Hip In Children Research Articles

High Reoperation Rates After Early Treatment of the Subluxating Hip in Children With Spastic Cerebral Palsy

Hip subluxation and dislocation are well-recognized complications of spastic cerebral palsy. Alternatives for treatment include observation, bracing, or surgery. The purpose of this study is to compare the rates of reoperation and acetabular development after early soft tissue procedures with those of varus derotational osteotomies performed to maintain reduced hips in severely involved children. A series of 60 patients with spastic cerebral palsy and hip subluxation younger than 6 years who underwent primary bilateral hip surgery at one hospital between 1980 and 1996, with a minimum of 4 years of follow-up, were retrospectively reviewed. Fifty-two patients had spastic tetraplegia and 47 were nonambulators. Measures of proximal femoral and acetabular development were made via radiographic analysis. Twenty-two patients underwent primary bilateral soft tissue procedures. At a mean 6-year follow-up, there was modest improvement seen in mean femoral head coverage and little improvement seen in mean indices of acetabular development. Seventeen of these 22 patients (77%) underwent reoperation. Thirty-eight patients underwent primary bilateral varus derotational osteotomies. At a mean follow-up of 5 years, there was also modest improvement noted in mean femoral head coverage with little change in the mean indices of acetabular development. Twenty-eight of these 38 patients (74%) underwent reoperation. In this population of severely involved patients with spastic cerebral palsy, the reoperation rate was high. Acetabular remodeling did not reliably occur as a result of either early soft tissue or proximal femoral procedures when performed at an average age of 4 years.

Impingement and childhood hip disease

Hip impingement is now recognized as a relatively common cause for hip pain in young adults. The early evolution of impingement begins in childhood in several common hip disorders (slipped capital femoral epiphysis, Perthes, early avascular necrosis due to other causes). Recognition and treatment of childhood impingement may prevent the evolution to early hip arthritis.

Factors Distinguishing Septic Arthritis from Transient Synovitis of the Hip in Children

Distinguishing septic arthritis from transient synovitis of the hip in children can be challenging. Authors of recent retrospective studies have used presenting factors to establish algorithms for predicting septic arthritis of the hip in children. This study differs from previous work in three ways: data were collected prospectively, C-reactive protein levels were recorded, and the focus was on children in whom the findings were so suspicious for septic arthritis that hip aspiration was performed. Over four years, we prospectively collected data on every child (a total of fifty-three) who underwent hip aspiration because of a suspicion of septic arthritis at our institution. Diagnoses of confirmed septic arthritis, presumed septic arthritis, and transient synovitis were determined on the basis of the results of Gram staining, culture, and a cell count of the hip aspirate. Presenting factors and laboratory values were recorded. To evaluate the strength of predictors, we performed univariate and multivariate analysis on data from forty-eight patients who met the inclusion criteria. Univariate analysis showed that fever, the C-reactive protein level, and the erythrocyte sedimentation rate were strongly associated with the final diagnosis (p < 0.05). On multivariate analysis, the C-reactive protein level and erythrocyte sedimentation rate were found to be significant predictors. However, the erythrocyte sedimentation rate was not independent of the C-reactive protein level on backward elimination, and the C-reactive protein level was the only risk factor that was strongly associated with the outcome at a 5% significance level. Patients with five predictive factors had a 98% chance of having septic arthritis, those with four factors had a 93% chance, and those with three factors had an 83% chance. This prospective study of children who presented with findings that were highly suspicious for septic arthritis of the hip builds on the work of previous authors. We found fever (an oral temperature >38.5 degrees C) was the best predictor of septic arthritis followed by an elevated C-reactive protein level, an elevated erythrocyte sedimentation rate, refusal to bear weight, and an elevated serum white blood-cell count. In our study group, a C-reactive protein level of >2.0 mg/dL (>20 mg/L) was a strong independent risk factor and a valuable tool for assessing and diagnosing children suspected of having septic arthritis of the hip.

Spontaneous dislocation of the hip in childhood

Journal Article Spontaneous dislocation of the hip in childhood Get access P N Ray P N Ray Hon. Surgeon, and Additional Surgeon Carmichael Medical College Hospitals, Howrah General Hospital, Calcutta Search for other works by this author on: Oxford Academic Google Scholar British Journal of Surgery, Volume 21, Issue 83, January 1934, Pages 523–526, https://doi.org/10.1002/bjs.1800218317 Published: 06 December 2005

Traumatic dislocation of the hip in childhood, and relation of trauma to pseudocoxalgia: Analysis of 59 cases published up to January, 1924

Traumatic dislocation of the hip in childhood, and relation of trauma to pseudocoxalgia: Analysis of 59 cases published up to January, 1924

Pediatric Femoral Avascular Necrosis after Pyarthrosis

Pyarthrosis of a child's hip can lead to osteonecrosis of the femoral head. Symptomatic treatment options for this condition are limited. We supposed that free vascularized fibula autografting would improve range of motion, decrease pain, and increase function in patients with symptomatic osteonecrosis of the pediatric femoral head secondary to pyarthrosis. We prospectively evaluated seven consecutive patients who presented with Stages IV and V osteonecrosis of the femoral head. All patients were treated with free vascularized fibular autografting to the femoral head. Postoperative evaluations of range of motion, pain symptoms, and functional activity showed improvements in all patients. Range of motion of the hip was significantly improved in the arcs of flexion (+23 degrees) and external rotation (+22 degrees). Harris hip scores significantly increased from an average preoperative score of 68 to an average postoperative score of 96. No patients needed revision surgery to hip arthrodesis or arthroplasty within the 3-year 11-month followup.

