Paralytic Dislocation Of Hip Research Articles

A modified angled plate for fixation of proximal femoral varus osteotomy in neuromuscular hip dislocation: Mechanical and clinical study

IntroductionProximal femoral osteotomy is an important step in the management of paralytic hip dislocation. Fixation by the angled plate is demanding and carries the risk of many complications. In this study, we made certain modifications for the angled plate. Does this plate provide a stable fixation for proximal femoral varus osteotomy? The main objective of this study was to assess the results of the modified plate in fixation of proximal femoral varus osteotomy in patients with neuromuscular hip dislocation. HypothesisThis new system would offer significant advantages over the existing systems in terms of easy application and stable fixation. Material and methodsTwenty patients with paralytic hip dislocation were included in this study. The ages ranged from 5 to 15 years with a mean of 8.88±2.92 years. There were 12 boys and 8 girls. Seventeen patients had cerebral palsy and 3 had meningocele disease. Preoperative radiographs were done, and the migration percentage (MP), acetabular index (AI), and neck-shaft angle (NSA) were measured. All patients were treated with open reduction, pelvic osteotomy, and proximal femoral varus osteotomy. The femoral osteotomy was fixed by the modified angled plate in all cases. ResultsThe osteotomy sites united in all patients and the mean time of union was 2.9±0.65 months. The acetabular index, migration percentage, and neck-shaft angle were reduced postoperatively. This reduction was statistically significant. The hips remained stable throughout the period of follow-up in all patients. No cases were complicated by non-union or implant failure. ConclusionThe modified angled plate (canulated interlocking blade Plate 90°) is a good method for the fixation of proximal femoral varus osteotomy in the management of neuromuscular hip dislocation. It provides a stable fixation. Level of evidenceIV; case series.

A Modified Angled Plate for Fixation of Proximal Femoral Varus Osteotomy in Paralytic Hip Dislocation

Objectives: Femoral osteotomy is an important step in the management of paralytic hip dysplasia. Fixation by the angled plate is demanding and carries the risk of many complications. In this study, we made certain modifications for the angled plate, and we aim to assess the results of the modified plate for fixation of proximal femoral varus osteotomy in paralytic hip dysplasia. Method: Twenty patients with paralytic hip dislocation were included in this study. The ages ranged from 5 to 15 years with an average of 9 years. There were 12 boys and 8 girls. Seventeen patients had cerebral palsy and 3 had meningocele disease. Pre-operative radiographs were done, and the migration percentage (MP), acetabular index (AI), and neck-shaft angle (NSA) were measured. All patients were treated by open reduction, pelvic osteotomy, and proximal femoral varus osteotomy. The femoral osteotomy was fixed by the modified angled plate in all cases. Results: The osteotomy sites united in all patients and the average time of union was 3 months. The acetabular index, migration percentage, and neck-shaft angle were reduced postoperatively. This reduction was statistically significant. The hips remained stable throughout the period of follow-up in all patients. No cases were complicated by nonunion or implant failure. Conclusion: The modified angled plate (canulated interlocking blade plate 90°) is a good method for the fixation of proximal femoral varus osteotomy in the management of paralytic hip dislocation. The modifications have made it easier for application and stable for fixation.

Operative treatment of paralytic hip dislocation in myelomeningocele by Dega transiliac osteotomy combined with iliopsoas transfer: technique and historical case series.

The technique of one stage procedure - open reduction, Dega transiliac with or without femoral subtrochanteric osteotomy combined with iliopsoas transfer according to Mustard - has been described for the treatment of paralytic dislocation of the hip in myelomeningocele patients. Historical series of 16 children (26 hips) operated on between 1987 and 2003 were analyzed retrospectively. There were nine boys and seven girls with upper and lower lumbar level lesions (15 with Sharrard groups 3 and 4 and one with Sharrard 2) and 20 dislocated and six subluxated hips. The mean age at operation was 5.1 years (3-12.3). Ten children were operated bilaterally. Follow-up ranged from 1 to 17 years (mean 10). Concentric reduction was achieved in 23 hips, subluxation in 1 and redislocation in 2. In one hip, acute avascular necrosis of the femoral head was visible early after operation. Immediately after the operation, most of the patients improved ambulation. After operation, 15 patients out of 16 became community ambulators. At the final follow-up, none of the patients worsened their ambulation due to operation. Open reduction and Dega transiliac osteotomy with or without subtrochanteric derotation/varus shortening osteotomy combined with iliopsoas transfer seem to be safe and valuable procedure for operative treatment of dislocated hip in myelomeningocele patients. Levels of evidence: level IV - case series.

