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PubMed1984

[A clinical and genetic study on the congenital dislocation of the hip].

Among 13,779 infants examined from 1974 to 1980 at Takashimadaira and Toride health centers, there were 45 patients with congenital hip dislocation, an incidence of 3.3 per 1,000 live births, that is, 0.08% and 0.53% respectively in male and female. The male to female ratio was 1: 7.4. Its incidence seems to be decreasing year by year with statistic significance, compared with the data previously reported. A family study was conducted based upon 117 patients with this disease diagnosed at the Tokyo Medical and Dental University from 1971 to 1980. Applying the recurrence rate of siblings and the incidence in the general population to the model proposed by Falconer, the heritability of liability to congenital hip dislocation in Japan is estimated to be 80 +/- 20% in males and 135 +/- 10% in females, which is beyond limitation of the heritability and much higher than Woolf's estimation (82% in male and 58% in female). This might be due to the insufficient size of the test population, but the genetic factors are presumed to play a more important role on the etiology of this abnormality.

Adult↗
PubMedDate not supplied

[Magnetic resonance tomography in diagnosis and therapy follow-up of patients with congenital hip dysplasia and hip dislocation].

AIM: In patients with congenital dislocation of the hip the assessment of the correct position of the hip joint after closed or open reduction is very difficult to make from the radiograph with the hips in plaster. As the delayed recognition of a recurrent hip dislocation has bad effects on the outcome of the affected hip a safe and reliable imaging method must be employed. METHOD: From 1993 to 1996 6 patients with 8 congenital dislocations of the hip joint were examined by magnetic resonance imaging for evaluation of the position of the hip in plaster after reduction. Magnetic resonance imaging was performed immediately after closed or open reduction. 3 hips had to be treated by open surgery. RESULTS: The investigation confirmed that magnetic resonance imaging allows perfect differentiation between the bony and cartilaginous parts of the hip joint in plaster as well. Interpositioning of soft tissues which prevent reduction could also be visualized clearly. The best sequence in order to differentiate bony from cartilaginous structures was a gradient echo sequence in flash-technique using a flip-angle of 60 degrees. In all cases the correct position of the hip joint after reduction could be demonstrated in plaster. CONCLUSION: Therefore, magnetic resonance imaging is the imaging method of choice for confirmation and documentation of the reduced position of the hip joint in plaster. Radiographs are no longer needed.

Cartilage, Articular↗
PubMed1996

Neglected congenital dislocation of the hip. Role of computed tomography and computer-aided design for total hip arthroplasty.

Computed tomography (CT) provides important three-dimensional anatomic details in congenital dislocation of the hip that are useful for total hip arthroplasty (THR) and are not obtainable with conventional radiographic evaluation. In this study, 84 patients (119 hips) with congenital dislocation of the hip were evaluated with CT before surgery. Specifically, both the acetabulum and the femur were analyzed to make the best selection of the prosthesis. The average anteversion of the acetabulum was 23 degrees, with an opening of 30.9 mm and a depth of 14.7 mm. The bone stock of the true acetabulum was calculated and the average available diameter for the acetabular implant was 44.9 mm. The CT topogram revealed the true leg-length discrepancy (average 0.5-1.9 cm), and the amount of a shortening osteotomy when necessary was determined. Finally, to determine the stem with optimum fit and fill, a three-dimensional reconstruction of the femoral canal using CT data and computer-aided design (CAD) was matched with a three-dimensional geometry of several stem designs and sizes obtained from a CAD system.

Computer-Aided Design↗
PubMed1984

Congenital dislocation of the hip and computerised axial tomography.

CT scans of 18 hips with typical congenital dislocation have been studied in 16 children. These show that the common position of dislocation is lateral, superior and slightly anterior, and that a "false acetabulum" can be distinguished even in young children. A defect in the posterior ischium causing distortion of the acetabulum was also present in most cases. The cartilage and the acetabular contents were well shown. Positions of reduction and the anteversion of the acetabulum and the femoral neck were studied. Hypotheses are presented on the mode of dislocation and on the cause of the pathological changes.

