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PubMed1990

Development of the hip joint in relation to congenital dislocation.

As an introduction to the pathology and treatment of C.D.H., a simplified outline of fundamental embryologic events and growth characteristics of the hip joint (selected from past and actual bibliography) is presented. Congenital dislocation of the hip appears to be the result of various genetic, developmental, environmental and mechanical factors that affect articular structures in the perinatal period. At this time, the hip joint is anatomically and functionally more vulnerable to alterations of its normal concentric disposition. If incongruency persists, subsequent morphological changes, characteristic of dysplasia will develop. The main conclusions derived from a review of the development of the hip joint in relation to C.D.H. are: 1) The hip joint is an anatomical and functional unit derived from a common primitive blastema. 2) Primitive condensed sclerotomic mesenchyme transforms into cartilage that shapes in a genetically determined pattern to form the femur and os innominatum in continuity. 3) The joint space develops by autolytic degeneration in the 7-8 week embryo. By the 11th week, the joint cavity, evolved in the capsule lined internally by synovium, has a well differentiated labrum and ligamentum teres with the basic morphology of a developed hip joint. Only after this stage is displacement possible. 4) Depth (and stability) of the acetabulum increase with development of the glenoid labrum and cartilaginous rim (incomplete only in its inferior portion). Here a fibrous band (transverse ligament) offers less resistance to displacement, but on occasions is an anatomic barrier to concentric reduction. 5) In the early fetal period, the acetabulum is a deep set cavity, becoming shallower at the time of birth. Femoral head coverage at birth is more deficient than at any other previous or subsequent stage of development. 6) The relationship between femoral and acetabular anteversion (instability index) is more important than absolute values which are variable during intrauterine life. The degree of femoral anteversion depends on teh rotational attitude and muscular action of the extremity.(ABSTRACT TRUNCATED AT 400 WORDS)

Hip Dislocation, Congenital↗
PubMed1985

[Congenital anterior dislocation of the hip].

An apparently congenital antero-superior hip dislocation is identified during surgery. With reference to this case, three possible clinical courses for congenital hip dislocations are outlined: As a rule full recovery is most frequent. However, a posterior dislocation which is persistent tends to become postero-superior upon weight-bearing. Anterior dislocations as well as antero-superior subluxation appear to be rather common. Both pathology and the CAT scan attest to this fact. Extension, which is a true dislocating position for a retracted hip in adduction anc rotated externally, is probably responsible for such an evolution. Anterior dislocation and especially antero-superior subluxation are frequent findings which can be explained anatomically. The eventual complications of the antero-superior wall of the acetabulum resulting from these, will be the objective of most of the usual treatments for residual hip dysplasia.

Female↗
PubMed1984

Surgical therapy for congenital dislocation of the hip in patients who are twelve to thirty-six months old.

Over a ten-year period, fifty-one congenitally dislocated hips in forty-one patients, whose ages ranged from twelve to thirty-six months, required open reduction. Supplemental procedures such as derotational osteotomy, pericapsular (Pemberton) osteotomy, and femoral shortening were performed as necessary. All of the patients have been followed for at least two years (average, 6.1 years). No patient had a significant limp, Trendelenburg gait, or avascular necrosis. Using Severin's classification of radiographic evaluation, twenty-nine hips (57 per cent) were rate as excellent and eighteen hips (35 per cent), as good. In our experience, open reduction of the hip together with correction of acetabular and femoral deformities affords the patient in the one to three-year-old age range an excellent chance of obtaining an anatomically satisfactory hip.

Age Factors↗
PubMed1993

[Delayed detection of hip dislocation: is the physician to blame?].

