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PubMed1999

The natural history of a posteriorly dislocated total hip replacement.

A retrospective review was conducted to delineate the natural history of the posteriorly dislocated total hip replacement. A total of 1,036 consecutive total hip replacements were performed between 1989 and 1992. Forty (3.9%) were known to have dislocated posteriorly. Twenty-four of these dislocations occurred after primary replacements, and 16 occurred after revision. Eighty-five percent of the dislocations occurred within 2 months and were reduced closed. No statistical differences were noted between these 2 groups with respect to height, weight, sex, age, and femoral and acetabular anteversion. Nonunion of the greater trochanter, modular femoral neck length, and operative approach appeared to affect hip stability. Twenty-three of the 40 dislocated hips (57.5%) redislocated. Sixteen of the 40 hips (40%) required reoperation for recurrent dislocation. Thirteen of the 16 revisions (81.3%) were successful. A dislocated total hip replacement that has been rendered stable does not preclude one from having a successful total hip replacement, and it does not appear to affect survivorship at intermediate follow-up.

Aged↗
PubMed1993

Cementless total hip arthroplasty for congenitally dislocated or dysplastic hips. Technique for replacement with a straight femoral component.

A new straight cementless stem was used for replacement of 67 dislocated or severely dysplastic hips. There were 45 hips with complete dislocation, 27 of which were cases after Schanz osteotomy. Technical solutions for various deformities are presented here. The acetabular component was placed at the level of the original cotyloid cavity or some lower position. In hips after total dislocation a metaphyseal shortening osteotomy was combined with distal advancement of the greater trochanter with intact attachment of the abductor muscles. This method was appropriate also for the femora, where high-seated Schanz osteotomy was previously performed. If the diaphysis was too narrow for the stem, it was split about 10 cm both anteriorly and posteriorly. In cases with unilateral total dislocation where Schanz osteotomy had been seated low, metaphyseal segmental shortening with angular correction was performed and the stem was used as an intramedullary nail. Special attention was paid to achieve sufficient abduction strength to balance the pelvis and abolish Trendelenburg limp and to restore leg length. The clinical and radiographic results of the consecutive series were assessed three to five years after the arthroplasty. Pain relief and the functional results including improvement of gait were generally good, primary complications were few, but the loosening and revision rate of the smooth-threaded acetabular component was unacceptably high. There were no problems with the press-fit cups. In general the outcomes were good even when reoperation was required.

Adult↗
PubMed1997

Pathological and hemodynamic study in a new model of femoral head necrosis following traumatic dislocation.

The blood of the femoral head is thought to be supplied by vessels originating from the medial and lateral circumflex femoral arteries and via the marrow cavity of the neck. Therefore, it is difficult to induce osteonecrosis of the femoral head when the marrow cavity of the neck is preserved. In the present study, we established a new model of femoral head necrosis by dislocating the hip joint and ligating the medial and lateral circumflex femoral arteries and veins. Measurement of femoral head blood flow revealed that a marked decrease to 14.7% of the control value was achieved by both hip dislocation and ligation of blood vessels. Pathologic examination showed no necrosis with either dislocation or ligation alone, whereas at 2 and 4 weeks 80% of the animals subjected to both procedures showed widespread necrosis. These pathologic findings considered in the light of results of the blood flow measurements suggest that a decrease in femoral head blood flow below 20% of the control value is needed to cause osteonecrosis. In addition, magnetic resonance images (MRI) of the model were evaluated in the combined dislocation and ligation group at 4 weeks (n = 5). Changes on MRI were seen in 3 of 5 dogs. The necrotic changes of the femoral head are thought to be detectable on MRI within 4 weeks after ischemia without enhancement.

Animals↗
PubMedDate not supplied

[Luxation of the hip and preventive examinations].

The present report on the possibilities and limitations of screening and its importance for the prevention of congenital hip dislocation is based on many years of practical experience in preventive medicine and equally extensive study of oblique presentation and congenital dislocation of the hip joint. The paper presents a review of the various forms of malformation of the hip and following a short discussion of the origins and prognoses of these various forms, deals with the various diagnoses. Two main examination periods are important for diagnosis: the neonatal period and the 4th month of life. In the neonatal period a hip joint is unstable if the Roser-Ortolani sign is positive. Other clinical symptoms are found in addition in the much rarer congenital dislocation of the hip. The advantage of examination in the neonatal period is that it enables the unstable hip joint to be treated immediately. As a rule this preventive treatment, involving little risk, results in normal development of the hip joint, instead of the possible defective development to hip dislocation. These possibilities in the neonatal period are limited by the degree of experience and the extent of cooperation between examiners and therapists. In the second main examination period, in the 4th month of life, the malformations which occur post partum should be identified. In contrast to the obviousness of the clinical hip joint findings in the neonatal period" clear clinical hip joint symptoms can only be expected in the 4th month of life with the most severe forms of hip dislocation.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1999

Cartilaginous differentiation in the joint capsule.

