Neglected Hip Dislocation Research Articles

Total Hip Replacement and Femoral Nail Lengthening for Hip Dysplasia and Limb Length Discrepancy: A Literature Review.

Developmental dysplasia of the hip (DDH) is a serious condition resulting in inadequate acetabular development, distorted bone configuration, and substantially alteredhip biomechanics. An extensive leg length discrepancy (LLD) is commonly encountered in such cases, making a total hip arthroplasty (THA) procedure extremely challenging. Although good results in terms of patients' satisfaction, implant survival rates and overall improved quality of life have been reported, complication rates are considerably higher than primary THA procedures performed for idiopathic osteoarthritis. Reconstructing a dysplastic hip arthrosis and equalizing a preexisting LLD is a technically demanding procedure that is associated with significant bone and soft tissue complications. Intramedullary lengthening through motorized nails has become increasingly popular to address difficult cases with extensive LLD following THA in recent years. However, limited data on femoral lengthening procedures implemented following THA are available considering complications, radiological results, and patient-reported outcomes following staged THA and subsequent femoral lengthening using a femoral magnetically-driven intramedullary lengthening nail. We performed a literature review of the past 10 years in PubMed using the terms neglected hip dislocation, DDH, THA, and intramedullary lengthening nail as keywords. A total amount of eight cases addressing LLD through a telescoping intramedullary nail following THA in DDH have been reported in recent literature. All eight patients underwent primary THA for DDH followed by the implantation of the intramedullary lengthening nail. The mean THA was lengthened by 28.9 mm (from 13.0 to 45.0). The mean time for nail implantation after THA was 11.1 months (from 3.5 to 21). The mean time for lengthening per day through the nail was 0.94 mm (from 0.65 to 1.0) from 26 days to 70 days, and the mean lengthening through the nail was 37.6 mm (from 24.0 to 70.0). Good union and consolidation rates were reported by the authors, while there were no complications. The intramedullary distraction osteogenesis method with a telescopic rod can be an effective method to manage leg length discrepancies while avoiding soft tissue complications in challenging cases of DDH.

Traumatic Posterior Hip Dislocation in a Child: When is an Anterior Open Reduction Indicated? A Case Report

Traumatic hip dislocations in children are uncommon, occurring in about 5% of all dislocations in children. Neglected hip dislocations are rarer and pose a serious threat to the normal development of the hip with complications of avascular necrosis and unstable gait. Open reduction is usually required, but the most appropriate surgical approach has not been clearly defined. We reported a child with a traumatic posterior hip dislocation who was successfully treated through an anterior approach after a previously failed posterior open reduction. An anterior open reduction of the hip following a previous failed posterior open reduction is a safe procedure and avoids the likelihood of an iatrogenic injury to the sciatic nerve. Pre-operative imaging with a CT scan or MRI is required in neglected cases to visualise intra-articular bone fragments, which can prevent a concentric reduction.

Staged reconstruction of unilateral neglected hip dislocation through total hip arthroplasty and subsequent intramedullary femoral lengthening

Background and purposeTotal hip arthroplasty (THA) is a successful approach to treat unilateral symptomatic neglected hip dislocation (NHD). However, the extensive leg length discrepancy (LLD) can hereby only be partially corrected. In case of residual LLD of more than 2 cm, subsequent femoral lengthening can be considered.Patients/material/methodsRetrospective analysis of clinical data and radiographs of five patients (age 38.1 (28–51) years) with unilateral NHD who underwent THA with (n = 3) or without (n = 2) subtrochanteric shortening osteotomy (SSO) and secondary intramedullary femoral lengthening through a retrograde magnetically-driven lengthening nail (follow-up 18.4 (15–27) months).ResultsLLD was 51.0 (45–60) mm before and 37.0 (30–45) mm after THA. Delayed bone union at one SSO site healed after revision with autologous bone grafting and plate fixation. Subsequent lengthening led to leg length equalisation in all patients. Complete consolidation was documented in all lengthened segments.ConclusionStaged reconstruction via THA and secondary femoral lengthening can successfully be used to reconstruct the hip joint and equalise LLD. The specific anatomical conditions have to be taken into consideration when planning treatment, and patients ought to be closely monitored.