Despite the screening campaigns for early detection of congenital dislocation of the hip, some cases continue to be diagnosed late. The main reason for the failure to diagnose this disorder at an early stage is still unclear. A dislocated or a dislocatable hip is not always apparent during the initial newborn screening examination, and repeated clinical examinations throughout the first 12 months are necessary in order to establish the presence or absence of this disorder. At birth, radiographs are usually normal and a systematic pelvic radiograph of the neonate has no place in neonatal screening. Sonography helps to detect hip pathology early. However, owing to the dynamic nature of the disorder, a single early non-selective ultrasound has proved to be too sensitive and to lack specificity. In the United States, failure to diagnose the congenital dislocation of the hip is the most common musculoskeletal cause of litigation brought against pediatricians. In Europe, the system of fault liability implicates an obligation of ability and means. Failure to diagnose or misdiagnosis is not a fault in itself as long as a complete history, careful physical examination and adequate and appropriate complementary examinations have been performed by an adequately trained physician. If congenital hip dislocation is recognized and treated early, most of the affected children will develop functionally and radiologically normal hips. The longer the dislocation remains untreated, the harder it is to relocate the hip and the higher the incidence of secondary acetabular dysplasia, necessitating surgical correction. However, early treatment is not always successful or without complication. Consequently, the damages due to late onset of the treatment are difficult to assess.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude of Health Personnel↗
PubMed1978

A long-term follow-up of congenital dislocation of the hip.

Drawing upon a total experience of 450 hips affected by established congenital dislocation or subluxation, the author presents the long-term results in 177 hips treated for the first time between the ages of nine months and three and a half years, in support of his contention that surgical endeavour should in the first place be directed towards the limbus and upper end of femur rather than the acetabulum. The 144 patients, all treated on lines previously described in this journal (Scott 1953; Somerville 1953a, b; Somerville and Scott 1957), have now been followed up annually for between ten and twenty-five years, both hips receiving equal scrutiny. In brief, the routine has consisted of arthrography, excision of any limbus shown to be inverted, reduction by traction in abduction, and rotation osteotomy of 70 degrees. The addition of 10 to 15 degrees of varus was found beneficial and has become routine. Some hips required secondary procedures, and regret is expressed that these were not carried out sooner. The upper age at which recovery of the acetabulum may occur was found to be much higher than generally supposed, with a critical period between eleven and fourteen. The main conclusion is that in the great majority of cases first seen in this particular age group, improvement of the mechanics of the joint, especially by attention to the upper end of femur, leads to satisfactory development of the acetabulum and good functional results, at least up to early adult life.

Acetabulum↗
PubMed1980

Teratological hip dislocation.

The hallmark of teratological congenital hip dislocation is its advanced severity at birth, signifying longer antenatal duration and accentuation of distortion. There may be contributions from a multiplicity of unrelated syndromes, such as local intrauterine factors, failure of proper formations early in the embryonic period, or genetically determined disorders. Treatment is generally difficult and the end result is uncertain.

Abnormalities, Multiple↗
PubMed1983

[Results and developmental complications of congenital dislocation of the hip treated at walking age by progressive orthopedic reduction and corrective osteotomy of the femoral axes. Study of 112 hips at the end of their growth].

The authors have analysed the results of treatment of 112 congenitally dislocated hips at the end of growth. They had been treated at walking age by progressive reduction and femoral osteotomy. Any hips that required open reduction were excluded from the study. Over the years, the principles of treatment remain the same but the technique was improved. Most of the poor results were related to trophic or vascular complications. Satisfactory results were obtained in 84 p. 100 of cases. Improvements in technique suggest to the authors that better results may be expected in the future.

Female↗
PubMed1999

Total hip arthroplasty with insertion of the acetabular component without cement in hips with total congenital dislocation or marked congenital dysplasia.

