Chronic Hip Dislocation Research Articles

The Wagner Cone Stem for Atypical Femoral Anatomy in Total Hip Arthroplasty: A Report of 320 Cases with Minimum 5-Year Follow-up.

The Wagner Cone Prosthesis was designed to address complex femoral deformities during total hip arthroplasty (THA), but its mid-term component survivorship and functional outcomes remain undetermined. The objectives of this study were to determine the implant survivorship, patient satisfaction, functional outcomes, osseointegration as seen radiographically, implant subsidence, and complications of THA using the Wagner Cone Prosthesis stem at intermediate-term follow-up. This study involved 302 patients with proximal femoral deformities, including developmental hip dysplasia and Legg-Calvé-Perthes disease, who underwent a total of 320 primary THAs using the Wagner Cone Prosthesis. The average age at the time of surgery was 49.4 ± 14.5 years (range, 18.8 to 85.6 years). Patient satisfaction was recorded using a self-administered questionnaire assessing satisfaction in 4 domains. The University of California at Los Angeles (UCLA) activity score, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Oxford Hip Score (OHS), the Forgotten Joint Score (FJS), radiographic outcomes, and complications were recorded. The mean follow-up time was 10.1 years (range, 5.2 to 15.5 years). Survivorship of the Wagner Cone Prosthesis was 98.7% (95% confidence interval [CI]: 97.2% to 100%) with stem revision as the end point and 95.8% (95% CI: 93.5% to 98.2%) with reoperation for any reason as the end point at 10 years postoperatively. In total, 3 stems were revised: 2 for infection and 1 for chronic hip dislocation. The median patient satisfaction score was 95 (interquartile range [IQR], 80 to 100), median UCLA score was 6 (IQR, 6 to 7), median WOMAC score was 18 (IQR, 16 to 22), median OHS was 40 (IQR, 36 to 47), and median FJS was 80 (IQR, 76 to 88) at the time of final follow-up. All Wagner Cone stems that were not revised showed radiographic evidence of osseointegration, with a mean stem subsidence of 0.9 ± 0.8 mm at the most recent follow-up. The use of the Wagner Cone Prosthesis stem in patients with complex femoral anatomy undergoing primary THA is associated with excellent component survivorship, high levels of patient satisfaction, good functional outcomes, and reliable osseointegration with minimal stem subsidence as seen on radiographs at intermediate-term follow-up. Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.

Dual Mobility Cup for Revision of Dislocation of a Hip Prosthesis in a Dog with Chronic Hip Dislocation

Dual Mobility Cup for Revision of Dislocation of a Hip Prosthesis in a Dog with Chronic Hip Dislocation

Unusual Presentation of a Chronic Native Hip Dislocation Sustained in Adulthood

Unusual Presentation of a Chronic Native Hip Dislocation Sustained in Adulthood

A new technique for proximal femoral resection in non-ambulatory patients with cerebral palsy

Proximal femoral resection may be proposed to non-ambulatory patients with cerebral palsy and chronic painful hip dislocation. McCarthy's technique confers good results but does not solve the problems related to femoral reascension (bone migration causing painful osseous or cutaneous conflict). We describe a new technique of resection-interposition of the proximal end of the femur which preserves the greater trochanter by an orthogonal osteotomy below the lesser trochanter while maintaining the gluteal-vastus lateralis strut in continuity. A suture of the remaining joint capsule upon itself and a trans-trochanteric capsulodesis are associated to stabilize the cephalic displacement of the femur.

Treatment of benign bone lesions of proximal femur using dynamic hip screw and intralesional curettage via Watson-Jones approach

