Reduction Of Congenital Hip Dislocation Research Articles

Treatment perspective after failed open reduction of congenital hip dislocation. A systematic review.

Failure of open reduction of developmental hip dislocation is a serious complication and revision surgery appear to be technically demanding with high complication rates. Little attention has been given in literature to patients in whom open reduction of developmental hip dislocation has failed. We present a systematic review about current perspectives and timing when to perform surgical revision after failed open reduction of developmental hip dislocation in children. Following the recommendations of the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" (PRISMA) statements we performed a comprehensive search of the PubMed and Google Scholar bibliographic database in order to select all studies published between 1980 and 2022. Studies were screened for the reasons for failure of open reduction, timing when revision surgery was performed, and for the surgical techniques used for revision. A total of 10 articles including 252 patients and 268 hips has been recorded. The most common causes of re-dislocation after open reduction are inadequate exposure and failure to release the obstructing soft tissues inside and around the hip. In 90% of the cases the anterolateral approach was performed for revision surgery. Avascular necrosis occurred in 5%-67% of cases and was the most encountered complication. Redislocation of developmental hip dislocation after an open reduction has poor long-term outcomes mainly due to a high rate of avascular necrosis of the femoral head. It is mandatory to obtain a stable reduction at the second surgery combining soft tissue release, capsulorrhaphy, pelvic and femoral osteotomies.

Surgical Method for the Treatment of Multiplanar Deformities of the Proximal Femur in Children with Aseptic Necrosis of the Femoral Head

The aim of the study was to evaluate the effectiveness of corrective intertrochanteric osteotomies of the femur in multiplanar deformities of the proximal femur after bloodless reduction of congenital hip dislocation in children.

Corrective Intertrochanteric Osteotomy of the Femur for Aseptic Necrosis of the Femoral Head after Bloodless Reduction of Congenital Dislocation in School-Age Children

The immediate results of treatment of 72 children aged 7 to 12 years with aseptic necrosis of the femoral head after bloodless reduction of congenital hip dislocation were analyzed. When treating patients, the following types of surgical treatment were used:extra-articular or open centering of the femoral head with intertrochanteric-torsion-varizing or devarizing and rotational osteotomy of the femur with bringing down the greater trochanter in the caudal direction. In all patients, pain and lameness disappeared, internal rotation of the lower extremities when walking, and the range of motion in the hip joint improved. Improved radiometric parameters characterizing the ratio of the acetabulum and the head of the femur and the angular values of the hip joint and proximal femur.

Surgical reduction of congenital hip dislocation.

Surgical reduction of congenital hip dislocation is technically challenging. In our practice, surgical reduction is usually reserved for patients who have failed non-operative treatment, which is the first-line strategy. However, primary surgery may be indicated if the dislocation is diagnosed late and can be performed until 8 years of age. The reduction step is crucial. It starts with painstaking exposure of the capsule. Identifying the lower part of the acetabulum is the key to accurate repositioning of the epiphysis. The main intra-articular procedures are resection of the ligament teres, adipose tissue within the acetabular cavity, and transverse acetabular ligament; and eversion of the radially incised limbus. In patients younger than 1 year of age, surgical reduction can be performed via the anterior approach or, in some cases, the obturator approach. No complementary steps are needed. If the diagnosis is made late, in contrast, reduction of the hip must be combined with corrective procedures on the femur and acetabulum designed to stabilise the reduction before the capsulorrhaphy, with the goal of optimising hip stability and minimising the risk of residual dysplasia. Femoral shortening and derotation osteotomy was classically reserved for children older than 3 years but has now been shown to be a useful and prudent procedure in younger patients. This osteotomy decreases pressure on the epiphysis, facilitates the reduction, and diminishes the risk of recurrence and avascular necrosis of the femoral head, which are the two dreaded complications. The outcome depends on the care directed to the procedure and on the quality of postoperative management.

Croissance de la tête fémorale après réduction de la luxation congénitale de la hanche

Purpose of the study This cohort illustrates growth of the center of ossification of the femoral head during and after orthopedic reduction of congenital hip dislocation. Material and methods Thirty files of pediatric patients with congenital hip dysplasia were studied retrospectively. Mean age of the children was 24.5 months. All had unilateral dysplasia, allowing a comparison of femoral head growth by calculating the centers of ossification on the AP views. Results Mean ratio between the radiological surface of the center of ossification of the femoral head on the dysplastic side and the normal side was about 1: 2. This ratio progressed rapidly during the first months after reduction and became 1: 1 at a mean 43 months after reduction. Beyond this time, growth of the femoral heads followed a similar pattern. Discussion Growth of the center of ossification of the femoral head is related to biomechanical stress forces. Reduction is the only event in the natural history of the disease, but renewed growth of the femoral head cannot provoke in itself normal acetabular growth. Complementary pelvic osteotomy was required for 13 hips. Conclusion Accelerated growth of the femoral head ossification center continues to be a good indicator of femoral head vitality. Early and rapid growth observed after reduction, without osteochondritis, can lead to a normal femoral head at the end of growth.

