Effectiveness of combined anteversion angle technique in total hip arthroplasty for treatment of ankylosing spondylitis affecting hip joint / 中国修复重建外科杂志

OBJECTIVE@#To explore the effectiveness of the combined anteversion angle technique in total hip arthroplasty (THA) for treating ankylosing spondylitis (AS) affecting the hip joint.@*METHODS@#A retrospective analysis was conducted on the clinical data of 73 patients with AS affecting the hip joint who underwent THA between August 2018 and August 2021. According to whether the combined anteversion angle technique was used in THA, the patients were divided into study group (37 cases, combined anteversion angle technique was used in THA) and control group (36 cases, traditional THA). There was no significant difference in baseline data such as gender, age, body mass index, disease duration, preoperative Harris score, range of motion (ROM), acetabular anteversion angle, acetabular abduction angle, femoral anteversion angle, and combined anteversion angle between the two groups ( P>0.05). The operation time, hospital stay, and complications of the two groups were recorded and compared. The Harris score and hip ROM were compared between the two groups before operation, at 1, 3, 6, 12 months after operation, and at last follow-up. The acetabular component anteversion angle, femoral component anteversion angle, acetabular component abduction angle, and component combined anteversion angle were measured postoperatively.@*RESULTS@#The operation time in the study group was significantly shorter than that in the control group ( P<0.05), and there was no significant difference in hospital stay between the two groups ( P>0.05). There was no intraoperative complication such as acetabular and proximal femoral fractures, neurovascular injuries in both groups, and the incisions healed by first intention. All patients were followed up 2-3 years, with an average of 2.4 years; there was no significant difference in the follow-up time between the two groups ( P>0.05). During the follow-up period, there was no complication such as hip dislocation, wound infection, delayed wound healing, deep venous thrombosis, and hip dislocation in both groups. The hip Harris score and ROM of the two groups gradually increased with time after operation, and the differences were significant when compared with those before operation ( P<0.05); the above two indicators of the study group were significantly better than those of the control group at each time point after operation ( P<0.05). Extensive bone ingrowth on the surface of the components could be observed in the anteroposterior X-ray films of the hip joint of the two groups at 12 months after operation, and the acetabular components was stable without femoral stem subsidence, osteolysis around the components, and heterotopic ossification. At last follow-up, the acetabular component anteversion angle, femoral component anteversion angle, and component combined anteversion angle in the study group were significantly superior to those in the control group ( P<0.05), except that there was no significant difference in the acetabular component abduction angle between the two groups ( P>0.05).@*CONCLUSION@#For patients with AS affecting the hip joint, the use of the combined anteversion angle technique during THA effectively promotes the recovery of hip joint function and enhances the postoperative quality of life of patients when compared to traditional THA.

EFECTIVIDAD DE LA TOXINA BOTULÍNICA TIPO A EN EL MANEJO DE LA CADERA ESPÁSTICA DE NIÑOS CON PARÁLISIS CEREBRAL / EFFECTIVENESS OF THE TOXIN BOTULINUM TYPE A IN THE DRIVING OF THE HIP CHILDREN'S SPASTICS WITH CEREBRAL PALSY

La espasticidad es uno de los principales factores de riesgo que predispone a la luxación de cadera en los niños con parálisis cerebral (PC). La aplicación de toxina botulínica (BTX A) en los músculos aductores de caderas reduce este riesgo

Spasticity is one of the main risk factors predisposing to hip dislocation in children with cerebral palsy (CP), Botulinum toxin A (BTX A) injection in hip adductor muscles reduces this risk

Disastrous triad of femoral head:femoral neck fracture meeting fracture-dislocation of femoral head / 中国骨伤

Femoral head and ipsilateral femoral neck fractures are serious and complicated injuries, which usually yield unsatisfactory results using conventional hip-preserving surgery. The key point of the management and prognosis mainly lies in femoral neck fractures. An apparent and consecutive relationship exists between femoral neck fractures and femoral head fracture-hip dislocation in such injuries. It is believed that disastrous triad of femoral head (DTFH) could summarize these specific injuries, and reflect the injury mechanism and prognostic characteristics. Based on our clinical observation and literature review, DTFH could be divided into three subgroups:TypeⅠ, common DTFH, in which femoral neck fractures occur following femoral head fractures-hip dislocation due to the same trauma; TypeⅡ, iatrogenic DTFH, in which femoral neck fractures come out in the caring process of femoral head fractures-hip dislocation; Type Ⅲ, stressed DTFH, in which femoral neck fractures occur after the management of femoral head fractures-hip dislocation. In the scenario, the line of femoral neck fractures locates distally to the femoral head fractures. Herein, we will discuss clinical characteristics of these types of DTFH.

Relationship between the gross motor function classification system and hip and lumbar spine development in children with spastic cerebral palsy / 中国骨伤