BACKGROUND: End-stage osteoarthritis secondary to total congenital dislocation or severe congenital dysplasia of the hip (class B or C according to the system of Eftekhar or type 2 or 3 according to the system of Hartofilakidis et al.) in adults presents special problems with regard to reconstruction of the hip. The purpose of the present study was to assess the intermediate-term results associated with the use of a porous ingrowth acetabular component for the treatment of these difficult cases. METHODS: We performed a prospective study of a consecutive series of twenty-one patients (twenty-four hips) who had had a primary total hip arthroplasty with use of a hemispherical acetabular component that was inserted without cement and fixed with screws. No patient was lost to follow-up. Three patients (four hips) died, of causes unrelated to the total hip arthroplasty, before a minimum duration of follow-up of five years. None of these patients had had revision. Of the remaining eighteen patients (twenty hips), fifteen were women and three were men. Ten hips had total dislocation, and ten had severe dysplasia. RESULTS: After an average duration of follow-up of eighty-three months (range, sixty-four to 102 months), the average Harris hip score was 90 points (range, 68 to 97 points). No patient had revision, loosening, or migration of the acetabular component; pelvic osteolysis; or a continuous radiolucent line at the mesh-bone interface of the acetabular component. The average rate of polyethylene wear was 0.08 millimeter per year (range, zero to 0.21 millimeter per year). CONCLUSIONS: The porous ingrowth acetabular component that was used in the present study functioned well at the time of the intermediate-term follow-up of this group of patients who had marked congenital dysplasia or total dislocation of the hip. The use of this component decreased the need for structural acetabular grafts. This component appears to perform as well as larger components of this design that have been assessed after similar durations of follow-up.

Adult↗
PubMed1977

Congenital dislocation of the hip. The relationship of premanipulation traction and age to avascular necrosis of the femoral head.

A retrospective study involving 276 patients with 319 congenitally dislocated hips was undertaken to assess whether premanipulation fraction prevents avascular necrosis. Roentgenographic criteria were utilized and only cases of frank dislocation unassociated with other disorders were included. It was found that in a child less than one year old, premanipulation traction of twenty-one days or more substantially reduces the incidence of avascular necrosis. For the child more than a year old, however, the prognosis is not as good, even if premanipulation traction is prescribed for twenty-one days or more. We found a 14 per cent incidence of avascular necrosis in children less than three months old and suggest that the cartilaginous femoral head prior to the appearance of the ossific nucleus is particularly vulnerable to vascular injury.

Age Factors↗
PubMed1984

Treatment of hip dislocation after walking age.

Between 1979 and 1981, 35 patients were treated at our institution. All patients were more than 18 months of age and 50 congenitally dislocated hips were treated. The average age at operation was 7 years and 3 months. Whereas children under the age of 6 were typically operated upon by open reduction and Salter, Pemberton, or Dega osteotomy partly combined with femoral osteotomy, in the group of the patients older than 6 years with high iliac hip dislocations, a method was used to avoid femoral shortening. By means of the Wagner distractor the dislocated hips were brought opposite to the acetabulum. This procedure was followed by femoral osteotomy and in most cases Chiari pelvic osteotomy. Despite a number of complications the results turned out better than expected. Compared with the preoperative X-ray classifications (Severin) the postoperative result was excellent in 10 cases, good in 20, fair in 15, and poor in 1 case.

Adolescent↗
PubMed1985

Radiological evaluation of asymmetrical limitation of hip abduction during the first year of life.

Asymmetrical limitation of abduction of the hip may be found on screening of children in the first year of life. The clinical features identified may occur in congenital dislocation of the hip but most infants do not have or develop hip dislocation. Radiological changes are present on the side of limitation of abduction and include a higher acetabular angle, retardation of femoral head epiphyseal development, pelvic obliquity and a rotational deformation of the pelvis in the transaxial plane. The appearances are postural deformities due to persistent infant positioning and are self-correcting. If aggressive treatment methods are to be avoided, the radiologist should not confuse these changes with those of congenital hip dislocation or subluxation.

Female↗
PubMed1982

Congenital bilateral hip and knee dislocation treated without surgery: 18-year follow-up.

Report of an 18-year-old black girl successfully treated for congenital dislocation of the hips and knees is presented. Progress from date of birth, methods of treatment, and results are given. It is concluded that the condition is unusual, that dysplasia and intrauterine forces are the cause, that early treatment gives excellent results without surgery, and that follow-up through the entire growth period is essential.

Female↗