High Congenital Dislocation Research Articles

Long-term treatment results of congenital hip disease in adolescents

Backgrоund. An analysis of modern literature reveals that presently, there are no algorithms for determining the correct method of surgical treatment for adolescents with high congenital hip dislocation; few publications are devoted to the treatment of adolescents with this pathology. Children are treated by podiatrists until the age of 18 before transferring to adult specialists. There remain debatable issues of total hip replacement in adolescents because there are time limits for hip preservation. The search for improved treatment methods for adolescents with this pathology by preserving their own bone structures continues to be relevant.
 Aim. To evaluate the long-term results of the treatment of adolescents with complete congenital hip dislocation after intertrochanteric osteotomy using the authors technique.
 Materials and methods. From 19902006, in the Republican Orthopedic and Traumatological Center of the Republic of Dagestan and the clinic of the Department of Traumatology and Orthopedics of the Dagestan State Medical University, 37 patients with high congenital dislocation of the hip underwent 49 operations using the method developed by the authors. The surgeries were performed by a single orthopedist and were presented as an angulatory lengthening by transtrochantiс osteotomy of the femur by fixation with a fingered plate. All patients underwent clinical, radiographical, biomechanical, and statistical evaluation before and after surgery using the Harris and VAS scales. The results of the study were processed using the Student, Pearson, and Kolmogorov coefficients and confidence intervals.
 Results. Over a long-term treatment period of up to 10 years, the average Harris score increased from 44.2 (95% CI 38.747.9) to 80.5 (95% CI 77.185.3). After the 10-year follow-up period (1015 years after surgery), the scores gradually dropped to 72.4 (95% CI 70.178.3). Unsatisfactory treatment results were found in 13.5% of cases and were mainly associated with an unsuccessful choice of support point under the pelvis and the preservation of uncompensated shortening of the limb. The alignment of the created degree of angulation of the hip in terms of adolescent age groups was not established. Differences in treatment results (depending on the inter-operation time for the bilateral dislocation of the hip) were not established. At follow-up periods of 1015 years after surgery, total hip replacement was performed in 21 joints (56.7%).
 Conclusions. The proposed method of surgical treatment of congenital hip dislocation in adolescents improves the staticdynamic capabilities of the hip joint and remains effective over the following 15 years of life. The duration of inpatient treatment is reduced and does not interfere with subsequent total hip arthroplasty.

Shortening Osteotomies for Total Hip Replacement in High Congenital Dislocation of the Hip

Total hip arthroplasty (THA) for the treatment of high congenital dislocation of the hip is a complex and technically demanding procedure. The difficulties encountered are due to the variety of anatomic deformities seen in these patients. Morphologic alterations are seen in the acetabulum, femur and the affected side of the pelvis, as well as the soft tissues.

Some Aspects of Total Hip Replacement with Subtrochanteric Shortening Osteotomy in Patients with Congenital Hip Dislocation (Review)

Total hip replacement (THR) in patients with a high congenital dislocation of the hip (Crowe type IV dysplasia in Crowe classification) is a technically difficult operation, associated with a high risk of complications. The most common variations of THRs used to restore the true center of rotation of the hip are subtrochanteric shortening osteotomy and proximal shortening osteotomy using the Paavilainen technique. Numerous publications refer to the technique and outcomes of subtrochanteric osteotomy, but fundamental differences of opinion persist on a number of points relating to the topic.The objective of the study is to analyze the publications on the treatment for crowe type IV hip dislocations using total replacement of the hip joint (HJ) with subtrochanteric shortening osteotomy.The hypothesis of the study was as follows: the method of fixation of the femoral component, the type of osteotomy and the design features of the implant (philosophy) are the factors that determine the effectiveness of the operation. The electronic databases eLIBRARY and PubMed were searched for publications containing keywords in Russian or English: high dislocation of the hip, total replacement of the Hj, shortening subtrochanteric osteotomy. As a result of the study, the proposed hypothesis was partially confirmed. There were only minor differences in the overall incidence of complications and the survivorship of implants when using different types of cementless stems. The incidence of non-unions after the installation of cemented femoral components was higher than with the implantation of cementless. We did not find convincing evidence of the advantage of the step-cut, V-shaped and oblique osteotomies compared with the transverse osteotomy. Typical complications for such operations were the nerve injuries, intraoperative hip fractures, dislocations and non-unions of the femur at the osteotomy site.