OBJECTIVE@#To investigate the relationship among the gross motor function classification system (GMFCS)and the development of hip joint and lumbar spine in children with spastic cerebral palsy.@*METHODS@#The clinical data of 125 children with spastic cerebral palsy admitted from January 2018 to July 2021 were retrospectively analyzed. There were 85 males and 40 females, aged from 4 to 12 years old with an average of (8.4±2.9) years. According to GMFCS, the patients were divided into gradeⅠ, Ⅱ, Ⅲ and Ⅳ groups. There were 27 cases in gradeⅠgroup, 40 cases in gradeⅡgroup, 35 cases in grade Ⅲ group and 23 cases in grade Ⅳ group. The migration percentage(MP), central edge angle(CE), neck-shaft angle(NSA), acetabular index(AI) were measured by the radiograph of pelvis, abnormal parameters were selected to evaluate the relationship between different GMFCS grades and hip joint development. Lumbar sagittal Cobb angle, lumbar sacral angle, lumbar lordosis index and apical distance were measured by lateral lumbar radiographs to evaluate the relationship between different GMFCS grades and lumbar spine development.@*RESULTS@#①Among the 125 spastic cerebral palsy children, there were 119 cases of pelvic radiographs that met the measurement standards. In the four groups with gradeⅠ, Ⅱ, Ⅲ, Ⅳ, MP was (22.72±3.88), (26.53±4.36), (33.84±4.99), and (49.54±7.87)%, CE was(30.10±6.99) °, ( 22.92±4.19) °, ( 17.91±5.50) °, and (-0.70±17.33)°, AI was (16.41±2.77) °, (20.46±4.63) °, (23.76±5.10) °, and ( 29.15±7.35)°, respectively, there were significant differences between the two comparisons (P<0.05). And the higher GMFCS grade, the greater MP and AI, and the smaller CE.The NSA was(142.74±10.03) °, (148.66±9.09) °, (151.66±10.52) °, and (153.70±8.05)° in four groups with gradeⅠ, Ⅱ, Ⅲ, Ⅳ, respectively. The differences between the two comparisons of the GMFCS gradeⅠgroup and the other three groups were statistically significant (P<0.05). NSA of GMFCSⅠgroup was significantly lower than that of the others, there was no significant difference among other groups(P>0.05). ② Among the 125 spastic cerebral palsy children, there were 88 cases of lumbar spine radiographs that met the measurement standards. ③The lumbar sagittal Cobb angle was(32.62±11.10) °, (29.86±9.90) °, (31.70±11.84) °, and (39.69±6.80)° in the four groups with gradeⅠ, Ⅱ, Ⅲ, Ⅳ, respectively;GMFSS of grade Ⅳ group was significantly higher than that of other three groups, there was significant difference between the two comparisons (P<0.05);there were no significant differences between other groups (P>0.05). In the four groups with gradeⅠ, Ⅱ, Ⅲ, Ⅳ, the lumbosacral angle was (31.02±9.91) °, ( 26.57±9.41) °, (28.08±8.56) °, and ( 27.31±11.50)°, the lumbar lordosis index was (4.14±12.89), (8.83±13.53), (13.00±11.78), and (10.76±9.97) mm, the arch apex distance was (9.50±6.80), (6.68±3.20), (7.16±4.94), and (6.62±4.13) mm, respectively, there were no significant differences between the two comparisons(P>0.05).@*CONCLUSION@#①In children with GMFCS gradeⅠ-Ⅳ, the higher the GMFCS grade, the worse the hip develops. ② Children with GMFCS grade Ⅲ-Ⅳ may be at greater risk for lumbar kyphosis.

Reducción incongruente de cadera tras luxación traumática por interposición de ceja posterior acetabular. Miniabordaje anterior de cadera y artroscopía seca para retiro del fragmento y evaluación articular / Posterior acetabular rim interposed within the joint after reduction of a traumatic hip dislocation. Anterior minimally invasive approach

Se presenta el caso de un paciente de veinte años a quien le queda un fragmento de la ceja acetabular posterior interpuesto dentro de la articulación tras la reducción de una luxación traumática de cadera. Se planteó un tratamiento por vía miniinvasiva anterior, con artroscopía seca con el fin de retirar el fragmento interpuesto, y la limpieza de la avulsión del ligamento redondo. En mesa de tracción se pudo retirar el fragmento interpuesto y evaluar el estado articular. Se muestran excelentes resultados clínicos e imagenológicos que desafían el concepto del abordaje posterior para lesiones posteriores. Nivel de Evidencia: III

The case of a twenty-year-old patient who has a fragment of the posterior acetabular rim interposed within the joint after reduction of a traumatic hip dislocation is presented. Anterior minimally invasive treatment was proposed, with dry arthroscopy to remove the interposed fragment and clean the round ligament avulsion. On the traction table, the interposed fragment could be removed, and the joint status evaluated. Excellent clinical and imaging results are shown what challenges the concept of a posterior approach for posterior lesions. Level of Evidence: III

Luxación controlada de cadera en el tratamiento de la condromatosis sinovial asociada a una lesión tipo cam / Surgical hip dislocation for the treatment of synovial chondromatosis associated with a cam deformity

La condromatosis sinovial es una rara enfermedad benigna del tejido sinovial que puede causar daño articular si no se trata adecuadamente. Mientras que la lesión tipo cam provoca una fricción entre el borde acetabular y la unión cuello-cabeza femoral que puede generar un daño condrolabral y, en su evolución natural, llegar a la artrosis. El tratamiento de la condromatosis sinovial de cadera es controvertido, entre la cirugía abierta o artroscópica, pero debe incluir la extracción completa de los cuerpos libres y la sinovectomía para evitar recurrencias. Por el contrario, la lesión tipo cam puede manejarse con artroscopia en la mayoría de los casos. Presentamos un caso clínico en el que se asocian ambas patologías y que fue tratado mediante luxación controlada de cadera. La elección de la luxación controlada permite una visión completa de la articulación y se ha utilizado con éxito en casos de condromatosis sinovial asociada a la lesión tipo cam. Nivel de Evidencia: IV

Synovial chondromatosis is a rare benign disease of the synovial tissue that can cause joint damage if not properly treated. On the other hand, cam deformity causes friction between the acetabular rim and the femoral neck-head junction, which can lead to chondrolabral damage and, in its natural progression, result in osteoarthritis. The treatment of synovial chondromatosis of the hip is controversial, involving open surgery or arthroscopy, but it should include complete removal of loose bodies and synovectomy to prevent recurrences. In contrast, a cam lesion can often be managed with arthroscopy. We present a clinical case where both conditions were associated and treated with controlled hip dislocation. The choice of controlled dislocation allows for a comprehensive view of the joint and has been successfully used in cases of synovial chondromatosis associated with cam lesions. Level of Evidence: IV

The importance of acetabular morphometry in determining hip dysplasia / Importancia de la morfometría acetabular en la determinación de la displasia de cadera

SUMMARY: The aim of this study was to evaluate the relation between acetabulum morphological measurements and present the reference values of the acetabulum. The study had a retrospective design and was conducted with 234 healthy subjects (108 females; 126 males) aged 18-53 years over a period of 4 years from 2018 to 2022. Eleven measurements including the center- edge angle (CEA), acetabular angle (AA), acetabular depth (AD), acetabular width (AW), dept to width ratio (ADWR), Extrusion A (EA)-B (EB), Extrusion index (EI), the lateral subluxation (LS), peak to edge distance (PED), and roof obliquity (RO) were taken. The p<0.05 value was considered significant. A significant difference was found in CEA, AA, EB, LS, and RO values, while there was no significance in the AD, AW, ADWR, EI, and PED measurements in comparison with acetabular morphometry according to gender. Also, in the evaluation of acetabulum to age-related changes, there was a significant difference in values of the CEA, AA, AD, AW, ADWR, LS, and PED from decades 1 to 5. The knowledge of radiological acetabulum findings is paramount for the diagnosis of hip dysplasia and may be useful for prosthesis, orthopedic and forensic experts. Also, the most interesting finding was that ADWR increased based on age in a directly proportional trend. The most apparent change based on age was seen in CEA (between decades 3-4), LS (decades 1-5), PED (decades 2-4), AD, and AW (decades 2-5).