Management of Neglected Traumatic Hip Dislocation in Children.

Neglected traumatic hip dislocation in children is uncommon and there is no consensus on appropriate management. Previous studies report varied operative management with high rates of avascular necrosis and postoperative subluxation/dislocation. We report a series of 7 consecutive cases who underwent operative reduction after neglected hip dislocation and describe our technique for treatment. All 7 children sustained posterior dislocations and had no treatment before presentation at our institution. An associated marginal acetabular fracture was present in 2 cases. One additional patient was excluded from the study due to complete loss of articular cartilage that precluded open reduction. The mean time before surgical intervention was 13.1 months (4 to 36 mo) with a mean age of 7 years (5.3 to 10.8 y). All children underwent preoperative skeletal traction for 10 to 14 days. A postero-lateral approach was used in all cases. The acetabulum was cleared of scar tissue and a femoral shortening performed as required (5 cases). Minor erosion of the articular cartilage of the posterior aspect of the femoral head was noted in 3/6 cases. After reduction, a posterior capsulorrhaphy was performed and the patient immobilized in a hip spica for 6 to 12 weeks. The mean follow-up was 44 months (33 to 56 mo). The majority of children (86%) could walk and run without a limp, could squat, and had no pain. One child had mild pain and a limp. Mean Harris Hip Score was 98.9. No hip subluxed or dislocated postoperatively. The radiographs at latest follow-up showed no evidence of growth disturbance in 29% of cases, coxa magna in 57%, and partial femoral head collapse in 1 case (14%). Of note, those patients managed within 8 months of injury had none or minimal evidence of growth disturbance. At medium-term follow-up, open reduction with a postero-lateral approach, posterior capsulorrhaphy, and femoral shortening (as required) produces a satisfactory outcome with a stable, congruent reduction. Good clinical function can be expected with a low incidence of avascular necrosis. Level IV.

Neglected Hip Dislocation with Posterior Wall Acetabulum Fracture for 4 years : an unusual presentation: management : A Case Report.

Neglected traumatic hip dislocation is not an uncommon condition seen in developing countries. In our case 26 years old male with neglected right posterior superior hip dislocation with deficit posterior acetabular wall (figure 1 and 2) with limb length discrepancy of 7cm, Harris hip score 46,presented to our hospital after 4 years of accident. He had gone multiple treatments for his right dislocated hip but was unsuccessful. In our hospital patient was patient was managed with un-cemented total hip arthroplasty with posterior acetabular wall reconstruction. On follow up hip joint shows good range of movements with no pain and limb length discrepancy of about 1 cm and Harris hip score 82. So THR provides good results in neglected hip dislocation with acetabular fractures. Keywords: Dislocation. Fracture. Total hip arthroplasty

External fixation-assisted reduction for the treatment of neglected hip dislocations with limb length discrepancy: a retrospective study of 13 cases

BackgroundThe purpose of this study was to evaluate a new method for treating neglected hip dislocation with limb length discrepancy by using external fixation-assisted pre-reduction.MethodsThirteen patients admitted between January 2010 to February 2018 with a mean duration from injury to surgery of 5.0 ± 2.1 months and an average preoperative leg-length discrepancy of 7.7 ± 2.3 cm were enrolled in this study. The dislocation and associated acetabular fracture type, clinical outcomes and residual limb length discrepancy were evaluated.ResultsAll patients had posterior dislocations, and nine patients presented with acetabular fractures and were followed-up for at least 12 months. The average traction duration of external fixators was 28.8 ± 8.0 days and all patients received second-stage open reduction and internal fixation. Six patients showed residual limb length discrepancy within 2 cm. Patients showed significant improvement in hip function and pain relief. Complications including avascular femoral head necrosis and osteoarthritis occurred in three patients.ConclusionEffective correction of limb length discrepancy and improved function were observed in patients with neglected hip dislocations and limb equality using traction by external fixation combined with second-stage open reduction. Further follow-up is required to determine long-term outcomes.

