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PubMed2002

Lasiotocus lizae sp. n. (Digenea: Monorchiidae), a new trematode from marine fish in the Taiwan Straits, China.

Lasiotocus lizae sp. n. (Digenea: Monorchiidae) was collected from the intestine of Liza carinata (Valenciennes) (Mugilidae, Perciformes) in the Taiwan Straits, China. L. lizae is most similar to Lasiotocus glebulentus Overstreet, 1971 from the intestine of Mugil cephalus from the Northern Gulf of Mexico in having tightly compacted vitellaria, a genital pore sinistral to the midline, the ovary usually dextral to the acetabulum, the similar sucker ratio, and in the presence of both a canalicular and uterine seminal receptacle. It differs from L glebulentus in its cirrus sac ending anterior to rather than posterior to acetabulum, in the ending position of caeca, in smaller eggs, and in having a single rather than several conspicuous concretions in excretory vesicle.

Animals↗
PubMed2000

Clinical practice guideline: early detection of developmental dysplasia of the hip. Committee on Quality Improvement, Subcommittee on Developmental Dysplasia of the Hip. American Academy of Pediatrics.

Developmental dysplasia of the hip is the preferred term to describe the condition in which the femoral head has an abnormal relationship to the acetabulum. Developmental dysplasia of the hip includes frank dislocation (luxation), partial dislocation (subluxation), instability wherein the femoral head comes in and out of the socket, and an array of radiographic abnormalities that reflect inadequate formation of the acetabulum. Because many of these findings may not be present at birth, the term developmental more accurately reflects the biologic features than does the term congenital. The disorder is uncommon. The earlier a dislocated hip is detected, the simpler and more effective is the treatment. Despite newborn screening programs, dislocated hips continue to be diagnosed later in infancy and childhood,(1-11) in some instances delaying appropriate therapy and leading to a substantial number of malpractice claims. The objective of this guideline is to reduce the number of dislocated hips detected later in infancy and childhood. The target audience is the primary care provider. The target patient is the healthy newborn up to 18 months of age, excluding those with neuromuscular disorders, myelodysplasia, or arthrogryposis.

Algorithms↗
PubMedDate not supplied

The use of a modular titanium endoprosthesis in skeletal reconstructions after bone tumor resections: method presentation and analysis of 37 cases.

We analyzed 37 patients who underwent segmental wide resection of bone tumors and reconstruction with a modular titanium endoprosthesis at the Orthopaedic Oncology Group, between 1992 and 1998. Twelve patients were male and 25 were female, with a mean age of 30 years (9 - 81). The mean follow-up was 14 months (2 - 48). The diagnoses were: osteosarcoma (14 cases), metastatic carcinoma (10), Ewing's sarcoma (4), giant cell tumor (4), malignant fibrous histiocytoma (3), chondrosarcoma (1), and aneurysmal bone cyst (1). Eleven articulated total knee, 8 partial proximal femur with bipolar acetabulum, 8 partial proximal humerus, 3 total femur, 2 partial proximal tibia, 2 diaphyseal femur, 2 diaphyseal humerus, and 1 total proximal femur with cementless acetabulum endoprosthesis implant procedures were done. The complications related to the procedure included: infection (5 cases), dislocation (3), module loosening (1), and ulnar nerve paresthesia (1). We used the following criteria for the clinical evaluation: presence of pain, range of motion, reconstruction stability, surgical and oncologic complications, and patient acceptance. The results were good in 56.8% of the cases, regular in 32.4% and poor in 10.8%.

Adolescent↗
PubMed2002

Life cycle of Brachylaima mascomai n. sp. (Trematoda: Brachylaimidae), a parasite of rats in the Llobregat delta (Spain).