To explore the effectiveness of dynamic hip screw (DHS) and intralesional curettage via Watson-Jones approach in treatment of benign bone lesions of the proximal femur. Between March 2012 and December 2016, 20 patients (21 lesions) with benign bone tumors or tumor like conditions of proximal femurs were treated with DHS and intralesional curettage via Watson-Jones approach. Their average age was 27.8 years (range, 11-51 years), including 13 males and 7 females. The pathological diagnosis were fibrous dysplasia in 11 cases, simple bone cyst in 2 cases, aneurysmal bone cyst in 2 cases, benign fibrous histocytoma in 2 cases, giant cell tumor in 2 cases, and chondroblastoma in 1 case, including 3 pathological fractures. According to the Enneking staging system, 18 patients were in stage S1, 3 patients with pathological fractures in stage S2. There was no varus deformity or valgus deformity. The operation time, intraoperative blood loss, and time of full weight-bearing were recorded. X-ray film and CT were used to observe the bone graft fusion and location of DHS. Complications were recorded. Visual analogue scale (VAS) and Musculoskeletal Tumor Society (MSTS) scoring were used to evaluate function of lower limbs. The average operation time was 177.1 minutes (range, 110-265 minutes). The average intraoperative blood loss was 828.6 mL (range, 200-2 300 mL). There was superficial incision infection in 1 case, deep incision infection in 1 case, and hip discomfort in 1 case, respectively. All patients were followed up 6-63 months (mean, 27.4 months). The time of full weight-bearing was 2 days in 2 patients with giant cell tumor and 2 to 13 weeks with an average of 7.2 weeks in the other patients. At last follow-up, VAS and MSTS were 0.19±0.51 and 29.62±0.97 respectively, showing significant differences when compared with the values before operation (3.52±2.62 and 23.71±8.77) ( t=5.565, P=0.000; t=-3.020, P=0.007 ). X-ray film showed the all bone grafts fusion with mean time of 8.2 months (range, 5-12 months). There was no pathological fracture of the femur, local tumor recurrence, chronic hip pain, dislocation, or femoral head necrosis during follow-up. The treatment of benign bone lesion of the proximal femur using DHS and intralesional curettage via Watson-Jones approach is a safe and effective method.

Capsular augmentation in Colonna arthroplasty for the management of chronic hip dislocation.

ABSTRACTColonna capsular arthroplasty represents an option for the management of chronic hip dislocation in young patients with dysplasia. In the appropriate patient, modern capsular arthroplasty procedures may provide an opportunity for hip preservation in patients with preserved femoral head cartilage and not appropriate for total hip arthroplasty. Here, we review our experience with surgical dislocation of the hip and capsular arthroplasty in a 27-year-old female with congenital hip dysplasia and chronic superior hip dislocation. Due to inadequate native capsular tissue, a decellularized dermal allograft was used for interposition and capsular arthroplasty augmentation. The femoral head with preserved articular cartilage was reduced into the enlarged native acetabulum using a parachute technique to hold the allograft in position. Post-operatively, the patient was placed in a hip abduction brace and made non-weight bearing for six weeks. A conservative physical therapy protocol was implemented to allow gradual increase in weight bearing and range of motion over the first 12 weeks post-operatively.

Anesthetic Management of a 13-Year-Old Adolescent With Mucolipidosis Type II for Total Hip Arthroplasty

Mucolipidosis II (ML II) or inclusion cell disease is a rare lysosomal storage disorder, inherited as an autosomal recessive trait. Deficiency of the lysosomal transport enzyme, N-acetylglucosamine-1-phosphotransferease, results in the intracellular accumulation of macromolecules (mucopolysaccharides and mucolipids) in the lysosome which leads to cellular dysfunction and a multi-system disorder. Manifestations are present at birth including muscle hypotonia, a weak cry, and failure to thrive. Additional physical signs include hip dislocation, inguinal hernia, hepatomegaly, limitation of joint movement, and cutaneous changes. Coarse facial features and skeletal abnormalities become more conspicuous with time. A rapidly progressive psychomotor deterioration, developmental delay and growth failure are often noted with a limited life span of 10 years. Due to the aforementioned physical abnormalities, surgical and anesthetic care may be required. We present a 13-year-old girl with ML II who required anesthetic care for a total hip arthroplasty due to chronic right hip dislocation. Previous reports of anesthetic care for these patients are reviewed, end-organ involvement is discussed, and options for anesthetic care are presented. J Med Cases. 2017;8(7):203-206 doi: https://doi.org/10.14740/jmc2834w

Satisfaction and pain levels after proximal femoral valgus osteotomy according to Schanz in patients with cerebral palsy and hip dislocation.

Outcome after Schanz osteotomy in the treatment of chronic hip dislocation in children with cerebral palsy was evaluated. Medical charts and questionnaires were used to assess pain, functional outcome and satisfaction. A total of 24 children, with a mean age of 13.8 years (± 8.9), were included in the study, out of which 11 were classified with Gross Motor Function Classification System (GMFCS) level IV and 13 with GMFCS level V. Current pain was comparable to patients without chronic hip dislocation, and satisfaction was intermediate. Functional outcome improved in several domains. Longer postoperative time was associated with improved pain and satisfaction. The Schanz osteotomy allowed improvement in pain levels; however, it did not completely meet caregiver's expectation and has high reoperation rates.

Salvage procedures for the painful chronically dislocated hip in cerebral palsy.