FEATURES OF THA IN PATIENTS WITH HIGH CONGENITAL HIP DISLOCATION

There are a fair number of papers presenting the outcomes of total hip arthroplasty with shortening subtrochanteric osteotomy in neglected hip dislocation. In most of them the authors used long modular stems or Wagner stems as a femoral component. The reports describing the outcomes of such procedures with standard femoral stems are rather rare.The purpose of this study was to evaluate short-term and medium-term outcomes of total hip arthroplasty with standard femoral stems and shortening subtrochanteric osteotomy for treatment of high hip dislocation.Materials and methods. From 2010 to 2016 the authors performed 18 hip arthroplasties with shortening subtrochanteric osteotomy in 16 patients with high hip dislocation. All patients were clinically evaluated using Harris Hip Score and radiography prior to and after the surgery.Results. The mean Harris Hip Score significantly improved compared to preoperative values from 39.7±1.4 to 84.7±1.6. At mean follow-up of 24±2.4 mounts the authors observed 2 case of nonunion at osteotomy site and 1 case of transient nerve palsy. Revision surgery was performed in 2 patients due to nonunion. The mean limb lengthening was 3.65±0.21 cm.Conclusion. Our data demonstrated that total hip arthroplasty with subtrochanteric osteotomy is an effective technique for treatment of Crowe type III-IV congenital hipdislocation with high rate of successful fixation on the typical femoral stem, healing of osteotomy site and satisfactory shortand medium-term clinical outcomes. The non-modular tapered stem provides sufficient stability in distal and proximal parts of the femur. The use of standard tapered stem allows to achieve good healing rates of the osteotomy.

Neglected hip dislocation: an unusual presentation, its management and review of the literature

Neglected traumatic posterior hip dislocation is not an uncommon condition seen in developing countries. Its treatment is fraught with great difficulties and controversies. Here we present a 31-year-old female patient presented to our hospital 2 years after sustaining an accident. She had gone through multiple treatments for her dislocated hip without any success. After arrival to our hospital, patient managed by constrained total hip replacement (THR). Her Harris hip score improved from 48 (preoperative) to 81 (postoperative). On follow-up she had a good range of movement of the hip with no pain, deformity and limb length discrepancy. Constrained THR provides promising results in neglected hip dislocation.

Risk Factors for Hip Displacement in Children With Cerebral Palsy: Systematic Review.

When hip displacement in children with cerebral palsy (CP) is identified early, treatment is more successful. The standard test is a radiograph of the pelvis measuring the migration index (MI). Our study aims to review published literature of the natural history of hip dislocation among children with CP and to define related risk factors to develop screening criteria for early recognition. The review included 10 studies with sample sizes greater than 20 children with CP below18 years who had hips with no surgical intervention or dislocation at initial presentation, minimum 2-year follow-up, and recorded MI, pattern, and Gross Motor Function Classification System (GMFCS) level. On the basis of this review, we suggest screening with 1 radiograph for GMFCS I and II, or, if MI>30%, an annual radiograph between ages 2 and 8 years, followed by a radiograph every 2 years until the age of 18 years. For GMFCS III, IV, and V, we recommend an annual radiograph if MI<30% or 1 every 6 months if MI>30% between ages 2 and 8 years, followed by radiograph every 2 years until the age of 18 years. Applying a practical surveillance program for children with CP can prevent hip dislocation, provide early treatment, and ultimately lead to consistently better outcomes than those of neglected hip dislocations. The GMFCS level has a strong impact on subluxation risk and that the risk continues to the end of growth. Level III-systematic review.

