[Guiding rules in the bloodless treatment of congenital dislocation of the hip].
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Hip Dislocation↗
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[The correction of the valgus position and anteversion in the treatment of congenital dislocation of the hip].
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Hip Dislocation↗
[CONGENITAL DISLOCATION OF THE HIP; INTRODUCTION].
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Hip Dislocation↗
[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↗
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↗
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↗
Socket loosening in arthroplasty for congenital dislocation of the hip.
Mechanical risk factors in loosening of the socket were radiographically analyzed in 123 Charnley arthroplasties performed during the period 1969-1982 for coxarthrosis secondary to congenital dislocation. The socket was placed as near the true acetabulum as possible without extensive soft-tissue release and without reinforcement of the acetabular roof by bone grafting. The rate of socket loosening was 19 percent using progression of a radiolucent line at the bone-cement interface to a width of greater than 1 mm as the criterion for loosening. Different predictors of loosening were analyzed by stepwise logistic regression analysis. Lack of lateral bony support for the socket was the prime predictor. The next most important predictors were the preoperative degree of hip dislocation and the position of the socket in relation to the true acetabulum.
Acetabulum↗
Congenital dislocation of hip in children: a review of patients treated in the Institute of Orthopaedics and Traumatology, General Hospital, Kuala Lumpur, 1975-1988.
A retrospective review of patients with congenital dislocation of the hip (CDH) seen in the Institute of Orthopaedics, Kuala Lumpur General Hospital from 1975 to 1988 is presented. There was a female predominance of 17 to five. The average follow-up was 43 months and the average age at final assessment was 63 months. The results were assessed clinically and radiographically using Severin criteria. Eighty eight percent of the hips had excellent or good clinical results at final review compared with 40% of the hips which had excellent or good radiological grading (Severin I and II). Initial acetabular angle before treatment and types of treatment appeared to have a correlation with the final result. The incidence of avascular necrosis was 16%.
Acetabulum↗
Total hip replacement for coxarthrosis secondary to congenital dysplasia and dislocation of the hip. Long-term results.
Between 1970 and 1982, sixty-six total hip replacements were performed with cement, without bone-grafting, in fifty-three patients who had congenital dysplasia and dislocation of the hip. Preoperatively, the patients had had Crowe type-II, III, or IV subluxation. Current information was available for fifty-nine hips in forty-six patients after an average duration of follow-up of sixteen years (range, ten to twenty-one years). The average age of the patients at the time of the operation was fifty-three years (range, twenty-three to seventy-three years). The average Harris hip score at the most recent examination was 92 points (range, 61 to 100 points). Eight hips were revised. The reason for the revision was infection in two hips, fracture of the femoral stem in two, and loosening of the acetabular component in four. The rate of revision for aseptic loosening, therefore, was 10 per cent (six hips). In the unrevised hips for which radiographs were available, the rate of radiographic loosening of the femoral component was 5 per cent (two hips) and that of the acetabular component was 32 per cent (twelve hips). We did not find a relationship between the amount of horizontal or vertical displacement of the center of the femoral head and the rate of loosening. Kaplan-Meier survivorship analysis with revision as the end point predicted a rate of survival of 85 per cent (95 per cent confidence interval, 75 to 95 per cent) at fifteen years. With radiographic loosening as the end point, the predicted rate of survival was 68 per cent (95 per cent confidence interval, 54 to 81 per cent) at fifteen years. We concluded that, for patients who have Crowe type-II, III, or IV congenital dysplasia of the hip, good long-term results can be obtained with insertion of a femoral stem with cement. The high rate of loosening of cemented acetabular components is a concern.
Adult↗
Shelf operation for congenital subluxation and dislocation of the hip.
One hundred forty-one shelf procedures were performed on 120 patients who had congenital hip dysplasia or dislocation. Long-term follow-up evaluation of hip function revealed that about three-fourths of the patients had satisfactory results. Although some children less than 10 years old may have benefited, this age group has the highest percentage of failures of shelf operation. The shelf procedure provides a buttress of bone for later reconstructive surgery such as cup or total hip arthroplasty.
Acetabulum↗
[Considerations on the evolution of the "normal" hip in monolateral congenital dislocation].
