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PubMed2003

[Radiological status of hip joints of children at the beginning of walking, when treatment of congenital hip dysplasia and dislocation was begun in the first two weeks of life].

This paper describes the radiological status on the start of walking in 31 hip joints in 24 children, in which the treatment of the developmental dysplasia with dislocation of the hip began in the first 2 weeks. Before the beginning of the treatment, ultrasonographic assessment revealed type D in 22% hips, type III in 55% and type IV in 23%. The radiographic evaluation was based on 6 parameters, which values were compared to the normal ones for the age group. It was estimated that only 32% hips had a correct radiological status, the other hips revealed smaller or greater dysplasia.

Female↗
PubMed1990

[Pathogeny and natural history of congenital dislocation of the hip].

Based on a review of the literature, the authors have made a critical study of several etiological factors. Endogenous factors such as acetabular dysplasia, increased anteversion of the femoral neck, capsular laxity support the genetic theory but they are neither constant nor necessary and are only facilitating factors. The major factor seems to be a mechanical one linked to the position in uterus: hyperflexion with adduction and external rotation causing an abnormal pressure on the greater trochanter leading to an expulsion of the head upward and backward. This theory can explain the natural history of C D H which is first, at birth a hip unstability followed by to possible evolutions: either a persistent luxation becoming irreducible or a spontaneous stabilisation leading sometimes to complete healing or to residual abnormalities (subluxation or dysplasia). This concept suggests practical conclusions: the importance of an early diagnosis, the selection of the signs of the hip at risk the pattern of prevention, the importance of non clinical investigations, the principles of the treatment based on postures, the indications for the different types of treatment.

Animals↗
PubMed1988

[Results of conservative treatment of congenital dislocation of the hip--significance of arthrography].

To evaluate the clinical value of hip arthrography, especially two-directional arthrography, the author compared the treatment results of three different groups, Group A: cases treated without arthrography, Group B: cases treated using anteroposterior arthrography and Group C: cases treated using two-directional arthrography. With Lorenz's method, all three groups achieved about 40% success to G-I, II by Severin's classification. G-III, IV was obtained in Group A, B and C at 50.4%, 19.5% and 2.8%, while cases of open reduction at 3.8%, 37.0% and 55.6%, respectively. By selecting the cases that may obtain G-III, IV with Lorenz's method and by applying open reduction to them, in Group C, reduction was obtained in 93.8% of cases treated with Lorenz's method and 91.7% when cases treated with open reduction were included. Using two-directional arthrography, cases which should not be treated conservatively may be identified to apply open reduction to obtain better overall results.

Adolescent↗
PubMed1984

Prevention of congenital dislocation of the hip. The Swedish experience of neonatal treatment of hip joint instability.

The extensive work on early diagnosis and treatment of CDH (in the broad sense of this term) in Sweden has formed the basis of our present organization of prevention of hip dislocation. Practically all children are born in hospital, at present about 93,000 per year (1980). Routine examination of the hip joints has been included in the check-ups of newborns since the beginning of the 1950's. The centralization of obstetrics, especially during the last decade, has facilitated the organization of these examinations by paediatric consultants in all obstetric departments. All cases of hip joint instability are recorded, and during the last few years the frequency has been about 12 per thousand, probably with some over-diagnosis due to registration of uncertain cases. All definite cases of hip instability have been treated immediately at the orthopaedic departments. A study of a series of untreated newborns with transient instability has shown that the majority, but not all, will develop normal hip joints without treatment. This has been one reason for the recommendation to treat all unequivocal cases of hip instability. The present organization of examination and treatment is described. Detailed and practical instructions for the examination and treatment are given. Follow-ups of children treated for hip instability in the neonatal period are reported. It has been found that in practically all these patients anatomically normal hip joints are achieved by means of correct and carefully followed up treatment. The findings in 65 patients with neonatal hip instability in whom the treatment was unsuccessful or inadequate have underlined the importance of a strict treatment schedule, experienced doctors and detailed information to the parents. The effect of diagnosis and treatment of hip instability neonatally on the frequency of late-diagnosed cases of CDH was studied by recording all late-diagnosed cases at all orthopaedic departments. It was clear from the latter study that instability of the hip in newborns represents "preluxation" and that the treatment of this can prevent later dislocation. Dislocation of the hip joint in newborn infants is very unusual. Nowadays it is rare even after the neonatal period--in recent years only 12% of the late-diagnosed CDH cases between 1 and 6 months of age at diagnosis. However, the total number of late-diagnosed cases in the whole country has not decreased by more than 50% compared with the period prior to the introduction of hip examination of newborns.(ABSTRACT TRUNCATED AT 400 WORDS)

Child↗
PubMed1980

[Late results of conservative treatment of congenital dislocation of the hip--over twenty-five years follow-up observation and statistical analysis of roentgenograms (author's transl)].

