Hip Dislocation In Adult Research Articles

Neglected Posterior Hip Dislocation in Adults presenting after One Year Managed Successfully with Single Stage Total Hip Arthroplasty: A Case Series

Introduction:Neglected hip dislocation in adults may present as a dilemma to an orthopedic surgeon and is an uncommon occurrence. Literature mentions both closed reduction and open reduction as methods of management but mostly in children. Few cases have been present in the literature regarding adults with neglected hip dislocations. While almost all have failed in closed reduction, the open reduction has not yielded good results and total hip arthroplasty (THA) as a single stage procedure has not been explored much in regard to neglected isolated posterior dislocations of the hip. We report a series of three cases all with neglected dislocation of over 1 year which was managed with single stage total hip replacement.Case Series:Three cases of neglected posterior dislocation of the hip of more than 1 year (26 years, 28 years, and 32 years of age all males) presented with right leg in adduction, flexion, and internal rotation deformity and painful limp. They were all managed inadequately by traditional bonesetters. No signs of acetabular fracture or avascular necrosis (AVN) were present in radiography and computer tomography. A global softening of the femoral head was encountered in all the cases and uncemented THA was done. All patients did well with good to excellent functional outcomes (Harris hip score [HHS] of 81, 91, and modified HHS of 83) with a minimum of 1 year follow-up. No post-operative complications were encountered.Conclusion:We want to emphasize the lack of literature concerning adult patients with neglected dislocations. Single stage THA is the best option considering the occurrence of AVN of the femoral head with global softening in such cases. A single stage THA attains good to excellent functional outcomes without any early post-operative complications.

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.

Treatment of mixed type femoroacetabular impingement using safe surgical hip dislocation in adults

This study aims to assess the experience gained in a single institution in the treatment of mixed type femoroacetabular impingement (FAI) using safe surgical hip dislocation (SSHD) technique. In this study, 22 hips of 21 patients (7 males, 14 females; mean age 33.8±10.6 years; range 19-52 years) treated by SSHD technique in our clinic between October 2009 and October 2014 were retrospectively evaluated. Preoperative and final Harris hip scores (HHS) and alpha angles were compared. Age, gender, laterality, impingement tests, preoperative HHS, cam and pincer type FAI radiographic indicators and intraoperative articular findings were assessed in terms of their influence to the final functional outcomes. Mean duration of the symptoms was 29.5 months. Groin pain, activated by flexion and internal rotation of the hip, was the main symptom. A radiographic diagnosis of "mixed type FAI" was made in all hips. Mean follow-up duration of 22 hips was 48 months. The difference between the mean preoperative and latest HHS was statistically significant (60.0 vs. 87.6 points, p<0.001). The treatment was considered satisfactory in 17 of 22 hips (77%) having a mean HHS of 95.0 points. Hips having a preoperative HHS of less than 60 points were more prone to unsatisfactory outcome. Among the investigated patient-dependent, clinical, radiographic variables and intraoperative articular findings, coxa profunda sign in a plain radiograph was found correlated with a higher rate of unsatisfactory outcome (p=0.040). Safe surgical hip dislocation procedure has a success rate of 77% after a mean follow-up of four years. Coxa profunda sign is associated with the unsatisfactory clinical outcome. Preoperative HHS of less than 60 points seems to be a negative predictive variable on the clinical outcome.

THE PECULIARITIES OF HIP ARTHROPLASTY UNDER THE CONDITIONS OF CONGENITAL HIP DISLOCATION IN ADUL TS

The goal: to optimize the tactics of total hip replacement (THR) under the conditions of congenital hip dislocation in adults. Methods: the results of THR in 11 patients (8 females, 3 males) with congenital hip dislocation Crowe IV type. The age of patients amounts from 15 to 57 years (37.4 years in average). 12 operations THR were performed. One patient underwent THR on both hips. An acetabular component was implanted on the place of true acetabulum in all cases. For 6 patients with more than 4 cm shortening of lower extremity THR was performed only after brining down of femoral head on the level of pure acetabulum using external fixator. In the case of bilateral hip dislocation THR procedure was performed on both sides with shortening osteotomies of proximal femurs that prevented biomechanical discrepancy of the lower extremities. Stem of endoprosthesis was selected according to the shape of intramedullar cavity of proximal femur in all cases. The results of treatment were observed from 6 months to 10 years. Average score according to Harris scale increased by 38.3 points. Healing of postoperative wounds was by the first intention. The bone grafts rearranged and played the role of acetabulum dome. The complications were observed in 2 cases. One patient with the shortening of 4.5 cm underwent THR simultaneously with extremity elongation. A sciatic neuritis was observed after the operation. The function of extremity was restored after 6 months of conservative treatment. Another case was associated with purulent complication that caused operative wound revision without removal of endoprothesis.

