Bilateral Hip Dislocation Research Articles

Orthotic treatment and walking ability of patients with myelomeningocele--analysis of influencing factors

In 106 patients with myelomeningocele, which were fitted with orthotic devices, we analyzed the influence of level of neurologic deficit, scoliosis and contractures of the lower extremities on different walking parameters, e.g. orthotic wearing time, duration of walking and velocity, step length and mobility status. The most important factor is the level of neurologic deficit. From a functional point of view a bilateral hip dislocation can be neglected. Whereas impairment of walking ability is strongly correlated with scoliosis of more than 50 degrees and unilateral hip dislocation; therefore both conditions should be treated operatively.

Beidseitige Hüftgelenksluxation bei infantiler Zerebralparese: konservative Therapie der weniger betroffenen Seite bei gegenseitiger Adduktorentenotomie

In cerebral palsy children with bilateral hip dislocation, a new therapeutic concept was established that treated the less affected hip conservatively and the more affected hip simultaneously with an adductor tenotomy. The current study assessed whether the clinical and radiological outcome was equal to that of established bilateral surgical treatments. We also examined whether this approach leads to an adequate motor function improvement of the affected children. In 41 children with cerebral palsy and bilateral hip dislocation, a prospective study assessed the hip abduction, migration percentage (MP) and the motor function (Rancho los Amigos scale). Depending on the pretherapeutic status, all patients were grouped into 3 abduction and 3 MP groups. The less affected hip was treated with a hip abduction splint whereas the more affected hip of the same child was simultaneously treated with a subcutaneous adductor tenotomy. All patients were assessed annually for 4 years. The hip abduction of the conservatively treated hips was pretherapeutically 41.8 +/- 2.6 degrees and improved significantly after 1 year. Patients with a pretherapeutic hip abduction < or = 20 degrees showed the most improvement. After 4 years, a significant deterioration of abduction was avoided in 49%. The pretherapeutic MP of the conservatively treated hips was 31.6 +/- 3.4% and was significantly but only slightly improved. The 4 year MP was significantly improved and the largest improvement was observed when the pretherapeutic MP was larger than 50%. A significant MP improvement after 4 years was achieved in 54%. After 4 years, 34% had undergone a motor function improvement. In 7% a motor function deterioration was observed. Posttherapeutically, the conservatively treated hips showed abduction and MP values that were comparable to those of surgically treated hip joints. In cerebral palsy children with bilateral hip dislocation, the conservative treatment of the less affected hip is suitable to achieve clinical and radiological results that are equal to the surgical treatment of the more affected hip. The concept of a combined conservative and surgical treatment of bilateral hip dislocation leads to an adequate motor function improvement that is comparable to established bilateral treatments.

Posterior bilateral hip dislocation with ipsilateral acetabular fracture

Posterior bilateral hip dislocation with ipsilateral acetabular fracture

Osseous dysplasia with severe short stature, multiple dislocations, and delayed bone age: Report on a second Lebanese patient

We describe a young girl with severe pre- and postnatal short stature, bilateral dislocation of hips, knees and elbows, and right clubfoot. Skeletal investigations disclosed an anisospondyly, the absence of ossification of the odontoid apophysis and of fusion of the neural arches of the cervical vertebrae, abnormal L3 and L4 vertebrae, partial agenesis of the coccyx, abnormal and sub-luxated radial heads, bilateral dislocation of the hips, dysplastic acetabulae, pseudoacetabulae, hypoplasia of the femoral heads, short femoral necks, short long bones with thin diaphyses, widening of the medullary canal and thinning of the cortical one, slightly enlarged metaphyses, and diffuse osseous demineralization. Bone age was delayed. The girl's parents are first cousins. Differential diagnoses are discussed and the possibility is raised that this might be a second patient with clinical features indicating an entity recently described in a young Lebanese boy [Mégarbané and Ghanem (2004); Am J Med Genet Part A 130A: 107-109]. A clinical follow-up of the latter patient is also reported.