Uncemented Total Hip Replacement After Two Years of Neglected Hip Dislocation With Fracture of Posterior Column and Wall of the Acetabulum

IntroductionPosterior hip dislocation of the hip with acetabular fracture is a challenging problem to treat. Such dislocations are associated with avascular necrosis of the femoral head if neglected. Managing such conditions with total hip replacement (THR) is very difficult because of associated altered anatomy.Case PresentationWe hereby report a two-year neglected hip dislocation with associated acetabular fracture successfully treated with uncemented THR. The patient was successfully treated with uncemented THR and experienced significant improvement in his functional status, with a Harris hip score of 82 at the two-year follow up. Radiologically, there were no radiolucent areas or osteolysis, with good consolidation of the bone graft.ConclusionsA neglected hip dislocation with acetabular fracture can be managed satisfactorily with uncemented THR. Bone reconstruction using chunk grafts and use of cementless components ensures long-term survival and also preserves adequate bone stock for revision, especially in young patients.

Reconstruction of Unstable Hips with Ilizarov Technique. Role of Pelvic Support and Distal Lengthening Realignment Osteotomy.

Hips can suffer severe damage due to untreated developmental dysplasia, septic arthritis, tuberculosis, a neglected fracture of the neck of femur and neglected hip dislocation. The Ilizarov technique offers an effective treatment by providing a stable hip with abolished Trendelenburg lurch and equalizing limb length discrepancy through distal lengthening realignment osteotomy. 20 patients with hip instabilities due to various etiologies were treated with the Ilizarov technique of pelvic support osteotomy and distal lengthening realignment osteotomy. There were 12 females and 8 males in the study group and the age range was 13 to 30 years. Average limb length discrepancy was 5.95 cms (range 4-8.5 cms).The pre-operative and post-operative range of motion and Harris hip score was collected and data analyzed by Student's paired t test. A p value of < 0.05 was taken to be statistically significant Results. The functional Harris hip score improved in all the patients at final follow-up. The mean Harris hip score was 56.95 (range 33-71) pre-operatively, which improved to 83.25 (range 73-85) at final follow up and was statistically significant (P-value < 0.05). The mean length achieved was 5.53 cms (4-8 cms). The mean external fixation time was 8.6 months and the mean healing index was 1.54 months /cm. 1. Ilizarov hip reconstruction is an excellent method of salvage in patients with unstable hips diverse etiologies especially in this part of the world, where patients demand unrestricted range of motion at hip, and in the younger age group, where other procedures do not offer a long term solution. 2. It provides an excellent functional outcome in hips of different etiologies. 3. However, for an excellent outcome, surgical expertise, patient compliance and meticulous follow-up are mandatory.

Closed reduction of paediatric neglected hip dislocation: Does it have a role?

Closed reduction of paediatric neglected hip dislocation: Does it have a role?

McHale Operation in Patients with Neglected Hip Dislocations: The Importance of Locking Plates

Neglected hip dislocation in patients with cerebral palsy is a challenge for the pediatric orthopedic surgeon. Many patients experience pain, limitation of hip motion, and sitting and hygiene problems. Arthrodesis, proximal femoral head resection, and subtrochanteric valgus osteotomy are effective salvage procedures for patients with painful hip dislocation and restricted hip motion when reconstruction of the hip is not possible. Osteopenia is one of the problems that can complicate the postoperative course in these patients. Postoperative cast immobilization may further worsen the osteopenia and can predispose to fractures of the femur after cast removal. Standard plating of the proximal osteotomy may not always provide adequate stability of the fixation. In order to prevent postoperative osteoporotic fractures we use locking plates, without casting. Since 2003 until 2011, we operated on 9 patients (14 hips) with painful neglected hip dislocations. The first three patients (five hips) were operated on using standard nonlocking plates. All other patients (nine hips) were operated on using locking plates. During the followup, the hardware failed in one of these cases. All patients treated with locking plates had not been casted postoperatively, and none had loss of fixation or fractures during the followup.

