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PubMedDate not supplied

Dynamic ultrasound assessment for monitoring of treatment of congenital dislocation of the hip.

Of the 7,827 babies born in Sheffield between March 1989 and August 1991, a total of 114 (1.4%) who had either clinical abnormality of the hip or high-risk factors for congenital dislocation of the hip (CDH) were examined by ultrasound at birth and at regular intervals. Dynamic ultrasound assessment of both hips was done to diagnose instability and to monitor the treatment. Abnormal findings were recorded in 55 babies at the first visit, and 31 of these subsequently required treatment with the Pavlik harness (3.9 per 1,000). Only one case of late CDH has been seen among the babies who were not examined by ultrasound. There were no cases of avascular necrosis in our series. Dynamic ultrasound examination of high-risk infants' hips is a reliable method of screening for CDH. Monitoring of hips treated with the Pavlik harness, by dynamic ultrasound examination, can identify failure to obtain a concentric reduction, and in such cases, splintage can be abandoned in favour of other modes of treatment. It can, therefore, reduce the chances of overtreatment and its associated complications.

Cohort Studies↗
PubMed1999

Development of acetabulum after closed reduction in developmental hip dysplasia.

The radiographic study of acetabulum development after closed reduction of 87 congenitally dislocated hips in 64 patients who were treated between 1980 and 1990 was conducted retrospectively. An average patient's age at the moment of closed hip reduction was 16 months (range between 6 to 24 months). On the average, patients were 16 months old (range between 6 to 24 months) at the moment of closed hip reduction. Development of bony acetabulum was followed for 8 years by measuring the AC angle. According to the age at the moment of closed reduction patients were sorted into three groups, the first group from 6 months to 12 months old (39 hips), the second group from 12 to 24 months old (28 hips) and the third group from 24 to 36 months old (20 hips). At the beginning of the treatment mean values of the AC angle in the first group were 37.2 degrees +/- 3.31 degrees; in the second group 39.7 degrees +/- 3.2 degrees; and in the third group 43.8 degrees +/- 2.7 degrees. The final values of the AC angle in the first group were 14.7 degrees +/- 3.21 degrees, in the second group 21 degrees +/- 3.02 degrees; and in the third group 24 degrees +/- 3.76 degrees. Normally and mildly dysplastic hips were achieved in 80.5% treated hips, while in 19.5% treated hips medium and serious dysplasia retarded. The acetabulum development in dysplastic hip after retained stable concentric reduction was the same as in the normal hip. The operative reconstruction of acetabulum should not be done before the third year of life.

Acetabulum↗
PubMed1993

Revision of failed open reduction of congenital dislocation of the hip.

We report a review of 33 hips (32 patients) which had required repeat open reduction for congenital dislocation of the hip. They were followed up for a mean of 76 months (36 to 132). Factors predisposing to failure of the initial open reduction were simultaneous femoral or pelvic osteotomy, inadequate inferior capsular release, and inadequate capsulorrhaphy. Avascular necrosis had developed in more than half the hips, usually before the final open reduction. At review, 11 of the hips (one-third) were in Severin grade 3 or worse; five had significant symptoms and only ten were asymptomatic and radiographically normal. Once redisplacement has occurred after primary open reduction, attempts to reduce the head by closed means or by pelvic or femoral osteotomy are usually unsuccessful and a further open reduction is necessary.

Child, Preschool↗
PubMed1992

Cause and prevention of osteochondritis in congenital dislocation of the hip.

All treatment modalities of congenital displacement of the hip (CDH) bear the risk of ischemic necrosis at the proximal femoral epiphysis. The causes of ischemic necrosis were investigated in a review of the literature and personal experience with CDH patients during the past 30 years. Compression of articular cartilage, caused by an increase in intraarticular pressure, has been implicated as the mechanism of osteochondritis. Muscle spasm, pressure on posterior circumflex vessels, and compromised pericephalic microcirculation in the newborn have been demonstrated to increase intraarticular pressure. The most dangerous causative factors include forced reduction under general anesthesia, spica cast immobilization of the hips in the Lorenz or Lange position, insufficient continuous prereduction traction, and splints or braces that are either too rigid or that force the hip into an extreme position. An intertrochanteric varus osteotomy can also lead to ischemic necrosis when performed at the time of reduction. Preventive measures include sufficient continuous traction, casting in a moderate position, and bracing that allows active movement. None of these measures constitute a guarantee against necrosis, but they will lessen the incidence and severity of involvement.

Child, Preschool↗
PubMed1992

Ultrasound in the early diagnosis of congenital dislocation of the hip: the significance of hip stability versus acetabular morphology.

Recent studies have suggested that ultrasound examinations may improve diagnostic accuracy in congenital dislocation of the hip, but there is differing opinion whether ultrasound diagnosis should be based on morphology or stability. Ultrasound was added to the routine clinical screening in 1503 newborns (1291 girls and 212 boys). Hip morphology was classified according to Graf (type 1-4), while sonographic stability was based on a modified Barlow maneuver, and classified as stable, elastic deflection (normal finding), unstable (provocating a gap between the femoral head and the acetabulum) and dislocated. Among 80 morphologically dysplastic hips, 73 (91%) were sonographically unstable or dislocated, while seven dysplastic hips were stable. On the other hand, in 49% of the sonographic unstable hips (69 out of 142) the acetabulum was either normal or just physiologically immature. 38 of these hips were left untreated and normalized spontaneously. There was a close correlation between sonographically and clinically determined hip stability (gamma = 0.95). Our study shows that the majority of morphologically dysplastic hips is sonographically unstable or dislocated, but also that morphologically dysplastic hips may be stable. Morphologically normal hips showing minor sonographic instability do probably not require treatment, and thus morphology seems to be an important diagnostic criterion.

Acetabulum↗