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At least 1,603 records · Page 89Linked to original sources
PubMed2001

Revision acetabular arthroplasty using a pedestal cup in patients with previous congenital dislocation of the hip - four case reports and review of treatment.

Despite extensive acetabular bone defects as found in revisions of total hip arthroplasty for high hip dislocation, the ilium usually still provides secure fixation of the pedestal of the acetabular component. Four cases are presented in which reconstruction was performed using a newly developed, conical, titanium, ribbed shaft socket designed for cementless press-fit into the dorsocranial ilium to obtain primary stability. In each case the pedestal cup allowed restoration of the original centre of rotation. There were no complications. A Harris hip score of 85 points was achieved after an average of 28.5 months. All components were radiologically stable. While the findings demonstrate the short-term efficacy of the procedure, longer follow-ups and a larger number of patients are needed before the durability of this reconstructive technique can be assessed.

Adult↗
PubMed2003

Proximal femoral resection for subluxation or dislocation of the hip in spastic quadriplegia.

Management of a painful or contracted hip dislocation in individuals with severe spastic quadriplegia is difficult. Clinical and radiographic results of 12 proximal femoral resection-interposition operations performed in seven non-ambulatory persons (five males, two females; mean age 14 years, 8 months; age range 6 years 11 months to 19 years 8 months) with severe spasticity were reviewed to determine if pain relief and restoration of motion were maintained. At a mean follow-up of 7 years 7 months (median 9 years 6 months) all participants maintained a good sitting position and a functional range of motion with improved hygiene. Hip pain was improved in all participants compared with their preoperative status. Proximal femur migration occurred causing slight pain in one person. Heterotopic ossification was observed but was not clinically significant. Complications included traction pin loosening and infection and a late supracondylar femur fracture 3 months after the operation. Proximal femoral resection effectively decreased pain and restored hip motion in those with severe spastic quadriplegia leading to improved sitting and perineal care.

Activities of Daily Living↗
PubMed1984

Traumatic dislocation of the hip with separation of the proximal femoral epiphysis. Report of two cases and review of the literature.

Traumatic hip dislocation with separation of the proximal femoral epiphysis is a rare injury. Twenty-six observations collected from the literature, together with two further cases presented in this paper, were statistically evaluated. Two types of injury were considered: T1, dislocation with complete separation and displacement of the epiphysis; and T2, dislocation with incomplete separation of the epiphysis. Two main therapeutic protocols had been carried out: restoration of anatomy, supplemented by different means of stabilization; and removal of the epiphysis with or without complementary procedures. Fifteen patients had been followed up for 2 years or more and avascular necrosis had been found in all of them. Leg-length discrepancy also had significant incidence. Eleven patients with T1 injury had been followed up to skeletal maturity: results were fair in four patients and poor in seven. Early surgical restoration of the proximal extremity of the femur, stabilized with Kirschner wires and cast, is the recommended treatment.

Accidents, Traffic↗
PubMed1995

High incidence of congenital dislocation of the hip in Northern Ireland.

To determine the incidence of congenital hip dislocation (CDH) a retrospective study was carried out of cases occurring in a defined population using multiple information sources. Of 138,600 children born in the period 1983-1987, a total of 243 were diagnosed with CDH, defined as those requiring splintage or surgery whose treatment extended beyond 6 months of age. Incidence and estimates of relative risks for pre-disposing factors were determined. The rate was 1.75 cases per 1000 livebirths. Major risk factors were female gender and breech presentation. The proportions of cases identified before 1, 3 and 6 months of age were 8, 14 and 35%, respectively. Despite using a restrictive definition, we have obtained an incidence rate among the highest reported in any United Kingdom population. Early detection is widely accepted as desirable, but neonatal screening has proved ineffective.

Female↗
PubMed1990

Abduction treatment in late diagnosed congenital dislocation of the hip. Follow-up of 1,010 hips treated with the Frejka pillow 1967-76.

There are many countries such as Poland where treatment of congenital hip dislocation is started late. The purpose of this work was to report our results in this group of children. 1010 hips in 780 children with congenital dislocation of the hip were treated with the Frejka pillow. The early results were evaluated in 830 hips at 15-36 months of age and the late results in 527 hips at a mean age of 14 (10-21) years. 90 percent of the children were treated by the same physician. The age at the onset of the treatment varied from 2 weeks to 24 months, with 12 percent younger than 3 months and 28 percent older than 6 months. The initial degree of dislocation was determined with our own index. Radiographic results were evaluated with a scoring based on four or six parameters. There were 6 percent failures, including lack of reduction or redislocation at the time when the child started to walk. Ischemic necrosis was observed in 14 percent of the hips, with significant permanent sequelae in 5 percent. Indications for surgical treatment of residual dysplasia were found in 4 percent of the hips evaluated early; and in the group evaluated late, still 5 percent of the hips required operation. There was good ability for spontaneous remodeling between the age of 3 and 7 years, whereas around the age of 10, the radiographic appearance of the hip became stabilized. At the end of treatment and at the time when the children started to walk, 59 percent of the early evaluated hips were still insufficiently remodeled; but in cases evaluated late, 95 percent of them had a normal or almost normal radiographic appearance. At that time, the clinical state of the children was satisfactory. The results of treatment depended on the initial degree of displacement. Only when treatment was begun after 5 months of age did the patient's age affect the treatment results. The Frejka pillow successfully reduced and stabilized these hips.