Simultaneous Open Reduction and Dega Transiliac Osteotomy for Developmental Dislocation of the Hip in Children Under 24 Months of Age

The authors studied retrospectively 33 hips in 26 children at an average of 9 years 5 months after simultaneous open reduction and Dega transiliac osteotomy for developmental dislocation of the hip (DDH). All children were younger than 2 years of life at surgery. At the latest follow-up 89% of the clinical results and 72% of the radiographic results were rated excellent or good, despite a 45% rate of avascular necrosis observed before surgery. The authors attempted to identify factors influencing the final result. Given the low complication rate (3%) and low reoperation rate (3%), the authors conclude that the reviewed surgical protocol is safe and efficient in the treatment of DDH in young children.

Hip joint subluxation after selective dorsal rhizotomy for spastic cerebral palsy

The effects of selective dorsal rhizotomy (SDR) procedures on the hip joints of children with spastic cerebral palsy (CP) are not well described. This study was performed to determine the incidence of hip subluxation in children with CP who underwent SDR at a single institution. The study group comprised 82 patients (164 hip joints) with a mean follow up of 3.9 years. Forty-four patients had spastic diplegia (53.6%), 35 had spastic quadriplegia (42.7%), two had spastic triplegia (2.4%), and one had spastic hemiplegia (1.2%). The mean patient age at SDR was 5.2 +/- 2.4 years. Preoperative and postoperative hip radiographs were reviewed and the femoral head center edge (CE) angles were recorded. The mean pre- and postoperative right CE angles were 14.1 and 17.2 degrees, respectively, and those of the left were 13.6 and 15.1 degrees, respectively. Considering a change in CE angle greater than 5 degrees as clinically significant, 72 hips (43.5%) remained unchanged, 63 (38.4%) improved, and 29 (17.7%) worsened. Of a number of preoperative variables, including age at time of surgery, Gross Motor Function Classification System (GMFCS) level, ambulatory status, extent of hip subluxation, preoperative scoliosis, and asymmetry of hip subluxation, only GMFCS level was associated with worsening of hip subluxation. Selective dorsal rhizotomy is more likely to have a positive effect or no effect on hip joint subluxation rather than to have a negative effect. More severe involvement, as measured using the GMFCS, may predispose to worsening of hip subluxation after SDR.

Traumatic Hip Dislocation in Childhood

Traumatic dislocation of the hip in childhood is uncommon and can be a consequence of minor trauma. The authors report a series of 35 dislocations in skeletally immature patients. Most were isolated posterior dislocations without acetabular lesions. In 75% of cases, reduction of the dislocation was easy. Nine children required surgery to remove interposed joint capsule and/or osteochondral fragments to achieve anatomic reduction. Outcomes were generally good, except in one patient in whom a displaced fracture of the femoral physis was followed by total head avascular necrosis. One case of partial necrosis had a satisfactory outcome. Epiphyseal necrosis, though uncommon, appeared to be inconsistent to prevent and hard to predict. Bone scan seems to be more effective than MRI for the detection of necrosis.

Differentiation Between Septic Arthritis and Transient Synovitis of the Hip in Children

Differentiation Between Septic Arthritis and Transient Synovitis of the Hip in Children

Differentiation Between Septic Arthritis and Transient Synovitis of the Hip in Children

1 Soroka University Medical Center Ben-Gurion University of the Negev Beer-Sheva 84104, Israel [email protected]

The Significance of Arthrocentesis on Transient Synovitis of the Hip in Children

Purpose: To evaluate the significance of arthrocentesis on transient synovitis of hip in children with a moderate degree of limping and large joint effusion. Materials and Methods: 119 cases of transient synovitis of the hip were evaluated retrospectively between January 1999 and December 2003, with respect to age (mean age: 5.6 years), sex (M:F=89:30), location (Right:Left=68:51), chief complaints (limping: 72; hip pain: 39; knee pain: 37), physical examination (limited internal rotation: 98), sonography of capsule neck distance (mean 5.9 mm), duration of hospitalization and morbidity. Among them, 47 cases with greater than 8 mm in capsule neck distance on sonography were compared, based on the duration of hospitalization, morbidity, and the change of capsule bulging between 18 cases in the arthrocentesis group and 29 cases in the non-arthrocentesis group. Results: The mean duration of hospitalization and morbidity were 1.7 days, 4.7 days in the arthrocentesis group and 2.1 days, 6.6 days in the non-arthrocentesis group, the distance of the capsule bulging decreased from 9.2 mm to 4.5 mm in the arthrocentesis group and from 9.0 mm to 7.6 mm in the non-arthrocentesis group. The duration of hospitalization, morbidity, clinical course and decrease in capsule bulging were more effective, statistically in the arthrocentesis group than in the non-arthrocentesis group. Conclusion: Arthrocentesis for transient synovitis can be effective method of treatment in cases of moderate degrees of limping and large joint effusions,in spite of the disadvantage of the invasiveness of the rocedure.