The proliferation and differentiation of cells are greatly influenced by their environment. Many growth factors and cytokines are reported to be environmental factors that affect the proliferation and differentiation of cells. Mechanical stress is also considered to influence these physiological reactions. The joint capsule, which is a part of the joint tissue, plays a very important role in the stability of the joint and in maintaining the intracapsular phenomenon. In patients with dislocated hip arthropathy, this capsule is involved in the weightbearing function by forming a sliding surface between the capsule and the femoral head articular cartilage. The surface of the tissue macroscopically shows cartilaginous change, which indicates cartilaginous differentiation caused by mechanical stress. We examined the cartilage-specific proteoglycan component, which is composed of cartilaginou matrix at the differentiation site. We investigated proteoglycan production, molecular size, and the gene expression of cartilaginous substrate. At the inner layer of the weightbearing area of the joint capsule, proteoglycan production was significantly higher than that of other noncartilaginous tissue. We also identified the gene expression of cartilaginous proteoglycan using the reverse transcription polymerase chain reaction (RT-PCR) method.

Aggrecans↗
PubMed1992

Dislocation in low-friction arthroplasty.

In a series of 2,050 low-friction arthroplasties, 61 cases (2.97%) of dislocation were analyzed. The mechanism of production was malposition of the components (group 1, 33%), deficiency of the abductor mechanism (group 2, 34%), or the association of both (group 3, 26%). Failure to find a cause was even more rare (group 4, 7%). The best treatment is prevention by careful surgical technique, since good results with different procedures have only been attained in 51% of dislocated hips.

Adult↗
PubMed1990

Femoral varus and acetabular osteotomies in cerebral palsy.

Sixty-three patients with cerebral palsy underwent proximal femoral varus derotation osteotomy for 86 subluxing or dislocating hips. Eleven hips underwent concomitant pelvic osteotomy. Adductor tenotomy was performed in all patients. The average preoperative femoral neck shaft angle was 158.2 degrees, with a center edge angle of -2 degrees. Femoral osteotomy effected an average femoral neck shaft angle of 132.2 degrees, with a center edge angle of +8 degrees. A Chiari osteotomy was performed when the acetabular index was greater than 35 degrees. This preoperative acetabular index of 46 degrees improved to 28 degrees postoperatively, and proved to be the most reliable indicator for need of an added pelvic osteotomy.

Acetabulum↗
PubMed1990

[Use of ultrasound in the study of the hip joints of fetuses during different periods of intrauterine development].

There has been investigated a hundred of women (aged 25-36 years) with aggravated obstetric-gynecologic anamnesis with wrong fetus position, familial predisposition for congenital hip dislocation and hip joint dysplasia. Fetuses were investigated at the "Toshiba" ultrasonography apparatus by a sensor with frequency of 5 mHz. Investigation of fetus hip joint in different terms of prenatal development has demonstrated that the joints were presented mainly by immature forms (11 a type) though at later terms of prenatal development there were present mature joints as well (1 a type). Ultrasonographic investigation permits to determine and measure the diameter of cartilaginous head of femur, evaluate its relation to cotyloid cavity, measure the center of the head ossification. The most intensive growth of the head occurs at 26-38 weeks of prenatal development. Hip joint stability can only be evaluated at later term of prenatal development.

Adult↗
PubMed2004

[The methods of shorting of proximal femoral and total hip arthroplasty for old femoral neck fracture with severe hip joint dislocation].

OBJECTIVE: To discuss the effective method and outcome to old femoral neck fracture with severe hip joint dislocation. METHODS: From April 1996, 7 cases of old femoral neck fracture with severe hip joint dislocation were treated by the shorting of posterior femoral and total hip arthroplasty. RESULTS: The average age of 7 patients was 51 years old and the mean follow-up was 27.3 months. The mean Harris score was improved to 84.3 from 36.7 before operation in the latest follow-up. The prosthesis position of acetabular and femoral was excellent, there was no sinking or softening of artificial joint, nonunion of femoral osteotomy. CONCLUSION: The preliminary clinical results are quite satisfactory of the shorting of posterior femoral and total hip arthroplasty to old femoral neck fracture with severe hip joint dislocation, the follow-up is necessary for further long-term outcome.

Adult↗
PubMed1995

Traumatic anterior dislocation of the hip: spectrum of plain film and CT findings.