El objetivo de este estudio fue evaluar la relación entre las medidas morfológicas del acetábulo y presentar sus valores de referencia. El estudio tuvo un diseño retrospectivo y se realizó con 234 sujetos sanos (108 mujeres; 126 hombres) de 18 a 53 años de edad durante un período de 4 años, desde 2018 hasta 2022. Once mediciones que incluyeron el ángulo centro-margen (ACM), ángulo acetabular (AA), profundidad acetabular (PA), ancho acetabular (AC), relación de profundidad y ancho (RPAC), extrusión A (EA)-B (EB), índice de extrusión (IE), subluxación lateral (SL). Se midió la distancia al margen (DAM) y la oblicuidad del techo (OT). Se consideró significativo el valor de p<0,05. Se encontró una diferencia significativa en los valores de ACM, AA, EB, SL y OT, mientras que no hubo significación en las medidas de AA, AC, RPAC, IE y DAM en comparación con la morfometría acetabular según el sexo. Además, en la evaluación del acetábulo respecto a los cambios relacionados con la edad, hubo una diferencia significativa en los valores de ACM, AA, PA, AC, RPAC, SL y DAM de las décadas 1 a 5. El conocimiento de los hallazgos radiológicos del acetábulo es primordial para el diagnóstico de displasia de cadera y puede ser útil para expertos en prótesis, ortopedia y medicina forense. Además, el hallazgo más interesante fue que RPAC aumentó según la edad en una tendencia directamente proporcional. El cambio más aparente según la edad se observó en ACM (entre las décadas 3 y 4), LS (décadas 1 a 5), DAM (décadas 2 a 4), PA y AC (décadas 2 a 5).

Luxación de cadera asociada a fractura del extremo proximal de fémur: reporte de caso y revisión del tema / Hip dislocation associated with fracture of the proximal end of the femur: case report and literature review / Luxação do quadril associada a fratura da extremidade proximal do fêmur: relato de caso e revisão da literatura

Las luxaciones traumáticas de cadera son poco frecuentes, y es excepcional la asociación lesional con fracturas del extremo proximal de fémur, habitualmente producidas por accidentes de alta energía. Un correcto diagnóstico, y tratamiento adecuado de la fractura, es la conducta ideal para disminuir las complicaciones. Presentamos el caso de un paciente masculino 49 años trabajador de la construcción que, en un accidente de tránsito, sufre una luxación de cadera asociado a fractura de cuello femoral, con excepcional presentación radiológica, con lesión del nervio CPE (ciático poplíteo externo), en que se realizó artroplastia total de cadera, con buena evolución y rehabilitación, retornando a su actividad laboral a los 11 meses del accidente. A propósito de este caso, realizamos una revisión bibliográfica para evaluar el tratamiento propuesto, el ideal, y pronóstico funcional de estas lesiones.

Traumatic hip dislocations are rare, and associated injuries involving fractures of the proximal end of the femur, usually as a result of high-energy accidents, are exceptional. A correct diagnosis and adequate treatment of the fracture is the most appropriate way to reduce complications. We present the case of a 49-year-old male construction worker who, as a result of a traffic accident, suffers from a hip dislocation associated with a femoral neck fracture, with exceptional radiological presentation, with injury to the EPS (External Popliteal Sciatic) nerve. Total hip arthropathy was performed, with good evolution and rehabilitation, and patient returned to work 11 months after the accident. In this particular case, we carried out a bibliographic review to evaluate the proposed treatment, the ideal treatment, and the functional prognosis of these injuries.

As luxações traumáticas do quadril são raras, e a associação de lesão com fraturas da extremidade proximal do fêmur, geralmente causada por acidentes de alta energia, é excepcional. O diagnóstico correto e o tratamento adequado da fratura é a abordagem ideal para reduzir as complicações. Apresentamos o caso de um operário da construção civil, 49 anos, que, em acidente de trânsito, sofre luxação de quadril associada a fratura do colo do fêmur, com apresentação radiológica excepcional, com lesão do nervo ciático poplíteo externo (CPE), em onde foi realizada a artroplastia total do quadril, com boa evolução e reabilitação, retornando ao trabalho 11 meses após o acidente. Em relação a este caso, realizamos uma revisão bibliográfica para avaliar o tratamento proposto, o ideal e o prognóstico funcional dessas lesões.

Research status of acetabular reconstruction in Crowe type Ⅱ and Ⅲ developmental dysplasia of the hip / 中国骨伤

Developmental dysplasia of the hip (DDH) is a major cause of hip arthritis and ultimately total hip arthroplasty. Due to the dysplastic acetabulum, how to place the acetabular cup becomes a challenge in acetabular reconstruction for such patients. Especially in the acetabula classified as Crowe typeⅡand type Ⅲ, the dislocation of the femoral head causes bone defects above the true acetabulum, which will affect the stability of the acetabular cup when the acetabular reconstruction is performed at the true acetabulum. Many acetabular reconstruction methods such as bone grafting, the use of small acetabular cups, socket medialization technique, and high hip center technique are used to increase the host bone coverage of the cup. However, each method has its own shortcomings that can not be ignored so that there is no unified conclusion on the acetabular reconstruction methods for Crowe typeⅡand type Ⅲ hip dysplasia. This article summarized and evaluated various reconstruction methods in combination with the acetabular morphology of DDH, and put forward the research direction in the future.

Artroscopía en fractura-luxación de cadera / Arthroscopy in hip fracture-dislocation

Los cuerpos libres intraarticulares en las luxaciones traumáticas de la cadera con fractura acetabular, o sin esta, son frecuentes. Presentamos un caso clínico de paciente femenina que sufrió accidente de tránsito, con luxofractura de cadera izquierda. Se realizó artroscopía de cadera extrayendo fragmento intraarticular. Ha tenido una evolución satisfactoria en su seguimiento. Control con TC de cadera no muestra fragmento osteocondral en su seguimiento, ni degeneración articular. Score de Harris de 95.