The aims of this study were to report functional outcomes of salvage procedures for patients with cerebral palsy (CP) who have chronic dislocation of the hip using validated scoring systems, and to compare the results of three surgical techniques. We reviewed 37 patients retrospectively. The mean age at the time of surgery was 12.2 years (8 to 22) and the mean follow-up was 56 months (24 to 114). Patients were divided into three groups: 14 who underwent proximal femoral resection arthroplasty (PFRA group 1), ten who underwent subtrochanteric valgus osteotomy (SVO group 2), and 13 who underwent subtrochanteric valgus osteotomy with resection of the femoral head (SVO with FHR group 3). All patients were evaluated using the Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD) and the Pediatric Quality of Life Inventory (PedsQL). Significant improvements occurred in most CPCHILD and PedsQL subsection scores following surgery in all patients, without significant differences between the groups. There were 12 post-operative complications. Less severe complications were seen in group 1 than in groups 2 and 3. Salvage surgery appears to provide pain relief in patients with CP who have painful chronic dislocation of the hip. The three salvage procedures produced similar results, however, we recommend the use of PFRA as the complications are less severe. Salvage surgery can be of benefit to patients with CP with chronic painful hip dislocation, but should be limited to selected patients considering complications.

Proximal femoral excision with interposition myoplasty for cerebral palsy patients with painful chronic hip dislocation.

PurposeProximal femoral excision is a salvage procedure for painful chronic hip dislocation in cerebral palsy (CP) patients. The primary objective of this article is to describe our experience of an amplified interposition myoplasty, with appropriate peri-operative pain and tone management strategies, in a cohort of non-ambulatory CP patients with painful chronic hip dislocation. Our secondary objective is to present the clinical outcomes of these patients.MethodsWe describe our experience in 20 CP patients (25 procedures) at mean 54-month (range 27–169) follow-up with a surgical technique that includes an augmented interposition myoplasty and tone management. The indications for surgery were pain (21 hips), poor sitting tolerance (11) and difficulty with perineal care (8).ResultsThe mean age was 22 years (range 10–40) with 11 patients Gross Motor Function Classification Scale (GMFCS) IV and 9 patients GMFCS V. Mean length of stay was 13 days (3–35). One procedure required revision at 12 months. Mean pain score improved from 7.8 (5–10) pre-operatively to 2.8 (1–5) post-operatively (p < 0.001). Sitting tolerance improved in all patients and in 75 % (15) perineal care was easier.ConclusionsOur interposition myoplasty technique with individualised pain/tone management has good outcomes in this cohort of patients with multiple co-morbidities.Electronic supplementary materialThe online version of this article (doi:10.1007/s11832-015-0662-z) contains supplementary material, which is available to authorized users.

Hip fusion as hip salvage procedure in cerebral palsy.

The treatment of the spastic hip in Cerebral Palsy (CP) remains a challenge especially in cases of advance changes. Many options are available and the key for a good outcome is to find the best surgical procedure to an individualized patient. The hip fusion is one of the surgical options. The authors presented a group of spastic CP with painful chronic hip subluxation and dislocation treated with hip fusion with a mean follow-up period of 14.5 years. Surgical technique, post-operative management and outcomes were shown, also with the observations done regarding the evolution of the contralateral hip after the hip fusion. They concluded that the hip arthrodesis is an option for patients with spastic CP with painful subluxation or dislocated hips with the goal of pain relief maintain or improve functional status, and facilitating the care. The best candidate is a young ambulatory patient with normal contralateral hip and normal spinal alignment.

Successful closed reduction after adductor tenotomy in a 14-year-old boy with chronic hip dislocation in Down syndrome

Dislocation or subluxation of the hip is considered as the most common hip problem in patients with Down syndrome. Recommended treatment of chronic dislocation treatment is open reduction combined with femoral and/or pelvis osteotomies. We report a Down syndrome child with chronic hip dislocation who was successfully treated with adductor tenotomy and closed reduction, which has not been reported previously.

Atraumatic posterior dislocation of the native hip: an unusual presentation of septic arthritis

We present a case of chronic posterior hip dislocation after severe joint destruction following septic arthritis. In the absence of trauma, infection must be considered in the differential diagnosis of a dislocated joint particularly in patients with risk factors such as intravenous drug abuse and immune compromise. Excision arthroplasty of the hip was performed with good pain relief and functional outcomes. This is an excellent temporary or permanent solution in managing such complex cases although alternative management options are discussed.

A hip resurfacing implant in an adolescent with cerebral palsy

Pain or skin irritation due to the femoral stump after proximal femoral resection for chronic spastic hip dislocation in children with severe cerebral palsy may be encountered. We describe a technique that, to our knowledge, has been unreported earlier and can deal with this phenomenon to improve the patient's comfort level and help the patient to sit more comfortably.