Outcome of traumatic hip dislocation in children

We reviewed 13 patients without an underlying syndrome with traumatic hip dislocation between 3 and 10 years of age (mean 4.8 years) at the time of injury. The final reviews were between 1 and 11 years (mean 6 years). All children had posterior dislocation, except one, who had an anterior dislocation. Time taken from trauma to reduction was less than 6 h in three patients, 6 h to 1 day in two patients, 1 day to 3 weeks in seven patients, and 4 weeks in one. All of them underwent closed reduction, except two, who required open reduction through a posterior approach. All patients had excellent hip function and radiographic result on the basis of Garret classification, except for one with limping at 4 years after trauma. The patients treated with hip spica after reduction (10 patients) did not have recurrent dislocation whereas two out of three patients who were treated without postreduction hip spica developed recurrent dislocation. One out of 13 patients without an underlying syndrome and a 6-year-old patient with Down syndrome with neglected hip dislocation and radiological avascular necrosis at presentation recovered with congruent hip following a complete and maintained reduction. This case series suggested that closed reduction was possible for cases of neglected hip dislocation for up to 3 weeks. Open reduction through the posterior approach was safe in neglected irreducible posterior hip dislocation. Those hips that underwent complete reduction and were maintained reduced with hip spica had an excellent functional outcome even in the presence of avascular necrosis. This is a level IV study.

Hüftarthroskopische Therapie bei veralteten extrakapsulären traumatischen Hüftluxationen bei Kindern

We report about the first hip arthroscopies of extracapsular neglected hip dislocations with concomitant injuries in two children (2 and 4 years old). The major problem of traumatic hip dislocation is avascular necrosis. Further problems are possible concomitant injuries. It is important not to cause further damage by therapeutic procedures. In a 4-year-old child the hip could be reduced under visualization and in a 2-year-old child with epiphyseal fracture the extent of the operation could be reduced. In both children large avulsion injuries of the ligamentum capitis femoris could be resected via hip arthroscopy. Hip arthroscopy can reduce surgical morbidity considerably and can possibly contribute to prevention of the feared avascular necrosis of the femoral head.

A very rare case with neglected hip dislocation coexisted with posterior acetabular lip fracture

Neglected hip dislocation is a rare situation among children. The coexistence of acetabulum fracture is less common. The result of treatment depends on the time of diagnosis. Early treatment is mandatory in such cases. Seven years old female brought to our outpatient clinic with the complaints of right hip pain and walking difficulty. Her parents said that she had fallen from a horse one month ago. X-ray and CT showed a posterior dislocation of her right hip and a fracture on her right posterior acetabular lip. We performed an open reduction via posterior approach. Because the hip was unstable we fixed the femoral head to the acetabulum by a Kirshner wire. Pelvipedal cast was applied after the operation for 6 weeks. After 6 months avascular necrosis (AVN) developed on her right femoral head, the range of motion (ROM) of the hip was restricted and she had minimal pain on her right hip.

A very rare case with neglected hip dislocation coexisted with posterior acetabular lip fracture

A very rare case with neglected hip dislocation coexisted with posterior acetabular lip fracture

Neglected Traumatic Hip Dislocation in Children

Traumatic dislocation of the hip in children is a rare injury. We report the outcome of open reduction of neglected traumatic posterior hip dislocation in 18 children. All patients had posterior dislocation and no associated fracture. They presented to the hospital because of persisting pain, deformity, and limp that were present for a mean period of 16 weeks after injury (range, 6-52 weeks). Open reduction was done in all patients because none of the hips could be reduced by skeletal traction in abduction. All of the hips had varying degrees of avascular necrosis (osteonecrosis), with preservation of joint space as seen on radiographs. At short term followup, seventeen children had an excellent functional outcome. We suggest that open reduction is a satisfactory treatment for neglected hip dislocation in children because an anatomically placed femoral head maintains the stimulus for growth of the pelvis and the femur. It prevents deformity and maintains limb length.

Late Reduction of Bilateral Traumatic Hip Dislocations in a Child

A 5-year-old girl with bilateral traumatic hip dislocations neglected for 6 weeks was successfully managed by skeletal traction for reduction and cast immobilization for 6 weeks. The delay in reduction did not preclude a good result. Osteoporosis of the femoral head was noted to be a favorable prognostic sign relative to its vascularity. Skeletal traction is an optimum method of reduction for neglected hip dislocations, while open reduction is rarely indicated. Prolonged restriction of weight bearing is unnecessary following soft-tissue healing.