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At least 1,711 records · Page 95Linked to original sources
PubMed1995

Influence of surgical approach on dislocations after Charnley hip arthroplasty.

Dislocations occurring in 3,199 Charnley total hip arthroplasties in two orthopaedic centers between 1979 and 1991 performed by either the transtrochanteric or posterior approach were studied. The incidence of dislocation within 2 years of surgery (2.8%), as well as the overall frequency (3.4%), did not differ between the two centers. Regardless of approach, there was a higher risk of dislocations for patients with osteoarthrosis. A logistic regression analysis, reflecting the differences in preoperative hip diagnoses and sex, indicated that the dislocation rate was not influenced by the surgical approach. More early dislocations were documented after the posterior approach, but without increases in the rates of recurrence or revision. Arthroplasties performed by less experienced surgeons through the posterior approach resulted in more dislocations.

Aged↗
PubMedDate not supplied

Dislocation after total hip arthroplasty.

Dislocation is one of the most common complications after total hip arthroplasty (THA). Risk factors include neuromuscular and cognitive disorders, patient non-compliance, and previous hip surgery. Surgical considerations that must be addressed include approach, soft-tissue tension, component positioning, impingement, head size, acetabular liner profile, and surgeon experience. Recent improvements in posterior soft-tissue repair after primary THA have shown a reduced incidence of dislocation. When dislocation occurs, a thorough history, physical examination, and radiographic assessment help in choosing the proper intervention. Closed reduction usually is possible, and nonsurgical management frequently succeeds in preventing recurrence. When these measures fail, first-line revision options should target the underlying etiology. This most often involves tensioning or augmentation of soft tissues, as in capsulorrhaphy or trochanteric advancement; correction of malpositioned components; or improving the head-to-neck ratio. If instability persists, or if a primary THA repeatedly dislocates without a clear cause, a constrained cup or bipolar femoral prosthesis may be as effective as a salvage procedure.

Arthroplasty, Replacement, Hip↗
PubMed2000

Radiographic analysis to determine the treatment outcome in developmental dysplasia of the hip.

The purpose of this retrospective study was to determine whether pretreatment radiographic findings of patients less than 6 months old with developmental dysplasia of the hip can predict treatment outcome. Medical records and radiographs were reviewed in a cohort of 35 patients (44 hips) less than 6 months old with a diagnosis of hip dislocation at one institution. Using pretreatment anteroposterior radiographs, we measured the superior gap (distance between the proximal metaphysis to Hilgenreiner's line) and the medial gap (distance between the femoral calcar and the lateral pelvic wall at that level) and analyzed these data along with the type of splint used (Pavlik harness verses other abduction orthosis). Medical records and radiographs from an aged-matched cohort of 20 patients (23 hips) treated at a second institution were analyzed by using the same clinical and radiographic criteria of hip dislocation. Of the 44 dislocated hips, 29 failed with a trial of splintage (66%). Of the 23 dislocated hips from the second institution, 16 failed a trial of splintage (70%). Statistical analysis evaluating the age of the patient, medial and superior gaps, and harness type revealed that an abnormal superior and medial gap consistently predicted success or failure of splintage. We concluded that infants with pretreatment radiographs revealing a superior gap equal to or less than 3 mm, or a medial gap equal to or greater than 10 mm should not be treated with an initial trial of splintage because failure is likely.

Chi-Square Distribution↗
PubMed1989

Pediatric update #9. Revision surgery in congenital dislocation of the hip.

Of 759 dislocated hips operated on in our department, 667 received their primary treatment in our hands, while 92 were revised by us after failure of primary surgery. In 71 hips, reconstructive operations were possible, whereas in 21, the joint was destroyed beyond any possibility of repair and a total hip replacement was performed. The reconstructive operations included 16 reopen reductions, five Colonna arthroplasties, six varization derotations, four open reductions and derotations, two valgization osteotomies, and 38 combined procedures. The latter included a shortening varization derotation osteotomy with an open reduction and a Chiari osteotomy of the pelvis. All the revised cases were improved in comparison with their functional status prior to revision. Of the 71 reconstructed joints, the result was good in 59. In the remaining 12, function was improved as compared with the preoperative status, but a total hip replacement will most probably be required in the future. Revision surgery after failure of previous operations for congenital dislocation of the hip can always improve function, but can rarely result in a normal joint. Primary operations should be performed with maximum caution, and it is certainly better to leave limping pain-free children alone than to transform them into limping children in pain.

Child↗
PubMed1990

The complications of Salter innominate osteotomy in the treatment of congenital dislocation of hip.

In the management of congenital dislocation of the hip, a common problem in our country, a high success rate can be achieved by using conservative treatment in children less than 1 year of age. Unfortunately, most cases are seen too late for conservative management and surgical treatment must be used. Open reduction and Salter innominate osteotomy have been used routinely in our department for children from 18 months to 6 years of age. Between the years 1970 and 1985, 229 hips in 164 children (141 girls and 23 boys) were treated by this method and were followed up in our department. Of these 164 children, 65 (39.6%) had bilateral involvement, 59 (35.9%) had a dislocation of the left hip and 40 (24.3%) of the right hip. We reviewed the technical errors and complications encountered in the treatment of these children: Inadequate rotation of the distal fragment after osteotomy was noted in 9 cases (3.9%), inadequate placement of the pins was seen in 17 cases (7.4%), resulting in secondary displacement of the graft in 5 (2.1%), redislocation of the hip in 13 (5.6%), hematomas and superficial infections were noted in 12 cases (5.2%), deep infections in 3 (1.3%), persistant stifness of the hip joint in 9 (3.9%), femoral fractures in 2 (0.8%) and avascular necrosis of the femoral head in 18 (7.8%). The pathogenesis and possible prevention of these complications are discussed.

Child, Preschool↗