Intra-articular loose bodies in traumatic hip dislocations with or without acetabular fracture are common. We present a clinical case of a female patient who had a traffic accident, with a left hip fracture-dislocation. Hip arthroscopy was performed, removing intra-articular fragment. It has had a satisfactory evolution in its follow-up. Control CT of the hip does not show an osteochondral fragment in its follow-up, nor joint degeneration. Harris score 95.

Pelvic Bone Deformity and Its Correlation with Acetabular Center-edge Angle / Deformidade dos ossos pélvicos e sua correlação com o ângulo centro-borda acetabular

Abstract Objective The purpose of the present study was to evaluate the pelvic bone deformities and its correlation with the acetabular center-edge (CE) angle. Methods Between August 2014 and April 2015, we prospectively evaluated patients aged between 20 and 60 years old. The exclusion criteria were: metabolic disease, previous hip or spine surgery, radiograph showing hip arthrosis ≥ Tönnis two, severe hip dysplasia, global acetabular overcoverage, acetabular crossover sign, hip deformities from slipped capital femoral epiphysis (SCFE) or Leg-Perthes-Calveé, and bad quality radiographs. At anteroposterior (AP) pelvic radiographs, we have evaluated: the CE angle, the acetabular index (IA), the acetabular crossover sign, the vertical and horizontal superior and inferior pelvic axis (H1: Horizontal line 1, superior pelvic axis; H2: Horizontal line 2, superior pelvic axis; V1: Vertical line, superior pelvic axis; HR: Horizontal line, inferior pelvic axis; VR: Vertical line, inferior pelvic axis). The superior and inferior pelvic axis were considered asymmetric when there was a difference ≥ 5 mm between both sides. Patients were divided into two groups: control and group 1. Results A total of 228 patients (456 hips) were evaluated in the period. According to the established criteria, 93 patients were included. The mean age was 39.9 years old (20 to 60 years old, standard deviation [SD] = 10,5), and the mean CE angle in the right hip was 31.5º (20 o to 40º), and in the left 32.3º (20 o to 40º). The control group had 38 patients, with asymmetric H1 in 4 cases (10.5%), H2 in 5 (13.1%), V1 in 7 (18.4%), HR in 5 (13.1%) and VR in 1 (2.63%). Group 1 had 55 patients, with asymmetric H1 in 24 cases (43.6%), H2 in 50 (90.9%), V1 in 28 (50.9%), HR in 16 (29.09%) and VR in 8 (14.5%). Comparing both groups, there was statistical significance for H1, H2 and V1 asymmetry (p < 0.001). Conclusion In the present paper, we observed the correlation between variation in the acetabular CE angle and asymmetry of the superior hemipelvis. The present authors believe that a better understanding of the pelvic morphologic alterations allows a greater facility in the diagnosis of hip articular deformities.

Resumo Objetivos O objetivo do presente trabalho é avaliar a deformidade dos ossos pélvicos e sua correlação com ângulo centro-borda acetabular (CE). Métodos Foi realizado um estudo prospectivo caso-controle, entre agosto de 2014 e abril de 2015. Os critérios de inclusão foram pacientes consecutivos com idades entre 20 e 60 anos. Os critérios de exclusão foram: doença metabólica, cirurgia prévia de quadril ou coluna, radiografia evidenciando artrose de quadril ≥ Tönnis 2, displasia do desenvolvimento do quadril (DDQ) severa, sobrecobertura acetabular global, sinal do cruzamento das linhas acetabulares, deformidades decorrentes de epifisiólise ou Legg-Perthes-Calveé, e radiografia sem qualidade adequada. Foram avaliados na radiografia anteroposterior (AP) de pelve: o ângulo CE, índice acetabular (IA), sinal do cruzamento das linhas acetabulares, mensuração do eixo horizontal e vertical da hemipelve superior e inferior (H1: Linha Horizontal 1, hemipelve superior; H2: Linha Horizontal 2, hemipelve superior; V1: Linha Vertical, hemipelve superior; HR: Linha Horizontal, hemipelve inferior; VR: Linha Vertical, hemipelve inferior). As mensurações H1, H2, V1, HR e VR foram consideradas assimétricas quando, na comparação de uma hemipelve em relação ao lado contralateral, evidenciou-se uma diferença > 5 mm. Os pacientes foram separados em dois grupos: controle e grupo 1. Resultados O total de pacientes avaliados no período foi de 228 (456 quadris). De acordo com os critérios estabelecidos, foram incluídos neste estudo 93 pacientes. A idade média foi de 39,9 anos (20 a 60 anos, desvio padrão [DP] = 10,5), e o ângulo CE médio do quadril direito foi de 31,5º (20º a 40º) e do esquerdo de 32,3º (20º a 40º). Um total de 38 pacientes foi incluído no grupo controle, sendo que com relação à H1, foi constatada aferição assimétrica em 4 casos (10,5%), H2 em 5 (13,1%), V1 em 7 (18,4%), HR em 5 (13,1%), e VR em 1 caso (2,63%). No grupo 1, foram incluídos 55 pacientes, sendo que com relação à H1, foi constatada aferição assimétrica em 24 casos (43,6%), H2 em 50 (90,9%), V1 em 28 (50,9%), HR em 16 (29,09%), e VR em 8 casos (14,5%). Na comparação entre o grupo controle e o grupo 1, observou-se diferença estatisticamente significativa para a assimetria das mensurações H1, H2 e V1 (p < 0,001). Conclusão No presente trabalho, evidenciou-se correlação entre variação do ângulo CE acetabular e assimetria da hemipelve superior. Os presentes autores acreditam que o melhor entendimento das alterações morfológicas pélvicas permite uma maior facilidade no diagnóstico das deformidades articulares do quadril.

