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PubMedDate not supplied

Total hip arthroplasty in congenital dislocated hips.

Experience with six typical cases demonstrates that total arthroplasty for congenital dislocated hips may be associated with malalignment of the ipsilateral knee, leg-length inequality, pelvic obliquity and structural changes in the lumbosacral spine. The preoperative planning may include computerized tomography scan to obtain accurate information about the optimal placement of the socket and the size and shape of the prosthetic components. Loosening of the stem or socket rather than polyethylene wear is the expected cause of late failure. The design of the femoral component should fit the canal and the shape of the proximal femur. Biological causes for failure, such as granulomatous reaction to wear, particles, and infection, are known but were not encountered in the present series of cases. The surgical technique is designed to obtain complete coverage of the socket in the available bone. A supplementary bone graft provides additional bone stock and is especially important for revision operations. Orientation of the components, stability of the joint, the need for tenotomy of contracted structures, and the improvement of abduction and flexion muscle power are also important considerations. Elderly patients with degenerated, painfully dislocated hips that are refractory to conservative treatment, may be candidates for arthroplasty.

Acetabulum↗
PubMedDate not supplied

Functional results of iliopsoas transfer in myelomeningocele hip dislocations.

Paralytic hip dislocations in 37 children with myelomeningoceles have been treated by open reduction, iliopsoas tendon transfer and various other procedures about the hip. At follow-up, less than half the patients were community ambulators and had maintained their reductions. The level of the spinal lesion, alignment of the lower extremities in relation to the trunk and pelvis and the presence of scoliosis including pelvic obliquity were more important factors in determining the patient's degree of function than the status of the hip reduction.

Child↗
PubMed2005

Knee injury in patients experiencing a high-energy traumatic ipsilateral hip dislocation.

BACKGROUND: Traumatic hip dislocation results from the dissipation of a large amount of energy about the hip joint. Clinically, these forces often are first transmitted through the knee en route to the hip. It is therefore logical to look for coexistent ipsilateral knee injury in patients with a traumatic hip dislocation. METHODS: Over a one-year period, we prospectively evaluated the ipsilateral knee of all patients who had a traumatic hip dislocation on the basis of a standardized history, physical examination, and magnetic resonance imaging. RESULTS: Twenty-one (75%) of the twenty-eight knees were painful. Twenty-five (89%) of the twenty-eight knees had visible evidence of soft-tissue injury on inspection. Magnetic resonance imaging revealed evidence of some abnormality in twenty-five (93%) of twenty-seven knees, with effusion (37%), bone bruise (33%), and meniscal tear (30%) being the most common findings. CONCLUSIONS: The present study provides evidence of a high rate of associated ipsilateral knee injuries in patients with a traumatic hip dislocation. Bone bruises may provide a plausible explanation for persistent knee pain following a traumatic hip dislocation. The liberal use of magnetic resonance imaging is recommended for the evaluation of these patients in order to detect injuries that may not be discoverable on the basis of a history and physical examination alone.

Accidents, Traffic↗
PubMed1976

Total hip reconstruction in chronically dislocated hips.

The pathological anatomy of chronically dislocated hips makes reconstruction for more difficult in them than in most cases. The acetabular component must be seated at the site of the original triradiate cartilage and the femur must be shortened four or more centimeters to prevent excessive limb lengthening. This means that the femoral component must be seated in the smallest, strightest portion of the intramedullary canal. A specially designed prosthesis is often needed. Twenty-two hips were operated on in this series, and all patients had relief of pain and improvement of gait. One major complication occured: a sciatic-nerve palsy due to overlengthening of the femur and improper postoperative positioning.

Acetabulum↗
PubMed2003

[Simultaneous asymmetric bilateral traumatic hip dislocation: a case report].

Asymmetric bilateral (one side anteriorly, the other posteriorly dislocated) traumatic hip dislocations are very rare. We present a 21-year-old male patient who had simultaneous anterior and posterior traumatic hip dislocations due to a car crash. He also suffered from a tarsometatarsal (Lisfranc's) fracture-dislocation. The patient underwent conservative treatment and was followed-up for 44 months. Final evaluations with Thompson and Epstein radiologic and clinical criteria showed an excellent result. To our knowledge, this is the first report of a case with asymmetric bilateral traumatic hip dislocations associated with Lisfranc's injury.

