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PubMed1985

Arthroplasty combined with cup-plastics in the surgical treatment of congenital dislocation of the hip.

The authors review the arthroplasty combined with cup-plastics in the treatment of congenital dislocation of the hip. The indications and surgical exploration are discussed in detail. Good results are reported. The complications and their solutions are also described. In the recent five years, 100 patients were operated by them. Based on their experiences, they suggest this intervention at an earlier age, too (i.e. 30 to 40 years). Moreover, they believe it to be an important possibility to provide an adequate rehabilitation for patients being still of working age.

Adult↗
PubMed1997

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↗
PubMedDate not supplied

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↗
PubMed2002

[Prognosis of remodeling of the dysplastic hip joint following conservative treatment of congenital dislocation].

This paper presents the detailed analysis of the character of remodelling of 84 dysplastic hips in 70 patients with congenital hip dislocation treated conservatively. It was found, that the remodelling can be done basing on 3 models. Observing the character of the remodelling of the particular joint and encountering it to appropriate model, it is possible to predict the status of the joint when the growth is finished. Presented method allows to predict, if the hip joint remodelling is done in the correct way or the dysplasia is going to persist or get worse. In this way we are able to precisely state indication to the surgical treatment of the residual dysplasia and to choose a appropriate age of surgery. The probability of the correct prognosis is approximately 84 to 94%. The practical way of prognosis was also presented.

Adolescent↗
PubMed2002

[Cemented total hip arthroplasty for severe dysplasia or congenital dislocation of the hip].

OBJECTIVES: We evaluated total hip arthroplasty and short-term results in the treatment of coxarthrosis due to neglected congenital dislocation or severe dysplasia of the hip. METHODS: Cemented total hip arthroplasty was performed in 23 hips of 22 patients (2 men, 20 women; mean age 48.6 years; range 28 to 65 years) with osteoarthrosis due to congenital dislocation or severe dysplasia of the hip. The acetabular component was placed at the level of the true acetabulum; four patients required augmentation with autogenous bone grafts due to severe acetabular deficiency. Femoral shortening osteotomy using a subtrochanteric step-cut osteotomy was performed in seven patients with high-riding hips. Five patients underwent proximal femoral shortening after the trochanter major was osteotomized and distally advanced. All patients were evaluated with the use of the Merle d'Aubigne and Postel hip scores. Radiologic evaluations were made by preoperative and follow-up radiographs. The mean follow-up was 52.8 months (range 30 to 108 months). RESULTS: According to the Merle d'Aubigne and Postel hip scores, the results were excellent in 17 hips (74%), good in four hips (18%), fair in one hip (4%), and poor in one hip (4%). One hip required revision because of nonunion of the acetabular graft. The femoral stem was fractured in one patient. Complications included temporary sciatic nerve palsy in one patient, deep venous thrombosis in one patient, early dislocation in one patient, and nonunion of the femur in one patient who underwent subtrochanteric step-cut osteotomy. CONCLUSION: Total hip arthroplasty for congenitally dislocated or severely dysplastic hips is more effective than other treatment methods. Long-term results can be improved by the use of contemporary cementing techniques.

Acetabulum↗
PubMed1990

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↗
PubMed1996

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↗
PubMed1993

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↗
PubMed1988

[Late results of the Colonna arthroplasty].

A long term follow-up study (20-26 years after the original surgery) is presented of 7 patients who underwent a capsular arthroplasty according to the method of Colonna for congenital hip dislocation. Clinically and, in part also radiologically, the results were amazingly good. If we respect a few essential rules before, during and after the operation, all aiming at avoiding hyperpressure in the hip joint, the Colonna procedure may still be an alternative to more modern reconstructive procedures of the acetabulum. This is particularly true for congenital dislocations in the older child or unsuccessfully treated high residual subluxations. In both cases the cartilage of the acetabulum is altered and deformed to such an extent, that no method can make it fit the femoral head, which is also deformed.

Acetabulum↗
PubMed1987

The correlation of arthrography with the results of treatment in late diagnosed congenital dislocation of the hip.

The aim of this study was to assess the value of arthrography of the hip in the investigation of late diagnosed congenital dislocation. The results of the treatment of 109 hips were related to the findings at arthrography. The hip radiographs at follow-up were normal in all cases where the arthrogram had demonstrated a congruent reduction (86). When the arthrogram had indicated a block in reduction the results were less favourable, and dysplasia or subluxation was present at follow-up in 19 cases, despite repeated conservative or operative treatment. Four hips appeared normal after operation. Arthrography gave valuable information and showed good correlation with the results of treatment.

Child, Preschool↗
PubMed1996

Use of iliofemoral distraction in reducing high congenital dislocation of the hip before total hip arthroplasty.

