[Obturator dislocation after abduction treatment of congenital hip dislocation].
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Child, Preschool↗
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[Late hip dislocation--treatment results of 1193 hips in attenuated abduction (Hanausek position)].
Results of 1193 dislocated and dysplastic hips in 695 children of a consistent treatment by skin traction and splinting in a mitigated abduction device (Hanausek position) are given with regard to the acetabular development and avascular head necroses. The acetabular development depends on the initial acetabular dysplasia and is overall satisfactory through final acetabular angles (Hilgenreiner) between 22 and 25 degrees even in highly dysplastic acetabula in late cases. The procedure is non-aggressive proven by low rate of femoral head necroses of 3.4%. Factors contributing to higher rates and degrees of iatrogenic damage to the femoral head are short time or no preceding longitudinal traction, low initial acetabular pathology and prolonged splinting.
Acetabulum↗
Cementless total hip arthroplasty in patients with high congenital hip dislocation.
BACKGROUND: The optimal surgical treatment for patients with high congenital dislocation of the hip remains controversial. The purpose of our study was to evaluate the mid-term to long-term results of cementless total hip arthroplasty in such patients. METHODS: The study included sixty-eight total hip replacements performed between 1989 and 1994 in fifty-six consecutive patients with high congenital hip dislocation at our hospital. The cup was placed at the level of the true acetabulum, and a shortening osteotomy of the proximal part of the femur and distal advancement of the greater trochanter were performed in 90% of the hips. At the time of final follow-up, at a mean of 12.3 years postoperatively, fifty-two patients (sixty-four hips) were evaluated by us with a physical examination, determination of Harris hip scores, and radiographs. RESULTS: The mean Harris hip score increased from 54 points preoperatively to 84 points at the time of final follow-up (p < 0.001). There was a negative Trendelenburg sign in fifty-nine (92%) of the sixty-four hips. There were thirteen perioperative complications (19%): three peroneal nerve palsies, one femoral nerve palsy, one superior gluteal nerve palsy, four nondisplaced fractures of the proximal part of the femur, one malpositioned stem perforating the posteromedial cortex of the femur, one superficial wound infection, and two early dislocations. With revision because of aseptic loosening as the end point, the ten-year survival rate for press-fit, porous-coated acetabular components was 94.9% (95% confidence interval, 89.3% to 100%). Eight of nine threaded acetabular components were revised, and the ninth was radiographically loose at the time of the last follow-up examination. The rate of survival for the CDH femoral components, with revision because of aseptic loosening as the end point, was 98.4% (95% confidence interval, 96.8% to 100%) at ten years. CONCLUSIONS: Total hip arthroplasty, with placement of the cup at the level of the true acetabulum, distal advancement of the greater trochanter, and femoral shortening osteotomy, can be recommended for patients with high congenital hip dislocation. Complications such as wear, osteolysis, and cup revision were secondary to the suboptimal design of the acetabular components used in this series.
Acetabulum↗
Surgical treatment of scoliosis in larsen syndrome with bilateral hip dislocation.
STUDY DESIGN: This is a report of a 12-year-old girl treated surgically for scoliosis associated with bilateral hip dislocation in Larsen syndrome. OBJECTIVE: To describe a rare case of scoliosis associated with Larsen syndrome and bilateral hip dislocation that was treated surgically with follow-up for 15 years. SUMMARY OF BACKGROUND DATA: There are few reports of the long-term follow-up of cases involving surgically treated scoliosis associated with bilaterally dislocated hips. METHODS: The patient's spine showed a right thoracic curve (T5-T12) with a Cobb angle of 77 degrees and did not show pelvic obliquity on an anterior-posterior radiograph film. On the sagittal alignment of her spine, the thoracic spine showed an abnormal lordosis (T5-T12: 19 degrees), and the lumbar spine had a hyperlordosis (L1-S1: 57 degrees) with a large lumbosacral angle (72 degrees ). We performed a posterior spinal fusion between T4 and L2 using Cotrel-Dubousset Instrumentation, anticipating the restoration of normal lumbar and cervical lordosis, as well as thoracic kyphosis. RESULTS: The Cobb angle of thoracic scoliosis improved from 77 degrees to 28 degrees, and a thoracic kyphosis of 12 degrees (T5-T12) was obtained. Subsequently, on the sagittal plane, the lumbosacral angle (sacral anteflexion) decreased from 72 degrees to 52 degrees, comparable to that of patients with hip dislocation, and the lumbar lordotic angle increased from 57 degrees to 66 degrees. The restoration of thoracic kyphosis resulted in an increase of lumbar lordosis and decrease of sacral anteflexion. At the 15-year follow-up,although the thoracic scoliosis (T5-T12) had increased to 36 degrees, good coronal and sagittal balance had been maintained. The patient is asymptomatic in her spine and hip. CONCLUSIONS: A case of scoliosis associated with dislocated hips in a patient with Larsen syndrome was successfully treated with posterior correction surgery. Fusion surgery between T4 and L2 provided an ideal sagittal balance of the total spine, while preserving 4 lumbar mobile segments.