High congenital hip dislocation in adults – arthroplasty and functional results

ObjectiveRetrospective case–control study on the authors’ experience regarding arthroplasty in high congenital dislocations of the hip in adults. MethodsSample with 11 high congenital hip dislocations (Hartofilakidis type C) that occurred in seven patients, who were submitted to hip arthroplasty by the same surgeon and with the same surgical technique. Mean follow-up period was 4.32±2.67 years (minimum one year) and all patients were evaluated by the same examiner. ResultsAll the arthroplasties had cementless fixation, with application of screwed acetabular cups, conical femoral stems, and a metal-polyethylene articular pars. In every patient, shortening femoral osteotomies were performed at subtrochanteric or supracondylar locations. The mean Harris Hip Score at the last evaluation was 88.55±4.50 (range 81–94). The mean time with high dislocation of the hip (42.91±14.59 years, range 19–68) showed a significant inverse correlation with Harris Hip Score (r=0.80; p=0.003). All patients reported important relief of pain complaints and are capable of ambulation without any external support. In the unilateral dislocations, leg length discrepancies were fully corrected; in the bilateral cases, isometric limbs were achieved in all patients. All osteotomies consolidated, with a mean interval of 3.27±0.47 months. There were complications in 18.18% of the sample: one iatrogenic intraoperative fracture of the greater trochanter and a transitory sciatic neurapraxia. ConclusionDespite being a demanding surgery with a reportedly high complication rate, total hip arthroplasty in high congenital dislocations, when properly indicated and technically correctly performed, allows an improvement in function and quality of life.

Clinical outcome of Zweymüller total hip arthroplasty for patients with high congenital hip dislocation

Treatment of high congenital dislocation of the hip (CDH) remains controversial. We report the outcome of hip arthroplasty using a cementless threaded cup and a cementless straight stem in patients with high congenital hip dislocation. Between January 2001 and August 2004, 17 patients with high congenital hip dislocation were treated. During surgery, at least 25% of the cup was anchored in bone. By monitoring somatosensory-evoked potentials (SEPs) of the common peroneal nerve we were able to reduce the femoral head into position in the true acetabulum by releasing soft tissues. A bulk autogenous femoral head bone graft was implanted in 5 patients to achieve at least 75% bony coverage of the acertabular component. Follow-up ranged from 48 months to 91 months with an average of 69.7 months. The mean Harris hip score increased from 43 points preoperatively to 89 points at the time of final follow-up (P<0.001). Radiographic analysis showed bony union of the bone graft in all cases.

The Trabecular Metal Monoblock acetabular component in patients with high congenital hip dislocation

Between November 1997 and December 2000 we performed 27 total hip replacements in 22 patients with high congenital dislocation of the hip using porous tantalum monoblock acetabular components implanted in the true acetabular bed. Clinical and radiological evaluation was performed at regular intervals for a mean of 10.2 years (8.5 to 12). The mean Harris Hip Score improved from 48.3 (15 to 65) pre-operatively to 89.5 (56 to 100) at the final follow-up. The mean Oxford Hip Score was 49.5 (35 to 59) pre-operatively and decreased to 21.2 (12 to 48) at one year and 15.2 (10 to 28) at final follow-up. Migration of the acetabular component was assessed with the EBRA software system. There was a mean migration of 0.68 mm (0.49 to 0.8) in the first year and a mean 0.89 mm (0.6 to 0.98) in the second year, after excluding one initial excessive migration. No revision was necessary for any reason, no acetabular component became loose, and no radiolucent lines were observed at the final follow-up. The porous tantalum monoblock acetabular component is an implant offering adequate initial stability in conjunction with a modulus of elasticity and porosity close to that of cancellous bone. It favours bone ingrowth, leading to good mid-term results.

Subtrochanteric shortening and cementless arthroplasty in high congenital dislocation of the hip

Subtrochanteric shortening and cementless arthroplasty in high congenital dislocation of the hip

Cementless Total Hip Arthroplasty in Patients with High Congenital Hip Dislocation

The optimal surgical treatment for patients with high congenital dislocation of the hip remains controversial. The purpose of our study was to evaluate the mid-term to long-term results of cementless total hip arthroplasty in such patients. The study included sixty-eight total hip replacements performed between 1989 and 1994 in fifty-six consecutive patients with high congenital hip dislocation at our hospital. The cup was placed at the level of the true acetabulum, and a shortening osteotomy of the proximal part of the femur and distal advancement of the greater trochanter were performed in 90% of the hips. At the time of final follow-up, at a mean of 12.3 years postoperatively, fifty-two patients (sixty-four hips) were evaluated by us with a physical examination, determination of Harris hip scores, and radiographs. The mean Harris hip score increased from 54 points preoperatively to 84 points at the time of final follow-up (p < 0.001). There was a negative Trendelenburg sign in fifty-nine (92%) of the sixty-four hips. There were thirteen perioperative complications (19%): three peroneal nerve palsies, one femoral nerve palsy, one superior gluteal nerve palsy, four nondisplaced fractures of the proximal part of the femur, one malpositioned stem perforating the posteromedial cortex of the femur, one superficial wound infection, and two early dislocations. With revision because of aseptic loosening as the end point, the ten-year survival rate for press-fit, porous-coated acetabular components was 94.9% (95% confidence interval, 89.3% to 100%). Eight of nine threaded acetabular components were revised, and the ninth was radiographically loose at the time of the last follow-up examination. The rate of survival for the CDH femoral components, with revision because of aseptic loosening as the end point, was 98.4% (95% confidence interval, 96.8% to 100%) at ten years. Total hip arthroplasty, with placement of the cup at the level of the true acetabulum, distal advancement of the greater trochanter, and femoral shortening osteotomy, can be recommended for patients with high congenital hip dislocation. Complications such as wear, osteolysis, and cup revision were secondary to the suboptimal design of the acetabular components used in this series.