Ilizarov Technique with Proximal Femoral and Triple Pelvic Osteotomy for the Treatment of Adolescent Developmental Dysplasia of the Hip / Técnica de Ilizarov nas osteotomias do fêmur proximal e pélvica tripla para o tratamento da displasia do desenvolvimento do quadril em adolescentes

Abstract Objective The significance of pelvic osteotomies in developed coxarthrosis is still disputable. Some authors believe that incongruence and early osteoarthritis of the articular surfaces are contraindications for joint-preserving surgery and will stimulate further progression. The opposite view is that triple pelvic osteotomy can be an alternative to early joint replacement. The present study reports the mid to long term results of adolescent patients with developed coxarthrosis treated by proximal femoral and triple pelvic osteotomies and fixed by the Ilizarov technique. Methods A retrospective review between 2002 and 2014 of the treatment of 26 patients with coxarthrosis due to developmental dysplasia of the hip (DDH). The sample was composed of 22 female and 4 male subjects with a mean age at operation of 14.7 years (range: 12-18 years) and mean follow-up of 5.9 years (range: 3-13 years). Results The initial functional results according to the Merle d'Aubigné and Postel criteria were: pain - 4.3 ± 0.05 points; range of motion - 3.6 ± 0.3 points; and gait - 4 ± 0.15 points. The average index of the weight bearing zone (WBZ) was of 38.7º ± 2.721º. The acetabular coefficient (AC) was of 162 ± 6.8, the center-edge angle (CEA) of Wiberg was of 3º ± 0.2º. The outcomes were followed up from 3 to 13 years. At the final follow-up, the radiographic outcomes showed that the value of the WBZ decreased to 8.2º ± 1.293º (0-15º), and that the AC increased to 249 ± 12.05. The average neck-shaft angle (NSA) was of 115º ± 4º, the articulo-trochanteric distance (ATD) was of 8,5 ± 1,5 mm, and the CEA of Wiberg was of 28º ± 1.6º) at the final follow-up. The distribution of the joints according to Tönnis et al was: grade I - 17 joints; grade II - 8 joints; and grade III - 1 joint. The outcomes were good for 14 patients (54%), fair for 10 patients (34.5%), and poor for 2 (11.5%) patients. Conclusion The treatment of adolescent hip dysplasia requires a proper assessment of the degree of dysplasia and the surgery needed to redirect pelvic components to achieve suitable conditions for hip remodeling, and our mid- to long-term results showed very good outcomes when applying these principles using the Ilizarov technique.

Resumo Objetivo A importância das osteotomias pélvicas na coxartrose desenvolvida ainda é discutível. Alguns autores acreditam que a incongruência e a osteoartrite inicial das superfícies articulares são contraindicação para a cirurgia de preservação articular e estimularão maior progressão. A visão oposta é a de que a osteotomia pélvica tripla pode ser uma alternativa à substituição articular precoce. Este estudo relata resultados de médio a longo prazo de pacientes adolescentes com coxartrose desenvolvida, tratados por osteotomias proximais do fêmur e pélvica tripla, fixados pela técnica de Ilizarov. Métodos Revisão retrospectiva entre 2002 e 2014 do tratamento de 26 pacientes com coxartrose devido a displasia do desenvolvimento do quadril. A amostra continha 22 mulheres e 4 homens. A idade média na operação foi de 14,7 anos (variação: 12-18 anos), e o acompanhamento médio foi de 5,9 anos (variação: 3-13). Resultados Os resultados funcionais iniciais de acordo com o método de Merle d'Aubigné e Postel foram: dor - 4,3 ± 0,05 pontos; mobilidade - 3,6 ± 0,3 pontos; e marcha - 4 ± 0,15 pontos. O valor médio do índice da zona de carga (ZC) foi 38,7º ± 2.721º. O coeficiente acetabular (CA) foi de 162 ± 6,8, e o ângulo centro-borda (ACB) de Wiberg foi de 3º ± 0,2º. Os resultados foram acompanhados por 3 a 13 anos. No acompanhamento final, os resultados radiográficos mostraram que o valor do índice da ZC diminuiu para 8.2 ± 1.293º (0º-15º), e o CA aumentou para 249 ± 12,05. A média do ângulo cervicodiafisário (ACD) foi 115º ± 4º, a distância articulotrocantérica (DAT) foi de 8,5 ± 1,5 mm, e o ACB de Wiberg foi 28º ± 1,6º no acompanhamento final. A distribuição das articulações segundo Tönnis et al foi: grau I - 17 articulações; grau II - 8 articulações; e grau III - 1 articulação. O resultado foi bom em 14 pacientes (54%), razoável em 10 pacientes (34,5%), e ruim em 2 (11.5%). Conclusão O tratamento da displasia do quadril na adolescência requer uma avaliação adequada do grau de displasia e a cirurgia necessária para reorientar os componentes pélvicos com o objetivo de alcançar condições adequadas para a remodelação do quadril. Nossos resultados de médio a longo prazo mostraram desfechos muito bons ao aplicarmos esses princípios usando a técnica de Ilizarov.

Obturator dislocation of total hip arthroplasty with disassembly of the prosthesis components and periprosthetic fracture in morbid obese patient / Luxación obturatriz de una prótesis total de cadera con desensamblaje de los componentes y fractura periprotésica en un paciente obeso

Abstract: Introduction: Anterior dislocation is a rare complication of total hip arthroplasty (THA). There exist only three cases in the literature. None of them report disassembly of the prosthesis components. We present a morbidly obese woman who suffered an irreducible obturator dislocation of an infected total hip arthroplasty (THA), due to uncontrolled adduction during an early debridement surgery. Following unsuccessful closed reduction attempts, a Vancouver B2 periprosthetic fracture and disassembly of the prosthetic components were observed. Two-stage revision THA was necessary to resolve the infection and restore hip functionality. In obturator dislocation, the femoral head prosthetic can be trapped in the obturator foramen, and this may disassemble the prosthesis components during reduction maneuvers; there's also risk of periprosthetic fracture. This mandate an open reduction of the joint. Patient obesity could be a determining factor for this rare type of hip arthroplasty dislocation. Obturator dislocation is an extremely rare complication of the total hip arthroplasty, whose reductions should be handled with caution given the risks of periprosthetic fractures. In most cases, an open reduction of the joint is required. Clinical importance: Our work is likely to be of great interest because it offers tips for the management of this rare complication based on our experience.

