Curved Periacetabular Osteotomy for the Treatment of Dysplastic Hips

Curved periacetabular osteotomy (CPO) was developed for the treatment of dysplastic hips in 1995. In CPO, the exposure of osteotomy sites and osteotomy of the ischium are made in the same manner as Bernese periacetabular osteotomy, and iliac and pubic osteotomies are performed in the same manner as rotational acetabular osteotomy. We studied the dynamic instabilities of 25 dysplastic hips before and after CPO using triaxial accelerometry. Overall magnitude of acceleration was significantly decreased from 2.30 +/- 0.57 m/sec2 preoperatively to 1.55 +/- 0.31 m/sec2 postoperatively. Pain relief and improvement of acetabular coverage resulting from acetabular reorientation seem to be related with reduction of dynamic instabilities of dysplastic hips. Isokinetic muscle strengths of 24 hips in 22 patients were measured preoperatively and after CPO. At 12 months postoperatively, the mean muscle strength exceeded the preoperative values. These results seem to be obtained due to no dissection of abductor muscles in CPO. The preoperative presence of acetabular cysts did not influence the results of CPO. An adequate rotation of the acetabular fragment induced cyst remodeling. Satisfactory results were obtained clinically and radiographically after CPO in patients aged 50 years or older. CPO alone for the treatment of severe dysplastic hips classified as subluxated hips of Severin group IV-b with preoperative CE angles of up to -20degrees could restore the acetabular coverage, weight-bearing area and medialization of the hip joint. CPO without any other combined procedure, as a treatment for 17 hips in 16 patients with Perthes-like deformities, produced good mid-term clinical and radiographic results. We have been performing CPO in conjunction with osteochondroplasty for the treatment of acatabular dysplasia associated with femoroacetabular impingement since 2006. The combined procedure has been providing effective correction of both acetabular dysplasia and associated femoral head-neck deformities without any increased complication rate. We have encountered an obturator artery injury in one case and two intraoperative comminuted fractures. Although serious complications such as motor nerve palsy, deep infection, necrosis of the femoral head or acetabulum, and delayed union or nonunion of the ilium were reported, such complications have never occurred in our 700 cases so far.

Total Hip Arthroplasty Using S-ROM Prosthesis for Dysplastic Hip

PURPOSE: The purpose of this study was to evaluate the clinical and radiological results of total hip arthroplasty using a proximal modular femoral stem in patients who had secondary coxarthrosis associated with a dysplastic hip. MATERIALS AND METHODS: Forty-two patients (45 hips) with secondary coxarthrosis were evaluated after undergoing primary total hip arthroplasty using an S-ROM proximal modular femoral stem. The average follow-up was 80 months (range: 60 to 96 months). Clinical and radiological assessments were performed based on the Harris hip score and the radiological changes around the prosthesis. RESULTS: The average Harris hip score improved from 52.2 points to 88.5 points. All femoral stems showed stable fixation; there were 37 cases by bony ingrowth and 8 cases by stable fibrous ingrowth. Neither osteolysis nor progressive radiolucent lines around the femoral stem were found at the last follow-up. Forty-one hips (91.9%) revealed excellent or good clinical results at the most recent follow-up. CONCLUSION: For advanced secondary coxarthrosis, total hip arthroplasty with the use of the proximal modular femoral stem yielded good mid-term results with respect to the clinical and radiological criteria.

Study on the diagnosis time of developmental dysplasia of the hip

We determined the time till diagnosis of developmental dysplasia of the hip in Urmia, Islamic Republic of Iran. A total of 1100 infants [530 boys and 570 girls] aged 1.5- 4.5 months attending university outpatient clinics for vaccination during June 2001 to January 2002 were examined for developmental dysplasia of the hip. Ortalani and Barlow methods and sonography were used for diagnosis. Of 105 suspected cases, 10 were confirmed with developmental dysplasia of the hip [2 boys and 8 girls]: 7 were diagnosed during the study and only 3 cases had been diagnosed previously. This late diagnosis is far greater than reported in other studies

Caracterización de la enfermedad luxante de cadera en la comuna de Los Andes / Characterization of the congenital dislocation of the hip commune of Los Andes