The terrestrial triheteroxenous life cycle of Brachylaima mascomai n. sp. (Trematoda: Brachylaimidae) is elucidated. Operculated, assymetric, embryonated eggs (25.4 x 12.7 microm) are passed with feces of the natural (Rattus norvegicus and R. rattus) and experimental (albino and wild mice, albino rats, Apodemus sylvaticus, Mus spretus [Muridae] and the golden gerbil) definitive hosts and ingested by the helicid gastropod Pseudotachea splendida, the only natural and experimental first intermediate host. Microcaudate cercariae harbored in branched sporocysts in the digestive gland emerge from this snail and contact P. splendida, Otala punctata, Theba pisana, and Helix (C.) aspersa snails developing into unencysted infective metacercariae in the kidney. Definitive hosts are infected by ingestion of infected snails; the adult parasites inhabit the small intestine. Chaetotaxic cercarial pattern specific at acetabular (S(II) 8-10 papillae) and cephalic (C(III) 13-15 papillae, H 16 papillae) levels. Three types of cercarial papillae are observed by scanning electron microscopy (SEM) and their arrangement is correlated with chaetotaxy for the first time in trematodes: argentophilic papillae with fingerlike process (cephalic, body, and acetabular levels), argentophilic papillae with opening (2 papillae in the M body level), and nonargentophilic dome-shaped papillae (alternated with argentophilic S(II) papillae on the ventral sucker). SEM detected interlacing network of ridges covering the metacercarial body. Adults with multidigitate tegumentary spines were observed by SEM. Subequal suckers; the acetabulum located in the posterior part of anterior fifth of body. Vitellaria extend from between middle level and anterior margin of anterior testis to between middle level and posterior margin of acetabulum. Uterus almost reaches the intestinal bifurcation.

Animals↗
PubMed2003

Organization of the musculature of schistosome cercariae.

Phalloidin-fluorescein isothiocyanate staining of filamentous actin was used to identify muscle systems within the cercariae of Schistosoma mansoni. Examination of labeled cercariae by confocal scanning laser microscopy revealed distinct organizational levels of myofiber arrangements within the body wall, anterior cone, acetabulum, and esophagus. The body wall throughout showed a typical latticelike arrangement of outer circular and inner longitudinal myofibers, with an additional innermost layer of diagonal fibers in the anterior portion of the body. Circular and longitudinal fibers were also evident in the anterior organ and esophagus and, to some extent, the ventral acetabulum. Most striking was the striation of the cercarial tail musculature.

Animals↗
PubMed1998

Treatment of high dislocation of the hip in adults with total hip arthroplasty. Operative technique and long-term clinical results.

The clinical results of eighty-four total hip arthroplasties performed through a transtrochanteric approach in sixty-seven patients who had a high dislocation of the hip (the femoral head completely out of the acetabulum), from 1976 to 1994, were reviewed. The acetabular component was placed in the true acetabulum and the femur was shortened at the level of the femoral neck, along with release of the psoas tendon and the small external rotators, in order to facilitate reduction of the components and to avoid neurovascular complications. Eleven hip prostheses (13 per cent) failed at a mean of 6.4 years (range, two months to sixteen years) postoperatively; the failure was due to aseptic loosening of both components in four hips, aseptic loosening of the stem only in three, late infection in three, and malpositioning of the acetabular component that caused recurrent dislocations in one. The other seventy-three hips were functioning well at the latest follow-up examination, two to twenty years (mean, 7.1 years) postoperatively. The overall cumulative rate of success was 92.4 per cent (95 per cent confidence interval, 89.5 to 95.3 per cent) at five years and 88.0 per cent (95 per cent confidence interval, 82.2 to 93.8 per cent) at ten years. We believe that this operative technique of total hip arthroplasty is effective for the treatment of the difficult condition of high dislocation of the hip.

Adult↗
PubMed1998

Total hip arthroplasty with use of an acetabular reinforcement ring in patients who have congenital dysplasia of the hip. Results at five to fifteen years.