The present study was based on the findings of 87 cases of CDH (132 joints) published by Prof. Igari and his colleagues in 1960. All these patients had been treated with conservative methods between 1935 and 1952. The average age at the time of the first follow-up examination was 11 years. Fortunately in 1978, after an average follow-up of 29 years (range 25 to 39 years), the author was able to reexamine 59 (90 joints) of the original 87 cases. The average age of the patients reexamined in 1978 was 31 years. In addition, 18 cases (26 joints) of CDH which were not treated and reached the age over 18 years were studied for comparison. The following observations were made: 1) Of the 90 joints examined, 18 joints (20.0%) showed normal findings in the roentgenograms. Twenty (39.9%) of the 59 cases were healed from a clinical standpoint. 2) The measurements which were taken at school age (1960), especially acetabular angle, approximate-acetabular-quotient, C.E. angle and acetabulum-head-quotient had a statistical correlation with those of the present reexamination. 3) Joints with a well-developed acetabulum at school age, even those with slight deformities of the femoral head and neck, were found to have become congruous by middle age. 4) The femoral head growth in untreated dislocated joints was poorer than the femoral head growth in joints which received conservative methods. The following conclusions were made: 1) The results of the reexamination were poorer in patients above 30 years of age than in patients under 29 years of age. However, it cannot be said without reserve that the results become poorer with an increase in patients' ages. The progrnosis is dependent on the time when treatment was started and the degree of displacement. 2) In patients who were treated on late stage the acetabulum seems to have developed poorly. The severity of the deformity of the femoral head and neck is related to the degree of displacement. 3) The disturbance of the femoral head nucleus during the treatment period gives some influences on the growth of acetabulum and femoral concentration, making its prognosis poorer. 4) The acetabular angle and C.E. angle at the end of treatment had a prognostic value. Joints with an acute acetabular angle (above 31 degrees) at the end of treatment should be treated with surgical methods.

Adult↗
PubMed1976

The anatomy and pathology of congenital dislocation of the hip.

At least 1 per cent of all newborn infants in the United Kingdom have CDH (Fig 10). Among these infants, approximately 85 per cent are normally formed and 15 per cent malformed. Among the normally formed infants, 90 per cent of the CDH are of the Grade 1 type, and 10 per cent of Grades 2 and 3. Such infants have a perinatal mortality of about 5 per cent. In contrast, among the malformed infants, about 50 per cent are CDH Grade 1, and 50 per cent Grades 2 and 3; their perinatal mortality is around 70 per cent. In other words, a much higher proportion than usual of the severe grades of CDH are found among the infants with a high perinatal mortality.

Acetabulum↗
PubMed1997

[Gray scale histographic analysis of the acetabular cartilage for quantifying hip ultrasound images].

AIM: Congenital dislocated hips are classified in ultrasound studies using the angle measuring system of Graf and evaluating the typical changes in acetabular form and structure. We attempted to quantify physiological and pathological changes in the acetabular cartilage using B-mode scan ultrasound studies. METHODS: Gray-level histograms were performed on 894 infant hips; 833 were classified by the Graf scheme as Type IIa and 61 as Type IIIa/b. We compared the histological structure of the cartilage of both the acetabulum and the head of the femur using objective parameters. RESULTS: We could show that gray-level histograms of the acetabular cartilage are an ideal way to study objectively ultrasound evaluations of the same area. Type IIa hips with histographically identified ossification zones show significantly higher healing rates than those without such areas. Type IIIb hips with histographically demonstrated pathological changes showed a significantly longer healing rate and a higher incidence of persistent dislocations that did Type IIa hips with normal cartilage. CONCLUSION: Structural changes in the acetabular cartilage can be evaluated not only qualitatively but also quantitatively to provide prognostic information in infants with congenially dislocated hips. Gray-level histograms nicely supplement ultrasound examination.

Acetabulum↗