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PubMed2002

Low-energy anterior hip dislocation in a dancer.

In this article, we report the case of a healthy young woman who sustained an anterior hip dislocation while participating in a noncontact activity (ballet dancing). The patient's atraumatic dislocation failed closed reduction secondary to interposition of anterior capsule and rectus femoris muscle. Open reduction using a Smith-Petersen approach was concentric and stable. Postinjury femoral nerve neuropraxia resolved within 6 weeks. At 2-year follow-up, the patient was without complications of the injury-including avascular necrosis and posttraumatic arthritis. She returned to dancing and is now asymptomatic.

Adolescent↗
PubMed1977

[Analysis of the metaplastic disturbances in dislocated hip joints in the orthopedic hospital of the Medical Academy in Magdeburg (author's transl)].

One of the most frequent and prognostically unfavorable complications occurring with therapy for dislocated hip joints is a metaplastic disturbance at the coxal end of the femur. We undertook a differentiation between metaplastic disturbances in necrosis of the center of the femur head and restorative disturbances. In the evaluated period between 1964 and 1974, 1298 children (2236 treated hips) were examined. Between 1965 and 1968 when the old, classical therapy for dislocation was employed, we established a metaplastic disturbances rate of 20%. The rate for necrosis of the femur head was 9% and the restorative disturbance rate was 11%. The metaplastic disturbance rate was lowered to 5.65% as a result of the modern, functional, early therapy instituted between 1969 to 1974. Here we established a rate of necrosis for the femur head of 0.45% and a restorative disturbance rate of 5.2%. This falls within the range established by Huber (5.5%) and Unger (6.06%). The possibility of an endochondral dysostosis must always be considered when bilateral restorative disturbances are present. We observed that restorative disturbances always occurred more frequently in connection with dysplasias. We fell that the cause is the endogenous tendency toward restorative disturbances of the center of the femur head. With early therapy, the possibility of a dislocation can, however, be avoided. In contrast to Kiltz, our later results and follow-up examinations indicate a poorer prognosis for necroses of the center of the femur head.

Age Factors↗
PubMed1989

[Classification of deformities of the glenoid labrum in congenital hip dislocation].

The authors have developed their own classification of the deformities of labrum glenoidale in congenital hip dislocation. Open reposition was performed by the Ludloff procedure. The basic material for their work was the group of patients operated on at I. Orthopaedic Clinic of the Faculty of General Medicine of Charles University in Prague in the years 1970-1985. In the course of this period they operated on 78 hip joints in 70 children, out of which 8 operations were bilateral, the group comprised 17 boys and 53 girls, operation was performed on 30 right hip joints and 48 left ones. The age of children ranged from 5 to 23 months. The average age of children in time of operation was 9.3 months. On the basis of the cadaver material the authors have found out that glenoidale represents an extensive part of acetabulum. Labrum glenoidale is considerably more sizable in the dorsal parts of acetabulum so that the head seems to be completely enveloped by ligamentary limbus and the acetabulum seems to form at least half of the ball-shaped surface. In the dorsal and upper parts the acetabulum is from great part formed by a fibrous structure which is easily deformed. The pressure applied to the head dorsally can result in its dislocation just because the cartilaginous model of acetabulum is flat in its dorsal and proximal parts. This easily deformable structure is under certain conditions deformed by pressure of the head in such a way that in the first phase in the course of the onset of the dislocation it is always everted and in the second phase the evertion lither persists or the head shifts over the margin of the limbus and the limbus is then inverted by reposition force. The authors present in their work the classification of the limbus. Proceeding from operation findings they divide limbi into four groups according to differences in their shape: Type I: regularly annular (everted) limbus--it corresponds to a normal anatomic shape, it is not pronouncedly deformed and does not present an impediment to reduction. Type II: inverted gracilis limbus--it is exaggerated in comparison to the normal one, usually it is inverted in the acetabulum, it is never rigid but elastic. Together with the structure of capsule it can be an impediment to reduction. It can be relatively easily everted. Type III: inverted callous limbus--it is sizable, rigid, reducing by its position the capacity of the acetabulum. The reduction is usually difficult.(ABSTRACT TRUNCATED AT 400 WORDS)

Acetabulum↗
PubMed2006

Minimal surgical approach for recurrent hip dislocation using the posterior lip augmentation device for the Charnley hip arthroplasty.

We present the management of recurrent posterior dislocations in cemented Charnley total hip arthroplasties treated with acetabular augmentation. Certain patients are elderly with comorbid conditions and diminished reserves. We have used a minimal surgical approach to implant 21 posterior lip augmentation devices in elderly patients. Ninety percent of the hips are stable with follow-up of 1 to 3 years (mean, 1.9 years). Eighty-four percent of the patients were satisfied with the outcome. Two cases, which redislocated, were further stabilized by changing the position of the posterior lip augmentation device and are stable. Because of a minimal surgical approach, the time duration of surgery, blood loss, transfusion requirement, inpatient stay, and morbidity are reduced. Posterior lip augmentation device surgery with a minimal approach is a safe and effective procedure for elderly patients who do not have any obvious cause for dislocation.

Aged↗
PubMed1995

Combined realignment procedure (femoral and acetabular) of the hip joint in ambulatory patients with cerebral palsy and secondary hip dislocation.