The purpose of our study was to examine the clinical and technical problems associated with reconstruction of the hip in patients who had congenital dysplasia and to offer recommendations for their solution. We reviewed the records on 123 consecutive total hip arthroplasties that had been performed by one of us (M. E. M.), between 1981 and 1986, for the treatment of coxarthrosis due to congenital dysplasia of the hip. A minimum of five years of follow-up was required for inclusion in the study. The study group consisted of seventy patients who had had a total of eighty-seven reconstructions. According to the classification of Crowe et al., eleven hips had type-IV acetabular dysplasia; sixty-five, type-II; and eleven, type-II. Acetabular reconstruction was performed with use of the Müller acetabular roof-reinforcement ring and a polyethylene cup, which was inserted with cement. Autologous graft from the femoral head was used in forty-two hips. Femoral reconstruction was performed with use of the Müller straight-stem component for congenital dysplasia of the hip in eighty hips and with use of a standard Müller straight-stem component in seven hips. At an average of 9.4 years (range, five to fifteen years) postoperatively, the result was described as excellent for sixty hips (69 per cent), as good for twenty-three (26 per cent), as fair for two (2 per cent), and as poor for two. Nine (10 per cent) of the hips had been revised. One revision had been performed because of aseptic loosening of the acetabular component; one, because of aseptic loosening of the femoral component; one, because of aseptic loosening of both components; and six, because of infection. Of the unrevised hips, three had had superior migration of the acetabular component of less than five millimeters, and mild protrusion had developed in one. Two hips had a continuous radiolucent line around the acetabular construct. Two hips had had subsidence of the femoral stem of less than three millimeters; one had a complete, non-progressive radiolucent line at the bone-cement interface; and four had a radiolucent line at the proximal part of the bone-cement interface. Six hips had evidence of endosteal osteolysis. Six hips had grade-III or IV heterotopic ossification according to the system of Brooker et al. These results compare favorably with others in the literature. We recommend restoration of the anatomical hip center with the use of an acetabular roof-reinforcement ring and a polyethylene cup inserted with cement for the reconstruction of a deficient acetabulum. The acetabular reinforcement ring prevents resorption of bone graft and migration of the cup, which are major causes of failure of the cup in patients who have had a reconstruction of a deficient acetabulum. Bone graft should be used medially and superiorly as needed to augment bone stock notably. Cement should not be used to fill acetabular defects as we believe that it contributes to aseptic loosening.

Arthroplasty, Replacement, Hip↗
PubMed1999

Injury to the growth plate after Pemberton osteotomy.

The Pemberton osteotomy involves cutting directly into the iliopubic and ilioischial limbs of the triradiate cartilage of the acetabulum. Complete closure of the triradiate cartilage after this osteotomy has been described in case reports. The present experimental study was performed to determine whether physeal osseous bars formed after Pemberton osteotomy. Eight Pemberton osteotomies were performed in six piglets. The animals were killed, and the acetabula were studied with use of radiography, computed tomography, and histological analysis for evidence of physeal injury. Plain anteroposterior radiographs of the pelvis did not clearly demonstrate the formation of osseous bars. However, Bucholz radiographs, made with the acetabulum placed directly on the cassette, showed osseous bars in three of the four specimens that were studied in this manner. Histological sections of the eight specimens of triradiate cartilage demonstrated five osseous bars in the iliopubic limb and four in the ilioischial limb. In two specimens, there was disruption of the cartilage without osseous bridging. Only two of the eight specimens had normal histological findings in both the iliopubic and the ilioischial limb of the triradiate cartilage.

Animals↗
PubMed1999

Primary total hip arthroplasty with use of the modular S-ROM prosthesis. Four to seven-year clinical and radiographic results.