Asymmetrical bilateral traumatic hip dislocation in an adult with bilateral acetabular fracture

This case report aims at presenting a unique case of simultaneous bilateral traumatic dislocation with right side anterior and the left side posterior together with bilateral acetabular fracture. Under general anesthesia, closed reduction of both hips was carried out. The case presented represents an unusual, severe combination of injuries resulting from a high-speed motor-vehicle accident. Traumatic hip dislocation represents a true orthopedic emergency. Given the severity of the associated complications, every effort should be made to ensure prompt diagnosis and immediate therapy.

Operative treatment of bilateral hip dislocations in a child with metatropic dysplasia

We present a case of bilateral hip dislocations with metatropic dysplasia. Radiographic features such as narrow thorax, dense wafer vertebral bodies, narrowing interpedicular distances, kyphoscoliosis, crescent-shaped iliac wings, dumbbell-shaped tubular bones, and inferiorly directing lesser trochanter conform to the findings of metatropic dysplasia. Hip dislocations were misdiagnosed by ultrasonographic and radiographic hip screening, owing to the severely deformed femoral heads and acetabulums. The diagnosis of hip dislocations became possible by magnetic resonance imaging. The bilateral hip dislocation was reduced by open reduction of the hip joints and femoral derotation varus osteotomies.

Traumatic Simultaneous Bilateral Hip Dislocation in the Elderly Patient: A Case Report

Traumatic Simultaneous Bilateral Hip Dislocation in the Elderly Patient: A Case Report

Bilateral asymmetric traumatic hip dislocation in an adult

Bilateral asymmetric traumatic hip dislocation in an adult

Unilateral Versus Bilateral Peri-ilial Pelvic Osteotomies Combined With Proximal Femoral Osteotomies in Children With Cerebral Palsy

The purpose of this study is to evaluate if bilateral peri-ilial pelvic osteotomies (PIPO) combined with proximal femoral varus derotation osteotomies (VDRO) influenced postoperative complications in children with spastic quadriplegia. Bilateral and unilateral hip subluxation or dislocation secondary to spasticity was present in 29 and 61 patients, respectively. The children were divided into 2 groups: group 1 were to be performed a surgery for unilateral PIPO associated with bilateral VDRO, and group 2 were to be performed a surgery for bilateral PIPO and VDRO. The average age of patients at initiation of surgery was 11.7 years (range, 5-20 years) for group 1 and 10.7 years (range, 5-19 years) for group 2. The hospital stay was similar for group 1 and 2 (P = 0.797), which was 9 days. In group 1, 11 (18%) of 61 children needed an average of 2 days (range, 1-7 days) in the intensive care unit postoperatively, and 4 of these 11 patients were reintubated because of respiratory problems. In group 2, 6 (20%) of 29 children were transferred to the intensive care unit postoperatively for an average of 2 days (range, 1-4 days) and 3 of these 6 children were reintubated because of respiratory problems. In conclusion, respiratory problems and anemia were the most common early postoperative complications, which occur with a similar rate in children with spastic quadriplegia who underwent bilateral or unilateral peri-ilial pelvic osteotomy(ies) combined with proximal femoral osteotomies. We believe that bilateral hip procedures including PIPO, proximal femoral osteotomies, and soft-tissue release can be performed safely in 1 stage and, based on this data, the staged procedure would probably have the same risk as the first procedure.