Is arthroplasty inevitable after Ilizarov hip reconstruction of unstable hip joints in adolescents and young adults? Long-Term Evaluation of 136 Cases

Introduction Whereas hip joint destroying trauma and diseases are difficult situations, the problem is more complex when it is complicated by hip instability. This could be a sequel of several hip affections such as trauma, septic or tuberculous arthritis, neglected developmental dysplasia of the hip, postoperative conditions, and neurologic pathologies (cerebral palsy, myelomeningocele, poliomyelitis). Purpose The purpose of this study is to evaluate long-term radiographic and clinical outcomes of the Ilizarov hip reconstruction for the treatment of painful and unstable hips in adolescents and young adults. Materials and methods The study included 136 patients with an average age of 18.3 years (range, 6 to 34 years); 75 patients were males (55.1%) and 61 females (44.9%). The primary causes of the hip instability were untreated or unsuccessfully treated cases of septic arthritis (40 cases; 29.4 %), congenital hip dislocation (28 cases; 20.6 %), paralytic hip dislocation (36 cases; 26.5 %), proximal femoral focal deficiency (14 cases; 10.3 %), neglected fracture of the femoral neck (10 cases; 7.4 %), osteoarthritis (6 cases; 4.4 %), and tuberculous hip arthritis (2 cases; 1.5 %). The intervention consisted in the performance of two osteotomies (proximal and distal) of the femur with pelviс support and placement of the Ilizarov apparatus of a specific assembly. Results The external fixation period ranged from 4 to 12 months (6.5 months on average). Patients were followed up for an average of 17.4 years (range, 5 to 27 years). Multiple clinical parameters at final follow-ups showed significant improvement, including pain relief, pain-free walking distance, lameness, hip flexion and abduction, hip contracture, and lumbar lordosis. Functionally, the mean Harris Hip Score improved with a statistically significant difference from 48 points (range, 35–65) before surgery to 83 points (range 70–90) after surgery. The pain disappeared in all patients, with the exception of six cases of pain in the early postoperative period. In all cases, supportive walking aids were no longer necessary, with the exception of two cases of persistent pain by physical activities. Walking ability and painless walking distance improved in all patients from an average of 35 m (range, 10 to 50 m) before surgery to 1,150 m (range, 1,000 to 1,500 m) after surgery, showing significant difference. Conclusion Ilizarov pelvic support osteotomy provided a multi-purpose solution to the complex challenging problem of hip instability in adolescents and young adults with variable primary etiologies. The improvements in the hip motion, mechanical axis, and correction of limb-length discrepancy lead to good functional outcomes over a long-term follow-up. This treatment modality might avoid or postpone the need for total hip arthroplasty for several years.

Developmental dysplasia of the hip and associated risk factors in Saudi children: A retrospective study.

