[Congenital dysplasia of the hip joint and congenital dislocation of the femur].
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Hip Dislocation, Congenital↗
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[Treatment of congenital dislocation or subluxation of the hip taken from personal material--factors determining the course and result of treatment].
A series of 65 children (130 hips) treated for congenital dislocation or subluxation of the hip with Pavlik harness been retrospectively reviewed. All patients were managed by the same physician and according to previously established principles. Mean follow-up after the termination of treatment was 7.5 months. Age at the onset of treatment and initial state of the hip were recognized as two major factors influencing the course and result of treatment. It was found, that the harness treatment is best initiated in first 9 weeks after birth and even a few weeks delay may seriously affect its efficacy. A dynamic index on alfa angle changes on serial ultrasound images of the hip (Graf method) has been introduced.
Age Factors↗
[Screening and diagnosis of hip instability in newborn infants].
Instability is the clinical sign that characterizes congenital dislocation of the hip. The methods used to detect hip instability do not all have the same value, and snapping is only an accessory and inconstant sign. In case of doubt, ultrasonography with dynamic test may be a useful complement to clinical examination. The natural course of the disease being unpredictable, treating all dislocated hips seems to be justified. The author discusses the risks and reliability of clinical examination and the criteria of hips at risk of dislocation to conclude in favour of clinical detection.
Hip Dislocation, Congenital↗
[Three-dimensional analysis of the hip during growth].
Ultrasonography provides a genuine breakthrough in the diagnosis of congenital dislocation of the hip and also helps considerably in evaluating the evolution and treatment. Current tridimensional analysis techniques, as described in this article, have revolutionized imaging. Operative situations may be simulated by a computer. Congruence, concentricity and coverage of the head may be evaluated.
Child↗
Dega osteotomy for the treatment of congenital dysplasia of the hip.
BACKGROUND: In 1969 Dega described a transiliac osteotomy to treat residual acetabular dysplasia secondary to congenital hip dysplasia or dislocation. We were unable to find a thorough description of the technique in the English-language orthopaedic literature, and the number of clinical follow-up series is small. METHODS: Twenty-two children (twenty-four hips) with an average age of five years and ten months and varying degrees of congenital hip dysplasia, subluxation, or dislocation were treated with a Dega osteotomy. Twenty hips (83%) had a concomitant femoral osteotomy and thirteen (54%) had an anterior open reduction of the hip in addition to the Dega osteotomy. To be included in the study group, each patient had to have complete clinical documentation of the range of motion, presence or absence of a limp, limb-length discrepancy, hip pain, and limitation of activity. Radiographs were reviewed to determine the acetabular index, the center-edge angle, whether the Shenton line was intact or broken, and any change in the projection of the obturator foramen. RESULTS: At an average of fifty-five months postoperatively, all patients demonstrated unlimited physical activity and no limp. The average acetabular index changed from 33 degrees preoperatively to 12 degrees at the time of follow-up. The center-edge angle ranged from less than -30 degrees to 18 degrees preoperatively and from 18 degrees to 40 degrees (average, 31 degrees) at the time of follow-up. A change in the obturator foramen was observed in fourteen hips (58%). The Shenton line was broken in seventeen hips preoperatively but in none postoperatively. One Dega osteotomy was revised immediately after the index operation, and three hips underwent late repeat correction of the proximal part of the femur; one of the repeat corrections was performed together with a repeat Dega osteotomy. CONCLUSIONS: Our initial experience with the Dega osteotomy demonstrated it to be a valuable surgical treatment of congenital dysplasia of the hip in a child of walking age. Our experience is comparable with that of many European authors, including those reporting studies from Dega's own institution.
Acetabulum↗
Comparison of results of two approaches to hip screening in infants.
We compared the success of the screening programmes for congenital dislocation of the hip in two hospitals in the same district, as applied to 68,861 live births over 11 years. Both used only clinical tests on new-born infants. Screening was less successful when the tests were done by junior paediatric physicians than by senior physiotherapists supervised by an orthopaedic surgeon. Clinical screening can be highly effective provided that all babies are screened at birth, and high-risk cases are followed up by a properly trained team with a well-designed protocol.
England↗
CT evaluation of pediatric hip disorders.
CT plays an important role in the management of children with congenital dislocation of the hip and torsional abnormalities of the femur. In addition, CT is also useful in evaluating children with inflammatory, neoplastic, and traumatic abnormalities of the pelvis.
Acetabulum↗
Correlation of fetal posture and congenital dislocation of the hip.
A statistical study was carried out on the incidence of CDH associated with mechanical factors in the uterus, including congenital genu recurvatum. There were 72 cases of CDH among 6559 infants (1.1 per cent). The incidence of CDH was 0.7 per cent in cephalic presentation, 2 per cent in footling presentation and 20 per cent in single-breech presentation. In another series, CDH was found in six of seven infants with congenital genu recurvatum. These findings suggest that a fetal posture with the hip flexed and the knee extended predisposes to the development of CDH.
Delivery, Obstetric↗
Long-term results of total hip arthroplasty with a cemented custom-designed swan-neck femoral component for congenital dislocation or severe dysplasia: a follow-up note.
