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At least 1,027 records · Page 57Linked to original sources
PubMed1999

Open reduction for congenital dislocation of the hip: comparison of the long-term results of the wide exposure method and Ludloff's method.

We compared the long-term clinical and radiographic results of two methods of open reduction for congenital dislocation of the hip; a wide exposure method (360-degree circumferential capsulotomy) versus Ludloff's method (limited capsulotomy via the medial approach). Thirty-one hips in 24 patients assigned to group A received the wide exposure method and 32 hips in 27 patients assigned to group B had the Ludloff reduction. All patients were surgically reduced at less than 3 years of age. The follow-up averaged 16 years. None of the hips in group A required additional operations; however, 34.4% of the hips in group B did. At the latest review, 26 (83.9%) of the hips in group A were rated as Severin class I or II. Except for one patient, none had pain or a limp. Of the hips in group B, 18 (56.3%) were rated as Severin class I or II. Three patients had pain or Trendelenburg gait. Avascular necrosis occurred in 3.2% of hips in group A and in 21.9% of hips in group B. The wide exposure method is capable of completely releasing the posterosuperior tightness resulting from capsular adhesion to the ilium and the contracted short external rotators. Releasing the posterosuperior tightness from these structures seemed to provide a better chance of achieving an anatomically and functionally satisfactory hip.

Acetabulum↗
PubMedDate not supplied

Long-term results of congenital dislocation of the hip treated with the Pavlik harness.

We present the radiographic and clinical results of 158 hips (127 congenital dislocations of the hip, 31 acetabular dysplasias) that were followed-up for > 20 years after the application of the Pavlik harness. The mean Sharp angle of these hips was larger than that of the normal Japanese hip, and the mean center-edge angle was smaller. Thirty hips (19%) were classified as class III, according to Severin's classification. Of 48 unaffected hips in the unilateral cases, 15 hips (31%) had steep acetabula. We believe an intrinsic factor disturbs the normal development of acetabular cartilage in both hips of the patients. Thirty-five hips (22.2%) showed variable grades of deformity of the femoral head, neck, or both. Clinically, most of the treated hips were good in the 3rd decade.

Braces↗
PubMed1994

[Treatment for congenital dislocation of the hip at the orthopedic department of the Institute of Orthopedics and Rehabilitation in Poznan from 1946 to 1991].

During forty-five years (1946-1991) over 6000 children were treated conservatively and over 6000 surgical procedures for congenital dislocation of the hip were carried out at Orthopedic Department of Institute of Orthopedics and Rehabilitation in Poznań. Modalities of treatment, types and numbers of operations are presented.

Child, Preschool↗
PubMed1989

One-stage surgical procedure for congenital dislocation of the hip in older children. Long-term results.

The one-stage procedure described in this article, which has been used in children older than three years of age, is the method of choice in the treatment of late-diagnosed congenital dislocation of the hip. The present authors and their patients have been more than satisfied with the results of this procedure. With femoral shortening as the fundamental step, this method can be applied in high dislocations, as well as in cases of subluxation in which a pelvic osteotomy is indicated, to restore the depth of the acetabulum and to prevent undue pressure on the femoral head, which is the main cause of avascular necrosis, joint stiffness, and failures. Evaluation of the results is confusing but should rely on resistance of the hip in daily function, clinical appearance, range of hip motion, and the patient's opinion. Roentgenologic evaluation seems to be even more difficult, because numerous parameters need to be taken into consideration and correlated with the preoperative appearance of the hip. Certainly, it is reasonable to expect the majority of patients to develop osteoarthritic changes eventually, but nearly all patients can live a normal or satisfactory life for a number of years. The present authors are convinced that many patients will remain symptom-free for a long period.

Bone Screws↗
PubMed1990

Treatment of osteoarthrosis secondary to congenital dislocation of the hip. Primary cemented surface replacement compared with conventional total hip replacement.

Seventy-four cemented conventional total hip arthroplasties (in fifty-five patients) and thirty-seven cemented surface replacements (in thirty-two patients) were done between 1971 and 1984 for treatment of osteoarthrosis secondary to congenital dislocation of the hip. The patients in the first group were older and had more severe dysplasia. In all patients, we tried to position the acetabular component at the level of the true acetabulum. In both groups, the operation relieved pain and improved the function of the hip in the short term. There were fewer and less severe early postoperative complications in the surface-replacement group, but the rate of long-term failure (revision or resection) was substantially higher. Survivorship analysis demonstrated that neither type of operation yielded durable results in younger patients; all revisions were in patients who were less than sixty years old. However, in older patients who had cemented conventional total hip arthroplasty, survivorship was excellent, regardless of the amount of dysplasia.

Adult↗
PubMed1977

[X-ray technique and congenital dislocation of hips (author's transl)].