BACKGROUND: A multicenter retrospective study was conducted to determine the clinical and radiographic results of primary total hip arthroplasty with insertion of the S-ROM modular femoral stem without cement in a series of patients who had been followed for four to seven years. Four centers participated in the study, with one contributing surgeon at each center. METHODS: Two hundred and eight consecutive patients who had a total hip arthroplasty with implantation of the S-ROM femoral prosthesis at one of the four centers during the study period were identified. Twenty-nine patients were lost to follow-up or had incomplete radiographic data, and twenty patients died from causes unrelated to the index arthroplasty. The remaining 159 patients formed the basis of this study. Sixteen of these patients had a bilateral procedure, resulting in 175 hips with complete clinical and radiographic data. The average age of the patients at the time of the index operation was fifty-nine years (range, twenty-two to ninety-three years). The duration of clinical follow-up averaged 5.3 years (range, four to 7.8 years), and the duration of radiographic follow-up averaged 4.9 years (range, four to 7.3 years). RESULTS: One patient (0.6 percent) had a failed femoral component, which was evidenced by progressive subsidence and lack of bone ingrowth. In addition, two patients (1 percent) had a revision of the acetabular component. The average Harris hip score increased from 35 points (range, 10 to 76 points) preoperatively to 91 points (range, 52 to 100 points) at the most recent follow-up examination. The radiographic evaluation revealed that 172 hips (98 percent) had stable bone ingrowth, two hips (1 percent) had stable fibrous ingrowth, and one hip (0.6 percent) had unstable fibrous ingrowth. Periprosthetic osteolytic lesions were noted in twelve hips (7 percent). The lesions were observed in the femur in eight hips, in the acetabulum in two hips, and in both the femur and the acetabulum in two hips. All femoral osteolytic lesions were localized within the greater trochanter or the proximal-medial portion of the femoral neck. No osteolytic lesions were evident distal to the stem-sleeve junction. CONCLUSIONS: Use of the modular S-ROM femoral prosthesis yielded excellent intermediate-term outcomes with respect to standard radiographic and clinical criteria. The issue regarding the theoretical increase in the rate of osteolysis due to metal debris generated at the modular femoral stem-sleeve junction was specifically addressed. We found that the rate of osteolysis in this series was not notably higher than that in other series reported in the orthopaedic literature. Although many possible factors may influence the rate of osteolysis in total hip arthroplasty, this finding suggests that the potential increase in osteolysis theoretically associated with this modular femoral implant was not observed at intermediate-term follow-up. Although longer follow-up is warranted so that the potential for osteolysis can be evaluated fully, no osteolytic lesions were evident distal to the stem-sleeve interface at the time of intermediate-term follow-up. This finding suggests that there is a circumferential seal at the modular junction of the stem that prevents the distal egress of wear debris.

Adult↗
PubMed2002

Surgical correction of residual hip dysplasia in two pediatric age-groups.

BACKGROUND: The goal of operative treatment of hip dysplasia or subluxation in children is to normalize the hip joint to delay or prevent the premature onset of osteoarthritis. In theory, intervention in early childhood, when the remodeling potential is greater, should provide the best opportunity for the development of a normal joint. METHODS: To determine the efficacy of early surgical intervention in restoring the normal morphology of the hip, according to radiographic criteria, we reviewed the cases of thirty-six children (fifty hips) with residual dysplasia or subluxation who were managed with either a femoral and/or a pelvic osteotomy when they were between two and eight years old (Group I). The average age at the time of surgery was 3.7 years, and the average duration of follow-up was 4.3 years. We compared these results with those achieved in fourteen patients (eighteen hips) with residual hip dysplasia or subluxation who were treated surgically at an older age, between eight and eighteen years old (Group II). The outcome was assessed with use of clinical as well as multiple radiographic criteria. We believe that a normal relationship between the acetabulum and the femoral head was established when there was an acetabular index of <20 degrees or a Sharp angle of <42 degrees, a center-edge angle of >20 degrees, and an intact Shenton's line. RESULTS: At the time of the latest follow-up, sixteen of the seventeen hips with residual dysplasia that had been treated with pelvic osteotomy alone in Group I and three of four such hips in Group II had a normal relationship between the acetabulum and the femoral head. Normal radiographic findings were noted in fifteen of the seventeen hips with residual subluxation that had been treated with combined femoral and pelvic osteotomies in Group I compared with four of eight such hips in Group II. CONCLUSIONS: We found that residual hip dysplasia or subluxation could be more predictably corrected, with normal radiographic results and with less morbidity and fewer complications, in children who were between two and eight years old than in those who were between eight and eighteen years old. Long-term follow-up is required to confirm whether the improved anatomy and function of the hip that resulted from early correction of residual dysplasia or subluxation lasts into adulthood.