BACKGROUND: This follow-up study updates the results in a consecutive series of nineteen cemented total hip replacements with a swan-neck femoral component in patients with congenital dislocation or severe hip dysplasia. The series was previously reported on in 1993. METHODS: The patients were petite, with an average height of 152 cm and an average weight of 50 kg, and the femoral canals could not accommodate an off-the-shelf femoral component. Sixteen of the nineteen hips were available for follow-up at an average of 13.3 years (range, eleven to twenty years). Fourteen hips had up-to-date clinical and radiographic examinations. RESULTS: At the time of the latest follow-up, thirteen hips were rated as excellent; two, as good; and one, as a failure because of loosening of both components requiring revision eleven years after the index operation. Another hip required acetabular revision because of loosening fifteen years after the index operation. The rates of femoral and acetabular component revision were 6% and 12.5%, respectively. Radiographic analysis demonstrated that no femoral component was loose. One cup was definitely loose at 19.5 years, and three cups were possibly loose at an average of fourteen years. The radiographic rate of acetabular loosening was 33%. The total rate of cup failure (radiographic loosening and revision) was 43%. CONCLUSIONS: The excellent clinical and radiographic results associated with the swan-neck femoral component, and the 94% rate of survival, at an average of 13.3 years (range, eleven to twenty years) indicate that the biomechanical objectives of this custom-designed prosthesis for patients with congenital dislocation or severe hip dysplasia were met. On the basis of this favorable long-term experience, we still use this prosthesis when the anatomic abnormality cannot be adequately addressed by use of a commercially available prosthetic component.
Adult↗
Polyethylene sockets and alumina ceramic heads in cemented total hip arthroplasty. A ten-year study.
From 1981 to 1983, we implanted Bioceram type-4 and type-5 prostheses in 61 hips in 54 patients with osteoarthritis secondary to acetabular dysplasia, congenital subluxation, or congenital dislocation of the hip. Fifty-seven hips in 50 patients were followed for a mean of 11.1 years (10 to 13). The mean age of the patients at operation was 53 years (31 to 70). Functional evaluation using the Merle d'Aubigné and Postel hip score showed a 77% success rate. Radiological loosening occurred in three femoral (5%) and 16 acetabular components (28%). Autologous femoral head grafts were used in 18 hips and became incorporated, giving mechanical support to the socket except for one which occupied a large weight-bearing area and eventually collapsed. The mean polyethylene wear was 1.1 mm (0 to 3.6) and the mean wear rate was 0.10 mm/year (0 to 0.31). A high rate of wear correlated with calcar resorption (p > 0.002) but not with acetabular loosening. There was no breakage of a ceramic head. Study of the ceramic heads and polyethylene sockets retrieved after ten years showed excellent surface roughness, sphericity, and bending strength for the heads but scratches and voids were seen on the sockets.
Bone Cements↗
[Results of the treatment of congenital dislocation of the hip by "extentions repositioning" and "Hanausekretention" (author's transl)].
Since 1969 all our patients below the age of three years, suffering from congenital luxation of the hip-joint, were treated conservatively. The "Extensions-reposition" and "Hanausekretention" were just slightly modified in providing the "Lorenzposition" by reducing the abduction. The rate of necrosis of the femoral head (4.3%) did not change significantly. In only one case we did not succeed in repositioning a completely luxated hipjoint conservatively. Children up to the age of 3 years can be treated conservatively by this method.
Child, Preschool↗
Some aspects of orthopaedic surgery in childhood.
The aetiological role of immunodeficiency in acute septic arthritis of the hip in infancy, the management of the condition after the acute infection has subsided, and the special hazards of infection in the region of the hip joint in the older child are discussed. The principles of treatment of congenital dislocation of the hip are examined in relation to the maintenance of acetabular growth potential. The factors determining the outcome of treatment in Perthes' disease are discussed and a comparison of the result in a series of cases treated by femoral osteotomy with those in untreated controls is presented.
Adolescent↗
Three-dimensional CT and MR imaging in congenital dislocation of the hip: clinical and technical considerations.
Three-dimensional (3D) CT and 3D magnetic resonance (MR) imaging were performed in four patients with congenital dysplasia of the hip. Two patients were studied by 3D CT and two by 3D MR. Prior to volume segmentation, two-dimensional (2D) MR image preprocessing was used to correct for nonuniform signal intensity distribution from local variations in field strength and coil response. An unsharp mask of the original MR scan was computed by extreme blurring of the image to suppress the details of the object. The unsharp mask was divided into the image on a pixel-by-pixel basis. For improved object contrast first and second echo images were combined in a 1:2 ratio. To add an additional feature for volume segmentation, 2D MR image homogeneity was computed based on 3 X 3 pixel neighborhoods. Volume segmentation was performed using one feature for CT, i.e., attenuation range, and two features for MR, i.e., signal intensity and image homogeneity range. Three dimensional CT and 3D MR demonstrated the 3D relationships of femoral heads and acetabula. Three-dimensional CT was limited to patients who had ossified femoral heads, whereas 3D MR demonstrated the cartilaginous femoral head. The extent of acetabular coverage on which the mode of therapy is based was shown. Three-dimensional MR permitted imaging without gonadal irradiation. The 2D MR image preprocessing described here should provide even better results in objects with greater contrast, i.e., nonosseus structures, and those of larger size with relation to image degradation from partial volume effect.
