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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↗
PubMed1985

Varus derotation osteotomy in the treatment of persistent dysplasia in congenital dislocation of the hip.

We have attempted to define the indications for and limitations of varus derotation osteotomy in the treatment of persistent dysplasia in congenital dislocation of the hip. We studied the cases of thirty-four patients (forty-four hips) who were divided into three groups according to age at operation, and evaluated the influence of femoral remodeling, age, acetabular response, instability, and pre-existing avascular necrosis with respect to the final results. The length of follow-up ranged from five to twenty-two years. Rapid return to a valgus femoral neck-shaft angle by remodeling was not a cause of failure in any age group. There were consistently good results in the patients who were less than four years old at the time of operation. Acetabular correction by remodeling occurred through the age of eight years, but four of thirteen hips in patients who were between the ages of four and eight showed persistent dysplasia despite the operative procedure. The results were less predictable as the patients approached the age of eight years. There was no benefit from isolated femoral osteotomy in ten of eleven hips in patients who were older than eight. Pre-existing avascular necrosis appeared to compromise the results of the procedure in all age groups.

Age Factors↗
PubMed1984

Arthroprosthesis in old unreduced congenital dislocation of the hip, using the "false" acetabulum. A study of 34 cases.

In adult patients with considerable loss of function due to an unreduced congenital dislocation of the hip with a false acetabulum, the authors posed the question "Is it feasible, with a reasonable chance of success, to perform an arthroprosthesis in the "pathological" position, using the false acetabulum as a seating for the cup?" The aim of this study was to assess, in particular, the holding properties of the cup which has to be fitted after appropriate reaming, into this rather precarious false acetabulum. They define the indications for this procedure and describe their technique. The results of 34 operations, followed up for an average of 5 years, confirm the validity of this procedure.

Acetabulum↗
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↗
PubMed1984

Salter procedure in congenital dislocation of the hip.

In a clinical and radiological study of 39 patients (43 hips) with congenital dislocation of the hip who were treated by a combined open reduction and innominate osteotomy, the success rate of a properly performed Salter procedure, the failed cases, and their reconstruction are described. The difficulty of this operation if not done strictly according to Salter's principles is stressed. We had 68.5% excellent and good results in children 1 1/2-4 years of age. Many failed procedures were salvaged when indicated by an open reduction followed after 6 weeks by a varus derotation femoral osteotomy. The Salter procedure should be done only after serious consideration. In our series, it was not easy even for surgeons with extensive experience.

Child, Preschool↗
PubMed1999

Concordance between hip ultrasonography and hip arthrography in the assessment of developmental dysplasia of the hip.

Controversy exists regarding the possibility of predicting hip reducibility in the congenitally dislocated hip, with arthrography still regarded as the gold standard in this situation. This study aims at assessing the degree of concordance between ultrasonography and arthrography in the detection of anatomic elements obstructing hip reduction. Forty-nine hips were studied both by ultrasonography and arthrography. Three anatomic sources of obstruction to reduction were assessed in each hip: ligamentum teres hypertrophy, inverted labrum, and the presence of soft tissue in the acetabulum. For each variable, congruence between ultrasound and arthrography was measured by kappa analysis. Values > 0.40 expressed sufficient concordance, and they were detected with regard to inverted labrum and the presence of soft tissue in the acetabulum. The results of this study suggest that ultrasonography may be considered a reliable technique for the prediction of the main causes of obstruction in the congenitally dislocated hip, such as inverted labrum and soft tissue in the acetabulum.

Arthrography↗
PubMed1984

Anetoderma. Clinical findings, associations, and long-term follow-up evaluations.

In 16 patients with anetoderma, a clinicohistologic entity related to a local dermal defect of elastic tissue, old lesions did not heal, and new lesions often continued to form for many years, despite various forms of treatment. Systemic lupus erythematosus, which occurred in one patient, must be ruled out in patients with anetoderma. Discoid lupus erythematosus occurred later in one patient. Other associated findings, noted in one patient each, included cataract, congenital hip dislocation, congenital fusion of the vertebrae at C2-3, diverticulum of the midesophagus, Addison's disease (before the onset of anetoderma), and mitral valve prolapse. Our results and a review of the literature indicate that patients with anetoderma must be examined for associated eye, bone, heart, pulmonary, digestive tract, and endocrine abnormalities for a better assessment of their skin disorders.

Adolescent↗
PubMed1979

[Contribution to the etiology of coxarthrosis. Radiographic and clinical evaluation of 976 arthrotic hip joints (author's transl)].