Femoral Artery Thrombus Complicating Open Reduction of Congenital Hip Dislocation

There are no reports in the literature of femoral artery thrombi occurring as a complication of open reduction of congenital hip displacement. In an 11-month-old female infant, a femoral artery thrombus most likely formed as a result of compression of the femoral artery with a muscle retractor hook used in performing Ludloff's procedure. Femoral artery thrombi should be considered as a possible complication of reduction of congenital hip dislocation with Ludloff's procedure.

当園におけるソルター骨盤骨切り術の治療成績

We evaluated 22 Salter's innominate osteotomies performed in 21 patients for treatment of residual subluxation and acetabular dysplasia after primary reduction of congenital hip dislocation. We only performed Salter's innominate osteotomy in 18 hips and additionally performed femoral osteotomy in 4 hips.The average age at surgery was 5.1±1.5 years, the average age at evaluation was 10.3±2.1 years and the average duration of follow-up was 5.1±1.6 years. We evaluated radiographic results using Severin's classification. Of the 22 hips, 18 achieved good results (82%) but 4 had poor results (18%). The mean center edge angle and acetabular head index at follow-up in the group with good results was statistically larger than that of the poorer group. Therefore Salter's innominate osteotomy was an effective surgical procedure for treatment of residual subluxation and acetabular dysplasia.

小児股関節における関節鏡検査および鏡視下手術の経験

Arthroscopy of 15 hip joints in 15 children were performed during the past 2 years. Of these, 13 hips were examined just prior to definitive surgery for evaluation of pathological changes, such as a hypertrophic ligamentum teres in manually unreducible congenital dislocation, a torn acetabular labrum or degeneration of articular cartilage in hip dysplasia and deformity of the femoral head in perthes' disease. Arthroscopic findings were useful for diagnosis, understanding pathology, and planning subsequent treatment. Two patients with residual subluxation after closed reduction of congenital hip dislocation were treated by a new method, “arthroscopic reduction”, in which intracapsular obstacles such as the ligamentum teres and fibrofatty tissue were completely resected arthroscopically. Short-term results of this method showed concentric reduction without coxa magna.

Intra-operative arthrography in open reduction of congenital hip dislocation

Intra-operative arthrography in open reduction of congenital hip dislocation

Closed Versus Open Reduction of Congenital Hip Dislocation in Patients Under 2 Years of Age

Closed Versus Open Reduction of Congenital Hip Dislocation in Patients Under 2 Years of Age

Open reduction of congenital hip dislocation. Advantages of the Ferguson medial approach.

Between 1974 and 1982, 56 hips of 51 children with congenital hip dislocation were treated by open reduction via the medial approach according to Ferguson. The mean age at operation was 7 (3-15) months. After 4 months of plaster cast immobilization, 41 hips had a normal acetabular index. Three hips required supplementary surgery: Salter's pelvic osteotomy in one case and a varus osteotomy in two cases. Of the remaining 53 hips, 26 received supplementary abduction treatment. During the first 2 years after reduction, 19 hips showed slight lateral displacement due to capsular laxity. The follow-up averaged 3 (0.5-8) years. All children older than 3 years now had stable, concentrically reduced hips without special treatment of the lateralization; in 9 of the 56 hips the acetabular roof was still dysplastic at follow-up. There was no difference in anteversion and neck-shaft angle between the treated and the contralateral hips. As vascular lesions were observed in only two hips and lateralization disappeared spontaneously, the Ferguson procedure seems safe.

Congenital dislocation of the hip in children. Comparison of the effects of femoral shortening and of skeletal traction in treatment.

Preoperative skeletal traction as an aid in reduction of congenital hip dislocation in the older child has been associated with an unacceptably high incidence of avascular necrosis, redislocation, and poor results. In contrast, femoral shortening as an aid in reduction has yielded a high rate of very satisfactory results, and may be essential for obtaining a stable, physiological, non-compressive reduction. We have analyzed the complications and the radiographic and functional outcomes of treatment in thirty-nine hips. It was clearly demonstrated that femoral diaphyseal shortening was preferable to traction as an aid in the operative reduction of a congenitally dislocated hip in children who were more than three years old.

On the Transposition of the Ileopsoas-Muscle in Operative Reduction of Congenital Hip-Dislocation

On the Transposition of the Ileopsoas-Muscle in Operative Reduction of Congenital Hip-Dislocation

The Resistance of Tissues as a Factor in the Manual Reduction of Congenital Hip Dislocation

The Resistance of Tissues as a Factor in the Manual Reduction of Congenital Hip Dislocation