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At least 1,099 records · Page 61Linked to original sources
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↗
PubMed1976

Combined procedure of open reduction and shortening of the femur in treatment of congenital dislocation of the hips in older children.

A one-stage, combined operative procedure for reduction of congenitally dislocated hips in older children consists of shortening of the femur; open reduction by an inferior approach to the joint; reconstruction of the acetabular roof; correction of anteversion of both the femoral neck and the neck-shaft angle; anterior transposition of the iliopsoas muscle. On 60 hips operated in children, ages 5 to 15 with a follow-up period, ranging from 5 to 9 years, the results were found to be excellent in 3 per cent, good in 60 per cent, fair in 30 per cent, and poor in 7 per cent. The procedure is indicated in children up to the time of early puberty. The primary indication is high bilateral dislocation. In unilateral dislocations some residual leg-length discrepancy frequently occurs. This procedure should be done only by orthopedic surgeons who have special training and experience in the treatment of congenital dislocation of the hip.

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↗
PubMed1993

The mechanical cause of congenital dislocation of the hip joint. Dynamic ultrasound study of 5 cases.

5 hip joints with untreated congenital dislocation of the hip were examined for hip movement by ultrasound. With the hip joint flexed, the direction of the dislocated femoral head was posterior to the acetabulum. The dislocated femoral head displaced more posteriorly when the knee joint was extended, with the hip joint held in flexed position. As the dislocated hip was extended, on the other hand, the direction of the dislocated femoral head was anterior to the acetabulum. The dislocated femoral head displaced more anteriorly when the baby tried to bend the hip with the joint held in extended position. These findings indicate that a fetal posture with the hip flexed and the knee extended predisposes to the development of CDH by the action of hamstrings, and that an infant posture with the hip extended is likely to provoke femoral head dislocation by the action of the iliopsoas.

Biomechanical Phenomena↗
PubMed1990

Heterotopic bone formation after total hip arthroplasty in patients with primary or secondary coxarthrosis.

Heterotopic bone formation was investigated in 392 Charnley low-friction total hip arthroplasties. A multivariate linear regression analysis was used to account for the influence of co-variables: sex, age at surgery, postoperative treatment with antiinflammatory drugs during at least the first 2 weeks, and previous ipsilateral hip surgery. A total of 232 hips had been treated for primary coxarthrosis, and 114 and 46 hips for secondary coxarthrosis due to congenital dislocation and fracture-dislocation of the hip, respectively. None of the hips with primary coxarthrosis previously had ipsilateral hip surgery, whereas 41 hips (36%) in patients with congenital dislocation of the hip and 28 hips (61%) in patients with fracture-dislocation of the hip had one or more ipsilateral surgical procedures prior to the arthroplasty. The sex ratio varied between the groups, with a male:female hip ratio of 1:1, 1:10, and 3:1 for the three groups, respectively. The risk of developing grades 2 or 3 heterotopic ossification after total hip arthroplasty were significantly higher in men, patients without postoperative treatment with antiinflammatory drugs, and patients above age 60. In contrast, the analysis documented that previous ipsilateral hip surgery and type of coxarthrosis did not influence lesion development, supporting the theory that a systemic, rather than local factor, is responsible for the development of heterotopic bone formation after total hip arthroplasty.

Adolescent↗