Age Factors↗
PubMed1980

Capsular arthroplasty of the hip for congenital dislocation.

During a 20-year period, capsular arthroplasty was performed on 32 congenitally dislocated hips (28 patients). The Colonna procedure was used, except that prereduction traction was omitted. Capsular arthroplasty was a primary surgical procedure for 12 patients (15 hips) in whom a late diagnosis of CDH was made (mean age at diagnosis, 3.9 years). The same operation was performed as a secondary, or salvage, procedure in a group of 16 patients (17 hips) who had undergone one or more previous operations that failed to secure reduction. The results of treatment in the two groups did not differ significantly. Long-term stability was achieved in 27/32 hips (84%). Excellent or good results were obtained in 17/32 hips (53%). Fair or poor results were obtained in 15/32 hips (47%). In 10/32 hips, there was marked stiffness and in 5/32 hips, redislocation occurred.

Arthroplasty↗
PubMedDate not supplied

A comparative study of bilateral versus unilateral congenital dislocation of the hip.

The presentations, treatment requirements, results, and complications of 50 patients with bilateral congenital hip dislocation were evaluated and compared with a similar group of unilateral dislocations. Diagnosis was significantly delayed in the bilateral dislocations. The only consistent sign on initial clinical examination of the bilateral group was the symmetrical restriction of hip abduction. Treatment requirements were similar for the unilateral and bilateral dislocations, and in fact, the unilateral dislocations were more likely to undergo reconstructive procedure after successful closed reduction. Overall results, when based on age at diagnosis, were similar for the two groups. In both groups, females required less treatment and were more likely to have a good result. The complication of avascular necrosis was seen more frequently in the unilateral dislocation, while the bilateral dislocation had a higher incidence of inadequate reconstructive operations.

Child↗
PubMed1999

[Reconstruction of hip joint function: old fracture-dislocation of hip joint complicated with deformed healing of upper 1/3 of fractured femur--a case report].

OBJECTIVE: To explore a method of reconstruction of hip joint function after deformed healing of the upper 1/3 of fractured femur as a complication of old fracture dislocation of hip joint. METHODS: A patient with loss of function in hip joint and fusion of knee joint was treated with lock for femur intra-medullary fixation in April 1997. RESULTS: Before operation, the diseased hip joint lost its most functions and the entire lower extremity was disabled because the knee joint had been fused. One year after operation, the follow-up examination revealed that the patient could walk by crutches without discomfort, his daily life and work recovered to normal. CONCLUSION: It is effective to treat a patient suffering old fracture-dislocation of hip joint complicated with deformed healing of the upper 1/3 of fractured femur by means of individualized artificial joint replacement and a prosthesis body with lock for femur intra-medullary fixation, and it is helpful for the development of a new clinical idea to reconstruct functions in the management of some particular cases.

Accidents, Traffic↗
PubMedDate not supplied

[Remodeling of the acetabulum after experimental hip joint dislocation--an animal experiment study of the rabbit].

PURPOSE: Little is known about the remodeling potential of the acetabulum after dislocation and relocation of the hip joint. Most clinical data rely on radiographic measurements in a clinical setting, with only few singular reports on histologic changes at the time of surgery. This study was undertaken to examine the remodeling potential of the rabbit acetabulum after different length of hip dislocation and to gain insight into the histology of the remodeling process involved. METHOD: The right knee joint was immobilized in 28 matched New Zealand white rabbits, causing dislocation of the associated hip joint. Assessment of the joint status was made by serial X-rays in a reproducible standardized way, allowing measurement of the Acetabular Index (AI). The untreated left hip joints served as controls in the histologic sections and also allowed to develop an age matched scale of normal acetabular development for radiographic assessment. Dislocation was unsuccessful in 2 rabbits, 9 animals were sacrificed with the joint dislocated, and in 13 animals a closed reduction was performed and maintained in a Petrie type position for 10 days. Reduction was unsuccessful in 4 cases. The reduced group was sacrificed after 4 to 12 weeks, the point of harvesting being determined by no further change in the serial standardized radiographic measurements of the AI. All surgical procedures were done under the supervision of a veterinary surgeon and followed an approved protocol. RESULTS: In the time observed, the normal values of the Acetabular Index drop from 30 degrees to 20 degrees over a time of 3 months. In animals with a dislocated hip the AI increased to 40 degrees, which was completely reversible and reached normal values in 4 weeks, if reposition was done at this time (group A). Later reposition did improve the AI, but compared to normal age matched values, the AI remained elevated (> 30 degrees), demonstrating a residual dysplasia (group B). The histologic sections of the control left joints showed normal hyaline cartilage with physiologic vertical stacking of the cartilage zones. In the dislocated group the vertical stacking was lost, with chondrocytes demonstrating a fibro-cartilaginous metaplasia. There was hypocellularity with loss of nuclear staining. These changes were completely reversed in the group A, but remained in group B. CONCLUSIONS: This study demonstrates that an early reduction will not only allow for a normalisation of the radiographic values, but that the histologic changes as they develop during dislocation can completely be reversed. Long standing dislocation will lead to a permanent tissue metaplasia similar to the one seen in compression testing of joint cartilage, therefore loosing the potential for remodeling. Similar processes may occur in the human situation and the findings here underline the necessity for early reduction to allow for a complete remodeling of the hip joint.

Acetabulum↗