lead to having a malformed hip with associated deformities.

There is more or less severe dysplasia of the coxofemoral joint, more or less significant shortening of the femur and more or less severe rotational and joint anomalies.

These alterations require adequate correction, with a dual objective:

• ensure the limb has the best functionality
• prepare the limb for subsequent lengthening, thus limiting the risk of complications or poor results.

SUPER-Hip Surgery: Always the Same Procedure?

Deformities of the hip, femur, and pelvis are highly variable. They range from mild cases requiring simple procedures to very serious cases requiring more complex interventions.

Experience is required to properly dose this procedure.

SUPER-Hip surgery: at what age should it be performed?

The SUPER-Hip procedure can be performed at any age. It is generally recommended to perform it around age 3, before starting a limb-lengthening program.

SUPER-Hip Surgery: When to Plan Limb Lengthening?

Once the hip correction program and possibly the knee and ankle correction have been completed, it is possible to schedule limb lengthening procedures: see the dedicated sheet.

If the lengthening program is approached without taking hip deformities into consideration, there is an increased risk of complications (dislocations, stiffness, joint contractures) or of having a poor outcome at the end of the lengthening.

SUPER-Hip surgery: can it be performed in Italy?

Until a few years ago, many families traveled abroad to undergo this procedure, facing grueling journeys, lengthy hospital stays, physiotherapy, and sometimes exorbitant expenses.

Fortunately, for several years now, these procedures have been available in Italy, significantly reducing costs and family commitments. In recent years, this trend has even reversed, with many patients coming from abroad to undergo these procedures at our center.