Acetabulum↗
PubMedDate not supplied

One-stage combined operation of congenital dislocation of the hips in older children.

From 1977 to 1983, 17 patients with 20 long-standing congenitally dislocated hips were treated with a one-stage combined operation and then followed for more than 3 years by our institution. The growth of the proximal femur after femoral osteotomy was studied. The average neck-shaft angle was 111 degrees immediately after operation, and 128 degrees at follow-up. The outcome was largely independent of either age at operation or bilateral involvement. Our findings revealed 30% good and 50% excellent results in our patients.

Child↗
PubMed1981

Inadequate reduction of congenital dislocation of the hip.

The orthopaedic literature contains conflicting opinions concerning whether the interposition of soft tissue between the femoral head and acetabulum after a closed reduction of a congenitally dislocated hip interferes with development of the joint. This article describes eleven such cases of complete congenital dislocation of the hip in which the hip was maintained in an appropriate position after closed reduction for a prolonged period. All cases were documented by arthrography. It was concluded that the soft tissue in the joint can represent an inadequate reduction. One cannot expect the soft tissue always to recede or disappear, and the interposition can lead to a poor result.

Casts, Surgical↗
PubMed1981

[Walking pattern of patients with hip disorders (author's transl)].

The purpose of the present paper is to investigate the walking pattern of patients with hip disorders. The materials consist of 37 cases of osteoarthritis, ten cases of fused hips and two cases of congenital hip dislocation which had not been treated. Of the 37 cases with osteoarthritis, seven cases were in pre-arthrosis or in the early stage of it. They had slight hip pain and an almost normal range of motion. Thirty cases were in advanced arthrosis and were treated by total hip replacement. For the purpose of examining the walking pattern of the above mentioned patients, three-dimensional components of the floor reaction force were measured by Matake's force plate, and three loop diagrams were made by taking two dimensions at a time and plotting them on an X-Y recorder in order to easily understand the walking as a pattern. In the present paper only the alpha-diagram, which is composed of the vertical, forward and backward components, was used. In the patients with osteoarthritis, the figure of the alpha-diagram decreases and the unweighting effect in the vertical floor reaction disappears as the degree of the hip pain increases, while, on the normal side, some compensatory function was seen in the characteristic figure. In the cases of untreated congenital hip dislocation, the figures of the alpha-diagram were similar to the pattern of a painful hip with osteoarthritis. From these facts it is concluded that the most important factor influencing the walking pattern is hip pain.

Adolescent↗
PubMed1996

Ludloff's medial approach for open reduction of congenital dislocation of the hip. A 20-year follow-up.

We reviewed 33 patients (35 hips) after open reduction of congenital dislocation of the hip using Ludloff's medial approach. The mean age at the time of operation was 14 months (5 to 29) and at the time of final follow-up 20.1 years (15 to 24) giving a mean duration of follow-up of 19.4 years (14 to 23). We evaluated the radiological results by the Severin classification and the extent of avascular necrosis using the criteria of Kalamchi. At the latest review 16 hips (45.7%) were in Severin groups I or II (acceptable results) and 19 (54.3%) in Severin groups III, IV or V (unacceptable results). There was evidence of avascular necrosis in 15 hips (42.9%). The radiological results began to become worse at about the age of ten years when type-II avascular changes presented. We conclude that Ludloff's medial approach for open reduction is unsatisfactory for the treatment of congenital dislocation since about half of our patients required additional operations.

Child, Preschool↗
PubMed1982

[Outcome of hips at risk in congenital dislocation of the hip].

54 hips with one or more risk factors of congenital dislocation of the hip reviewed. 16 only received an early treatment. At follow up (2 and half years to 3 years) no difference could be found between treated or untreated cases, and no correlation could be made between the X-Rays measurements and the risk factor. 30% of the hip showed one or more abnormal angles (C-CE-or TALUS) 9 children reviewed at 5 and half still showed an abnormal talus. Actually, it is very difficult to accurately determine the radiologic criteria between normality and pathologic in children hips.

Child, Preschool↗