Accidents, Traffic↗
PubMed1993

Hip dislocation.

Explore the source record for details and available documents.

Hip Dislocation↗
PubMed2006

Traumatic inferior hip dislocation in an adult with ipsilateral trochanteric fracture.

Traumatic Inferior dislocation of hip in adult is an extremely rare occurrence. We report a case of an inferior hip dislocation associated with an intertrochanteric fracture. Treatment consisted of an initial closed manipulative reduction of the dislocation with the aid of a Schanz screw inserted in a T handle universal chuck and using C-arm imaging. A dynamic hip screw was then used to fix the intertrochanteric fracture. At 2.5 years after the injury, the patient has symmetrical range of motion versus his contra lateral normal hip. Radiographs of the hip show normal anatomy without signs of avascular necrosis of the femoral head. To our knowledge, this is the first reported case of an adult with an inferior hip dislocation with a trochanteric fracture.

Accidents, Traffic↗
PubMedDate not supplied

Location of acetabular deficiency and associated hip dislocation in neuromuscular hip dysplasia: three-dimensional computed tomographic analysis.

Forty-one hips in 24 patients with neuromuscular disease (NMD) were studied using three-dimensional computed tomography (3DCT). The location of the acetabular deficiency was posterior (37%), anterior (29%), midsuperior (15%), and mixed (19%) (anterosuperior, posterosuperior, and global). Although subtle morphologic changes occurred in the entire acetabulum, the major acetabular deficiency coincided with the direction of the subluxation or dislocation. The location of the acetabular deficiency that develops in cerebral palsy is not always posterosuperior, as suggested by other authors. The pattern of spasticity that results in muscle imbalance around the hip joint and changes in proximal femur architecture causes hip subluxation or dislocation, which may be either, posterior, anterior, or midsuperior. 3DCT studies are required to analyze accurately and understand acetabular deficiency in childhood NMD. These image data also allow more accurate planning for surgery in neuromuscular hip dysplasia.

Acetabulum↗
PubMedDate not supplied

Untreated hip dislocation in cerebral palsy.

The purpose of this study was to evaluate the problems associated with hip dislocation in adults with cerebral palsy. Twenty-nine subjects with dislocated hips and no prior hip surgery were identified. There were a total of 38 dislocated hips. Age range was 21 to 52 years (average 34). Seven dislocated hips (18%) were definitely painful and four hips (11%) produced only mild or intermittent pain. Twenty-seven hips (71%) were not painful. The seven painful hips underwent proximal femoral resection, resulting in excellent range of motion and no pain. In conclusion, for established nonpainful hip dislocation in the severely involved spastic quadriplegic patient, aggressive surgical treatment should be undertaken only after careful consideration of the natural history. If a dislocated hip becomes painful in adulthood or develops an adduction contracture interfering with perineal care, a proximal femoral resection can be performed with reliably good success.

Adult↗
PubMed1990

[Computed tomography in untreated congenital hip dislocation in adolescence].

Untreated cases of congenital dislocation of the hip (CDH) in the adolescent age are rarely encountered in the western world but are not uncommon in our clinical practice. The pathoanatomy has not been well studied. Previously poor results of operative treatment are partially related to this lack of understanding of the true pathoanatomy and the failure to select the appropriate modality of treatment. Computed tomography (CT) has the capability to show the three-dimensional structure and was used in this study. From September 1985 to July 1988, we had 15 patients (18 dislocated hips) for CT study. Their ages ranged from 8 years 6 months to 22 years 5 months. The patients were divided into 4 types according to the position of dislocation, formation of pseudojoint and size of the true acetabulum: (1) high dislocation without pseudojoint formation; (2) high dislocation with pseudojoint formation; (3) low dislocation with pseudojoint formation; and (4) wide acetabulum. By measuring the diameter of the true acetabulum and femoral head, and the anteversion of the true acetabulum and proximal femur, we had the following results: (1) the size of the acetabulum and femoral head in dislocated hips were smaller than the normal side; (2) most of the acetabula in the dislocated hips were still large enough to accommodate the corresponding femoral heads, even up to the age of 22 years; and (3) the degree of anteversion was similar between the acetabula in normal and dislocated hips, but was more prominent in the proximal femur of a dislocated hip than the normal side.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetabulum↗