Radiograms and case histories of 654 randomized patients with 976 arthrotic hip joints have been reviewed in an attempt to make an etiological diagnosis. 98.3% of the patients and 98.8% of arthrotic hips, respectively, could be determined as to their underlying praearthrotic deformities according to Hackenbroch sen. The respective mean value gained from 6556 patients published in the world literature is 74.2% with marked individual variations. Most frequent praearthrotic condition was found to be congenital hip dislocation, followed by epiphyseolysis capitis femoris juvenilis, trauma, coxitis, M. Perthes, coxa vara, protrusio acetabuli, idiopathic femoral head necrosis, ankylosing spondylitis and several more rare basic conditions.--The most important reasons for differing results are discussed: Specific composition of clinic cases, completeness of documentation, experience of the reviewer and considerable space for personal interpretation. Relevant epidemiological data are also mentioned; they are in agreement with clinical experience and published data.--Finally it is stated that present diagnostic methods are not able to detect all praearthrotic conditions.

Adolescent↗
PubMedDate not supplied

[Ultrasonography studies of the fetal hip].

Recent advances in ultrasound technology, especially high-resolution sonography, now permit visualisation of the fetal hip development. Since early diagnosis and treatment of congenital hip dislocation significantly influence the outcome of the disease, ultrasound screening of the newborn infants showed to be the most effective method. In our study assessment of the fetal hip has been performed on the prenatal level in order to provide basic knowledge on fetal hip development from 14th to 40th weeks of gestation. From the 20th week of gestation bony structures are clearly visible and allow the assessment of acetabular configuration. Soft tissue and chondral acetabular components are recognizable from the 21st week. For pre- and postnatal comparative measures Graf's method and standard documentation is used.

Female↗
PubMedDate not supplied

[Radiographic study of the hip in infancy and early childhood].

In the age of sonography, there is increasing disapproval of radiologic examination of the hip in infancy and early childhood. Justifiably, the sonogram has replaced the X-ray in many examinations of the hip joint in infants and small children, thus sparing them radiation exposure. It must be remembered, however, that sonography is primarily a screening method for detecting congenital hip dislocation and dysplasia in infancy. There is still no substitute for radiologic examination of hip joints which require treatment or have been treated. Performance of survey radiograms, and if necessary arthrography, with a specific diagnostic goal permits an interpretation of all pathomorphologic changes associated with hip dislocation in infancy and early childhood. There is no place for computerized tomography in this context. It is still impossible to predict the extent to which, in the future, magnetic resonance imaging, with new coil configurations and shorter examination times, will open a new chapter in hip joint examination.

Child, Preschool↗
PubMedDate not supplied

[The management of congenital hip luxation with arthrographic control, an individual risk-reducing and time-saving method. I. Choice of method and risk assessment based on arthrographic findings].

In 388 congenital hip dislocations arthrography was used to indicate the safest form of treatment. Immediate reduction in the squatting (human) position of plaster cast (Fettweis, Salter) was followed by 3.4% of avascular necrosis of the femoral head, while plaster casts after preliminary traction showed 14.8% necrosis and unsuccessful closed reductions preceeding open reductions 11.8%. Further investigations demonstrated the influence of mechanical factors. A higher percentage of avascular necrosis was found in a narrow capsular entrance between a deformed upper limbus (or acetabular bulge) and a protruding transverse ligament with insufficient reduction (lateral displacement greater than 5 mm) and abduction of more than 45 degrees. The percentage of avascular necrosis was also depending on the development of the epiphyseal nucleus, it was 0.9% in normal forms of nuclei, 4.5% when the nucleus had not appeared at the beginning of treatment, 4.7% in small and 12.5% in retarded nuclei. The rate of necrosis was increasing with age and the degree of dislocation. Critical arthrographic findings have been described. In sufficiently open joints and full reductions Pavliks harness or hip spicas in squatting (human) position are applied immediately. With moderate narrowing of the acetabular entrance and lateral displacement traction is used for 3-4 weeks with repeated arthrography. In severe soft tissue changes of the acetabulum and lateral displacement (greater than 5-7 mm) open reduction is safer than a forced closed reduction.

Adolescent↗
PubMedDate not supplied

Assessment of complex hip deformity using three-dimensional CT image.

We used three-dimensional computed tomography (CT) to define the bony configuration of the acetabulum and the proximal femur and their relationship to complicated and/or neglected congenital hip dislocations and Legg-Calvé-Perthes disease. Three-dimensional CT was useful for preoperative planning and postoperative evaluation of hips with complex deformities, which were often difficult to assess by means of plain radiographs or conventional two-dimensional CT. The coverage of the femoral head under the acetabular roof and the severity of the hip dysplasia could be assessed easily with three dimensional CT, and acetabular and femoral torsion could be measured.

Child↗