Chronic traumatic hip dislocation: the Cambodian experience

Background: Evidence is conflicting on the best way to manage patients presenting late following a traumatic hip dislocation. Objective: Report our experience of managing patients presenting late following a traumatic dislocation of the hip. Patients and method: A retrospective analysis of patients presenting late with a traumatic hip dislocation to the Children’s Surgical Centre between January 2002 and September 2010 was performed. Thirty-three eligible patients were identified. Twenty-eight patients underwent femoral head conserving treatments. In four patients, total or hemi-arthroplasty was performed, and one patient underwent hip arthrodesis. Results: Eleven patients had documentation of the absence or presence of evidence of avascular necrosis (AVN). Of these, three patients had clinical or radiological signs of AVN. Nineteen patients returned for follow-up and five had an excellent outcome, seven had a good outcome, four had a fair outcome, and one had a poor outcome. Two patients did not have enough clinical information in their medical records to have their outcome classified. A better outcome at follow-up was associated with a shorter mean average time from trauma and the use of femoral head conserving operative interventions. Conclusion: This study supports the theory that patients presenting late following a traumatic hip dislocation can achieve satisfactory outcomes if managed with femoral head conserving strategies, as the femoral head retains its vascular supply in the majority of cases. We also propose that consideration be given to drilling the femoral head during open reduction to ascertain the integrity of its blood supply. Keywords: Avascular necrosis, hip dislocation, hip trauma

Proximal femoral resection arthroplasty for patients with cerebral palsy and dislocated hips

Background and purpose Chronic hip dislocation in non-ambulatory individuals with cerebral palsy (CP) can lead to severe problems, of which pain is often the most severe. We studied the outcome of proximal femoral resection, especially regarding pain, sitting balance, perineal care, and patient satisfaction.Patients and methods During the period 1998–2005, we operated 20 non-ambulatory patients with spastic quadriplegic CP (8 females and 12 males). 13 patients had unilateral dislocation and 7 had bilateral. The mean age at operation was 15 (3–27) years. The indications for operation were chronic hip dislocation plus severe problems with pain (17 patients), perineal care (16), and sitting (10). Patients were followed from 1 to 6 years.Results 14 patients were satisfied with the surgery, 3 were dissatisfied, 2 were uncertain, and 1 patient had died 5 days postoperatively. Of the 15 patients who had suffered from considerable pain before surgery, 8 had complete relief from pain and 7 patients experienced improvement. Of the 2 patients who had had mild pain, 1 was unchanged and 1 patient deteriorated. All patients who had not been able to sit were able to sit after the surgery. Only 1 patient had difficulties with perineal hygiene at follow-up. Postoperative complications included deep vein thrombosis (1 patient) and edema, loss of appetite, and the need for gastrostomy (1 patient). 7 patients had prolonged pain for up to 6 months after surgery. 1 of these was reoperated because of persistent pain due to a bony-spike heterotopic ossification.Interpretation Most patients with chronic hip dislocation and severe pain or other major problems appear to benefit from proximal femoral resection. Pain, sitting ability, and perineal care improved and most patients and caregivers were satisfied.

A weak, numb and wasted hand

A 56-year-old male retired office manager suffered from chronic hip dislocation. During a fall, he injured his left forearm requiring an orthopaedic procedure to remove wood fragments from the medial aspect of the forearm. For the following 9 months, he suffered from paraesthesias of the left hand, affecting the little finger and hypothenar eminence over the palmar surface. This was worse at night. His grip strength was also affected. A weak, numb and wasted handJournal of Clinical NeuroscienceVol. 16Issue 1PreviewE. Ulnar nerve entrapment in Guyon’s canal. Full-Text PDF

Pelvic displacement osteotomy for chronic hip dislocation in myelodysplasia

Twelve children with lumbar-level myelodysplasia (average age, eight and three-quarter years) underwent twenty-one pelvic displacement osteotomies for subluxated or dislocated hips. Nineteen of the twenty-one hips remained reduced on three-year follow-up. Gains in gait pattern, ease of bracing, and reduced pelvic obliquity were noted. Active function about the hips was not improved, nor was there a decrease in the amount of bracing needed following the osteotomy. Pelvic displacement osteotomy can be utilized in selected cases as part of the over-all management of chronic hip dislocation in myelodysplasia.

Long-Term Results in the Bucket-Handle Acetabuloplasty

JBJS Journal Case Connector Reviews JBJS.org Surgical Techniques Open Access JOPA JBJS.org JBJS Journal Case Connector Reviews Surgical Techniques Open Access JOPA