Child↗
Arthrography in the evaluation of congenital dislocation of the hip.
To assess the value of intraoperative arthrography, 48 preoperative hip arthrograms of 35 children under 18 months of age treated for congenital dysplasia of the hip were reviewed. The frequency of the common arthrographic observations was assessed and was compared with the findings observed from the plain roentgenograms, and with the pathoanatomy seen at the time of open reduction. Arthrography proved reliable in identifying the depth of reduction (medial dye column, 100%), the configuration of the osteocartilaginous structures (96%), and the presence of potentially obstructing soft tissue (limbus, 98%, and ligamentum teres, 78%). Arthrography was less reliable in discerning psoas contracture (36%), despite its presence at all open reductions. Arthrography proved reliable in outlining the inverted limbus that can obstruct closed reduction. Because ossification of the femoral head was frequently eccentric, the center edge (CE) angle of Wiberg was calculated from arthrography more accurately than from roentgenograms.
Acetabulum↗
"Missed" or late-diagnosed congenital dislocation of the hip. A clinical entity.
Reported series of neonatal examinations of the hip by trained orthopedic surgeons reveal cases of dislocation of the hip discovered many months after the previous normal examination. The possibility of delayed dislocation of the hip needs further study and its recognition is important for the medical and legal professions. Physicians may be blamed erroneously for failure to diagnose CDH at an early stage. In 10 documented cases, early examinations by qualified experts revealed normal hip findings, although the patients were later discovered to have CDH. In five instances, the physical examinations were done by specialists in children's orthopedics. In one case of a child being examined for knock-knee, X-rays accidently included the hips and showed CDH. Thus, clinical signs are not infallible and an occasional case will be missed on examination even in children older than one year. Congenital dysplasia of the hip is a dynamic process and parents should be warned of the possibility of delayed dislocation. Repeated examinations of the hips are recommended.
Female↗
[Late assessment of the hip joint treated with the Freyka pillow without complications for congenital dysplasia and dislocation].
Clinical and radiological assessment of 504 hips in 389 patients of 10 to 21 years of age (13 years 10 month on average) has been carried out. The patients were treated by Freyka pillow in the childhood. Those with no reduction achieved primarily and operated on because of residual dysplasia as well as patients with severe avascular necrosis were excluded from this study. In 99% of the hips no clinical abnormality was found except for the change of rotation range--decreased external rotation. Radiographic assessment revealed 60% excellent results and 35% good ones with dominant residual feature of increased anteversion of the femoral neck. Remaining 5% were rated as fair--these were the cases that should have been operated on at a suitable time.
Adolescent↗
Retroversion of the acetabular dome after Salter and triple pelvic osteotomy for congenital dislocation of the hip.
Retroversion of the acetabular dome has been associated with hip pain and osteoarthritis in several studies. Nevertheless, this acetabular alignment received little attention when studying the radiological outcome of pelvic osteotomies in childhood. We therefore reviewed the charts and X-rays of 73 patients with congenital dislocations, who underwent 97 pelvic osteotomies in childhood. We focussed our attention on anterior overcoverage or retroversion of the acetabular dome, respectively. Eighty-six Salter and 11 LeCoeur osteotomies were performed on patients with a mean age of 4.8 years. The mean age at last X-ray documentation was 16.5 years. The version of the acetabular dome was estimated qualitatively from the relationship of the anterior and posterior border to each other and measured semiquantitatively using templates developed by Hefti. According to Lequesne's criteria 94% of the hips were normal or borderline at maturity. A retroverted acetabular dome was present in 27% and averaged -15 degrees. It was more frequent (60% versus 24%) and more pronounced (-16 degrees versus +5 degrees) after Le Coeur's than after Salter's osteotomy and in the residually dysplastic hips (83% versus 22%; -15 degrees versus +3 degrees). It is suggested that anterior overcoverage of the femoral head results from ignorance, when choosing the type and performing the pelvic osteotomy, of where coverage needs to be improved in an individual hip. We question the long-term outcome of these hips because such rotational misalignment has been suggested to be associated with early hip pain and osteoarthritis. In order to avoid such misalignment, preoperative evaluation of where coverage needs to be improved in an individual hip and efforts for better intraoperative control of acetabular reorientation should be made.
Acetabulum↗
[Ultrasonographic study of the hip joint in infants].
We performed ultrasonography screening for the hip joint in 145 infants between January 2003 and January 2004 at Nakajo-machi in Niigata Prefecture. This ultrasonographic study was conducted by Graf's method. The method could discriminate normal hip joints and was able to visualize 11 abnormal hip joints as well. All abnormal hip joints were dysplastic. This method is more useful than x-ray examination for infants, since the cartilaginous femoral head and the soft tissues around the hip could be clearly visualized. As a result, ultrasonography appears to be a useful screening method for congenital dislocation of the hip joint, without the hazard of radiation caused by x-rays.
Hip Dislocation, Congenital↗