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PubMed2006

An analysis of the risk of hip dislocation with a contemporary total joint registry.

Dislocation rates after total hip arthroplasty in a community setting have not been well documented. We used a community based joint registry to evaluate hip dislocations that occurred within 1 year after total hip arthroplasty. We evaluated patient, implant, and technical factors associated with dislocation, including primary versus revision surgery, femoral head size (28 mm versus > or = 32 mm), operative time, surgeon volume, surgical approach, age, gender, diagnosis, American Society of Anesthesiologists (ASA) classification, and body mass index (BMI). There were 1693 primary total hip arthroplasties and 277 revision procedures performed from 2001-2003. The overall dislocation rate was 1.7% for primary total hip arthroplasties and 5.1% for revision procedures. Patients with ASA scores of 3 or 4 had a 2.3-fold dislocation increase compared with patients with scores of 1 or 2. Patients with rheumatoid arthritis had an increased risk of dislocation. The dislocation rates for primary total hip arthroplasty were 2% for 28 mm heads and 0.7% for heads > or = 32 mm. The surgeon's patient volume, surgical approach, operative time, and body mass index had no effect on dislocation.

Age Distribution↗
PubMedDate not supplied

Recurrent hip dislocation in intermediate spinal atrophy.

Recurrent hip dislocation after corrective orthopaedic surgery in children and teenagers with intermediate spinal atrophy has not been reported in the literature. Four cases with long-term follow-up are presented. These represent the only cases surgically treated in 30 years of following spinal atrophy patients. Thus, it seems significant that all hips redislocated after the surgical procedure. In addition, two patients had second operations with subsequent dislocation. Pelvic obliquity should not be the basis for the surgery, as spinal fusion is generally necessary for wheelchair users. The sagacity of performing surgery for hip dislocations is raised.

Adolescent↗
PubMed2001

Arthroscopic treatment for traumatic hip dislocation with avulsion fracture of the ligamentum teres.

Traumatic hip dislocation in children is a rare condition. Immediate closed reduction is a treatment of choice, but when incongruent reduction results, it can be due to interposition and requires open arthrotomy. We present a previously unreported technique of arthroscopic treatment that was used successfully for traumatic hip dislocation in a 10-year-old girl with impingement of the avulsed ligamentum teres. Arthroscopy was effective in confirming the exact nature of the interposition material and excising the fragment with minimal invasion.

Arthroscopy↗
PubMed2006

[Evaluation of pediatric patients with traumatic hip dislocation].

OBJECTIVES: We evaluated pediatric patients who were treated for traumatic dislocation of the hip. METHODS: Traumatic dislocation of the hip was detected in five children (all boys; mean age 9 years; range 7 to 13 years) between 1991 and 2005. Dislocations occurred in the right hip in four cases, and in the left hip in one, all of which had posterior localization. Etiology was fall during play in two children, and fall from height or car crash in three. One patient had posterior wall avulsion fracture of the acetabulum. Early radiologic follow-ups included conventional radiographs and computed tomography. Functional results were assessed with the Harris hip scoring system. Four patients had a sufficient follow-up period with a mean of 44 months (range 19 to 64 months). RESULTS: All the patients were treated with closed reduction under general anesthesia after a mean of 6.4 hours (range 2 to 16 hours) following trauma. Functional results were excellent in all the patients, with a mean Harris hip score of 92 (range 84 to 96). Based on early postoperative radiologic control with computed tomography, no surgical intervention was considered for posterior wall avulsion fracture of the acetabulum in one patient. At 40-month follow-up, he had no complaints, had a full range of motion and a hip score of 92. While no complications were observed in patients undergoing early reduction, one patient whose dislocation was reduced 16 hours after trauma developed avascular necrosis of the femur head 18 months after treatment, at which time his hip score was 84. CONCLUSION: Early reduction is of particular importance for the follow-up course of traumatic hip dislocations in childhood.

Adolescent↗
PubMed2001

Treatment of dysplastic and congenitally dislocated hips with the Zweymueller total hip prosthesis.

Uncemented Zweymueller total hip prostheses were implanted in 35 dysplastic or dislocated hips in 33 patients. Sixteen hips were dislocated and 19 hips were dysplastic; in 12 hips, an intertrochanteric or pelvic osteotomy was performed in early childhood. In all cases, the titanium screw socket was implanted at the level of the original cotyloid cavity. Osteotomy of the greater trochanter, shortening osteotomy, or roof acetabuloplasty were not performed. In cases in which the femoral cavity was too narrow for the Zweymueller stem, an anterolateral longitudinal window-shaped osteotomy was performed. In cases of severe dysplasia, cotyloid cavity bone grafts from the resected femoral head were placed medially to reinforce the acetabular bottom. Clinical and radiographic follow-up ranged from 3-8 years. Average Harris hip score improved from 47 points preoperatively to 86.2 points postoperatively. Complications included two primary anterior dislocations, two temporary femoral nerve pareses, and two deep vein thromboses. At longest follow-up evaluation, no revision was indicated in any of the hips. Satisfactory results in this series were attributed to careful patient selection, precise preoperative radiographic planning, and an operative technique that included implantation of the socket at the primary acetabulum and achievement of primary stability using press-fit fixation.