In a retrospective study we evaluated the results of 11 patients with cerebral palsy and concomitant hip dislocation who were still able to walk. They had been surgically treated with proximal femoral osteotomy (varization and derotation) and acetabular osteotomy (triple osteotomy) in order to achieve stabilization of the hip joint. The patients' mean age was 14.4 +/- 3.7 years. The female:male ratio was 7:4. All 11 hip joints were successfully stabilized. The range of passive abduction significantly increased from 20 degrees preoperatively to 42 degrees postoperatively. The range of flexion slightly decreased from 101 degrees to 92 degrees. Internal rotation significantly decreased from 51 degrees to 37 degrees. External rotation increase from 27 degrees preoperatively to 41 degrees postoperatively. Preoperatively 4 of the 11 patients had been able to walk without any walking aids; 7 had been able to walk with support. Concerning the ambulatory status, mild improvement was achieved postoperatively in 3 patients. The CCD-angle decreased significantly from 138.9 degrees preoperatively to 118.7 degrees postoperatively. The migration index according to Reimers improved significantly from 50.2% preoperatively to 24.2% postoperatively. Prior to surgery 4 cases showed a grade 1 dislocation, 6 cases a grade 2 dislocation, and 1 case a grade 3 dislocation. We succeeded in performing a complete reposition in all patients. Preoperatively the CE- angle was only -3 degrees (+/- 11.3 degrees) and was improved to 27.1 degrees (+/- 5.3 degrees). The ACM-angle measured 45.4 degrees preoperatively and 49.5 degrees postoperatively. The sitting balance was improved in all patients. Furthermore the problem of anal care was reduced.

Acetabulum↗
PubMedDate not supplied

Assessment of congenital hip dislocation with real-time ultrasound: a pictorial essay.

Real-time ultrasound (US) is the imaging method of choice for diagnosis and follow-up of congenital dislocation of the infant hip (CDH). Clinical aspects and the role of imaging are reviewed. Technique and anatomy, both normal and abnormal, are illustrated, as well as, the use of sonography during treatment with Pavlik harness and spica cast. Correlation of ultrasound findings with clinical examination, other available imaging studies and long-term patient follow-up shows 100% sensitivity and 100% specificity for real-time US diagnosis of CDH.

Hip Dislocation, Congenital↗
PubMed1994

Traumatic hemipelvectomy associated with contralateral hip dislocation: case report.

A case of a 28-year-old man surviving traumatic hemipelvectomy is presented. This patient is the first reported survivor in Australia of traumatic hemipelvectomy and one of few survivors reported in the world literature. Accurate and rapid early management including good resuscitation, rapid transport to the operating room and an aggressive team surgical approach all contributed to survival. Acute complications can be kept to a minimum by adhering to the approach of rapid resuscitation and early intervention by a team of surgeons. Associated dislocation of the contralateral hip with sciatic nerve damage and subsequent heterotopic calcification has not been previously reported and presents a significant obstacle to rehabilitation. Early attention to the psychological status of the patient and early involvement of rehabilitation specialists is advocated.

Accidents, Traffic↗
PubMed1998

Which procedure gives best results in reconstructing dislocated hip joints in cerebral palsy?

A retrospective study of the surgical repair of dislocated or subluxed hip joints in patients with spastic cerebral palsy was carried out to determine the procedure with the lowest recurrence rate. An open reduction and a corrective femoral osteotomy were combined with different pelvic osteotomies and different interventions on the iliopsoas muscle in most cases. The radiological results in 58 hip joints of 42 patients were assessed with a follow-up time of 5.9 years on average (2.8 to 11.0 years). Although some combined procedures were carried out in only an small number of cases, we can still draw some conclusions. The results were better, if a pelvic osteotomy and an intervention on the iliopsoas muscle were performed. An additional iliopsoas transfer made the hip joints more stable over the long term than lengthening. For severely deformed acetabula the Pemberton osteotomy was superior to the Chiari osteotomy. The Salter osteotomy was a good alternative in cases with mild subluxation. With some combined procedures the redislocation rate was as high as 66%, whereas the combination of an open reduction, a femoral osteotomy, an iliopsoas transfer and a Pemberton or Salter osteotomy gave a redislocation rate of only 11%. A concentric reduction of the hip joints was necessary. Primarily noncentered joints did not improve during the later course.

Acetabulum↗
PubMed2004

Trochanteric osteotomy for incarcerated hip dislocation due to interposed posterior wall fragments.

A series of 12 patients was retrospectively reviewed to evaluate the use of sliding trochanteric osteotomy for reduction of hip dislocations that were irreducible due to interposed posterior wall fragments. Compared to similar patients who did not have irreducible dislocation or trochanteric osteotomy, the 12 patients had significantly longer operations with more blood loss. Patients with osteotomy tended toward a higher incidence of posttraumatic arthritis, but Harris hip scores at 2 years were identical to matched comparisons. No adverse effects of trochanteric osteotomy were identified.

Acetabulum↗
PubMedDate not supplied

[Preliminary treatment of congenital hip dislocation using physical therapy based on neurophysiology].

Adductor tightness is a typical symptom in CDH. In cases of subluxation and complete dislocation even a rigid abduction contracture can occur, preventing reduction and favouring redislocation. The contracture of the hip joint is the result of neurophysiological disorders, which can be treated by an exercise program on a neurophysiological basis. 62 children with 73 severely contracted and 5 hypotonic hip dislocations have been treated by the so-called "Vojta-program" before reduction. In a prospective study over 5 years this kind of treatment has been very successful: the incidence of necrosis of the femoral head could be reduced to 4%, long-lasting traction was not necessary anymore and the rigid hip joints required open reduction only in 2 cases.

Cerebral Palsy↗