[Symptomatology and diagnosis of dysplasia of the hip joints and congenital dislocation of the hip in premature infants].
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Hip Dislocation, Congenital↗
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Growth disturbance of the proximal part of the femur after treatment for congenital dislocation of the hip.
The radiographs of ninety patients in whom treatment of unilateral congenital dislocation of the hip was complicated by disturbance of growth of the proximal part of the femur were studied retrospectively. All patients were followed until closure of the affected proximal femoral physis. We divided the patients into three groups, according to the degree of vascular insufficiency: patients who had mild vascular insufficiency of the hip, which had little effect on growth; those who had moderate vascular insufficiency, which produces partial arrest of growth; and those who had severe vascular insufficiency, which causes complete arrest of growth. Good correlation was found between the initial degree of vascular insufficiency and the radiographic results at the most recent follow-up. The radiographic signs that were used to predict the extent of physeal involvement were a crescent-shaped epiphysis, medial bowing of the femoral neck (a shorter and more concave curve between the lesser trochanter and the proximal femoral metaphysis [the lateral portion of the Shenton line]), lateral tilting of the capital epiphysis, and premature physeal closure. Signs that were diagnostic of existing physeal involvement were elevation of the greater trochanter and shortening of the affected extremity. The presence and severity of these signs correlated well with the degree of vascular insufficiency. Medial bowing was the most reliable prognostic factor for the determination of the fate of the hip joint at maturity.
Adolescent↗
[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↗
[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↗
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↗
[Evaluation of radiological results in hip joints after complete reposition-reconstruction of congenital dislocation of the hip].
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Adolescent↗
Routine ultrasound screening for neonatal hip instability. Can it abolish late-presenting congenital dislocation of the hip?
We have undertaken routine ultrasound screening for neonatal hip instability in Coventry since June 1989. Of the 14,050 babies scanned during the first three years, 847 (6%) had ultrasound abnormalities. A grading system, based on the percentage of femoral head coverage, is presented. The proportion of abnormal hips decreased gradually so that by nine weeks, 90% had normal ultrasound appearances. Abnormality was more common in babies with a family history of CDH and in breech presentations. All babies with clinically abnormal hips had an abnormal first ultrasound examination. Five babies not diagnosed by clinical examination and with no risk factors had abnormal ultrasound appearances and were subsequently found to have clinically abnormal hips. Routine ultrasound screening has detected cases which would otherwise have presented late.
Female↗
Congenital dislocation of the hip treated by total hip arthroplasty.
Thirty-two total hip arthroplasties (THAs) were performed on 26 severely incapacitated patients with congenital dislocation of the hip. The arthroplasty technique varied with the problems encountered, but the cup was always placed in the true acetabulum. In 19 cases, femoral head autografts were transplanted. The overall results were satisfactory. Roentgenologic evaluation of the bone grafts showed no nonunion or secondary displacement. Nineteen previously invalid patients now lead normal lives. Five patients are minimally incapacitated and only two were unimproved by the operation. THA with autogeneic grafts to deepen the acetabulum is recommended whenever a congenital dislocation of the hip in an adult is associated with severe pain.
Adolescent↗
Avascular necrosis and the Pavlik harness. The incidence of avascular necrosis in three types of congenital dislocation of the hip as classified by ultrasound.
We analysed the incidence of avascular necrosis in 101 hips of 90 infants with congenital dislocation treated with Pavlik harness and followed up for more than one year. Using ultrasonography in the flexed-abducted position the hips were classified as type A when the femora head was displaced posteriorly, but within the socket and making contact with the posterior inner wall of the acetabulum; type B when it was in contact with the posterior margin of the acetabulum, with its centre at this level or anterior to it; and type C when it was displaced out of the socket, with its centre posterior to the posterior rim of the acetabulum. Eighty-seven hips were reduced by the harness (86%), and seven of these developed avascular necrosis (8%). All 69 hips with type-A dislocation were reduced and only one (1.4%) showed slight avascular necrosis. Eighteen (78.3%) of 23 hips with type-B dislocation were reduced, and six developed avascular necrosis (33.3%). In one hip, the femoral head was severely damaged. None of the nine hips with type-C dislocation was reduced in the harness. We concluded that the Pavlik harness is indicated for type-A but not for type-B or type-C dislocations.