Adult↗
PubMed2006

Simultaneous ipsilateral posterior knee and hip dislocations: case report, including a technique for closed reduction of the hip.

In isolation, dislocations of the hip and knee require emergent reduction to minimize the risks of serious complications, including vascular and neurologic injury, osteonecrosis of the femoral head, and loss of motion and function. With simultaneous dislocation of the ipsilateral hip and knee, as in the situation of hip dislocation with concomitant femoral shaft fracture, reduction of the hip may prove difficult because of the inability to control the femoral segment. In this setting, general anesthesia is commonly required. We present the case of a patient who sustained an ipsilateral hip and knee dislocation who underwent closed reduction of the knee in the emergency department but required general anesthesia and the insertion of Schanz pins in the femur to reduce the hip dislocation.

Accidents, Traffic↗
PubMed1999

Open reduction of late unreduced traumatic posterior hip dislocation in 12 children.

We present 12 children with late unreduced traumatic posterior dislocation of the hip. All had posterior dislocation and no associated fracture. The dislocation had remained unreduced for a mean period of 20 (6-52) weeks. Open reduction was done in all cases, since none of the hips could be reduced with upper tibial skeletal traction in abduction. All the hips showed varying degrees of avascular necrosis, with preservation of joint space on roentgenograms. 11 children had an excellent outcome, according to the criteria of Garrett et al. (1979), after a follow-up of mean 26 (24-36) months. We suggest that open reduction is a satisfactory treatment for hip dislocation of any duration in children.

Child↗
PubMedDate not supplied

[Incidence and start of inpatient treatment of pediatric hip dislocations in West Germany].

A national report of hospitalized children with cdh (up to the 6th year of age) (treated in 1983) is presented. 196 (63.1%) of all university hospitals and orthopaedic departments took part in this statistic. The number of all collected children was 1172,888 of them had a hip dislocation. Hospital treatment of children with a dislocated hip started on the average in the age of 9 months, that means much to late. Only 4.1% of the children showed neurological symptoms. The patents are reported in detail. The presented data lead to the conclusion, that the actually performed legal examination of children is insufficient for early detection of cdh. A general orthopaedic clinical and ultrasound examination in the first week of life should be introduced.

Acetabulum↗
PubMed1989

Bilateral posterior hip dislocations with femoral head fractures.

An unusual case of bilateral posterior fracture-dislocation of the hip (Pipkin Type IV) occurred in a 63-year-old man with Paget's disease of the pelvis. Other injuries included a displaced humeral shaft fracture and patellar ligament disruption. Bilateral cemented total hip arthroplasty was performed to avoid the need for prolonged immobilization. Postoperative low-dose irradiation was used because of the risk of heterotopic ossification.

Early Ambulation↗
PubMed1976

Traumatic hip dislocation in childhood. A report of three cases.

Three cases of traumatic dislocation of the hip joint in children are presented. All were subjected to immediate closed reduction under general anesthesia, followed by immobilization by means of skin traction for 2 weeks. Weight-bearing was resumed 2-3 weeks after the injury, and at follow-up examinations 23 to 27 months later the hip joints were found to be normal both clinically and radiographically.

Child, Preschool↗
PubMed1997

Hip Dislocation: Current Treatment Regimens.

Dislocation of the hip occurs only with high-energy trauma, and concomitant injuries are common. Early diagnosis and institution of treatment are necessary to obtain the best possible results. Treatment protocols include emergent reduction of the femoral head to reestablish perfusion, postreduction radiography and computed tomography to look for associated fractures and to judge the concentricity of the reduction, stability testing, and early mobilization. Open reduction may be required if a concentric reduction cannot be obtained in a closed manner. Despite appropriate management, posttraumatic arthritis and avascular necrosis may occur, with reported rates as high as 15% to 30%. Patients who sustain a hip dislocation should be made aware of these potential complications at the time of initial treatment.

Journal Article↗
PubMed1993

[Traumatic hip dislocation in childhood].

Authors describe the diagnostic and therapeutic problems of the traumatic dislocation of the hip in children and report on the experiences of their 8 cases. It is stressed that the condition of the good result in the early diagnosis and reduction. For the recognition and treatment of the late complications a 1.5-2 years follow-up of the patients is thought to be important.

