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PubMed1990

[Clinical and ultrasonic diagnosis of congenital hip dislocation (dynamics of changes in early therapy)].

The authors present part of their prospective epidemiological study of congenital dysplasia of hip joints within which newborns were examined by ultrasonogram prior to the beginning of the therapy. Apart from the standard examination in the frontal plane after Graf they examined on principle also the ultrasonographic stability by the dynamic test after Schuler as well as by the application of the probe anteriorly with the simultaneous provocation according to Palmén. The authors have processed pathological ultrasonographic findings in 53 newborns (64 hip joints). The technique of the examination by ultrasound from the anterior approach is explained in detail. The comparison of both dynamic tests has shown that the examination from the anterior approach is considerably more sensitive than Schuler's dynamic test and also fully correlates with the clinical finding. It is a fact that the shift of the head in the flexion dorsally represents the most important component of the movement in unstable hip joint during provocation, it is far more noticeable than the lateralization of the head or the shift in the cranial direction. After achieving ultrasonographic stability the classical Graf method is sufficient for the registration of residual changes on the acetabular rim. The follow-up of patients until their complete healing has shown a surprisingly rapid remodellation of hip joints. The whole complex of clinically unstable hip joints has been divided into subgroups according to Graf classification. In type IIc or IId on the basis of ultrasonographic examination from the anterior approach the stable joints from the ultrasonographic viewpoint have been distinguished from unstable ones. The follow-up carried out in short intervals has shown that of longest duration is the remodellation of total dislocation and, on the contrary, of shortest duration is the healing of joints in the IIc or IId type. An absolute majority of affected hip joints have become normal until 3rd month of the age. The complex does not include two patients with teratological dislocation, the incidence of which has been determined in our study by the ratio of 2 cases in 35,550 of timely examined newborns. The role of the factor of spontaneous stabilization cannot be in this part of the study completely discounted. However, herewith we present part of an accomplished epidemiological study where the number of timely diagnosed patients including late diagnoses corresponds to the number of dislocations and subluxations determined within the conventional late diagnosis.

Female↗
PubMed1992

Diagnosis and treatment of congenital dislocation of the hip.

Up to 10 percent of infants in the United States are born with congenital dislocation of the hip. The disorder is readily diagnosed using the Ortolani and Barlow maneuvers. If congenital hip dislocation is recognized and treated within the first six to 12 months of life, affected joints develop normally in the vast majority of infants. Prolonged dislocation makes it difficult to return the femoral head to the acetabulum and is associated with a higher incidence of osteoarthritis and poor hip function in adulthood. Infants diagnosed with congenital hip dislocation before six months of age may be managed with a simple positioning device or a Pavlik harness. Older children may require traction, casting or surgery. Radiographs, ultrasound scanning, hip arthrography, computed tomography and magnetic resonance imaging can be helpful in making the diagnosis. Avascular necrosis of the femoral head is the most serious complication of treatment. Family physicians can play a major role in reducing the morbidity associated with improper treatment.

Child↗
PubMedDate not supplied

[Primary surgical treatment of congenital hip dislocation].

After discussing some technical aspects of the surgical treatment of the congenital luxation of the hip, the Author reports on 148 of his own cases operated over a period of 8 years. He then goes on to evaluate the follow up also with regard to the age when treated and to describe the more unsuccessful cases. Also in the light of bibliographical data, he then considers the different indications for the treatment of the congenital luxation of the hip, pointing out in his conclusions that among the many reasons that have made him a firm upholder of the primary surgical treatment of the congenital luxation of the hip is the very small percentage of postreductive osteocondrosis which, as is known, often gives rise to serious, irrevocable invalidation.

Age Factors↗
PubMedDate not supplied

[Final results of ultra-early diagnosis in congenital hip dislocation in the newborn infant population].

Data relating to the first year's work in ultra-early mass diagnosis of cases of congenital dysplasia of the hip are presented. Stress is laid on the importance of this type of screening as a means of preventing the crippling sequelae that this disease. Attention is drawn to the simplicity and cheapness of the examination. Particular reference is made to the notable frequency with which this form of dysplasia was observed in the children of parents known to be original inhabitants of the Sangone Valley.

Hip Dislocation, Congenital↗
PubMed1991

Ultrasound screening for congenital dislocation of the hip. Results and correlations between clinical and ultrasound findings.

The author reports the findings of clinical and ultrasound screening for congenital dislocation of the hip in 1000 consecutively examined newborns. This study found that medical history and clinical signs do not always guarantee diagnosis of congenital hip dislocation. The disease can in fact be present even in the absence of clinical signs, including the Ortolani click sign. Ultrasound is a safe and reliable diagnostic tool which should be used together with clinical examination in the screening of newborns for congenital dislocation of the hip.

Female↗
PubMed1980

Capsular arthroplasty of the hip for congenital dislocation.

During a 20-year period, capsular arthroplasty was performed on 32 congenitally dislocated hips (28 patients). The Colonna procedure was used, except that prereduction traction was omitted. Capsular arthroplasty was a primary surgical procedure for 12 patients (15 hips) in whom a late diagnosis of CDH was made (mean age at diagnosis, 3.9 years). The same operation was performed as a secondary, or salvage, procedure in a group of 16 patients (17 hips) who had undergone one or more previous operations that failed to secure reduction. The results of treatment in the two groups did not differ significantly. Long-term stability was achieved in 27/32 hips (84%). Excellent or good results were obtained in 17/32 hips (53%). Fair or poor results were obtained in 15/32 hips (47%). In 10/32 hips, there was marked stiffness and in 5/32 hips, redislocation occurred.