Resumen: Introducción: La luxación anterior es una complicación poco frecuente de la artroplastia total de cadera (ATC). Sólo existen tres casos en la literatura. Ninguno de ellos informa del desmontaje de los componentes de la prótesis. Presentamos el caso una mujer obesa que sufrió una luxación irreducible de una artroplastia total de cadera (THA), la cual estaba infectada, debido a la aducción no controlada durante una cirugía de desbridamiento temprano. Después de los intentos fallidos de reducción cerrada, se presentó una fractura periprotésica clasificada como Vancouver B2 y el desmontaje de los componentes protésicos. Ameritó cirugía de revisión en dos etapas, lo cual se realizó para resolver la infección y restaurar la funcionalidad de la cadera. En la luxación obturatriz, la cabeza femoral puede quedar atrapada en el agujero obturador y, como consecuencia, favorecer la disociación de los componentes protésicos al intentar la reducción, asimismo puede favorecer un brazo de palanca que produzca una fractura periprotésica. La obesidad puede ser un factor determinante para la producción de esta rara complicación. Por todo lo anterior, se recomienda considerar de entrada la reducción abierta. La luxación obturatriz es una complicación rara en la artroplastia total de cadera; su tratamiento puede ser difícil y asociarse a fracturas. La relevancia de este caso es que permite mostrar algunas estrategias de manejo para prevenir complicaciones catastróficas.

Lupus and Perioperative Complications in Elective Primary Total Hip or Knee Arthroplasty

BACKGROUND: The number of patients with systemic lupus erythematosus (herein, lupus) undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA) is increasing. There is disagreement about the effect of lupus on perioperative complication rates. We hypothesized that lupus would be associated with higher complication rates in patients who undergo elective primary THA or TKA.METHODS: Records of more than 6.2 million patients from the National Inpatient Sample who underwent elective primary THA or TKA from 2000 to 2009 were reviewed. Patients with lupus (n = 38,644) were compared with those without lupus (n = 6,173,826). Major complications were death, pulmonary embolism, myocardial infarction, stroke, pneumonia, and acute renal failure. Minor complications were wound infection, seroma, deep vein thrombosis, hip dislocation, wound dehiscence, and hematoma. Patient age, sex, duration of hospital stay, and number of Elixhauser comorbidities were assessed for both groups. Multivariate logistic regression models using comorbidities, age, and sex as covariates were used to assess the association of lupus with major and minor perioperative complications. The alpha level was set to 0.001.RESULTS: Among patients who underwent THA, those with lupus were younger (mean age, 56 vs. 65 years), were more likely to be women (87% vs. 56%), had longer hospital stays (mean, 4.0 vs. 3.8 days), and had more comorbidities (mean, 2.5 vs. 1.4) than those without lupus (all p < 0.001). In patients with THA, lupus was independently associated with major complications (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.1 to 1.7) and minor complications (OR, 1.2; 95% CI, 1.0 to 1.5). Similarly, among patients who underwent TKA, those with lupus were younger (mean, 62 vs. 67 years), were more likely to be women (93% vs. 64%), had longer hospital stays (mean, 3.8 vs. 3.7 days), and had more comorbidities (mean, 2.8 vs. 1.7) than those without lupus (all p < 0.001). However, in TKA patients, lupus was not associated with greater odds of major complications (OR, 1.2; 95% CI, 0.9 to 1.4) or minor complications (OR, 1.1; 95% CI, 0.9 to 1.3).CONCLUSIONS: Lupus is an independent risk factor for major and minor perioperative complications in elective primary THA but not TKA.

Strategy of acetabular anteversion in total hip arthroplasty with lumbar degenerative kyphosis / 中国骨伤

OBJECTIVE@#To investigate how to place the anteversion of acetabular prosthesis more reasonably in patients with lumbar degenerative kyphosis.@*METHODS@#A total of 122 patients with degenerative kyphosis of lumbar spine who underwent total hip arthroplasty from December 2017 to October 2019 were included and divided into experimental group and control group, 61 cases in each group. In experimental group, there were 25 males and 36 females, with a median age of 67.0 years;the median course of disease was 46.0 months;the functional pelvic plane with acetabular anteversion was set according to different types of pelvic anterior plane bracket. In control group, there were 27 males and 34 females, with a median age of 67.0 years;the median course was 42.0 months;in control group, the anteversion was set by the traditional method. The patients were followed up for 3 months. The operation time and blood loss were recorded. The incidence of infection and dislocation within 3 months was counted. Harris score before and 3 months after operation was recorded. Functional anteversion angle of standing position was measured 3 months after operation.@*RESULTS@#Compared with control group, there was no difference in operation time and blood loss between the two groups (P=0.918, 0.381);there was no infection between two groups within 3 months after operation;there was 1 case of hip joint dislocation in the control group and no dislocation in experimental group. There was no significant difference in Harris score before and after operation. Three months later, reexamination of pelvic standing radiographs showed that the number of patients with functional anteversion of acetabular prosthesis outside the safe area was less in experimental group thanin control group (@*CONCLUSION@#According to the preoperative evaluation and classification of patients, better functional anteversion of acetabular prosthesis can be obtained with the help of pelvic anterior plane reference bracket in hip arthroplasty with lumbar degenerative kyphosis.

Luxación recidivante de la cadera en la neurofibromatosis tipo-1 / Recurrent hip dislocation in neurofibromatosis type-1

RESUMEN Introducción: La neurofribomatosis tipo 1 es un desorden genético común que puede afectar el esqueleto de forma frecuente. Las manifestaciones esqueléticas de la neurofibromatosis tipo 1 incluyen escoliosis, pseudoartrosis congénita de tibia y lesiones quísticas intraoseas. Objetivo: Describir las características clínicas e imagenológicas de esta enfermedad, encontradas en el caso que se presenta, así como el tratamiento realizado y la evolución de la paciente. Presentación del caso: Se presenta una luxación de la cadera resultante de un neurofibroma intraarticular en una paciente femenina de 17 años que sufrió un trauma menor. La luxación y su causa en esta paciente fueron sospechadas en un inicio por el cuadro clínico y los hallazgos anormales en las primeras radiografías de pelvis, y más tarde fue confirmada con tomografía axial computarizada e imágenes por resonancias magnéticas. Se le realizó una reducción cerrada bajo anestesia general con posterior tracción por partes blandas durante cuatro semanas. El caso fue seguido por consulta externa durante un año sin presentar un nuevo episodio de luxación de cadera. Conclusiones: La luxación recidivante de cadera asociada con neurofibromatosis tipo 1 es una ocurrencia rara y está poco reportada en la literatura. Este caso ilustra las características clínicas y sobre todo imagenológicas de la neurofibromatosis tipo 1, mediante las radiografías, imágenes por resonancia magnética y tomografía axial computarizada con reconstrucción. El tratamiento realizado, reducción cerrada bajo anestesia general con posterior tracción por partes blandas durante cuatro semanas, fue satisfactorio(AU)

