[Aseptic necrosis of the femur head in children with congenital dislocation of the hip].
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On the basis of the authors' experience during the past 18 years, clinical data on CDH in the newborn were studied and summerized as follows. The use of diaper with hip-flexed position decreased not only the incidence of click, but also the frequency of CDH in infancy, indicating their effectiveness for the prevention of CDH. It is important to know whether the hips are dislocated or dislocatable at the original examination, when one decides on indication and initiation of treatment. The affected hips should be treated when "dislocated state" is found and the instability persists for 1 or 2 weeks or when "dislocatable state" is found and the instability persists for 2 or 3 weeks. Treatment with harness is useful for the newborn with CDH. The use will not cause any complication. Development of infants with CDH following after newborns with CDH is influenced by postnatal environmental factors as well as late diagnosis.
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A retrospective review of sixty-eight innominate osteotomies that were performed in fifty-four patients at a university teaching hospital was undertaken to compare the results of these operations with those published by Salter and by his colleagues and to see if the results were different when the procedure was combined with open reduction compared with when it was performed after open reduction. Over-all, nearly three-quarters of the patients had excellent or good radiographic and clinical results. Avascular necrosis occurred in four patients after open reduction and innominate osteotomy. Postoperatively, eight complications developed in seven patients. Innominate osteotomy improved coverage of the femoral head. There was no noticeable difference between the results of innominate osteotomy combined with open reduction and those of innominate osteotomy performed after a previous open reduction. The patients who had an open reduction combined with innominate osteotomy before the age of four years had better results and required fewer subsequent procedures than did patients who had the operation after that age.
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The results of 106 patients with osteoarthritis secondary to severe congenital hip dysplasia and dislocations of the hip operated at the Endo-Klinik were evaluated after an average follow up of 21 months. 142 "St. Georg-Mini" total hips were implanted employing Refobacin-Palacos R. The clinical results were graded as "combined performance" which considered hip pain, walking distance, hip mobility and walking aids. In 93% of the cases "combined performance" was improved at follow up and 91.7% of the patients were satisfied with the result. The early (during hospitalization) and late (after discharge from hospital) complication rate which had an influence on the result at follow up was 2.1% (n = 3) and 3.5% (n = 4) respectively. There were no deep infections. An extended indication for total hip arthroplasty also for younger patients with severe osteoarthritis secondary to hip dysplasia is discussed and can be advocated.
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