Child↗
[Recurrent traumatic hip dislocation in a child].
Recurrent traumatic hip dislocation is rarely seen in childhood. We presented a case of traumatic hip dislocation which was treated by conservative methods. A two-year-old girl was treated with closed reduction and a hip spica cast for posterior traumatic dislocation in the right hip. Two years later, a recurrent dislocation occurred following a minor trauma on the same side. She was again treated with closed reduction and immobilization with a hip spica cast for three weeks followed by a three-week load bearing restriction. Early follow-up examinations showed an increased internal rotation of the hip compared to the left side, suggesting increased posterior capsular laxity. It then disappeared on her final follow-up at age six and magnetic resonance imaging showed no evidence for avascular necrosis or capsular laxity. She was asymptomatic and her physical examination was within normal limits. Of note, several members in her family had developmental dysplasia of the hip.
Casts, Surgical↗
[Prevention of hip dislocation in children with cerebral palsy by early tenotomy of the adductor and psoas muscles].
The effectiveness of early tenotomy of the psoas and adductor muscles for the prevention of dislocation of the hip dislocation in children with cerebral palsy precluding walking was studied in 40 hips in 24 children with severe disability. Age at the time of the procedure ranged from 1 1/2 years to 10 years. Results were evaluated by measuring Reimers' migration percentage (MP). Mean follow-up was three years. A satisfactory outcome (at least 10% improvement in MP at last follow-up) was seen in 67% of cases. The study of correlations with age and degree of displacement at surgery showed that results were satisfactory in 90% of children who had surgery before 4 years of age and whose MP was under 33%. To have preventive value, this procedure should be carried out at 2 years of age, before development of dislocation of the hip.
Age Factors↗
Three-dimensional computerized selection of hip prostheses in patients with congenital dislocated hips.
This study assessed the effectiveness of the combined use of computed tomography (CT) and computer-aided design (CAD) in the preoperative evaluation and implant selection in 20 patients (20 hips) with congenital dislocation of the hip who were scheduled to undergo total hip arthroplasty. Computerized selection of the femoral implant with optimum fit and fill was made after a three-dimensional reconstruction of the femoral canal using CT data and CAD. Implantation of all sizes of 5 noncemented and 2 cemented femoral implants was simulated using CATIA software (IBM, Kingstone, NY). When patients underwent surgery, 18 of 20 preselected prostheses agreed by type and size with the prostheses implanted. The remaining 2 preselected implants agreed by type only. In patients with dislocated and dysplastic hips, combined use of CT and CAD allows effective preoperative planning by providing the surgeon with vital information about the proximal femoral canal geometry and the possible femoral implant with optimum fit and fill to be used.
Aged↗
Proximal femoral epiphysiolysis during reduction of hip dislocation in adolescents.
Traumatic hip dislocation is an uncommon injury in children. The urgency of closed reduction to prevent possible osteonecrosis may present some pitfalls. Adolescents with open proximal femoral physis may have sustained trauma to the physis at the time of dislocation that can lead to displacement of the epiphysis during the reduction maneuver. The purpose of this study is to report 5 cases with this complication and discuss potential etiology and management. All of the 5 patients were between 12 and 16 years old and underwent closed reduction under conscious sedation. Epiphysiolysis of the femoral head was diagnosed after reduction in all 5 patients. Every patient underwent emergent open reduction and internal fixation of the femur and open hip reduction. Avascular necrosis was identified in all 5 patients within 3 to 15 months postinjury. If there is any suspicion of associated physeal injury or if there is any physeal instability noted under fluoroscopy, an open reduction is recommended in the operating room under radiograph guidance to prevent displacement.
Adolescent↗
[Femoral head resection in dislocated hip in cerebral palsy children].
The purpose of this study is to assess the outcome of proximal femoral resection in dislocated hip in cerebral palsy patients. Between 1993-2003 we treated 5 nonambulatory patients with quadriplegic form of cerebral palsy. We performed 6 resection of the proximal part of the femur. The average age at the surgery was 15.8 years (9-19.5 years) and average follow-up was 69 months (12-144 months). The indication to surgery was persistent hip pain. The results were good--the pain relieved, the movement in ,,the hip" was better and hygiene improved. Femoral head resection is radical, invasive method but we recommended it for selected group of severly spastic nonambulatory cerebral palsy patients with painful hip dislocation.
Adolescent↗
Cementless total hip arthroplasty and limb-length equalization in patients with unilateral Crowe type-IV hip dislocation.
