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PubMed2004

[Treatment of developmental dislocation of the hip with improved Pemberton method].

OBJECTIVE: To find a more perfect method of treating developmental dislocation of the hip(DDH). METHODS: From March 1994 to December 2002, on the basis of the ordinary operative method, Pemberton method was improved for 48 cases of DDH 49 articulatio coxae which had superficial and small acetabula but big heads of femur. Osteotomy points were moved higher to enlarge area of bone flap turned over. A piece of full thickness ilium including periosteum was removed as a free bony graft. Capsula articularis growing thicker was made into 2 layers, of which the inner layer was used to tighten articularis and the outer layer was used to stabilize bone flap. RESULTS: All patients were followed up for 18 months to 5 years, the function of articulatio coxae and degree of bony union, inclusion area to head of femur and ischemic necrosis of femoral head were observed through X-ray. According to Zhou Yongde's criteria for the curative effect of congenital dislocation of the hip, there were 18 cases of 26-30 scores(3 hips), 27 cases of 21-25 scores, 2 cases of 16-20 scores(3 hips), and 1 case under 15 scores, and the total superior rate was 93.8%. CONCLUSION: Improved Pemberton method can enlarge inclusion area to head of femur, avoid decreasing acetabular volume, and stabilize articulatio well, which made operative indication bigger than original Pemberton method.

Child↗
PubMed1992

Early and late loosening of the acetabular cup after low-friction arthroplasty.

Between 1971 and 1979, 680 low-friction arthroplasties of the hip were performed in 598 patients. The average duration of follow-up was twelve years and eight months. Sixty-one acetabular cups had loosening as seen on roentgenograms eighteen years postoperatively, resulting in a total cumulative probability of loosening of 19 per cent, according to survivorship analysis. In twenty-nine cups, the loosening appeared within ten years after the operation (early loosening) and in thirty-two, more than ten years after the operation (late loosening). Early loosening was associated with deficient structure of the bone of the acetabulum, a previous congenital dislocation of the hip, acetabular fracture, or acetabular protrusion in all instances (p < 0.01). Late loosening was associated with the depth of acetabular wear. Of the thirty-two cups that had more than two millimeters of wear, eighteen (56 per cent) had loosening on the roentgenograms (p < 0.001). In hips that had early loosening, migration was the most frequent finding, and its rate of progression was higher than in hips that had late loosening (p < 0.001). In late loosening, a complete bone-cement radiolucency of more than two millimeters was the most frequent finding. Clinical failure was seen in twenty-two (76 per cent) of the twenty-nine cups that loosened early and in nine (28 per cent) of the thirty-two cups that loosened late. The probability of extensive resorption of bone necessitates close observation of patients who have early loosening, while a reasonable period of observation is possible for those who have late loosening.

Acetabulum↗
PubMed1994

Congenital cutis laxa with ligamentous laxity and delayed development, Dandy-Walker malformation and minor heart and osseous defects.

We present a female infant exhibiting congenital cutis laxa with retardation of growth and motor development, ligamentous laxity and congenital dislocation of the hips. This connective tissue disorder was associated with Dandy-Walker malformation, atrial and ventricular defect and minor bone abnormalities including multiple wormian bones, abnormal tubulation of long bones and absent twelfth pair of ribs. This association is believed to be unique.

Abnormalities, Multiple↗
PubMedDate not supplied

[Transmission sonographic diagnosis of infant hips].

By means of transmission sonography with incoherent ultrasound it is possible to obtain areal cross-section images of infants' hips which are free of interference and demonstrate axes accurately. It is possible to assess the condition of tendons, ligaments, capsular structures, and the bones, and their relative positions. The authors report on experience gathered since 1982 with the instrument developed at the Gesellschaft für Strahlen- und Umweltforschung (Society for Radiation and Environmental Research) in Munich. In addition to a brief description of the unit and an explanation of the examination technique, they discuss criteria of assessment and demonstrate on the basis of sample results that transmission sonographic findings can be assessed reliably in patients up to the age of 9 months. The possible significance of transmission sonography in the diagnosis and observation of congenital dislocation of the hip is discussed.