Contraindications↗
Low friction arthroplasty for old untreated congenital dislocation of the hip.
We report the replacement of 42 hips in 34 adults with untreated congenital dislocation. We used Charnley low friction implants, cementing the cup at the level of the true acetabulum after deepening and enlarging it by our own technique of cotyloplasty. Results were evaluated in 38 hips after a mean of 5.5 years. All the patients showed marked improvement, with no infection and, as yet, no late revision. The technical difficulties of the operation and the complications are discussed.
Adult↗
Soft tissue collagen in congenital dislocation of the hip. Biochemical studies of the ligamentum teres of the femur and the hip joint capsule.
Collagens of the ligamentum teres of the femur and the hip joint capsule of 14 patients with congenital dislocation of the hip (CDH) were studied biochemically. Collagen was a major component of these tissues. Solubility of collagen was reversely related to age except in two cases. Collagen of both ligamentum teres of the femur and hip joint capsule was composed of type I, III and V collagens except in three cases. In these three cases with nevus or general joint laxity, two additional collagenous components were also found. The ratios of type III collagen to type I collagen were increased in CDH except in one case with short stature. These abnormalities of collagen metabolism could be the underlying cause of CDH and other clinical symptoms in these patients.
Amino Acids↗
[PLASTIC SURGERY OF THE COTYLOID CAVITY ASSOCIATED WITH ANTERIOR ENERVATION IN SURGICAL THERAPY OF HIP ARTHROSIS SECONDARY TO CONGENITAL DISLOCATION].
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Acetabulum↗
Total hip arthroplasty for congenital dysplasia or dislocation of the hip. Survivorship analysis and long-term results.
Two hundred and thirty-two total hip replacements with cement were performed between 1965 and 1987 in 190 patients who had osteoarthrosis secondary to acetabular dysplasia resulting from congenital dysplasia or dislocation of the hip. Forty-nine patients (fifty hips) who died or who did not have at least three years of clinical and radiographic follow-up were excluded; therefore, the study comprised 141 patients (182 hips), 125 of whom were women and sixteen of whom were men. The mean age at the time of the operation was 42.5 years (range, 19.5 to 76.5 years), and the mean duration of follow-up was 9.9 years (range, 3.1 to 22.8 years). A Charnley low-friction prosthesis with a 22.25-millimeter femoral head was used in all hips. A trochanteric osteotomy was performed in 164 hips. A direct lateral approach was used only when there was a limb-length discrepancy of less than two centimeters. Bulk autogenous graft was not used to augment the fixation of the acetabular component. The hips were divided into two groups on the basis of the degree of subluxation or dislocation according to the classification of Crowe et al. One hundred and thirty-six hips were grade I, II, or III (indicating subluxation) (Group S), and forty-six hips were grade IV (indicating dislocation) (Group D). At the most recent follow-up evaluation, 128 (94 per cent) of the 136 hips in Group S and forty-four (96 per cent) of the forty-six hips in Group D caused no or only slight pain (a score of 6 or 5 points, respectively, according to the system of Merle d'Aubigné and Postel). Nineteen cups (10 per cent) and five stems (3 per cent) failed and were revised. The rate of revision for loosening of the femoral component in Group D (2 per cent [one stem]) was similar to that in Group S (3 per cent [four stems]). In comparison, the rate of revision of the acetabular component in Group D (15 per cent [seven cups]) was almost twice that in Group S (9 per cent [twelve cups]). This study demonstrated satisfactory clinical results at a mean of nearly ten years. The fixation of the femoral components appeared to be satisfactory; however, the failure of the fixation of the acetabular components in Group D (the dislocated hips) is a cause for concern.
Adult↗
Ultrasound screening for congenital dislocation of the hip: a limited targeted programme.
