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PubMed1990

[Early diagnosis of congenital hip dislocation in neonates].

On the basis of the analysis of the examination of hip joints in 1000 newborns the author supports his former statement that of almost the same frequency as the acknowledged symptomatology of unstable hip joint (in 6.5 per cent) is the pathological symptomatic group of increased tension of tendons of the origin of adductors (in 4.7 per cent), sometimes also with reduced abduction, less palpable head of the hip joint and the symptoms presented by him can improve the quality of screen position case of breech presentation. This was found in 5.2 per cent of deliveries. The combination of both symptomatic groups occurs in 1.4 per cent. Out of individual symptoms in the breech presentation of highest frequency--according to the author--is the increased tension of the origin of adductors (in 94.2 per cent), be it isolated form of incidence (in 25 per cent) or in combination with other symptoms. In the examination technique he includes also the symptom of the hyperextensibility of the knee and relates its frequency (82.7 per cent) with the breech presentation and with the increased joint laxicity conditioned hormonally. After the analysis of mechanical effects in the foetal stage of pregnancy he attempts to correlate clinical neonatal symptomatology with the pathological anatomical classification after Ogden. He arrives at the conclusion that only combined identification of symptoms of both the instability of the hip joint and the symptoms presented by him can improve the quality of screening and thus reduce the incidence of unidentified defect of the hip joint in 3rd month of age of the child. Further progress can be made only after the introduction of a purposeful sonographic screening of the newborn and infant hip joints. The author, however, considers for irreplaceable the method of a careful clinical examination of newborns.

Hip Dislocation, Congenital↗
PubMed2000

Acetabular revision after failed total hip arthroplasty in patients with congenital hip dislocation and dysplasia. Results after a mean of 8.6 years.

BACKGROUND: Revision of a total hip arthroplasty in a patient who has had congenital hip dysplasia or dislocation is often more difficult than a standard revision operation. The purpose of this study was to assess the efficacy and complications of use of a cementless hemispherical acetabular component for revision of an acetabular component of a failed total hip replacement in patients whose initial problem was arthritis secondary to congenital dislocation or dysplasia. The mean duration of follow-up was approximately eight years. METHODS: We reviewed a consecutive series of sixty-one hips in fifty-three patients who underwent a cementless acetabular revision with use of a hemispherical acetabular component, with or without concurrent femoral revision. Data were collected prospectively. The mean age of the patients at the time of the index operation was fifty-six years. A mean of 1.9 ipsilateral hip operations had been performed previously. Thirty-nine hips (64 percent) had a so-called high hip center prior to the index revision. With one exception, the uncemented acetabular component was fixed with screws. Fifty-one acetabular components were placed with so-called line-to-line fit, and ten were oversized by one to three millimeters. In thirty-eight hips, the femoral component was revised as well. Twenty-nine femora were reconstructed with use of a cemented device, and nine were revised with an uncemented patch-porous-coated femoral stem (a stem on which the porous coating appears in patches). RESULTS: Four patients (five hips) died prior to the five-year minimum follow-up interval. With the exception of one hip treated with resection arthroplasty because of deep infection, none of the hips in these deceased patients had been revised or had a loose component. One living patient (one hip) had a resection arthroplasty, and one additional patient (two hips) had both stable acetabular components rerevised at the time of femoral rerevision at another institution because of loosening and osteolysis. One patient refused to return for follow-up, but the components had not been revised. The remaining fifty-two hips in forty-six patients were followed for a mean of 8.6 years (range, 5.0 to 12.7 years). The mean Harris hip score was 80 points (range, 56 to 100 points) at the time of the latest follow-up. No acetabular component had been revised, although two had migrated. No other acetabular component was loose according to our radiographic criteria. Thus, the mechanical failure rate on the acetabular side was 3 percent (two of sixty-one) for the entire series and 4 percent (two of fifty-two) for the patients who had been followed for a mean of 8.6 years. On the femoral side, the mechanical failure rate was 3 percent (one of twenty-nine) for the cemented stems and six of nine for the uncemented patch-porous-coated stems. CONCLUSIONS: Of the approaches used in this difficult series of patients requiring revision, the hybrid arthroplasty (a cementless acetabular component and a cemented femoral component) yielded overall good results after an intermediate duration of follow-up.

Acetabulum↗