Studies investigating the association between developmental dysplasia of the hip (DDH) and risk factors in Saudi Arabia are rare. Investigate the association between DDH and several risk factors among Saudi children. The medical records of 82 children born in or admitted to King Abdul Aziz Medical City in Riyadh, Saudi Arabia with clinical suspicion of hip dislocation (HD) were included. The association between DDH and the following risk factors was investigated: age < 3 y, female-gender, twinning, first-born child, C-section, breech presentation, prematurity, positive family history and presence of associated abnormalities. HD was confirmed in 73 (89%) children (Positive HD) and excluded in 9 (11%) children (Negative HD). Eleven (13.4%) children were excluded from the positive cases as it was confirmed that they have paralytic hip dislocation not DDH. DDH was confirmed in 62 children (75.6%). The Chi square test (χ2) and odds ratios (OR) revealed that the positive family history, female-gender, age < 3 years, and presence of associated abnormalities had significant associations with the presence of DDH with P values and OR equal 0.00 (16.4), 0.002 (3.1), 0.005 (2.6), and 0.04 (1.9) respectively. Breech presentation, twinning, first-born children, prematurity, and C-section were not associated with DDH with P values and OR equal 0.93 (1.1), 0.46 (0.4), 0.11 (0.4), 0.08 (0.3), and 0.002 (0.3) respectively. Positive family history, female-gender, age < 3 years, and presence of associated abnormalities had approximately 16, 3, 2.5, and 2 times increased risk for DDH.

A novel subsartorial approach in open reduction of developmental dysplasia of the hip: a preliminary 2-year follow-up report of 20 hips

Background: The anterior (Smith-Peterson) and medial (Ludloff) procedures are the most common approaches used for subluxation or dislocation in developmental dysplasia of the hip that cannot be treated conservatively. If conservative treatment has failed, additional procedures on the pelvic or femoral side may become necessary. Methods: In this prospective study we used a new subsartorial approach in the surgical treatment of 20 hips (17 patients of whom three had bilateral hip dysplasia) with a mean follow-up of 23.9 mo (range 22-26 mo). There were 16 hips in 13 girls and four unilateral hips in four boys. At surgery, the ages ranged from 9 to 24 mo, with a mean of 16.5 mo. The degree of initial hip subluxation was graded according to the Tönnis classification, with two hips (10%) type II, eight hips (40%) type III, and 10 hips (50%) type IV. We evaluated the clinical and radiographic outcomes of the patient cohort with the McKay and Severin classifications, respectively. Results: Clinically there were 15 hips (75%) with an excellent results and five hips with good results. According to the radiographic Severin classification, nine hips had an excellent result (type I), 10 had a good result (type II), and one hip had a fair result (type III). One hip (5%) developed avascular necrosis according to the Kalmachi and MacEwan classification but eventually had good clinical outcome precluding any surgical intervention. Two girls (10%) developed left lateral subluxation 3 mo postoperatively. Femoral derotation osteotomy was done 6 mo postoperatively. Conclusions: The subsartorial approach was a safe, reliable, and reproducible approach in the pediatric hip in patients younger than 2 yr of age who had not had a previous operation or a history of paralytic hip dislocation. We recommend this approach for surgeons who are familiar with the pediatric hip.

TREATMENT OF PARALYTIC HIP DISLOCATION AMONG SPASTIC QUADRIPLEGIC CEREBRAL PALSY PATIENTS BY MEANS OF FEMORAL AND PELVIC OSTEOTOMY, WITHOUT OPENING THE JOINT CAPSULE (CAPSULOPLASTY)

Objectives: To show the preoperative planning and results from surgical treatment for paralytic hip dislocation among patients with cerebral palsy. The techniques used were proximal femoral varus derotation osteotomy in association with Dega iliac osteotomy, without opening the joint capsule. Methods: We performed a retrospective review of ten hips in eight patients with spastic quadriplegic cerebral palsy who underwent surgical treatment between 2003 and 2005, with the same surgical technique. The pre and postoperative clinical and radiological parameters, and the preoperative planning using an image intensifier, were assessed. The clinical parameters analyzed were: pain, hygiene-related difficulties and positioning difficulties. The radiological parameters were Reimer's index, the acetabular index and the neck-shaft angle. These results were subjected to statistical analysis. Results: We obtained good results with this technique. After a mean follow-up of three years, all the hips were observed to be stable at the last assessment, and there was a high degree of satisfaction among the families in relation to the treatment. We also showed that preoperative planning using an image intensifier allowed us to reduce and stabilize these hips without the need for capsuloplasty. Conclusion: The authors conclude that in treating hip dislocation among spastic quadriplegic cerebral palsy patients, capsuloplasty is unnecessary for stabilizing the coxofemoral joint.