Total hip arthroplasty for the treatment of congenital hip dislocations in adults: about 15 cases

L’arthroplastie totale de la hanche sur luxation congénitale représente un défit pour le chirurgien orthopédiste. Il est maintenant bien établi que le traitement de la maladie congénitale de la hanche chez l’adulte présente un vrai « miracle fonctionnel ». L’évolution des techniques chirurgicales et des matériaux a permis d’élargir les indications de remplacement prothétique jusqu’aux cas les plus complexes allant ainsi à l’encontre de Charnley et Feagin qui écrivaient, en 1973, qu’il n’existait pas de place pour l’arthroplastie totale de la hanche dans les luxations invétérées. Il s’agissait d’une étude rétrospective d’une série de 15 PTH sur luxation congénital de la hanche chez l’adulte, le recueil des données sociodémographiques, cliniques, paracliniques et thérapeutiques s’est fait à l’aide d’une étude des dossiers médicaux des 15 patients et aussi en répondant à un questionnaire au dernier recul. L’âge moyen de nos patients a été de 28 ans; avec une prédominance féminine sex ratio 2F/1H. Il s’agissait d’une dysplasie sévère stade VI selon la classification de crow chez 4 cas, type III chez 9 cas, et seulement 2 cas type II. Tous les patients ont bénéficiés d’une arthroplastie totale de la hanche cimentée, avec anneau de soutien chez 9 cas, et une butté osseuse chez 2 cas. Au dernier recul les résultats fonctionnel selon le score PMA sont excellents et très bon dans 74% des cas. La prise en charge chirurgicale des luxations congénitales de la hanche à l’âge adulte doit obéir et répondre à un cahier de charges lourdes, il s’agissait souvent d’une population jeune et féminine exigeante sur le plan fonctionnel et esthétique. Plusieurs techniques chirurgicales ont été décrites en essayant de résoudre les problèmes liées à cette pathologie, hypoplasie cotyloïdienne et fémorale, l’inégalité des membres inférieurs, etc. L’arthroplastie totale de la hanche sur les luxations congénitales à l’âge adulte reste un challenge pour le chirurgien orthopédiste. C’est une intervention difficile et nécessite une technicité et une programmation et planification particulière pour guetter les incidents indésirables surtout lorsqu’il s’agit d’une population jeune et féminine.

CORR Insights™: Femoroacetabular Impingement Predisposes to Traumatic Posterior Hip Dislocation

Posterior hip dislocation in adults generally is viewed to be a result of high-velocity trauma, typically an impact of the knee against the dashboard or high-energy sports injury, while little attention has been paid to the experience that traumatic posterior dislocations sometimes occur after minor trauma. Four recent publications [5, 8, 10, 11] suggest that femoroacetabular impingement (FAI) may cause this type of “motion-induced” hip instability [1], resulting in hip dislocation after varying degrees of trauma, including, sometimes, lower-energy impacts when they occur against a flexed and internally rotated hip. In the past, traumatic dislocation has been thought to be a function of some degree of inherent hip instability, perhaps from reduced coverage of the femoral head; however, traumatic hip dislocation rarely is seen in hips with acetabular dysplasia. The abovementioned recent observations [5, 8, 10, 11] support the speculation that leverage, rather than insufficient coverage, may contribute to traumatic hip dislocation, particularly in the setting of some lower-energy injuries. Perhaps related to this, component impingement has been implicated as a cause of prosthetic hip instability, accelerated wear, and unexplained pain in total hip replacements [7, 9]. The retrospective study by Steppacher et al. corroborates the previously published notion that native hips with traumatic posterior dislocations likely are caused by femoroacetabular collisions, as patients with dislocations in their series were more likely to have morphologic features of FAI, including cam deformities and retroverted acetabulae. Their study had limitations, which they discussed, including the absence of a matched control group assembled for this study (they instead used data from previously published normative cohorts), and the impact of head and rim fractures on their interpretation of radiographic measurements. Even so, their conclusions seem valid, and they fit into the context of the developing literature on this subject [5, 8, 10, 11]. As concluded by Steppacher et al., an explanation for low-energy dislocations most likely is the early interaction between an aspherical femoral head and/or a prominent acetabular rim acting as a fulcrum, making these hips more susceptible to traumatic dislocation. Different activities and vocations, may share common attributes of rapid, forceful, repetitive hip flexion and internal rotation [11]. In light of the kinematic attributes described in several studies [2–4, 6], it is conceivable that these motions, performed in hips with restricted motion, can induce subluxations with subsequent shear stresses (posterior acetabular rim, femoral head), that can produce pathologic changes (posterior labral damage, femoral head lesions) even in the absence of complete dislocations. Future studies, using clinical findings for computational models will shed further light into the phenomenon of motion-induced recurrent joint separations that potentially result in subluxations or even complete dislocations of the hip.