Surgical Treatment of Scoliosis in Larsen Syndrome With Bilateral Hip Dislocation

This is a report of a 12-year-old girl treated surgically for scoliosis associated with bilateral hip dislocation in Larsen syndrome. To describe a rare case of scoliosis associated with Larsen syndrome and bilateral hip dislocation that was treated surgically with follow-up for 15 years. There are few reports of the long-term follow-up of cases involving surgically treated scoliosis associated with bilaterally dislocated hips. The patient's spine showed a right thoracic curve (T5-T12) with a Cobb angle of 77 degrees and did not show pelvic obliquity on an anterior-posterior radiograph film. On the sagittal alignment of her spine, the thoracic spine showed an abnormal lordosis (T5-T12: 19 degrees), and the lumbar spine had a hyperlordosis (L1-S1: 57 degrees) with a large lumbosacral angle (72 degrees ). We performed a posterior spinal fusion between T4 and L2 using Cotrel-Dubousset Instrumentation, anticipating the restoration of normal lumbar and cervical lordosis, as well as thoracic kyphosis. The Cobb angle of thoracic scoliosis improved from 77 degrees to 28 degrees, and a thoracic kyphosis of 12 degrees (T5-T12) was obtained. Subsequently, on the sagittal plane, the lumbosacral angle (sacral anteflexion) decreased from 72 degrees to 52 degrees, comparable to that of patients with hip dislocation, and the lumbar lordotic angle increased from 57 degrees to 66 degrees. The restoration of thoracic kyphosis resulted in an increase of lumbar lordosis and decrease of sacral anteflexion. At the 15-year follow-up,although the thoracic scoliosis (T5-T12) had increased to 36 degrees, good coronal and sagittal balance had been maintained. The patient is asymptomatic in her spine and hip. A case of scoliosis associated with dislocated hips in a patient with Larsen syndrome was successfully treated with posterior correction surgery. Fusion surgery between T4 and L2 provided an ideal sagittal balance of the total spine, while preserving 4 lumbar mobile segments.

Bilateral traumatic anterior hip dislocation - a case report

We report a 33-year-old trader with bilateral traumatic anterior hip dislocation following a road traffic accident. Both hip dislocations were reduced under general anesthesia followed by immobilization of the hips with skin traction. He discharged himself against medical advice one week after injury.

Complete Bilateral Agenesis of the Ilium in a 7-Year-Old Ambulatory Girl

A 7-year-old ambulatory girl with complete bilateral agenesis of the ilium is reported. To document the clinical evolution and the spino-pelvic balance of a girl with bilateral agenesis of the ilium. Scapuloiliac dysostosis is a rare focal skeletal dysplasia consisting in hypoplasia of ilium and scapula. A 7-year-old girl with a short stature was referred to our clinic at 35 months of age for an asymptomatic lumbar hyperlordosis. She presented a waddling gait, and normal range of motion of her upper and lower limbs. The neurologic examination was within normal limits. Initial radiographs at 35 months of age showed complete bilateral agenesis of the ilium with preservation of the pubis, ischium, and sacrum, associated with a bilateral high hip dislocation. The lumbar lordosis and sacral slope were 89 degrees and 84 degrees, respectively. A radiographic skeletal survey also showed hypoplasia of both scapulae. At 7 years old, the girl was fully ambulatory, with a waddling gait and had no pain. The sacral slope and lumbar lordosis have increased to 97 degrees and 97 degrees, respectively. There was no evidence of spondylolisthesis. So far, the patient has required no treatment for her condition. This article reports a unique case of scapuloiliac dysostosis with complete bilateral agenesis of the ilium in an ambulatory girl. This case indicates that a functional gait is possible with bilateral congenital absence of the ilium, provided that there is adequate muscular support and normal neurologic function.

Multidirectional Habitual Bilateral Hip Dislocation in a Patient with Down Syndrome

A multidirectional (anterior and posterior) bilateral habitual nontraumatic dislocation of the hip in a 3-year-old girl with Down syndrome is reported. The treatment was conservative with application of a spica cast for 12 weeks to shrink the capsule. During the first 6 weeks of treatment, the hips were immobilized in abduction and full external rotation. During the last 6 weeks, the hips were in abduction and slight internal rotation. After cast removal, the hips seemed to have been stabilized, and the child has remained asymptomatic for the last 12 months.