Hip Dislocation, Congenital↗
PubMed1987

[Principles of sonographic examination of the hip].

The advantages of ultrasound in the diagnosis of congenital dislocation and dysplasia of the hip, compared with other imaging diagnostical methods are obvious, since an exact and early diagnosis of hip immaturity can be made. Using realtime sonography, it is possible to directly visualise the motion of the femoral head in the acetabulum and verify any instability of the joint. Especially hips which are classified as being in the critical range should always be examined dynamically to judge their grade of instability. This is necessary because these hips often show no pathology when examined clinically. Unlike radiography, hip sonography can diagnose the grade of hip maturation from the day of birth. Newborn screening can thus result in early detection and treatment of pathological hip joints. Since introducing routine newborn screening at our hospital, we have been able to achieve an earlier onset of therapy in 80% of the cases, within the first four weeks of age. The percentage of CDH diagnosed before and after introducing the newborn screening did not differ. Babies which are classified as being in the "risk group" were followed up regularly. Subsequent to the dynamic examination of the hip, problems of describing the arthrosonographic anatomy of the hip are discussed.

Acetabulum↗
PubMed1982

Early diagnosis of congenital dislocation of the hip. First experimental examinations and results.

Preliminary trials with computer tomography in the diagnosis and evaluation of dysplastic hips have brought the following results: (1) The figures closely resemble the x-rays and are as easily read, however, the amount of radiation is much less. (2) Cartilage form and borders are visible so that diagnosis is possible prior to the age of 3 months. (3) Since soft tissue contours are visible, it is expected that arthrography would be superfluous, thereby resulting not only in less x-ray exposure for the small child or infant but also reduction in risk due to anaesthesia and of joint puncture with its risk of infection (though minimal). As to whether or not the question of cost will be so positively answered, it is not yet clear. Further evaluation of this technique is presently being undertaken.

Animals↗
PubMed1987

Management after application of the Pavlik harness in congenital dislocation of the hip.

The Pavlik harness was applied to a group of outpatients to treat CDH (group I), to a group of hospitalized patients (group II), and to a third group who received additional treatment to prevent avascular necrosis of the femoral head, based on the theory that the weight of the lower extremity plays an important role in the successful reduction by the Pavlik harness (group III). The results of the three groups were carefully compared in order to determine the ideal management of infants after application of the harness. No difference was found in the therapeutic results between group I and group III, when the reduction was attempted on the outpatient basis. However, the rates of reduction and anatomical healing were lower in the hospitalized patients of group III than in group II patients, but there was no difference in the incidence of avascular necrosis of the femoral head between the two groups. In the treatment of CDH using the Pavlik harness, application of the harness on the outpatient basis should be the first choice. It is fundamental to let the weight of the lower extremity help in effecting abduction of the hip joint, but the general and local reactions of the infant must be watched constantly, because too much pressure on the hip joint could invite avascular necrosis of the femoral head. If reduction at the outpatient clinic fails, the patient should be regarded as having the treatment-resistant type of CDH, and should be treated further with traction of the lower extremity, muscle release, and adjustment of the hip joint angle.

Femur Head Necrosis↗
PubMed1985

Somatometric characteristic of hypermobile patients with coxarthrosis.

Different body build has been observed in hypermobile women with coxarthrosis as compared with other hypermobile individuals. The study summarizes results of somatometric measurements in 38 hypermobile women with coxarthrosis based on congenital dislocation of the hip (CDH) and the same number of hypermobile controls. The following differences were found: Patients with coxarthrosis were heavier, shorter, more robust and had a larger quantity of fat tissue. In the control group ten out of 38 (26%) showed arachnodactyly, whereas in the coxarthrosis group no arachnodactyly was found. In Heath-Carter anthropometric somatotype the samples differed in all three somatotype components (endomorphy, mosomorphy, ectomorphy), the greatest difference being in ectomorphy. The results obtained are recommended for use in the primary preventive care of coxarthrosis.