Accidental Falls↗
PubMed1971

Problems in the early recognition of congenital hip dislocation.

Seven cases of infants whose hips were clinically normal at birth, and in whom hip dislocation was later recognized, are reported. In spite of the widespread practice of routine examination of the hips of newborn babies, infants and young children are still presenting with congenital dislocation of the hip. This is probably owing to there being two aetiological types. Every opportunity to re-examine the hips of children under 2 or even 3 years of age must be taken and a high level of suspicion maintained.

Age Factors↗
PubMed1983

[Surgical treatment of dislocated hips after 5 years of age].

Fifty dislocated hips after the age of 5 were treated between 1975 and 1980. The surgical procedures performed combined tenotomy of the iliopsoas and adductor muscles, shortening of the femur, capsulorraphy and a pelvic osteotomy usually for re-orientation (Salter procedure) and rarely for widening of the acetabulum (Chiari procedure). It is thought that tenotomies and femoral shortening were more efficient than pre-operative traction which produced osteoporosis. However post-operative traction was used. In some cases plaster cast immobilisation was not used. The advantages of this technique were an acceleration of the surgical programme, better articular stability and early mobilisation. Osteochondritis and post operative stiffness were rare. The average range of movement included 90 degrees of flexion and lumbar balance was the most significantly improved factor. This type of surgical procedure aims to slow the development of coxarthrosis but it cannot diminish the risk. The limit of age for such treatment appears to be 10 years. After that, the indications need to be assessed carefully.

Age Factors↗
PubMed1999

Severity of injuries associated with traumatic hip dislocation as a result of motor vehicle collisions.

BACKGROUND: Previous reports have shown a high rate of associated injuries in patients who sustain traumatic hip dislocation. Since these earlier reports appeared, improvements have been made in passenger safety systems and the rate of restraint usage has increased. The purpose of this study was to review the associated injuries present in a current series of patients who sustained traumatic hip dislocation as a result of motor vehicle collisions. METHODS: We retrospectively reviewed our trauma registry and identified 66 patients who sustained traumatic hip dislocation as a result of motor vehicle collisions. Thirty patients (45%) were restrained and 36 (55%) were unrestrained. Airbags were known to have deployed in 14 cases. RESULTS: The incidence of associated injuries was 95% (63 patients). Orthopedic injuries alone were seen in 22 patients (33%), whereas associated injuries were seen in 44 patients (67%). Abdominal injuries were present in 10 patients (15%), thoracic injuries were present in 14 patients (21%), closed head injuries were present in 16 patients (24%), and craniofacial injuries were present in 14 patients (21%). Acetabular fractures were seen in 46 patients (70%), femoral head fractures were identified in 9 patients (14%), and other extremity fractures occurred in 26 patients (39%). The average Injury Severity Score for all patients was 17.4 (range, 9-59). The average Injury Severity Score of the restrained patients was not statistically different from that of the unrestrained patients (p = 0.491). CONCLUSION: Although improvements in automotive safety features and restraint usage have occurred since previous reports appeared, there continues to be a high rate of severe injuries associated with traumatic hip dislocation that occur in motor vehicle collisions. We believe that all patients who sustain traumatic hip dislocation warrant a general surgery trauma evaluation to rule out any potential associated injuries.

Accidents, Traffic↗
PubMed1993

Simultaneous asymmetric bilateral traumatic hip dislocation.

A 25-year-old man presented to the emergency department with simultaneous right anterior and left posterior hip dislocations resulting from a motor vehicle accident. Simultaneous bilateral traumatic hip dislocation is an uncommon occurrence. More rare is asymmetric simultaneous bilateral hip dislocation, with only ten cases documented in the English-language literature. The importance of an anteroposterior pelvic radiograph after significant major trauma is emphasized. Several serious complications can be associated with this condition, so expeditious management in the ED is warranted.

Accidents, Traffic↗
PubMed1988

Breech position, delivery route and congenital hip dislocation.

The purpose of this study was to investigate whether the mode of delivery for fetuses in breech presentation in any way influenced the frequency of congenital hip dislocation. In 13,559 singleton births 583 fetuses were in breech position, and the cesarean section rate was 39.1%. Eighty-three infants were born with congenital hip dislocation, 11 of whom had been in breech position. Of these 11, cesarean section was required in 5 cases. There was no difference in frequency of congenital hip dislocation between fetuses in breech presentation delivered by cesarean section vs. by the vaginal route. The frequency of breech presentation in congenital hip dislocation was 13.3%. Including 7 external versions, the rate was 21.7%. Female to male ratio was 4:1. The frequency of congenital hip dislocations in infants born in vertex presentation was 5.5 per mille and for infants born in breech presentation it was 18.9 per mille.

Breech Presentation↗