BACKGROUND: Total hip arthroplasty in patients with unilateral congenital high dislocation of the hip (Crowe type IV) presents many challenges, including the problem of a marked limb-length discrepancy. The purpose of this retrospective study was to analyze the results of total hip replacement with limb-length equalization in these patients. METHODS: From 1988 to 1996, fifty-six patients (forty-seven women and nine men) with unilateral Crowe type-IV dislocation of the hip were treated with a cementless total hip arthroplasty at a mean age of 35.4 years. The preoperative limb-length discrepancy averaged 4.9 cm. Prior to the total hip arthroplasty, forty-eight patients with a limb-length discrepancy of >4.0 cm underwent iliofemoral distraction with use of an external fixator for eight to seventeen days. The acetabular cup was placed in the anatomical position in every patient. Shortening femoral osteotomies were not required. RESULTS: The iliac fixator pins loosened in six patients. No patient had a pin-site infection, hip joint infection, or nerve palsy. At the time of follow-up, at an average of 147.2 months, the Harris hip score averaged 90.2 points. Overall, the mean lengthening after the total hip arthroplasty was 4.6 cm. There were no revisions of the femoral stem. Nine cups were revised, four because of polyethylene wear and five because of loosening. CONCLUSIONS: We were able to safely place the acetabular cup at the anatomical position without femoral shortening by bringing the femoral head to the normal level preoperatively; thus, we could restore nearly normal limb length. We believe that our twelve-year results are similar to those of total hip arthroplasty in patients without dysplasia.
Adult↗
Traumatic hip dislocation during childhood. A case report and review of the literature.
Traumatic hip dislocations rarely occur during childhood. Males sustain pediatric hip dislocations four times more often than do females. Posterior hip dislocations comprise 87% of all pediatric hip dislocations. A soft, pliable acetabulum and ligamentous laxity predispose the immature hip joint to a dislocation secondary to minimal trauma. Potential associated injuries include fractures and neurovascular injury, whereas avascular necrosis (AVN) and degenerative joint disease are potential sequelae. Optimal treatment should be prompt reduction of the hip in order to minimize the risk of AVN of the femoral head.
Accidental Falls↗
[Magnetic resonance tomography in therapy follow-up after repositioning treatment of congenital hip dislocation].
INTRODUCTION: After treatment of infantile hip dislocation in terms of reduction and retention in plaster casts or splints a problem of therapy controlling exists. To assess if the femoral head is in correct position centered in the socket ultrasound is not possible, because one cannot achieve the necessary standard position. Computertomograms are associated with a hereditary taint of radiation and plain roentgenograms lack of presentation of the important cartilaginous structures. METHOD: To control infantile hips after open or closed reduction from 1990 until 1996, 43 examinations by MR imaging were performed in 34 children. RESULTS: In our series MRI was able to provide exact information about the position of the femoral head independently of its state of ossification. Also, a clearly visualisation of the different structures of the acetabular fossa, particular acetabulum, pulvinar, bony and cartilaginous acetabular rim and limbus was possible. Furthermore the MR images showed interpositioned soft tissue, intraarticular effusion and displayed cartilaginous parts of the acetabular rim. CONCLUSIONS: MRI is an exact method to assess the anatomical and pathological conditions of the childlike hip joint. Because of the disadvantages of CT and X-ray, MRI is superior in terms of controlling the results after treatment of infantile hip dislocation.
Acetabulum↗
Iliofemoral distraction and hip reconstruction for the sequelae of a septic dislocated hip with chronic femoral osteomyelitis.
We describe a technique of 'cross-hip distraction' to reduce a dislocated hip with subsequent reconstruction of the joint for septic arthritis with extensive femoral osteomyelitis. A 27-year-old woman presented with a dislocated, collapsed femoral head and chronic osteomyelitis of the femur. Examination revealed a leg-length discrepancy of 7 cm and an irritable hip. A staged technique was used with primary clearance of osteomyelitis and secondary reconstruction of the hip. A cross-hip monolateral external fixator was used to establish normal anatomy followed by an arthroplasty. A good functional outcome was achieved. The use of cross-hip distraction avoids soft-tissue and nerve damage and achieved improved abductor function before arthroplasty.
Adult↗
Maneuvers for reducing dislocated hips. A new technique and a literature review.
Twelve consecutive dislocated hip prostheses and one dislocated hip joint were reduced in the emergency room using the method described in this paper. This method has multiple advantages. It uses a lever and fulcrum technique and therefore is capable of producing substantial levels of force with less effort. The patient and physician are in relatively comfortable positions and little assistance is necessary.
Hip Dislocation↗
Traumatic hip dislocation with ipsilateral femoral shaft fractures.
A traumatic dislocation of the hip joint associated with an ipsilateral femoral shaft fracture is a rare injury resulting from severe trauma. Initially the dislocated hip joint is often unrecognized and consequently reduction is delayed. Early diagnosis and reduction of the hip joint improves the functional prognosis. The maximum functional recovery is possible only with greater awareness of this combined injury. Examination of the hip joints by clinical roentgenography in the critically injured patient, especially those with head injuries, or physical signs masked by extremity swelling, should be a routine procedure.
Accidents, Traffic↗
Dislocated hips viewed in two planes.
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Child↗
A review of the clinical and radiographic studies of dislocated hips.
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Child↗
The East Baltimore Lift: a simple and effective method for reduction of posterior hip dislocations.
A supine technique for reducing posterior dislocations of the hip is presented. We believe this technique provides more controlled traction than do other maneuvers and have found it to be a safe and effective method to reduce the posteriorly dislocated hip.
Hip Dislocation↗