Bone Diseases, Developmental↗
PubMed2004

Total hip arthroplasty for congenital hip disease.

BACKGROUND: It is generally agreed that the clinical and radiographic results of total hip replacement performed for degenerative arthritis secondary to congenital hip disease vary depending on the severity of the anatomical abnormality. In this study, we report the mid-term and long-term clinical and radiographic results of total hip arthroplasty performed for each of the three different types of congenital hip disease. METHODS: Between 1976 and 1994, the senior author performed 229 consecutive primary total hip arthroplasties in 168 patients with osteoarthritis secondary to congenital hip disease. Seventy-six hips were dysplastic, sixty-nine had a low dislocation, and eighty-four had a high dislocation. The Charnley low-friction technique was performed in 178 hips, and the so-called hybrid technique was performed in forty-six hips. Cementless arthroplasty was used in only five hips. RESULTS: After a minimum of seven years of follow-up, the rates of revision of the acetabular components were 15% in the dysplastic hips, 21% in the hips with a low dislocation, and 14% in those with a high dislocation. The rates of revision of the femoral components were 14%, 14%, and 16%, respectively. Survivorship analysis predicted an overall rate of prosthetic survival at fifteen years of 88.8% +/- 4.8% in the dysplastic hips, 73.9% +/- 7.2% in the hips with a low dislocation, and 76.4% +/- 8.1% in those with a high dislocation. CONCLUSIONS: An understanding of the anatomical abnormalities and the use of appropriate techniques and implants make total hip arthroplasty feasible for treatment of the three types of congenital hip disease. In patients with a low dislocation, the major technical problem is reconstruction of the natural acetabulum. In those with a high dislocation, the challenge is to place the acetabular component inside the reconstructed true acetabulum and to use an appropriate femoral implant in the hypoplastic narrow femoral diaphysis.

Adult↗
PubMed2006

Minimum ten-year results of primary bipolar hip arthroplasty for degenerative arthritis of the hip.

BACKGROUND: Bipolar hip arthroplasty has been advocated by some as an alternative to total hip arthroplasty for the treatment of degenerative arthritis of the hip. We sought to assess the results of this procedure at our institution after a minimum duration of follow-up of ten years. METHODS: We retrospectively reviewed a consecutive series of 152 patients (173 hips) who underwent primary bipolar hemiarthroplasty for the treatment of symptomatic degenerative arthritis of the hip with a cementless femoral component between 1983 and 1987. Of the original cohort of 152 patients, ninety-two patients (104 hips) were available for clinical and radiographic review at a mean of 12.2 years postoperatively. At the time of the latest follow-up, self-administered Harris hip questionnaires were used to assess pain, mobility, activity level, and overall satisfaction with the procedure. Biplanar hip radiographs were made to evaluate bipolar shell migration, osteolysis, and femoral stem fixation. RESULTS: At the time of the latest follow-up, nineteen patients (nineteen hips) had undergone revision to total hip arthroplasty because of mechanical failure, and three patients (three hips) were awaiting revision because of symptomatic radiographic mechanical failure. Twelve acetabular revisions were performed or scheduled for the treatment of pelvic osteolysis or protrusio acetabuli secondary to component migration. Acetabular reconstruction required bone-grafting, an oversized shell, and/or a pelvic reconstruction ring. The overall rate of mechanical failure was 21.2% (twenty-two of 104 hips), with 91% (twenty) of the twenty-two failures involving the acetabular component. Reaming of the acetabulum at the time of the index arthroplasty was associated with a 6.4-fold greater risk of revision. The rate of implant survival, with revision because of mechanical failure as the end point, was 94.2% for femoral components and 80.8% for acetabular components at a mean of 12.2 years. Of the remaining sixty-nine patients (eighty-one hips) in whom the original prosthesis was retained, seventeen patients (24.6%) rated the pain as moderate to severe. Nearly 30% of patients with an intact prosthesis required analgesics on a regular basis. Radiographs were available for fifty-eight hips (including all of the hips with moderate to severe pain) after a minimum duration of follow-up of ten years; twenty-eight of these fifty-eight hips had radiographic evidence of acetabular component migration. CONCLUSIONS: This bipolar cup, when used for hemiarthroplasty in patients with symptomatic arthritis of the hip, was associated with unacceptably high rates of pain, migration, osteolysis, and the need for revision to total hip arthroplasty, especially when the acetabulum had been reamed. To the extent that these findings can be generalized to similar implant designs with conventional polyethylene, we do not recommend bipolar hemiarthroplasty as the primary operative treatment for degenerative arthritis of the hip.