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Child↗
Relationship of pain to the radiological anatomy of the hip joint in adults treated for congenital dislocation of the hip as infants: a long-term follow-up of patients treated by three methods.
Sixty female patients with congenital dislocation of the hip treated by three methods were followed up to a mean age of 27.3 years. Standard radiographic measurements of hip joint morphology, including stereoscopic measurements of acetabular and femoral neck anteversion, were made. The Severin score of the hip joint, but not acetabular or femoral neck anteversion, was related to symptoms. Hips treated by femoral derotation osteotomy had superior results to hips treated by traction reduction alone. Both of these methods gave much better results than treatment by closed manipulative reduction. The "normal" opposite hip was morphologically abnormal, although usually asymptomatic.
Female↗
Treatment of congenital dislocation of the hip. Results of closed reduction and immobilization in the hip spica cast.
Treatment of congenital dislocation of the hip (CDH) by closed reduction and immobilization in the hip spica cast is one of the accepted methods for use in patients under one year of age. We report 74 congenitally dislocated hips treated with premanipulation skin traction, closed reduction under anesthesia, adductor tenotomy and immobilization in the hip spica cast. Satisfactory results were obtained in 60 hips. In seven hips, avascular necrosis of the capital femoral epiphysis was observed with careful management, closed reduction and immobilization in a spica cast provides good results for treatment of CDH.
Casts, Surgical↗
Risk factors of avascular necrosis in the treatment of congenital dislocation of the hip.
We examined the causes of iatrogenic avascular necrosis of the femoral head in 254 hips with congenital dislocation (CDH) treated conservatively. The influence of the age of the child, the height of the displacement of the femoral head, the extent of acetabular dysplasia, and the method of treatment on the frequency and degree of necrosis were estimated. The investigation showed that children are at the highest risk of iatrogenic necrosis in the following cases: (a) age less than 6 months, (b) severe acetabular dysplasia, (c) use of an abduction apparatus such as the Frejka pillow for outpatients, and (d) "frog-leg" position after reduction.
Age Factors↗
[Correlations of congenital femoral dislocation and scoliosis].
In the article is analysed the state of spine and hip joints on the basis of comparative appreciation of orthospondylometric and coxometric data in accordance with the roentgenograms in anteroposterior projection. It has been revealed that the point in common between the congenital hip dislocation and scoliosis is the same dysplastic essence. Biomechanical changes, which take part in this community, determine the final formation of pathology of spine and hip joints. In the process of examination of children with congenital hip dislocation recommended detection and preventive treatment of the spine changes and in case of spine pathology the hip joint pathology should be looked for.
Adolescent↗
[Total arthroplasty of the hip in inveterate congenital dislocation].
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Adult↗
Congenital dislocation of the hip: a possible inborn error of collagen metabolism.
Significant changes in the type of collagen, the fibril diameter and the nature of the crosslinks have been demonstrated in the joint capsules of subjects with congenital displacement of the hip (CDH). These changes are probably tissue specific since no detectable change could be observed in the skin of these subjects compared to controls. These preliminary biochemical studies clearly demonstrate that CDH involves an error in collagen metabolism.
Child, Preschool↗
Modular noncemented total hip arthroplasty for congenital dislocation of the hip. Case report and design rationale.
The highest rate of failure and the greatest technical difficulty in total hip arthroplasty occurs with congenital dislocation of the hip (CDH). Predisposing factors are failure to secure special femoral components to fit an extremely narrow and straight medullary cavity with space for only a very thin mantle of cement. The acetabulum is usually atrophic, and bone grafts are commonly required to support a small-diameter cup. The young age of the average patient and high levels of activity contribute to cement failure. A new modular cementless prosthesis provides excellent immediate skeletal fixation and pain relief in CDH patients. Five modular components are screwed or press-fit into bone. The modular approach facilitates implantation, reduces inventory, and is adaptable to unforeseen problems. These advantages are ordinarily absent with standard or custom cemented components. Modular components may also permit easier revision. The prosthesis is made of titanium alloy for its superalloy strength, elastic modulus, and bioinertness. By omitting the cement mantle, press-fit is obtained with the largest possible implant. The large size minimizes stem breakage in these young, small bones. Excellent short-term results suggest that modular cementless implants are indicated in some patients with CDH.
Adult↗