Mutations Near Amino End of α1(I) Collagen Cause Combined Osteogenesis Imperfecta/Ehlers-Danlos Syndrome by Interference with N-propeptide Processing

Patients with OI/EDS form a distinct subset of osteogenesis imperfecta (OI) patients. In addition to skeletal fragility, they have characteristics of Ehlers-Danlos syndrome (EDS). We identified 7 children with types III or IV OI, plus severe large and small joint laxity and early progressive scoliosis. In each child with OI/EDS, we identified a mutation in the first 90 residues of the helical region of alpha1(I) collagen. These mutations prevent or delay removal of the procollagen N-propeptide by purified N-proteinase (ADAMTS-2) in vitro and in pericellular assays. The mutant pN-collagen which results is efficiently incorporated into matrix by cultured fibroblasts and osteoblasts and is prominently present in newly incorporated and immaturely cross-linked collagen. Dermal collagen fibrils have significantly reduced cross-sectional diameters, corroborating incorporation of pN-collagen into fibrils in vivo. Differential scanning calorimetry revealed that these mutant collagens are less stable than the corresponding procollagens, which is not seen with other type I collagen helical mutations. These mutations disrupt a distinct folding region of high thermal stability in the first 90 residues at the amino end of type I collagen and alter the secondary structure of the adjacent N-proteinase cleavage site. Thus, these OI/EDS collagen mutations are directly responsible for the bone fragility of OI and indirectly responsible for EDS symptoms, by interference with N-propeptide removal.

Bilateral asymmetric traumatic hip dislocation in adolescence: a report of two cases and review of the literature

Traumatic bilateral asymmetric hip dislocation is an extremely uncommon injury and rarely seen in children. We report two such cases in adolescent females injured in separate accidents. One of these patients also suffered a left femoral shaft fracture, ipsilateral labral avulsion and contra-lateral acetabular fracture. We report our experience in the management of this complex injury pattern and review the pertinent literature on the subject.

Das Arterial-Tortuosity-Syndrom

The arterial tortuosity syndrome is a rare congenital disorder characterized by elongation and generalized tortuosity of the major arteries including the aorta. Associated clinical features consist of excessively stretchable skin and joint laxity which is indicative of a connective tissue disorder such as Ehlers-Danlos or Cutis laxa syndrome. The gene locus of the arterial tortuosity syndrome has recently been localised on chromosome 20q13; inheritance ist autosomal recessive. - We report on a newborn with arterial tortuosity syndrome and hiatal hernia, bilateral hip dislocation, inguinal hernias and diffuse tortuosity of the great arteries including the aorta. Known gene loci involved in Ehlers-Danlos syndrome, cutis laxa syndrome and other connective tissue disorders were excluded by specific DNA markers. By homozygosity mapping with polymorphic microsatellite markers it was possible to confirm the gene locus for the ATS on chromosome 20q13. In addition to the presentation of this patient, a review of the literature is presented.

One-stage treatment of congenital severely dislocated hips in older children through various acetabuloplasty techniques

Background There is no consensus regarding the best treatment for children with late diagnosis of congenital hip dislocation.Patients and methods This retrospective study involved 29 hips in 22 children (19 girls) with an age range of 3–14 years, who had been operated with various techniques for congenital hip dislocation between 1998 and 2002. 6 patients had right, 9 patients had left, and 7 patients had bilateral congenital hip dislocation. The mean length of follow-up was 3 (1–5) years.Results While the mean acetabular index was 53°(35–65) preoperatively, at the last follow-up it was 30° (15–50). 27 hips were type 4 and 2 hips were type 3 by Tönnis criteria. Satisfactory reduction (Severin Class I) had been achieved in 19 hips at the follow-up radiography, and they developed no osteonecrosis. The outcome was successful in children under 7 years of age, but problems encountered in those over 7 increased unless sufficient reduction had been achieved.Interpretation Age at treatment of late-diagnosed congenital hip dislocation appears to be important for outcome.

