CONGENITAL DISLOCATION OF THE HIP. EARLY DIAGNOSIS AND TREATMENT.
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[Screening of congenital dislocation of the hip in the newborn. A systematic and rigorous clinical examination. A restricted use of imaging].
(1) Clinical examination of the hips should be systematically performed in the newborn, in order to detect a possible congenital dislocation. This translates into hip joint instability, which can be evidenced by both Ortolani's and Barlow's signs, the latter being more sensitive. Special attention should be paid for abduction range, as limited abduction is a warning sign. (2) Use of imaging, especially sonography will be restricted to specific cases only. It's prescription, technical realization as well as interpretation have to be carefully done, so that it is actually relevant to uncertain or "at risk" situations. (3) Treatment if needed, should be ideally managed by a paediatric orthopaedic surgeon.
Diagnosis, Differential↗
Pattern of congenital orthopaedic malformations in an African teaching hospital.
BACKGROUND: Congenital Orthopaedic malformations are common malformations that are usually unacceptable to the common populace in the West African sub-region. There is paucity of knowledge about the common types of Orthopaedic congenital malformations in our environment This study was undertaken to determine the pattern of congenital Orthopaedic malformations in a Teaching Hospital. STUDY DESIGN: This was a prospective study of all the Orthopaedic congenital malformations seen in our surgical outpatient departments and the inpatient referrals from the wards between January 1995 and December 2003. RESULT: There were 284 patients in total with a male to female ratio of 2:1 and age range between two days to nine years. Clubfoot (CTEV) accounted for 52.8% of all the malformations while Congenital knee dislocation (CDK) and calcaneovalgus deformity accounted for 8%. Congenital hip dislocation (CDH) accounted for only 2.2% of all the cases. CONCLUSION: Congenital talipes equinovarus deformity is the most common congenital orthopaedic malformation in this environment while congenital hip dislocation (CDH) is rare when compared with the Caucasians.
Calcaneus↗
Sonography in congenital dislocation of the hip.
A new technique for ultrasonic examination of the hip joint was evaluated in neonatals and infants. An anterior approach was used with the sound sector centered over the femoral head and parallel to the femoral neck. The ultrasonograms corresponded to lateral radiographs of the joint with the leg in Lorenz' first position. It was possible to evaluate the size and depth of the acetabulum and the size and position of the femoral head. The projection also permitted a dynamic examination for determination of hip instability. Thus, the technique provided a method for an objective diagnosis in congenital dislocation of the hip (CDH). In 216 hips, the results of clinical evaluation for CDH were correlated with the degree of instability demonstrated by ultrasound. The comparison showed the clinical diagnosis to be highly inaccurate.
Evaluation Studies as Topic↗
[Value of the orthopedic examination of newborn infants with regard to the diagnosis of hip dislocation].
Out of a total of 10,617 new-born babies examined, 11.1 percent required supervision as a result of clinical signs pointing to a congenital dislocated hip joint, and 6 percent as a result of anamnestic indications. X-ray follow-up examinations after four months showed pathological hip joint findings in 27.7 percent of the patients under supervision. Out of a total of 1,587 new-born babies without pathological findings (both clinical and anamnestic), 1.2 percent showed pathological hip findings in an X-ray examination performed at the age of four months. The overall incidence of congenital dislocated hip joints was found to be 5.8 percent. The results point to the importance of regular and thorough hip examinations in child-welfare centers even after earlier checks on new-born babies which revealed no pathological findings.
Follow-Up Studies↗
Hip disease and the prognosis of total hip replacements. A review of 53,698 primary total hip replacements reported to the Norwegian Arthroplasty Register 1987-99.
We studied the rates of revision for 53,698 primary total hip replacements (THRs) in nine different groups of disease. Factors which have previously been shown to be associated with increased risk of revision, such as male gender, young age, or certain types of uncemented prosthesis, showed important differences between the diagnostic groups. Without adjustment for these factors we observed an increased risk of revision in patients with paediatric hip diseases and in a small heterogeneous 'other' group, compared with patients with primary osteoarthritis. Most differences were reduced or disappeared when an adjustment for the prognostic factors was made. After adjustment, an increased relative risk (RR) of revision compared with primary osteoarthritis was seen in hips with complications after fracture of the femoral neck (RR = 1.3, p = 0.0005), in hips with congenital dislocation (RR = 1.3, p = 0.03), and in the heterogenous 'other' group. The analyses were also undertaken in a more homogenous subgroup of 16,217 patients which had a Charnley prosthesis implanted with high-viscosity cement. The only difference in this group was an increased risk for revision in patients who had undergone THR for complications after fracture of the femoral neck (RR = 1.5, p = 0.0005). THR for diagnoses seen mainly among young patients had a good prognosis, but they had more often received inferior uncemented implants. If a cemented Charnley prosthesis is used, the type of disease leading to THR seems in most cases to have only a minor influence on the survival of the prosthesis.