Arthroplasty↗
PubMed1997

Total hip arthroplasty in neglected congenital dislocation of the hip.

Between 1984 and 1995, 74 total hip replacements were performed in 64 adult patients who had painful untreated congenital dislocation of the hip. The arthroplasty was performed in the position of the true acetabulum in all patients who had either high or low congenital dislocations of the hip. The femoral head was positioned in the true acetabulum after either osteotomy of the greater trochanter or shortening of the femur, or progressively using external fixation. Information was available on all patients with a followup of 1 to 11 years (mean, 7.2 years). Of the 74 replaced hips, 70 showed marked improvement concerning pain, gait, and mobility, according to the Merle D'Aubigne and Postel scale. Four hips were revised with satisfactory results. The reason for revision was infection in one case and loosening of the plastic cup in three cases. Shortening of the femur by removing a segment of bone below the level of the lesser trochanter followed by osteosynthesis without osteotomy of the greater trochanter was found to be the best method for treating bilateral and several unilateral high congenital dislocation of the hip.

Adult↗
PubMed1991

[Comparative analysis of osteotomy methods in open setting of congenital hip dislocation in children].

There is given an analysis of the treatment of 89 children (99 joints) with congenital femur dislocation, which were subjected to corrective osteotomy at the open setting by three different methods. There are shown the advantages of oblique osteotomy, proposed by the authors. There have been developed and substantiated the indications for application of oblique and transversal osteotomy of the femur.

Child, Preschool↗
PubMed1991

[Surgical treatment of congenital hip dislocation in adults].

In the article is summarized the experience of treatment of adult patients with congenital dislocation of the femur. In clinic there has been applied not widely practised access by means of inter--of supratrochanteric osteotomy. After that the proximal fragment of the femur is diverted outwardly and the capsule is opened on the medial side. In this way the blood supply of the head and neck of the femur is maximally spared. During 12 years there have been operated 67 patients aged 15-50 years. Dynamic observation of patients indicated absence of such grave complication as the aseptic necrosis of the head of the femur that is the principal confirmation of low-traumatic character of the operation.

Adolescent↗
PubMed1990

Abduction treatment in late diagnosed congenital dislocation of the hip. Follow-up of 1,010 hips treated with the Frejka pillow 1967-76.

There are many countries such as Poland where treatment of congenital hip dislocation is started late. The purpose of this work was to report our results in this group of children. 1010 hips in 780 children with congenital dislocation of the hip were treated with the Frejka pillow. The early results were evaluated in 830 hips at 15-36 months of age and the late results in 527 hips at a mean age of 14 (10-21) years. 90 percent of the children were treated by the same physician. The age at the onset of the treatment varied from 2 weeks to 24 months, with 12 percent younger than 3 months and 28 percent older than 6 months. The initial degree of dislocation was determined with our own index. Radiographic results were evaluated with a scoring based on four or six parameters. There were 6 percent failures, including lack of reduction or redislocation at the time when the child started to walk. Ischemic necrosis was observed in 14 percent of the hips, with significant permanent sequelae in 5 percent. Indications for surgical treatment of residual dysplasia were found in 4 percent of the hips evaluated early; and in the group evaluated late, still 5 percent of the hips required operation. There was good ability for spontaneous remodeling between the age of 3 and 7 years, whereas around the age of 10, the radiographic appearance of the hip became stabilized. At the end of treatment and at the time when the children started to walk, 59 percent of the early evaluated hips were still insufficiently remodeled; but in cases evaluated late, 95 percent of them had a normal or almost normal radiographic appearance. At that time, the clinical state of the children was satisfactory. The results of treatment depended on the initial degree of displacement. Only when treatment was begun after 5 months of age did the patient's age affect the treatment results. The Frejka pillow successfully reduced and stabilized these hips.

Age Factors↗
PubMed1989

[The role of exogenous factors in the etiology of congenital hip dislocation: a socio-epidemiologic study].

The authors present in their work the results of the analysis of the relation between congenital dislocation of vertebral joints and social factors which they have found out in 120 children singled out of 9516 live-born children in the Martin district (Slovakia) in the period 1979-1983. The investigation of social factors has been based on the analysis of socioeconomic and social conditions of the Martin district which has no regional particularities. According to their results the share of exogenous factors in the origin and development of this disease is manifested more frequently in the first-borns (having the highest representation in the examined group). On the top of the list of social indices, which they have examined in primiparae and multiparae respectively, there are unsuitable housing conditions (living in discord with mother-in-law in the same house-hold), high percentage of impregnation before marriage which can be considered a strain and longterm conflicting situation and can have together with other factors a sociopathogenetic effect.

Adult↗
PubMed1984

Congenital dislocation of the hip in children. Comparison of the effects of femoral shortening and of skeletal traction in treatment.

Preoperative skeletal traction as an aid in reduction of congenital hip dislocation in the older child has been associated with an unacceptably high incidence of avascular necrosis, redislocation, and poor results. In contrast, femoral shortening as an aid in reduction has yielded a high rate of very satisfactory results, and may be essential for obtaining a stable, physiological, non-compressive reduction. We have analyzed the complications and the radiographic and functional outcomes of treatment in thirty-nine hips. It was clearly demonstrated that femoral diaphyseal shortening was preferable to traction as an aid in the operative reduction of a congenitally dislocated hip in children who were more than three years old.

Child↗
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↗