Strategies of Hip Management in Myelomeningocele: To do or not to do

Paralytic hip dislocation in myelomeningocele is common and can be a complicated problem. This review summarizes results of surgical techniques employed in this patient population in order to achieve and maintain reduction of paralytic hip dislocations. This review also examines the controversial question of whether or not hip surgery in patients with myelomeningocele provides improved functional results. Finally this paper suggest appropriate goals and recommendations for treatment of the paralytic hip dislocation in myelomeningocele.

Treatment of Paralytic Hip Dislocation in Children with Myelomeningocele by a Combination of Innominate Pelvic Osteotomy, Intertrochanteric Femoral Osteotomy, and Muscle Transfer

The results of 64 operations to correct paralytic dislocation of the hip in children with myelomeningocele (MMC) were reviewed. Innominate pelvic osteotomy was combined with intertrochanteric femoral osteotomy and a muscle transfer. The mean follow-up period is 4 years 4 months. The results show that permanent bony stability of the hip joint can be achieved with a combination of these surgical procedures. Because this surgical treatment leads to no true improvement in functional ability, use of orthotic devices was not decreased.

Posterior Iliopsoas Transplantation in the Treatment of Paralytic Hip Dislocation in Spina Bifida

Children of Spina Bifida have many deformities in lower extremity correlate to their spinal cord damage. The purpose of this paper is to discuss about the treatment of paralytic hip dislocation. From 1972 to 1979, 9 unstable hips have been surgically treated. Sharrard procedure have been done on 8 hips and modified Sharrard procedure on 1hip. Subrequently, 8hips were reduced and remain so for several years.

SPINA BIFIDA MANIFESTA ORTHOPEDIC PROBLEMS AND THE ANALYSIS OF AMBULATORY FUNCTION

1) The interest in the spina bifida children with higher rehabilitation potential than C. P. is increasing recently in Japan.2) From 1970, over one hundred spina bifida children visited Kanagawa Children's Medical Center. We are approaching them from several aspects. The problems of orthopedic surgery and habilitation are reported in this paper including ambulatory function.3) The management of deformities of spine and lower extremities shoud be done under the proper understanding of their developing mechanism.4) We classified the level of paralysis into six groups according to the lowest level of the nerve preserved. The patients with intakt L5 show no paralytic hip dislocation and have independent ambulation with or without short leg braces.5) Therefore, L5 nerve is seemed to be the critical level for the spina bifida children.6) The children with the paralysis below this level can get indipendent ambulation until the age of three to four by proper management.

Physeo-epiphyseal injuries of lower extremities in myelomeningocele.

During the last few years the neurosurgical and urological treatment of children with myelomeningocele has completely changed the prognosis of patients with this congenital defect. Consequently, at present myelomeningocele is the outstanding cause of paraplegia in childhood, and due to the better control of hydrocephalus and urinary tract infections the number of patients surviving the hazards of early infancy is increasing steadily. In Sheffield, 73 per cent of such infants were still alive after 2-3 years, and within the next decade, therefore, myelomeningocele will rival trauma as a cause of paraplegia in the young adult (Stark 1972). To the orthopedic surgeon this group of patients creates a series ot problems which, although not unique in every respect, demand reasoning and solutions in ways with which the orthodoxly educated orthopedic surgeon is not familiar. Examples of such problems are the paralytic hip dislocation and club foot in these patients, as well as the osteoporosis and liability to fractures which occur without any warning by pain. A “new” skeletal complication of patients with myelomeningocele has been encountered during the last two years, consisting in damage to the growth plate (physis) of the lower extremities, and, in one case, of the throclea tali. The lesion is characterized by a broadening and loosening of the physis, possibly due to repetitive trauma, and in one case proceeding to a virtual pseudarthrosis. This complication may prove to be of importance, since both growth rate and configuration of the affected bones are impaired.

Paralytic dislocation of hip

Paralytic dislocation of hip