Hip-Spine Syndrome

The influence of the pathologic state of the hip joint on the total sagittal alignment of the spine was investigated in patients with congenital hip dislocation retrospectively The purpose of this study was to analyze the total sagittal alignment of the spine and the clinical symptoms in patients with bilateral congenital hip dislocation. SUMMARY OF BACKGROUND OF DATA: Abnormality in the hip joint causes abnormal curvature of the sagittal alignment of the spine and induces lumbago or lower leg pain. However, there have been no reports on the influence of bilateral congenital hip dislocation on the sagittal alignment of the spine. A total of 9 patients (8 females and 1 male) were analyzed. Their average age was 57 years (range, 46-68 years). We measured the thoracic kyphosis (T1-T12), the lumbar lordosis (L1-S), the sacral inclination (SI), the femoral flexion angle (FFA), pelvic angulation (PA), and the distances from the pelvic hip axis (HA) to the C7 plumb line and from the promontorium to the C7 plumb line. To evaluate clinical symptoms, we used the Japanese Orthopedic Association (JOA) score of low back pain (full score is 29 points) and Visual Analog Scale (VAS) for lower back pain and lower leg pain, and the possible time of walking without rest. The average thoracic kyphosis, lumbar lordosis, SI, and PA were 42 degrees , -78 degrees , 68 degrees , and 27 degrees , respectively. The FFA averaged 10 degrees , leading to a duck-like posture. The distances from HA and, promontorium to the C7 plumb line averaged -2 cm and 4 cm, respectively. A posterior shift of the gravity line with respects to the hips was compensated for by lumbar hyperlordosis, which led to a posterior shift of the center of the spine. Regarding the clinical symptoms, the JOA score averaged 20 points and the VAS for lower back pain (lumbago) and lower leg pain averaged 6.4 and 3.1, respectively. The average possible walking time without rest was 20 minutes. The total sagittal alignment of the spine in patients with bilateral hip dislocation was compensated for by anterior angulation of the pelvis and by lumbar hyperlordosis. The main clinical symptoms were lower back pain, and not lower leg pain.

Bilateral simultaneous iliac dislocation of the hip.

Traumatic anterior dislocation of the hip is an uncommon injury and bilateral anterior dislocation of the hip is still rare. A case is described of hitherto unreported simultaneous bilateral anterior iliac hip dislocation, complicated by fracture of the femoral head on one side. The extreme rarity of this fracture and the peculiar mechanism of injury (the treatment planning and the post reduction protocol) make this case worth reporting. (Hip International 2004; 14: 196-8).

Chiropractic Management of Patients with Bilateral Congenital Hip Dislocation with Chronic Low Back and Leg Pain

Objective To discuss conservative methods for treating patients with chronic low back and leg pain associated with the biomechanical and postural alterations related to bilateral congenital hip dislocation. Clinical Features This report describes the cases of 2 adult female subjects with bilateral congenital hip dislocation without acetabula formation who suffered from chronic low back and leg pain managed conservatively by chiropractic methods. The first subject is a 45-year-old woman with a 9-month history of right buttock pain and radiating right leg pain and paresthesia down to the first 2 toes, with a diagnosis of a herniated L4 intervertebral disk. The second subject is a 53-year-old woman who complained of chronic intermittent low back pain and constant unremitting pain on her right leg for the last 3 years. Intervention and Outcome Chiropractic manipulation utilizing Logan Basic apex and double notch contacts, as well as sacroiliac manipulation on a drop table with a sacrum contact and with a posterior to anterior and superior to inferior (PA-SI) rocking thrust, together with a spinal stabilization exercise program, were used on these 2 patients. Both patients had significant clinical improvement, with reduction on the Visual Analogue Scale (VAS) of 67% and 84%, Oswestry Disability Index improvement of 73% and 81%, and an improvement on the Harris hip score of 71% and 44%, respectively. Conclusion A conservative management approach, including specific chiropractic manipulation and a spinal stabilization exercise program, can help manage the treatment of adult patients with chronic low back and leg pain related to bilateral congenital dislocation of the hips.