ABSTRACT Introduction: Neurofribomatosis type 1 is a common genetic disorder that can frequently affect the skeleton. Skeletal manifestations of type 1 neurofibromatosis include scoliosis, congenital pseudoarthrosis of the tibia, and intraosseous cystic lesions. Objective: To describe the clinical and images characteristics of this disease, which are present in the case we report, and to describe the treatment and evolution of the patient. Case report: A hip dislocation resulting from an intra-articular neurofibroma is presented in a 17-year-old female patient who suffered minor trauma. Dislocation and its cause in this patient were initially suspected due to the clinical condition and abnormal findings on the first pelvis x-rays and later it was confirmed by computed tomography and magnetic resonance imaging. Closed reduction was performed under general anesthesia with posterior soft tissue traction for four weeks. The case was followed by outpatient consultation for one year with no new episode of hip dislocation. Conclusions: Recurrent hip dislocation associated with neurofibromatosis type 1 is a rare occurrence and it is poorly reported in the literature. This case illustrates the clinical and particularly imaging characteristics of type 1 neurofibromatosis, using x-rays, magnetic resonance imaging, and computed tomography with reconstruction. Closed reduction under general anesthesia was the treatment performed followed by soft tissue traction for four weeks, which was satisfactory(AU)

RÉSUMÉ Introduction: La neurofibromatose de type 1 (NF1) est un trouble génétique commun qui peut affecter fréquemment le squelette. Les manifestations squelettiques de la neurofibromatose de type 1 comprennent la scoliose, la pseudarthrose congénitale du tibia et les lésions kystiques intra-osseuses. Objectif: Décrire les caractéristiques cliniques et radiographiques de cette maladie rencontrées dans ce cas, ainsi que le traitement appliqué et l'évolution de la patiente. Présentation du cas: Le cas d'une patiente âgée de 17 ans atteinte de luxation de la hanche dû à un neurofibrome intra-articulaire et souffrant un traumatisme insignifiant, est présenté. Dès le début, la luxation et sa cause ont été suspectées, étant donné le tableau clinique et les résultats anormaux des premières radiographies du bassin, qui ont été confirmés plus tard par tomographie axiale assistée par ordinateur et IRM. Une réduction fermée sous anesthésie générale avec une traction postérieure des parties molles pendant quatre semaines a été réalisée. Ce cas a été suivi en consultation externe pendant un an sans présenter un nouvel épisode de luxation de hanche. Conclusions: La luxation récidivante de hanche liée à une neurofibromatose de type 1 est une affection rare et peu abordée dans la littérature. Ce cas met en évidence les caractéristiques cliniques, et particulièrement radiographiques, de la neurofibromatose de type 1 au moyen de radiographies, IRM et tomographie avec reconstruction. Le traitement appliqué, c'est-à-dire, la réduction fermée sous anesthésie générale avec une traction postérieure des parties molles pendant quatre semaines, a été satisfaisant(AU)

Evaluación del seguimiento radiográfico para desplazamiento de cadera en pacientes con parálisis cerebral en el Centro Hospitalario Pereira Rossell / Assessment of X-ray follow-up for hip displacement in patients with cerebral palsy at the Pereira Rossell Hospital / Avaliação do seguimento radiográfico para deslocamento de quadril em pacientescom paralisia cerebral no Hospital Pereira Rossell

Introducción: la luxación de cadera es una complicación severa en pacientes con parálisis cerebral (PC), sobre todo en pacientes incluidos en el sistema de clasificación de la función motora gruesa (GMFCS, por su sigla en inglés) III-V. Para su identificación son necesarias radiografías de pelvis. Objetivos: evaluar el seguimiento radiográfico en estos pacientes y la detección precoz de esta complicación en nuestro hospital. Material y método: se revisaron historias clínicas y radiografías de 17 pacientes GMFCS III-V, entre 2 y 8 años de edad al momento de la radiografía de pelvis índice, midiendo el porcentaje de migración (PM) de cadera de acuerdo al índice de Reimer, el ángulo cérvico-diafisiario y calculando el CPUP Score de cada cadera. Evaluamos el control radiográfico al año o posteriormente a esa fecha, y de no haber sido así, se citaría a los pacientes a control radiológico para detectar las caderas con riesgo migratorio elevado. Resultados: de los 17 pacientes evaluados, 3 (18%) tuvieron una nueva radiografía de pelvis al año; 6 (35%) pacientes la tuvieron posteriormente al año, y antes de la fecha de control designada, 7 (41%) pacientes nunca fueron controlados, citándose para nueva radiografía en 2018. Un paciente (6%) se perdió en el seguimiento. Un paciente presentó una cadera con riesgo alto (CPUP Score 50%-60%), el resto tuvo PM dentro de rangos normales. Conclusiones: pocos pacientes con PC GMFCS III-V tuvieron un seguimiento radiográfico anual. Los monitoreados posteriormente no mostraron progresión de esta condición. El resultado de este estudio y la literatura respaldan la introducción de un programa de vigilancia en nuestro hospital.

Introduction: hip luxation is a severe complication in patients with cerebral palsy (CP), especially in gross motor functional classification system (GMFCS) III-V patients. Pelvic x-rays are necessary to identify this condition. Objectives: to assess the x-ray follow-up in these patients and the early detection of this complication in our hospital. Method: the medical records and x-rays of 17 GMFCS III-V patients who were between 2 and 8 years old at the time of index pelvic x-ray were reviewed, measurement of the hip migration percentage according to Reimer´s index, the cervical-diaphyseal angle and calculation of the CPUP hip score for each hip. We assessed the follow-up x-ray a year later or later than that date, and in the even this had not happened, we would call the patients in for a control x-ray to identify the hips with an increase migration risk. Results: 3 (18%) out of 17 patients assessed underwent a new pelvic x-ray a year later. 6 patients (35%) underwent one later than one year after and prior to the control visit planned, 7 (41%) patients were never controlled and they were called for a new x-ray in 2018. One patient (6%) was lost during follow-up. One patient had an increased risk hip (CPUP Score 50-60%), the rest had normal migration percentages. Conclusions: few patients with PC GMFCS III-V underwent annual follow-up. Those monitored did not evidence progression of this condition. This study and the relevant literature back up the introduction of a surveillance program in our hospital.