Traumatic anterior dislocation of the hip represents 11% of all hip dislocations and is classified into superior and inferior types [1]. Whereas inferior anterior hip dislocation is easily recognized on an anteroposterior radiograph of the pelvis, the radiographic appearance of superior anterior hip dislocation is less straightforward, often leading to an initial misdiagnosis of posterior hip dislocation. Misdiagnosis of the direction (anterior versus posterior) of a hip dislocation can result in failed closed reduction or an improper surgical approach to open reduction. In addition, recognition of associated impaction fractures is important, as patients with this finding have a greater tendency to develop traumatic arthritis [2, 3]. This pictorial essay, which is based on our experience with 20 cases of anterior hip dislocation, including five of the rare superior type, illustrates the spectrum of radiographic findings and distinguishing features associated with anterior hip dislocation.

Adult↗
PubMed2005

Auditing hip ultrasound screening of infants at increased risk of developmental dysplasia of the hip.

BACKGROUND: Clinical examination, while useful, has been shown to be insufficient as the sole screening method in infants. Ultrasound examination at 8 weeks in high risk infants is an integral part of the screening process in some units. AIMS: To show the efficiency of hip sonography in detection of developmental dysplasia of the hips in those without clinically dislocated hips. METHODS: All infants born at the National Maternity Hospital between January 1994 and December 2001 were included. All those with clinically dislocated hips were treated by a Pavlik harness and referred for follow up to a paediatric orthopaedic surgeon. An 8 week hip ultrasound scan was performed for those infants with stable hips on examination but who met the following criteria: (1) a first degree relative with congenital dislocation of hips; (2) breech presentation at birth; and (3) a persistent "click" at birth in an otherwise stable hip. RESULTS: During the period of study a total of 52 893 infants were born in the National Maternity Hospital. Based on the criteria above, 5485 hip ultrasound scans were performed. Of those scanned, 18 (0.33%) were found to have dislocated hips and 153 (2.78%) to have dysplasic hips. The 18 infants with dislocation were treated with Pavlik harness; the remaining 153 were followed up by serial ultrasound examinations but did not require active intervention. CONCLUSIONS: Among the population of infants at increased risk of developmental dysplasia of the hip, the hip screening programme identified 18 cases among 5485 infants; a rate of 3.2 per 1000. Hip sonography is therefore worthwhile.

Breech Presentation↗
PubMed2001

Prevention of dislocation after hip arthroplasty: lessons from long-term followup.

Regarding dislocation after total hip arthroplasty, prevention is worth an ounce of cure. The current authors evaluated dislocation after total hip arthroplasty during the 26-year practice of one surgeon to identify potential variables that can contribute to the prevention of dislocation. Between 1970 and 1996, dislocation after total hip replacement occurred after 7.2% of primary hip arthroplasty procedures (298 of 4164 primary hip replacements) and 11.2% of revision hip arthroplasty procedures (90 of 803 revision hip replacements). Significant findings included an increase in dislocation when 22-mm modular femoral heads were used and a decrease in dislocation after revision for dislocation when constrained liners were used. An additional finding was that 26% of first time dislocations occurred more than 2 years after surgery. Concerning prevention of dislocation, small head modular femoral components should be used cautiously, and constrained liners should be considered in complex revision cases. Patients should be counseled concerning the potential for dislocation many years after their arthroplasty.

Aged↗
PubMed1997

[Sonographic measures of the hip joint of 1328 newborns of Han and Uygur nationalities-relative factors of congenital dislocation of hip].

The four sonographic methods (Engesaeter, Terjesen, Graf, Morin-Harcke) were used for examining the hip joint of 1328 newborns of Han and Uygur nationalities. The difference between Han and Uygur newborns was not statistical significant, but some literatures reported that in our country, the incidence of different nationalities in different regions varied. Our conclusion is that there is no obvious relationship between the depth of the acetabulum and the percentage of the femoral head covered by the acetabulum. It is caused by other factors, inherent or acquired. The value of the hip joint of the male and female has significant difference (P < 0.0005). The incidence of CDH in girls is much higher than that in boys. This may be related to the different depth of the acetabulum and different percentage of the femoral head covered by the acetabulum. In the period of newborn, girl's depth of the acetabulum is smaller than that of boys.

Anthropometry↗
PubMed1976

Traumatic anterior dislocation of hip joint with vascular damage.

Closed reduction of an anterior dislocation of the hip joint in a 15-year-old boy failed because of interposition of capsule, iliopsoas and rectus femoris muscles. The immediate complications were compression of the common femoral artery, tear of the femoral vein, and fat embolism 24 hours after the injury. The sequelae were periarticular ossification and avascular necrosis of the femoral head. The definitive treatment was a Charnley total hip arthroplasty.

Adolescent↗

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