Adolescent↗
Clinical application of computed radiography in orthopedic surgery.
Since 1988, Fuji Computed Radiography (FCR) system (Fuji Medical Systems, Tokyo, Japan) has been used at Osaka Prefectural Hospital (Osaka, Japan) for all kinds of images. In this paper, we discuss the advantages and disadvantages of computed radiography (CR) images from the standpoint of an orthopedic surgeon. Contours, which can not be seen on conventional radiographs, are clearly visualized on the CR image. Adequate information for diagnosis can be obtained with a great reduction in x-ray exposure during the screening of scoliosis or congenital dislocation of hip joint. However, because the scale is reduced by one half in antero-posterior views of the bilateral hip joint, CR images are unsuitable for postoperative measurement of total hip arthroplasty (THA). Furthermore, caution is required because the clear zone after THA is emphasized on edge-enhanced CR image.
Absorptiometry, Photon↗
Neonatal hip screening.
CONTEXT: A "missed" case of congenital hip dislocation (CDH) can be a disaster for the patient and the outcome may be poor. Considerable resources are expended on screening programmes to identify appropriate cases early but a recent change in terminology to developmental dysplasia of the hip (DDH) and a realisation that neonatal hip maturation is poorly understood has made it difficult to know who should be screened and why. STARTING POINT: Neonatal hip screening is well established although some experts feel that the effectiveness of clinical let alone ultrasound screening programmes is unproven. Several European countries undertake population screening, while selective screening occurs in 93% of UK units. K Holen and colleagues recently reported (J Bone Joint Surg 2002; 84-B: 886-90) a prospective randomised trial of just over 15 500 newborn babies in which they compare universal and selective screening programmes. With a follow-up of 6-11 years, one late-detected hip dysplasia was seen in the universal group compared with six in the selective group (not statistically significant). These investigators found, on the background of an excellent clinical programme, no additional benefit from universal screening and thus advocate selective screening. WHERE NEXT: The aims of a screening programme must be defined, then evaluated. A consideration of costs can never take into account family pain and distress. The results of the universal screening programme in Coventry, UK, are impressive and significantly better than results from other UK centres. If the Coventry results are the gold standard, then it is necessary to work out how this can be achieved elsewhere rather than worry about whether it is unachievable.
Hip Dislocation, Congenital↗
[Technical aspects of ultrasonography of the fetal hip joint].
Recent advances in ultrasound technology now permit direct access to foetal structures with visualisation of foetal hip development. Since early diagnosis and treatment of congenital hip dislocation significantly influence outcome of the disease, ultrasound screening of newborn infants proved to be the most effective method. In our study assessment of the foetal hip has been carried out to provide basic knowledge on foetal hip development from 14.-40. weeks of gestation. Technique of foetal hip ultrasound is presented. Diagnosis should include qualitative and quantitative descriptions of foetal hip structures. Alpha and Beta angles according to Graf's classification are frequently measurable from the 21st week of gestation, but tend to be more reliable towards the end of pregnancy.
Female↗
Radiographic course after acetabuloplasty and femoral osteotomy in hip dysplasia.
The radiographic course of 101 hips with residual dysplasia treated with roof plasty combined with intertrochanteric varus derotation osteotomy using the osteotomy wedge as a roof graft after Mittelmeier were reviewed. The average followup period was 8.8 years. The acetabular angle was improved by an average of 16 degrees (postoperative mean, 19 degrees; average at followup, 18 degrees). The center edge angle also was improved by 16 degrees and was stable at 25 degrees average at followup. The neck shaft angle, abnormal in 70% of hips preoperatively, was reduced by the varus osteotomies to a mean of 111 degrees and showed a spontaneous postoperative increase to normal values of an average of 129 degrees. There was no correlation of the postoperative of the neck shaft angle to patient age, preoperative valgus extension, correction angle, or length of followup. In nearly all cases, an almost anatomic joint shape was achieved. With a complication rate of only 1%, especially regarding the rate of necroses of the femoral head, the presented surgical technique can be recommended as highly effective, reliable, and safe for the treatment of congenital hip dislocation.