La luxación congénita de cadera es la malformación ortopédica más frecuente en el hombre. En Chile estudios muestran que la LCC tiene una incidencia de 7 por 10.000 nacidos vivos, y la displasia alrededor del 4 por ciento en lactantes de 3 meses de edad. El objetivo de este estudio fue caracterizar la luxación congénita de cadera en el Hospital San Juan de Dios de los Andes entre los meses de enero a julio del 2002. Para ello se tomaron todos los niños controlados en el policlínico de traumatología infantil por diagnóstico de displasia de cadera en este período (97 fichas). La edad de diagnóstico fluctuó entre 1 y 12 meses. La espera en la atención por especialista varió de 1 a 12 semanas. Los tratamientos más frecuentes fueron correas de Pavlik (41,6 por ciento) y doble pañal (37 por ciento); la edad de diagnóstico fue de 5,2 y 5,1 meses respectivamente, con un tiempo de manejo de 12 y 15 meses respectivamente. De los niños que requirieron cirugía (13,5 por ciento), la edad promedio de diagnóstico fue de 7,1 meses y el seguimiento a la fecha de 20 meses. Los factores de riesgo para displasia de cadera son reproducidos en este estudio. Tanto el retraso en la edad de diagnóstico como en el tiempo de espera en la atención repercuten en el tipo y duración de tratamiento necesario. Resulta por tanto fundamental la toma de conciencia de este cuadro por las madres y el equipo de salud permitiendo diagnóstico y manejo oportuno.

Enfermedad luxante de cadera: tratamiento con osteotomía de Salter seguimiento a largo plazo / Congenital hip dislocation: treatment with Salterïs osteotomy a long-term review

Diecinueve pacientes con 22 caderas luxadas congénitas fueron tratadas con reducción abierta y osteotomía de Salter del hueso innominado. El seguimiento clínico promedio fue de 24,7 años (rango entre 20,5 a 30,4 años), y el seguimiento radiológico promedio fue de 14,8 años (rango entre 5,9 a 24 años). Resultados excelentes y buenos se obtuvieron en 18 caderas (82 por ciento), utilizando el score de Gulman. El resultado radiológico fue excelente y bueno en 13 caderas (59 por ciento), según el score de Severin. Complicaciones: 6 caderas (27 por ciento) desarrollaron necrosis de la cabeza femoral tipo II de Bucholz y Ogden. Hubo un caso de infección profunda (4,5 por ciento). Nuestros hallazgos demuestran que la osteotomía de Salter proporcionan una mejoría real y persistente en pacientes con enfermedad luxante de caderas con displasia acetabular severa

Ultrasonografía: un método de pesquisa de la displasia y luxación congénita de la cadera / Ultrasonography: a screening method for dysplasia and congenital dislocation of the hip

Se evaluaron 808 niños mediante ultrasonografía en una pesquisa de displasia de cadera en el Hospital Roy H. Glover de Chuquicamata entre noviembre de 1993 y abril de 1996. 97,3 por ciento fueron caderas normales o fisiológicamente inmaduras (tipo 2a+, según Graf); de estas últimas un 6,97 por ciento emperoraron. 3,8 por ciento eran caderas patológicas a la pesquisa inicial o al seguimiento de las caderas inmaduras

Hipermelanosis nevoide lineal y espirilada / Nevoid hypermelanosis lineal and espirilada

Presentamos dos casos de hipermelanosis nevoide lineal y espirilada (HNLE) congénita. Las máculas hiperpigmentadas aparecieron al nacimiento y se extendieron gradualmente, siguiendo la configuración de las líneas de Blaschko. El primer caso de asoció con displasia congénita de cadera y retardo mental leve. Histológicamente el exámen reveló incremento de pigmento en la capa basal epidermal, aumento de tamaño y vaculización de los melanocitos, ausencia deincontigencia pigmentaria o melanófagos en la dermis. Esta entidad representa un desorden separado recientemente de otras alteraciones pigmentarias que sigue las lineas de Blaschko, tales como la incontinencia pigmenti, el nevus verrucoso sistematizado precoz e hipomelanosis de Ito. Casos similares reportados en la literatura sugieren una presentación esporádica y puede estar asociado con otras anomalías congénitas más severas. La patogénesis de esta condición no está clara; un mosaoicismo cromosonal puede ser responsable para este patron de hipermelanosis. La existencia de casos familiares supone la posiblidad de que un factor genético puede estar comprometido en la patogénesis de la HNLE