Aged↗
PubMed1983

Sonography of the neonatal and infant hip.

Using real-time high-resolution sonography, it is possible to directly visualize the cartilaginous femoral head and define its relation with the acetabulum in normal and pathologic states. Thirty-six examinations were performed on 33 infants, newborn to 1 year of age. Two transverse views were obtained through the femoral head and acetabulum. The medial transverse scan was particularly helpful in casted or splinted patients. The lateral transverse view allowed visualization of the triradiate cartilage. All studies performed on a control group of 20 were normal. The diagnosis of hip dislocation was suggested sonographically in three patients and was confirmed radiographically in each case.

Female↗
PubMed1993

The self-locking Balgrist hip socket for cementless fixation: biomechanical principles and clinical results.

The Balgrist hip socket, initially made entirely of HDPE (high molecular weight polyethylene), now made of outer titanium alloy shell that faces the bone of the acetabulum has been in clinical use for 10 years. The purpose of this presentation is to illustrate the biomechanical principles that have governed this unique design and to present the clinical results that we have obtained until the end of 1991 with 717 implants. From 1982 to 1987 Balgrist HDPE sockets had been implanted for 346 hips, from 1984 to 1991 Balgrist Titanium alloy sockets have been implanted for 371 hips. The number of revision are 55 of 717 hips. 48 hips out of 55 were with Balgrist HDPE sockets. On the contrary, only 7 hips were with Balgrist titanium socket. The greatest benefit of Balgrist Titanium socket is the excellent mechanical lock with subchondral bone of the acetabulum.

Biomechanical Phenomena↗
PubMedDate not supplied

Growth profiles and articular cartilage characterization in a goat model of Legg-Calve-Perthes disease.

Numerous animal species, including the goat, have been evaluated as potential models for human Legg-Calve-Perthes disease (LCPD). These models disrupt the vasculature of the femoral head, causing it to collapse, and therefore do not mimic all the clinical patterns of the human disease. Baseline data regarding the weight and femoral length in the growing goat are not available. This study characterized the goat's normal growth for comparison with that of humans. The growth aberrations in the proximal femur created by surgically ablating the capital physis were described and compared with the aberrations observed in human LCPD cases. Age, weight, and femoral length (test and control) data were obtained for goats approximately 1 to 14 months of age. At 4 months of age, a craniolateral surgical approach was used to expose the cranial lateral capital physis so that it could be cauterized. Postoperative radiographs were evaluated by graphic analysis to assess the resultant changes in the morphology of the proximal femur. The articular cartilage of the femoral head and acetabulum was evaluated mechanically, using indentation testing, to determine the apparent modulus of elasticity, and histopathologically regarding its thickness and proteoglycan content. The proximal femurs of goats and humans exhibit similar morphology and growth patterns. There was a positive correlation between age, weight, and femoral lengths in the goat. The surgical procedure was effective in ablating the capital femoral physis as indicated by shorter femoral lengths and fragmented, flattened, and mushroomed femoral heads. The histopathological data revealed that the articular cartilage was significantly thicker in the operated hip joints at the ventrocaudal and cranial acetabula and the dorsal and ventral femoral heads. The test cartilage exhibited significantly less positive staining for proteoglycans in the dorsocaudal and the cranial acetabula as well as the ventral femoral head. The apparent modulus of elasticity, of the test cartilage was significantly lower than the control value at the dorsocaudal acetabulum. These data show that the surgical procedure produced morphological changes that mimic those in human LCPD. The increased thickness of the articular cartilage of the LCPD femoral head may account for the articular degeneration observed in older patients with LCPD, as increased cartilage thickness is associated with decreased tissue quality.