Acetabulum↗
Laser Doppler flowmetry during open reduction for developmental dysplasia of the hip.
Laser Doppler flowmetry was used intraoperatively to monitor femoral head perfusion during open reduction of 13 congenital hip dislocations in 11 patients. Laser Doppler determinations ranged from 12 to 400 mV before reduction and 30 to 300 mV after reduction. Three patients had magnitude changes in excess of 50%. One had increased perfusion, and two had decreased blood flow. Avascular necrosis of the hip occurred in one patient that was not predicted by laser Doppler flowmetry. Femoral head perfusion measured 175 mV for the dislocated hip and 180 mV after reduction of the femoral head and completion of the pelvic osteotomy. The authors conclude that laser Doppler flowmetry is not a reliable method for monitoring femoral head perfusion during open reduction of the hip for developmental hip dysplasia.
Child, Preschool↗
Hyperexplexia: an inherited disorder of the startle response.
A family is presented with hyperexplexia, a rare autosomal dominant neurological disorder. Affected individuals manifest flexor hypertonia and hypokinesia during infancy. Later and throughout life, the condition is characterized by exaggerated involuntary myoclonic startle reactions, which on occasion result in falling. There are also marked nocturnal myoclonic jerks. Many family members have had congenital hip dislocations and inguinal hernias. Pre- and postnatal hypertonia is proposed as the cause for these problems. The nature and location of central nervous system dysfunction in hyperexplexia was investigated using electroencephalographic and brainstem-evoked response techniques. A dysfunction of cortical inhibition of the brainstem-mediated startle response is discussed as a possible pathogenic mechanism. Accurate diagnosis of this disorder is important in order to provide appropriate counseling and to initiate effective treatment.
Adolescent↗
A device to aid in positioning for the Andrén-von Rosen hip view.
The authors describe a device which simplifies positioning of the infant when using the Andrén-von Rosen hip view. This device facilitates achievement of the precise angles of abduction and rotation and aids in the diagnosis of congenital hip dislocation.
Hip Dislocation, Congenital↗
Neonatal proximal femoral epiphysiolysis.
The authors pressent two cases of proximal femoral epiphysiolysis (PFE) in neonates. Radiographs show superolateral displacement of the proximal femoral metaphysis in relation to a normal acetabulum, which differentiates PFE from a congenital hip dislocation. Early diagnosis and treatment of PFE can prevent coxa vara.
Birth Injuries↗
Bristol-Myers Squibb/Zimmer award for distinguished achievement in orthopaedic research. Long-term follow-up of pediatric orthopaedic conditions. Natural history and outcomes of treatment.
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Adolescent↗
Splinting for CDH--initial impressions of a 'user-friendly' alternative.
A lightweight, washable, and easily adjusted splint for the congenitally dislocated hip, designed to improve maternal compliance, is described. Observations are currently scientifically uncontrolled, though initial impressions are favourable.
Hip Dislocation, Congenital↗
Iatrogenic failure of a ventriculoperitoneal shunt. Case report.
A previous undescribed cause of ventriculoperitoneal shunt malfunction is presented. Limitation of abdominal excursion by a spica cast used to correct congenital hip dislocation reduced cerebrospinal fluid flow through a shunt. This easily correctable cause of "shunt failure" nearly resulted in replacement of a working shunt.
Casts, Surgical↗
The effect of early anterior approach open reduction with functional postoperative treatment on the early development of the acetabulum in CDH.
Between 1980 and 1983, 30 anterior approach open reductions were performed on congenitally dislocated hips of 29 patients after unsuccessful conservative treatment; patients were between 6 and 18 months old. After the removal of the obstruction from the acetabulum, the reduction was performed with preservation of the limbus. Some part of the capsule was removed to constrict and tighten it and to prevent redislocation. This capsuloplasty demonstrates the success of a Pavlik harness and abduction splint postoperatively, without plaster fixation. The accelerated development of the acetabulum could be observed on radiograph by this functional treatment, compared to the control group treated with the usual hip spica postoperatively. The development of the acetabulum on the operated side almost equals the sound side within a year. If the operation was performed earlier, joint development would be quicker.
Acetabulum↗