Treatment of acute septic arthritis of the hip in infancy and childhood; report of seven cases

Treatment of acute septic arthritis of the hip in infancy and childhood; report of seven cases

Imaging of traumatic dislocation of the hip in childhood.

Traumatic hip dislocation in childhood is a rare consequence of violent trauma. After reduction, outcome is usually favourable although epiphyseal necrosis can occur. Reduction must be carried out as soon as possible and is achieved easily, although if the labrum is involved, surgery may be required to achieve complete reduction. To analyze a retrospective series of traumatic hip dislocations in children, describing the therapeutic and imaging strategy. A total of 42 patients were studied. Their mean age was 10 years 3 months. All relevant radiographic, CT, MRI and radionuclide bone scan examinations were reviewed. Special attention was paid to associated lesions. In 22 patients the dislocation was caused by low-energy trauma. Road traffic accidents accounted for 17 dislocations. An acetabular fracture was present in six patients and the femoral head was fractured in three. Reduction was easily achieved in 31 patients. In 11 patients the postreduction radiograph and CT showed joint space asymmetry secondary to labral entrapment. Only two patients developed epiphyseal necrosis. It has been difficult to define and evaluate accurate principles for a medical imaging strategy in this group of patients. Analysis of plain radiographs is essential before and after reduction of the joint, and it is important to perform postreduction CT in every patient whose joint space remains widened. A radionuclide bone scan should be performed between the second and third weeks after injury to assess epiphyseal vascularity. With the use of specific sequences, MRI may be an alternative modality to assess epiphyseal vitality.

Mechanoreceptor evaluation of hip joint capsule and ligamentum capitis femoris in developmental hip dysplasia: a preliminary study*

We aimed to determine if there are mechanoreceptors in the hip joint capsule and ligamentum capitis femoris (LCF) of patients with developmental dysplasia of the hip (DDH). We took capsule and LCF biopsies from 20 hips of 20 patients who were operated on because of DDH. The mean age was 10.2 months (range 6-20 months) at the time of surgery. There were 12 girls and eight boys. Teratologic and secondary hip dislocations were not included in this study. Full thickness, 0.5 x 0.5 cm anterior capsule and LCF portions were taken for biopsy specimen. Specimens were stained with hemotoxylin eosin and examined immunohistochemically using monoclonal antibody against S-100 protein. In both analyses no mechanoreceptor was found in any samples of capsule or LCF. In this preliminary study we could not find mechanoreceptors in the local anterior joint capsule and LCF of the hip in children with DDH. We think that additional studies are necessary in order to understand the mechanoreceptor characteristics of the hip joint in children not only with DDH but also in children with healthy hips.

(v) The irritable hip in childhood

Transient Synovitis is the most common cause of limp in childhood. By definition, hip “irritability” should be transient and function should return to normal in 7–10 days. The differential diagnosis is important, particularly the early recognition of septic arthritis or tumour. Clinical experience, team-working and appropriate investigations should ensure effective management of the child when there is concern. In practice, the vast majority of these cases can be recognised and reviewed in the casualty department as outpatients.

Hip disorders in childhoodJohn V Banta and David Scrutton (Eds.); Mac Keith Press (distributed by Cambridge University Press, Cambridge), 2003, price E50.00 (US$75.00), hardback, ISBN 1 898 68333 6

This is a very useful reference book and is a comprehensive account of disorders that can manifest problems at the hip joint in children. The hip can be involved in many systemic disease processes as well as local pathology and this book covers medical and orthopaedic problems that can manifest at the hip. The editors propose the book to be aimed primarily at paediatricians, physiotherapists, occupational therapists, nurses and orthotists. However, the breadth of material in the book is such that it should also be very useful to paediatric rheumatologists and orthopaedic surgeons who see many children with musculoskeletal problems. Many of the chapter authors are orthopaedic surgeons and although there is a bias towards orthopaedic problems in the content, this is nonetheless an excellent reference book.

Joint asymmetry after closed reduction of traumatic dislocation of hip in childhood

Joint asymmetry after closed reduction of traumatic dislocation of hip in childhood

Ultrasound-Guided Aspiration of the Hip in Children: A New Technique

Ultrasound-Guided Aspiration of the Hip in Children: A New Technique

Joint replacement for sequelae of childhood hip disorders.

Joint replacement for sequelae of childhood hip disorders.