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PubMed1958

Congenital dislocation of the hip.

In a study of 42 cases in which open reduction of congenital dislocation of the hip was carried out after conservative treatment had failed, the following observations were made (in a relatively short period of follow-up observation):No one pathological change, as observed at operation, was inordinately associated with failure of closed reduction.By far the highest incidence of successful results of open reduction was obtained in cases in which the operation was done in the second and third year of life. The highest incidence of successful operation, as appraised immediately after the procedure, was in patients more than one year and less than six years of age. Results as determined roentgenographically were in close agreement with results observed clinically.

Female↗
PubMedDate not supplied

Early results of medial approach open reduction in congenital dislocation of the hip: use before walking age.

The operative findings and results in our first 40 consecutive open reductions of the congenitally dislocated hip by the medial approach are presented. These were all performed by one surgeon before walking age and, with one exception, all patients were aged less than 11 months at operation. Follow-up was from 2 to 7 years (mean 4.6 years). A vascular necrosis did not occur, but coxa magna and significant acetabular dysplasia were each present in one case. We have not performed any secondary operations.

Age Factors↗
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↗
PubMed1995

The acetabular response to proximal femoral varus rotational osteotomy. Results after failure of post-reduction abduction splinting in patients who had congenital dislocation of the hip.

The acetabular response to proximal femoral varus rotational osteotomy was studied radiographically in twenty-eight patients who had had thirty-three congenitally dislocated hips. All of the patients had previously been managed with open or closed reduction followed by use of a spica cast and had worn an abduction orthosis for at least one year after the reduction. The indications for the femoral osteotomy were a persistently increased acetabular index or subluxation, or both. The average of the patients at the time of the femoral osteotomy was twenty-five months. The average preoperative acetabular index was 32 degrees. At an average of seven years after the osteotomy, the acetabular index had improved to an average of 16 degrees. Four hips had had one subsequent procedure for persistent acetabular dysplasia. Despite a failure of the acetabulum to respond to use of an abduction splint, the proximal femoral varus rotational osteotomy stimulated improvement in the acetabular index to within normal limits in twenty-nine of the thirty-three hips.

Acetabulum↗
PubMedDate not supplied

Prediction for prognosis from radiologic measurements of patients treated with the Pavlik harness for congenital dislocation of the hip.

Radiologic measurement was made in 96 hips of 96 female patients with congenital dislocation of the hip (CDH) treated only with the Pavlik harness before reaching age 6 months until time of maturity. Radiographs were retrospectively examined to determine whether prognosis of the hip joints was predictable up to approximately 3 years of age. Highly accurate prediction was possible using multivariate analysis. The patient group assessed as "satisfactory" with discriminant analysis had an incidence of Severin's classification of group III or lower of < 1% of significance level. This analysis appears to be a useful screening method for judging CDH after treatment.

Child, Preschool↗
PubMed1986

Hip arthroplasty for congenital dislocation.

From 1974 through 1981, total arthroplasty was performed for arthrosis following congenital dislocation in 25 hips in 17 patients. Pain was the main indication for surgery. Early complications were two dislocations and one deep venous thrombosis. One malpositioned socket and one loosening of the femoral prosthesis and socket were revised. At follow-up 2-9 years postoperatively, 16 hips were excellent, eight good, and one poor. The dysplastic pelvis and femur require implants of special design, and the original acetabulum should be prepared and reinforced at surgery. A radiographic method for calculation of the center position of the hip before and after surgery proved simple and exact.

Adult↗
PubMed1985

[Etiology, pathogenesis and pathology of dysplastic hip dislocation].

Neonatal hip examination and early therapy of CDH proofed to be best in preventing early osteoarthritis of the hip. Nevertheless we still happen to be confronted with congenital dislocated hips and hip dysplasias diagnosed after walking age. The pathologic changes of the dislocated hip joint are described.

Child Development↗
PubMed2003

[Open reduction after failure of conservative treatment for congenital dislocation of the hip initiated before the age of six months].

PURPOSE OF THE STUDY: The aim of this study was to present the indications, technique and results of open reduction for congenital hip dislocation performed after failure of conservative treatment. MATERIAL AND METHODS: Criteria of inclusion in the series were: congenital dislocation of the hip treated conservatively before the age of six months requiring open reduction for failure of initial treatment between 1978 and 1998. During this period, 3000 hips sustained conservative treatment. The series counted 33 hips in 29 children. Mean number of different conservative methods used for one hip was 2.6. One-third of the hips had had previous surgery. Avascular necrosis was noticed in 17 cases (51.5%). Mean age at open reduction was 2 years. Pelvic (61%) and/or femoral (79%) osteotomies were combined with open reduction. RESULTS: Mean follow-up was 9.5 years. Among the complications, minor avascular necrosis was noticed in five hips without preoperative lesions. Hip joint congruency was excellent or good in 80.7% of the cases. There were no recurrent dislocations. Ten hips (32.3%) were free of avascular necrosis but 4 presented severe avascular necrosis (13%). DISCUSSION: Indications for open reduction are exceptional, attesting to the efficacy of conservative treatment. This salvage procedure achieves good results in the hands of experienced surgeons. The quality of the reduction depends not only on the intra- and extra-articular excision, but also on the stability achieved with peri-articular osteotomies. The main factor of prognosis is avascular necrosis induced by previous treatment.

Age Factors↗
PubMed1997

Intracapsular pressure in congenital dislocation of the hip.

Intracapsular hip joint pressure was measured in six infants with congenital dislocation of the hip (CDH) or acetabular dysplasia with hip joint instability diagnosed at an average of 4.3 months of age (range: 3-8 months). In the extension and neutral rotation position, the mean pressure was 8.9 mm Hg. After reduction, obtaining stability with the hip joints in the "frog-leg" position (i.e., maximum flexion around the axis of the neck of the femur), the mean pressure was 74.6 mm Hg. When obtaining stability with the hip joints in 20 degrees of flexion, abduction, and inward rotation, the mean pressure was 104 mm Hg, and in approximately 20 degrees of flexion, abduction, and forced inward rotation it was 160 mm Hg. We conclude that these rotational positions, often used to retain the joint in CDH or hip joint instability, induce intracapsular pressures that may cause occlusion of epiphyseal-physeal vessels and thus may be responsible for the avascular epiphyseal necrosis and growth disturbance seen in these patients.

Acetabulum↗