Luxación de cadera en pacientes con espina bífida / Hip dislocation in patients with spina bifida

Spina bifida is commonly associated with hydrocephalus and feet malformations, however its association with congenital dislocation of the hip is not well document. We retrospectively analyzed the medical records of 120 children aged 6 months to 15 years old admited to a rehabilitation center with the diagnosis of spina bifida. Fifty six children (55.4 percent) had dislocation of the hip (36 of 53 women and 20 of 48 men). These figures are higher than those reported for newborns by the Latin-American Collaborative Stud of Congenital Malformations. We conclude that congenital dislocation of the hip is frequent in children with spina bifida

Avaliacao do tratamento do quadril na artrogripose multipla congenita / Evaluation of treatment of the hip in arthrogryposis multiplex congenita

Os autores estudaram a patologia do quadril na Artrogripose Multipla Congenita (AMC) em 21 pacientes do Departamento de Ortopedia e Traumatologia do Hospital das Clinicas da FMUSP. Estes pacientes apresentavam 18 luxacoes da articulacao do quadril, sendo 11 bilaterais e sete unilaterais; foi observado rigidez na articulacao coxo-femoral nos tres remanescentes. A idade dos pacientes variou de 1 mes a 14 anos, com media de dois anos e quatro meses. O acompanhamento dos pacientes foi de dois anos a 23 anos. O tratamento empregado nos casos de rigidez e contratura da articulacao do quadril consistiu de manipulacoes e ortese em um caso e tratamento cirurgico, por tenomiotomias multiplas, em dois casos. Nos casos de luxacao da articulacao o tratamento usado foi: reducao incruenta (com ou sem tenotomia dos musculos adutores do quadril) em sete casos, reducao cruenta em dois ou, entao, tratamento conservador com o uso de ortese de abducao em dois. Em alguns casos de luxacao de ambas articulacoes e pela gravidade das deformidades nos membros inferiores (joelhos e pes), optou-se pelo abandono de tratamento da patologia do quadril pois estes pacientes nao seriam ambulatorios independentes; isto em sete casos...

Congenital dislocation of the hip: a long-term follow-up in Korea

The results of fifty-eight congenitally dislocated hips in fifty-four children, who were between two months and eleven years old when treatment was begun, have been reviewed. Thirteen hips were treated by closed reduction, seventeen hips by open reduction, seventeen hips by Salter's innominate osteotomy, five hips by Klisic operation, and six hips by other operations. At an average 5.1 year follow-up (range, three to twelve years), a 91% satisfactory result was obtained when treatment was started under two years of age. With preoperative traction, in the cases when the femoral head was pulled down below to the zero station, the clinical result was satisfactory in 83%. We think that the treatment of congenital dislocation of the hip should be started before two years of age and that the femoral head should be pulled down below to the zero station to prevent avascular necrosis, and to obtain a satisfactory result.

Luxaçäo congênita de quadril: avaliaçäo dos resultados com seguimento médio de cinco anos e dez meses

Os autores apresentam os resultados da avaliaçäo de 29 casos de luxaçäo congênita de quadril (com um tempo médio de seguimento de cinco anos e 10 meses), tratados de acordo com uma filosofia uniforme, consistindo de reduçäo concêntrica, mobilizaçäo precoce em dupla abduçäo e estabilizaçäo na posiçäo de carga nos casos de perdas tardias da reduçäo, utilizando o realinhamento distal pela osteotomia femoral. As acetabuloplastias eram reservadas para as displasias acetabulares, em crianças com mais de quatro anos de idade. Apesar de o tempo de seguimento ser relativamente curto, foi concluído ser esta rotina eficaz, dando 89% do resultados clínicos considerados como bons e excelentes e 79,3% dos casos classificados nos grupos I e II de Severin, quanto ao aspecto radiográfico final