Adult↗
PubMedDate not supplied

Decline in the incidence of late diagnosed congenital dislocation of the hip.

INTRODUCTION: We reviewed the incidence of early and late diagnosed CDH over a 13 yr period in a single maternity with a well established follow-up program and a stable population base. In March 1991, all newborn infants were nursed in the lateral or supine position, having previously been nursed prone. In addition, a dedicated hip screener was appointed in October 1992. We wished to determine whether these changes could have led to a reduction in late diagnosed CDH. METHODS: Babies with suspected CDH were seen by a single consultant orthopaedic surgeon within 1 week of birth. Splints were not applied until diagnosis was confirmed by the orthopaedic surgeon. The study period was from January 1983 to December 1995, inclusive. RESULTS: 37,383 babies were born during the study period, an average of 2,876 births per annum. The average rate of babies referred to the orthopaedic surgeon was 12.8 per 1,000 (range 5.5-28.2 per 1,000). The average incidence of babies splinted early was 7.19 per 1,000 (range 4.0-14.1 per 1,000) with no discernible increase or decrease over the yrs. In contrast, there was a clear reduction in the incidence of late diagnosed CDH; 42/24,713 births (January 1983-February 1992) compared to only 2/12,673 births (March 1992-December 1995; p < 0.0001. Twelve of the 44 infants (27 per cent) diagnosed with late diagnosed CDH were discovered by the policy of routine hip radiographs at 6 months of age of all babies born by breech presentation (2/12) or those with a positive family history of CDH in a first degree relative (10/12). Six others had a diagnosis of CDH confirmed by X-rays done at 6 months of age because of doubts about their examination in the newborn period. CONCLUSIONS: Nursing infants in the supine or lateral position and the introduction of a single hip screener were associated with a reduction in the incidence of late diagnosed CDH. Routine hip radiographs of high risk infants at 6 months of age proved to be a valuable safety net in detecting a significant proportion of previously undetected infants with CDH.

Breast Feeding↗
PubMed1999

Colonna capsular arthroplasty: a 33-year follow-up of four patients.

We evaluated the results of Colonna capsular arthroplasty in 4 patients with unilateral congenital dislocation of the hip. All of these patients were female, aged 10-14 years at the time of surgery, and 42-50 years at the time of follow-up. The most striking finding in this study was the good ability to walk. Although radiographs showed considerable joint degeneration, all of these patients had only mild to moderate pain in the hip.

Adolescent↗
PubMed2003

Magnetic resonance imaging after reduction for congenital dislocation of the hip.

BACKGROUND: Reliable concentric reduction of the femoral head and subsequent retention in a centred position are indispensable preconditions for the remodelling of the acetabulum in developmental dysplasia of the hip (DDH) and to prevent damage to the hip joint, i.e. avascular necrosis. The objective of this study is to evaluate the necessity of verifying the reduced position of the articulation in the plaster cast. METHOD: MRI was carried out in 15 infants with 21 unstable hip joints after reduction under arthrographic control and fixation in a plaster cast in the 'human' position with the hips flexed above 90 degrees and abducted to 50 degrees or 60 degrees. When the reduction was found to be inadequate-the hip still partially or completely dislocated-the plaster cast was removed, reduction repeated, a new cast applied, and MRI carried out again. RESULTS: After primary reduction, 1 of 21 hips was dislocated, and 2 showed unsatisfactory reduction. Three hip joints out of 21 (14.3%) were not fixed in the plaster cast in the optimal centred position. CONCLUSION: In view of the number of inadequate reductions in plaster casts, we recommend verifying the position of the hip joint by MRI. This MRI documentation should be established as a standard examination post-reduction.

Casts, Surgical↗