Positioning, Fixation techniques and x-ray protection with methods accessible for every practising radiologist, are discussed on the example of roentgendiagnosis of congenital dislocation of hips (CDH) in young infants. Established radiologic criteria to diagnose CDH are mentioned and their dependence from correct radiologic techniques are stressed. Pitfalls arising from incorrect fixation and positioning of the infant are discussed.

Austria↗
PubMed1994

Principles of screening and congenital dislocation of the hip.

The call for screening for an increasing number of surgical diseases is becoming louder and more frequent. There is a general perception that screening is 'good' but it is important to consider the evidence carefully. There is one surgical disease that provides considerable experience of the process of screening over a period of 30 years and this is congenital dislocation of the hip (CDH). In retrospect, it is clear that screening for this disease has not been a total success. Although some specialised centres have achieved excellent results, in the country as a whole screening has been a failure. The reasons for this are analysed and emphasis is placed on the principles of screening which are briefly summarised. The results of various studies on screening and experiments on the basic functional anatomy of the neonatal hip are described. The initial results of our method of selective ultrasound screening appear to be encouraging and some evidence of a possible collagen abnormality in CDH is presented. As a general principle, however, it is suggested that strict randomised controlled trials should take place before national screening programmes are started.

Collagen↗
PubMed1978

Morphology of the acetabulum in congenital dislocation of the hip. Gross, histological and roentgenographic studies.

At autopsy, the hips of six infants who died soon after birth and had unilateral congenital hip dysplasia were found to have a cartilaginous ridge in the acetabulum which separated the hip socket into two sections. In two of the hips with a moderate degree of dysplasia and in one completely dislocated hip the ridge was formed exclusively by a bulge of acetabular cartilage. In three completely dislocated hips the ridge was formed by a bulge of acetabular cartilage covered by the inverted labrum. The acetabular cartilage showed signs of degeneration whereas the triradiate cartilage was normal. Examination of many newborn infants indicated that hip "clicks" are common and are not diagnostic of hip dysplasia. This diagnosis should be made only when the femoral head slides with a jolt over the acetabular ridge, causing a true positive Ortolani sign. Scattered ossification centers in the acetabular cartilage were seen on the roentgenograms of nearly half of fifty-nine hips with congenital dislocation reduced after the child was two years old, but less frequently in hips reduced at an earlier age.

Abnormalities, Multiple↗
PubMed1990

[Hip reduction in its congenital dislocation and the evaluation of long-term results].

Having analysed the outcomes of the treatment of 57 patients with congenital dislocation of the hip for over 20 years, the authors give an evaluation of closed reduction after Lorenz, according to the method of M. S. Sitenko and open reduction like arthroplasty. Doing this they evaluated the results from the points of view of stabilization of the joint function, development of dysplastic arthrosis and equal lengths of the legs. The outcomes of treatment after Lorenz were the best ones.

Adolescent↗
PubMed2006

Congenital dislocation of the hip. A re-appraisal of the upper age limit for treatment.

Difficulties posed in managing developmental dysplasia of the hip diagnosed late include a high-placed femoral head, contracted soft tissues and a dysplastic acetabulum. A combination of open reduction with femoral shortening of untreated congenital dislocations is a well-established practice. Femoral shortening prevents excessive pressure on the located femoral head which can cause avascular necrosis. Instability due to a coexisting dysplastic shallow acetabulum is common, and so a pelvic osteotomy is performed to achieve a stable and concentric hip reduction. We retrospectively reviewed 15 patients (18 hips) presenting with developmental dysplasia of the hip aged four years and above who were treated by a one-stage combined procedure performed by the senior author. The mean age at operation was five years and nine months (4 years to 11 years). The mean follow-up was six years ten months (2 years and 8 months to 8 years and 8 months). All patients were followed up clinically and radiologically in accordance with McKay's criteria and the modified Severin classification. According to the McKay criteria, 12 hips were rated excellent and six were good. All but one had a full range of movement. Eight had a limb-length discrepancy of about 1 cm. All were Trendelenburg negative. The modified Severin classification demonstrated four hips of grade IA, six of grade IB, and eight of grade II. One patient had avascular necrosis and one an early subluxation requiring revision. One-stage correction of congenital dislocation of the hip in an older child is a safe and effective treatment with good results in the short to medium term.

Age Factors↗
PubMed1993

Pemberton osteotomy for residual acetabular dysplasia in children who have congenital dislocation of the hip.

We reviewed the results for fifty-two hips in forty-two patients who had had a Pemberton pericapsular osteotomy between 1968 and 1984 as treatment for residual acetabular dysplasia of the hip. The average age of the patients at the time of the osteotomy was four years. The average duration of follow-up was ten years. At the time of the most recent follow-up, forty-two of the fifty-two hips had a rating of Severin class IA, an essentially normally developed hip. The results of the Pemberton osteotomy were unpredictable if there had been necrosis of the femoral head (without infection) preoperatively. We believe that the Pemberton osteotomy is a safe, effective procedure for the treatment of acetabular dysplasia in patients who have congenital dislocation of the hip.

Acetabulum↗