Femoroacetabular Impingement Predisposes to Traumatic Posterior Hip Dislocation

Traumatic posterior hip dislocation in adults is generally understood to be the result of a high-energy trauma. Aside from reduced femoral antetorsion, morphologic risk factors for dislocation are unknown. We previously noticed that some hips with traumatic posterior dislocations had evidence of morphologic features of femoroacetabular impingement (FAI), therefore, we sought to evaluate that possibility more formally. We asked whether hips with a traumatic posterior hip dislocation present with (1) a cam-type deformity and/or (2) a retroverted acetabulum. We retrospectively compared the morphologic features of 53 consecutive hips (53 patients) after traumatic posterior hip dislocation with 85 normal hips (44 patients) based on AP pelvic and crosstable axial radiographs. We measured the axial and the lateral alpha angle for detection of a cam deformity and the crossover sign, ischial spine sign, posterior wall sign, retroversion index, and ratio of anterior to posterior acetabular coverage to describe the acetabular orientation. Hips with traumatic posterior traumatic dislocation were more likely to have cam deformities than were normal hips, in that the hips with dislocation had increased axial and lateral alpha angles. Hips with posterior dislocation also were more likely to be retroverted; dislocated hips had a higher prevalence of a positive crossover sign, ischial spine sign, and posterior wall sign, and they had a higher retroversion index and increased ratio of anterior to posterior acetabular coverage. Hips with posterior traumatic dislocation typically present with morphologic features of anterior FAI, including a cam-type deformity and retroverted acetabulum. An explanation for these findings could be that the early interaction between the aspherical femoral head and the prominent acetabular rim acts as a fulcrum, perhaps making these hips more susceptible to traumatic dislocation.

Traumatic hip dislocation in adults

Traumatic hip dislocation occurs during high-energy trauma and is often associated with other life threatening injuries. Dislocation can be anterior or posterior and urgent reduction is mandatory to reduce the risk of avascular necrosis of the femoral head. Undisplaced femoral neck fractures should be excluded prior to attempted reduction. Various closed reduction techniques have been described and most dislocations can be reduced with a closed technique. Failure to achieve reduction makes open reduction mandatory. This review describes the diagnosis, investigation and management of this complex and challenging injury.

Untreated Hip Dislocation in Cerebral Palsy

The purpose of this study was to evaluate the problems associated with hip dislocation in adults with cerebral palsy. Twenty-nine subjects with dislocated hips and no prior hip surgery were identified. There were a total of 38 dislocated hips. Age range was 21 to 52 years (average 34). Seven dislocated hips (18%) were definitely painful and four hips (11%) produced only mild or intermittent pain. Twenty-seven hips (71%) were not painful. The seven painful hips underwent proximal femoral resection, resulting in excellent range of motion and no pain. In conclusion, for established nonpainful hip dislocation in the severely involved spastic quadriplegic patient, aggressive surgical treatment should be undertaken only after careful consideration of the natural history. If a dislocated hip becomes painful in adulthood or develops an adduction contracture interfering with perineal care, a proximal femoral resection can be performed with reliably good success.