Femoral shortening and cementless arthroplasty in high congenital dislocation of the hip

We performed cementless total hip arthroplasty with femoral shortening in 28 hips of 23 patients with high-riding congenital dislocation of the hip. All the acetabular cups were placed in their original anatomic location. If needed, the acetabulum was reconstructed using the femoral head. The proximal diaphyseal step-cut shortening osteotomy was performed and stabilized by cerclage or cable grips. The follow-up results at average 48 months postoperatively were scored clinically by the Merle D'Aubign[eacute] and Harris hip scores and were good and excellent in 89.2%. One acetabular cup showed progressive radiolucent lines suggesting aseptic loosening. Two superficial wound infections, 1 femoral nerve palsy, 1 sciatic nerve palsy, 2 nonunions, and 1 acetabular fracture were observed during the follow-up.

Total Hip Arthroplasty in Neglected Congenital Dislocation of the Hip

Between 1984 and 1995, 74 total hip replacements were performed in 64 adult patients who had painful untreated congenital dislocation of the hip. The arthroplasty was performed in the position of the true acetabulum in all patients who had either high or low congenital dislocations of the hip. The femoral head was positioned in the true acetabulum after either osteotomy of the greater trochanter or shortening of the femur, or progressively using external fixation. Information was available on all patients with a followup of 1 to 11 years (mean, 7.2 years). Of the 74 replaced hips, 70 showed marked improvement concerning pain, gait, and mobility, according to the Merle D'Aubigne and Postel scale. Four hips were revised with satisfactory results. The reason for revision was infection in one case and loosening of the plastic cup in three cases. Shortening of the femur by removing a segment of bone below the level of the lesser trochanter followed by osteosynthesis without osteotomy of the greater trochanter was found to be the best method for treating bilateral and several unilateral high congenital dislocation of the hip.

Use of iliofemoral distraction in reducing high congenital dislocation of the hip before total hip arthroplasty

The iliofemoral distraction with Wagner's apparatus was conducted in 20 adult patients with untreated unilateral congenital dislocation of the hip (Crowe group IV) before total hip arthroplasty. During the distraction period of 8 to 17 days, this technique had effectively reduced high dislocation of 4.5 cm (range, 3.5 5 cm). No pin-tract infection was encountered. Surgical difficulties in total hip arthroplasty for these patients were reduced. Potential problems, such as irreducibility, overshortening, nerve palsy, and displaced femoral fractures, were avoided. At an average follow-up period of 43 months (range, 25–63 months), all patients have excellent or good results, with an average Harris hip score of 94.3 (range, 84–100). Leg length was restored. The iliofemoral distraction is valuable prior to difficult total hip arthroplasty for high dislocation.

Congenital hip dislocation and subtrochanteric pseudoarthrosis: Hip replacement based on computer-aided analysis

A 57-year-old woman with neglected high congenital dislocation of the right hip (Figure 1) and a severe dysplasia of the left hip had progressive pain in both hips, leg-length discrepancy and limitation of motion. On the right side there was a subtrochanteric pseudoarthrosis after an osteotomy performed when the patient was 10 years of age. The patient was admitted to our department and the physical examination revealed a healthy woman,

Total hip arthroplasty in high congenital dislocation. 21 hips with a minimum five-year follow-up.

Total arthroplasty was performed on 21 congenitally dislocated hips in 18 women. In all cases the femoral head was dislocated cranially at least one-fifth of the height of the pelvis. The components were both cemented, the acetabulum being replaced to its original position. The acetabular roof was reconstructed by bone graft in 13 hips, and trochanteric osteotomy was done in 18 hips. The patients were assessed at a median follow-up time of 7.5 years when their median age was 54 years. Nine patients had been revised or required revision. At follow-up the average functional score (according to Charnley) was 6 for pain, 4 for walking ability and 5 for range of motion. The Harris hip score was 82. The patients' subjective evaluation of their satisfaction with the late results on a visual analogue scale was 93, range 23 to 100. The high loosening rate in such patients demands regular follow-up and preparedness for revision surgery.

Multiple joint dislocations in mother and child

Summary An unusual combination of multiple dislocations with excessive joint laxity and high congenital dislocation of the hips was found in an infant and his mother. Improvement of the joint laxity with age was noted. This syndrome is thought to represent a new mutation inherited as a dominant trait.