Animals↗
PubMed1978

A roentgen stereophotogrammetric investigation of innominate osteotomy (Salter).

The effect of the innominate osteotomy according to Salter was investigated by a roentgen stereophotogrammetric method in a 17-year-old girl with hip dysplasia as a part of the tricho-rhino-phalangeal (Giedion) syndrome. The osteotomy resulted in a total rotation of 32 degrees about an axis passing cranially to the pubic symphysis and the osteotomy. The acetabulum rotated 22 degrees forwards about a transverse axis, 9 degrees laterally about a longitudinal axis and 24 degrees laterally about a sagittal axis. The acetabulum was translated 2 mm laterally along a transverse axis, 21 mm caudally along a longitudinal axis and 19 mm dorsally along a sagittal axis. The position of the screw axis indicates that some motion also took place in one or both of the sacroiliac joints. The correction as measured with the CE-angle was 25 degrees which was almost the same as the correction about the sagittal axis. It is, however, noted that the CE-angle was also dependent upon the rotations about the transverse and longitudinal axes.

Adolescent↗
PubMed1980

Total hip replacement in congenital dislocation of the hip.

Twenty cases of congenital dislocation of the hip were treated with total hip replacement. The hips were completely dislocated with the femoral head supported by a nearthrosis proximal to the original acetabulum. The concept was to reconstruct the hip with an acetabular cup at the site of the original acetabulum even if a portion of the proximal end of the femur had to be sacrificed in the process. The Harris prosthesis appears, in most instances, to be the most suitable type of prosthesis but it was concluded that the surgeon needs a selection or prostheses for this procedure. Nine-tenths of the patients were improved by the procedure and the complications could mostly be successfully dealt with. This type of surgery is justified in cases with special indications.

Adult↗
PubMed1984

Functional treatment of congenital dislocation of the hip.

A prerequisite for the development of congenital dislocation of the hip is ligamentous laxity of the hip-joint, which is demonstrable shortly after birth when the hip can be easily dislocated and reduced. This situation is described as dislocatable hip. Ligamentous laxity naturally tends to disappear, and 90% of all dislocatable hips in fact stabilize spontaneously. No dislocation develops unless an exogenous factor is involved. In infants born in breech presentation the hyperextension of the knees with the resulting increased tension in the hamstrings plays a role. During or shortly after birth, the deflexion of the hip-joint causes an increased tension in the relatively shortened iliopsoas muscle, as a result of which the hip can be dislocated in postero-superior direction. By the time the infant is two months old secondary changes (more specifically restricted abduction) become more pronounced. It may therefore be stated that contracture of the iliopsoas muscle is one of the causes, and restricted abduction a consequence of congenital dislocation of the hip. The degree of dislocation is determined by a balance between the degree of ligamentous laxity and the influence of exogenous factors. When the infant starts to stand and walk, its body weight also begins to function as a deforming exogenous factor. When dislocatable hips are not treated immediately after birth, the frequency of congenital dislocation of the hip at the age of three months amounts to 1-2 per 1000 neonates. The male:female ratio is 1:4. The secondary changes in the osseous structures of the hip-joint should always be studied three-dimensionally. Apart from conventional antero-posterior pelvic roentgenograms, CT-scans can enhance spatial insight. The secondary changes manifest themselves in an enlarged neck-shaft angle, increased femoral anteversion, an increased inclination of the acetabulum and possibly also in diminished acetabular anteversion. In view of the high radiation load involved, examination by CT-scan is not yet a routine procedure in congenital hip dislocation. Radiological examination is usually confined to an antero-posterior pelvic roentgenogram on which the acetabular angle, the neck-shaft angle and the CE-angle can be measured. These are all values projected in a frontal plane. To determine the real values the degree of acetabular and femoral torsion has to be known. With the aid of the CT-scan the torsion of the acetabulum and of the femoral neck as well as their summation - the instability index - can be measured without difficulty.(ABSTRACT TRUNCATED AT 400 WORDS)

Child↗