Abnormal hips, arising from a clinical universal neonatal hip screening programme, were referred to a specialist paediatric orthopaedic surgeon for ultrasound (US) assessment. Two different methods of US screening were undertaken in consecutive years: (a) Clinically abnormal hips were assessed for dynamic stability without formal assessment of dysplasia; and (b) Morphologic and dynamic assessment was undertaken in clinically abnormal and "at risk" hips. US has been reported as an accurate method for initial diagnosis of instability of the hip joint. The incidence of late congenital dislocation of the hip (CDH) was not reduced by extending the US programme to include "at risk groups" and morphologic assessment of the hips. Morphologic assessment of the hip alone cannot be recommended as a secondary screening programme for the diagnosis of hip dislocation. However, it may be of value in evaluation of persistent dysplasia and its relationship with dislocation. Targeted screening programmes may reduce the rate of late CDH requiring operative procedures; further trials of US are necessary.
Female↗
Trochanteric growth disturbance after upper femoral osteotomy for congenital dislocation of the hip.
We reviewed 14 patients (16 hips) treated by open reduction and upper femoral derotation osteotomy for congenital dislocation of the hip. Nine patients with 11 treated hips had growth deformities of the proximal femur; in all of them the top screw of the fixation plate lay within the cartilaginous precursor of the greater trochanter. In the five control hips the top screw was more distal. In the nine patients (mean follow-up 10.8 years) there was an increase of 14 degrees in the neck-shaft angle (p = 0.01) and of 18 degrees in the angle between the capital femoral physis and the shaft (p = 0.01) compared to the control group. This indicates that growth disturbance of the greater trochanteric apophysis as a result of plate fixation leads to long-term deformity.
Bone Plates↗
The teardrop in congenital dislocation of the hip diagnosed late. A quantitative study.
We retrospectively reviewed the radiographs of the pelvis and hips of forty-five patients who had unilateral congenital dislocation of the hip treated with closed reduction and application of a cast without subsequent operations. The radiographs were made at the time of the initial diagnosis, two years after the reduction, when the child was ten years old, and at skeletal maturity. The width, shape, and type of the teardrop; the thickness of the acetabular floor; the acetabular index; the center-edge angle; the articulotrochanteric distance; and the Severin class at maturity were measured in the dislocated and contralateral, normal hips. At the time of the initial diagnosis, a well defined teardrop was seen in thirty-six (80 per cent) of the normal hips and in seven (16 per cent) of the dislocated hips. There was no difference in the width of the teardrop in the seven dislocated hips compared with that in the normal hips, although the v-shaped and crossed types of teardrops were more frequent in the dislocated hips. The v shape was not observed in the normal hips but was seen in sixteen dislocated hips two years after the reduction and in twelve dislocated hips when the children were ten years old. The superior and inferior widths of the teardrop of the dislocated hips were significantly greater than those of the normal hips (p < 0.001 and p < 0.05, respectively) when the children were ten years old. The hips with residual acetabular dysplasia had a v-shaped teardrop, widening of the superior width of the teardrop, and thickening of the acetabular floor. These hips, which were usually Severin class IV at the time of skeletal maturity, had a poor prognosis in adult life.
Acetabulum↗
Open reduction through a medial approach for congenital dislocation of the hip. A critical review of the Ludloff approach in sixty-six hips.
We reviewed the results of open reduction through the medial approach of Ludloff, done for congenital dislocation in sixty-six hips (sixty-three children). The mean age at the time of the operation was twelve months (range, two to sixty-three months), and the mean duration of follow-up was six years (range, two to thirteen years). Avascular necrosis was evident preoperatively in two hips (3 per cent) and was noted postoperatively in another seven hips (11 per cent). There was a correlation between the age of the patient at the time of the operation and postoperative avascular necrosis, with an increased prevalence of the complication in patients who had been managed with the open reduction after the age of twenty-four months. One redislocation and two subluxations were noted at the time of the first changing of the cast, four weeks postoperatively. Although the acetabular index decreased from a mean of 38 degrees preoperatively to a mean of 16 degrees at the time of follow-up, acetabular dysplasia did not resolve in 33 per cent of the hips and pelvic osteotomy was performed. We consider the Ludloff approach to be a safe and effective method for the treatment of congenital dislocation of the hip in infants who are less than the age of twenty-four months and in whom a concentric reduction with less than 60 degrees of abduction was not achieved following closed reduction. The advantages of this approach include direct access to the iliopsoas, the transverse acetabular ligament, and the constricted capsule; minimum loss of blood; and a cosmetically acceptable scar.
Child↗
Congenital dislocation of the hips and congenital renal anomalies.
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Hip Dislocation, Congenital↗