The iliofemoral distraction with Wagner's apparatus was conducted in 20 adult patients with untreated unilateral congenital dislocation of the hip (Crowe group IV) before total hip arthroplasty. During the distraction period of 8 to 17 days, this technique had effectively reduced high dislocation of 4.5 cm (range, 3.5-5 cm). No pin-tract infection was encountered. Surgical difficulties in total hip arthroplasty for these patients were reduced. Potential problems, such as irreducibility, overshortening, nerve palsy, and displaced femoral fractures, were avoided. At an average follow-up period of 43 months (range, 25-63 months), all patients have excellent or good results, with an average Harris hip score of 94.3 (range, 84-100). Leg length was restored. The iliofemoral distraction is valuable prior to difficult total hip arthroplasty for high dislocation.

Adult↗
PubMedDate not supplied

[Total prosthesis for major arthrosis sequelae of congenital dislocation of the hip (author's transl)].

The author reports his personal experience with the use of total hip arthroplasty in 48 adult patients with major arthrosis sequelae from congenital dislocation of the hip. Particular emphasis is laid on a description of a classification of these sequelae, the technique used for total prosthesis application, and the results obtained, which are the consequence of close cooperation between the members of the surgical team, and the way in which the technique performed has been improved over the course of the years.

Hip Dislocation, Congenital↗
PubMed1994

Closed reduction for congenital dysplasia of the hip. Functional and radiographic results after an average of thirty years.

The functional and radiographic results of closed reduction in 152 congenitally dislocated hips of 119 patients who had been managed between 1938 and 1969 were reviewed retrospectively. The average age of the patients at the time of the reduction was twenty-one months (range, one to ninety-six months). At the time of the latest follow-up evaluation, the average age was thirty-one years (range, sixteen to fifty-six years). The average duration of follow-up was thirty years (range, fifteen to fifty-three years). At the latest follow-up evaluation, the Iowa hip rating averaged 91 points (range, 38 to 100 points) and the Harris hip score averaged 90 points (range, 33 to 100 points). Thirty-five hips were rated Severin Class I; thirty-five, Class II; twenty-eight, Class III; fifty-three, Class IV; and one, Class VI. Disturbance of growth in the proximal end of the femur occurred in ninety-one hips (60 per cent). Eight contralateral hips that had appeared normal also demonstrated disturbance of proximal femoral growth. In many hips, partial physeal arrest could not be determined for ten to twelve years after the reduction. Seventeen hips (twelve patients) had a total replacement when the patients were an average age of thirty-six years (range, nineteen to fifty-three years). Sixty-five hips (43 per cent) had radiographic evidence of degenerative joint disease. Patients who did not have a growth disturbance of the proximal end of the femur or evidence of subluxation tended to function extremely well for many years despite a radiographic result that was less than anatomical. Function tended to deteriorate with time, even in the absence of disturbance of growth in the proximal end of the femur. Despite generally good function at the latest follow-up evaluation, the prognosis for these patients remained guarded.

Adolescent↗
PubMedDate not supplied

Salter innominate osteotomies in congenital dislocation of the hip.

Clinical and radiographic data on 29 hips and 24 patients between the ages of 18 months and 5 years with congenital dislocation of the hip (CDH) who underwent Salter innominate osteotomies were reviewed. All patients were examined clinically and radiographically at an average postoperative follow-up of 9 years 3 months (range 3-14 years). All patients had good or excellent radiographic results by Severin classification. The complication rate was low. Three patients required reoperation for failed initial procedures. These three patients had hypertrophic subchondral sclerosis and joint space narrowing at follow-up. Our results indicate that the Salter innominate osteotomy if performed properly, has a high rate of clinical and radiographic success.

Child, Preschool↗
PubMed1987

Diagnosis by ultrasound of congenital dislocation of the hip joint.

Two hundred thirty-four hips of 117 babies from one day to 18 months of age were examined ultrasonographically for congenital dislocation of the hip joint. Ten hips in eight babies were dislocated or subluxated and there were 11 hip dysplasias in seven babies. In the normal hip, the adaptation between the acetabulum and the femoral head is well demonstrated, and there is no apparent interposition of the limbus between the acetabular roof and the cartilaginous head. In the dislocated hip, the protrusion of the acetabular rim is not so clear as that of the normal hip, and the limbus is seen to be interpositioned between the acetabular roof and the cartilaginous head. In severe cases, the acetabular rim is hidden under the shade of the femoral head. Ultrasonography is an effective method of determining the incidence of dislocation and of diagnosing hip subluxation as well as dysplasia and does not have the hazards of x-ray examination.

Female↗
PubMed1985

Hip replacement for congenital dislocation and dysplasia.

Seventeen patients with arthrosis secondary to congenital dislocation or dysplasia of the hip were treated by total hip replacement. Nine hips were completely dislocated, while 12 were dysplastic and subluxated. The operation was performed as a modification of Charnley's standard technique, the acetabular prosthesis was always placed in the neoacetabulum, and no particular attempt was made to correct the shortening of the leg. In eight patients bone grafting to the upper lateral acetabular edge was done. Only a few complications occurred and no postoperative dislocations. On average 4 years after the operation, the clinical and radiographic results were satisfactory. The operation used here is less difficult than placing the cup in the original acetabulum.

Acetabulum↗