Introdução: a luxação de quadril é uma complicação grave nos pacientes com paralisia cerebral (PC), principalmente nos pacientes "Gross motor funcional classificativo system (GMFCS) III-V". Para sua identificação é necessário realizar radiografias de pélvis. Objetivos: avaliar o seguimento radiográfico nesses pacientes e realizar a detecção precoce desta complicação no hospital. Material e método: foram estudados os prontuários e radiografias de 17 pacientes GMFCS III-V, com idades entre 2 e 8 anos no momento da radiografia de pélvis índice, medindo a porcentagem de migração (PM) de quadril de acordo com o índice de Reimer, o ângulo cervico-diafisiario e calculando o CPUP Score de cada quadril. Foi feito o controle radiográfico um ano ou mais depois da data da realização da radiografia; quando não foi possível os pacientes foram convocados para a realização de controle radiológico para detectar os quadris com risco migratório elevado. Resultados: dos 17 pacientes avaliados, 3 (18%) realizaram uma nova radiografia de pélvis um ano depois da primeira, 6 (35%) pacientes depois de um ano mas antes de ser convocados para controle, 7 (41%) pacientes nunca foram controlados, sendo convocados para uma nova radiografia em 2018. Um paciente (6%) foi perdido. Um paciente apresentou um quadril com risco alto (CPUP Score 50-60%), os demais tinham PM dentro de intervalos normais. Conclusões: poucos pacientes com PC GMFCS III-V tiveram um seguimento radiográfico anual. Os que foram monitorados posteriormente não mostraram progressão desta condição. O resultado deste estudo e a literatura respaldam a introdução de um programa de vigilância no nosso hospital.

Luxación anterior obturatriz traumática de cadera en la edad pediátrica: reporte de un caso / Anterior dislocation traumatic hip obturator in pediatric age: a case report / Obturador traumático de cadeira com luxação anterior em idade pediátrica: relato de caso

La luxación de cadera de tipo anterior-obturatriz es una patología inusual en la ortopedia pediátrica pero con complicaciones potencialmente graves en la evolución. A propósito, presentamos el caso de una niña de 14 años que sufrió una luxación anterior-obturatriz secundaria a un traumatismo de alta energía. Se le realizo reducción cerrada en block quirúrgico bajo anestesia general, con buena evolución y sin complicaciones, con un seguimiento 24 meses.

Hip dislocation of the anterior-obturator type is an unusual pathology in pediatric orthopedics, but with potentially serious complications in evolution. By the way, we present the case of a 14-year-old girl who suffered a secondary anterior-obturator dislocation and high-energy trauma. A closed reduction was made in the surgical block under general anesthesia, with good evolution and without complications in a follow-up of 24 months.

A luxação anterior-luxação do quadril obturador é uma patologia incomum em ortopedia pediátrica, mas com complicações potencialmente graves na evolução. A propósito, apresentamos o caso de uma menina de 14 anos que sofreu um deslocamento obturador prévio secundário a trauma de alta energia. Uma redução fechada foi realizada no bloco cirúrgico sob anestesia geral, com boa evolução e sem complicações no seguimento de 24 meses.

The Effect of Graft Positions on the Stability of Total Hip Arthroplasty with Different Types of Subtrochanteric Shortening / Efeito das posições dos enxertos na estabilidade da artroplastia total de quadril com diferentes tipos de encurtamento subtrocantérico

Abstract Objective The aim of the present study is to investigate the biomechanical stability of different subtrochanteric osteotomy types and graft positions in cases of dysplastic coxarthrosis that require total hip arthroplasty with shortening osteotomy, as well as to find out the most effective osteotomy type and graft position. Method Femur sawbones were used to compare different types of femoral shortening osteotomy (transverse, oblique, and step-cut). Strut grafts, which were prepared at the side of the subtrochanteric shortening osteotomy, were fixed in different positions (anterolateral, mediolateral, and anteroposterior). The fixation of the strut grafts was performed using two steel cables (with 2.0mm of thickness) with the same strength. The failure values of composite femurs were recorded for axial and rotational loadings. Results Biomechanically, there were no statistically significant differences between the types of femoral subtrochanteric shortening osteotomy and the positions of the applied strut graft. Conclusion No superiority was observed between the types of femoral subtrochanteric shortening osteotomy regarding stability. Additionally, against stress, similar results were obtained for different strut graft positions. In conclusion, we believe that using the method in which the surgeon is experienced and that is the easiest to apply would be the best choice.

Resumo Objetivo O objetivo do presente estudo é investigar a estabilidade biomecânica de diferentes tipos de osteotomias subtrocantéricas e posições de enxertos em coxartroses displásicas que necessitam de artroplastia total de quadril com osteotomia de encurtamento, e determinar o tipo de osteotomia e a posição do enxerto que são mais eficazes. Método Modelos de fêmur (sawbones) foram usados para comparar os tipos de osteotomia de encurtamento femoral (transversal, oblíqua e emdegrau de escada [step-cut]). Os enxertos em haste, preparados do lado da osteotomia subtrocantérica, foram fixados em diferentes posições (ântero-lateral, medial-lateral e ântero-posterior). A fixação dos enxertos foi feita com2 cabos de aço (de 2,0mmde largura) de mesmaresistência.Os valores de falha dos fêmures compostos para cargas axiais e rotacionais foram registrados. Resultados Do ponto de vista biomecânico, não houve diferenças estatisticamente significativas entre os tipos de osteotomia de encurtamento subtrocantérico femoral e as posições dos enxertos em haste aplicados. Conclusão Não houve superioridade entre os tipos de osteotomia de encurtamento subtrocantérico femoral quanto à estabilidade. Além disso, em relação à resistência ao estresse, os resultados obtidos com diferentes posições das hastes foram similares. Assim, acreditamos que o método mais indicado é aquele em que o cirurgião é experiente e cuja aplicação é mais fácil.

Diagnosis and Management of Hip Dislocation in Patients with Kabuki Syndrome

BACKGROUND: Kabuki syndrome is a rare genetic disorder characterized by distinct dysmorphic facial features, growth deficiency, intellectual disabilities, unusual dermatoglyphic patterns, and skeletal abnormalities. The incidence of hip dislocation in Kabuki syndrome ranges from 18% to 62%. We reviewed the outcomes of management of hip dislocations in patients with Kabuki syndrome with special attention to the diagnostic processes for hip dislocation and Kabuki syndrome. METHODS: Among 30 patients with mutation-confirmed Kabuki syndrome, we selected six patients who had hip dislocations and reviewed their medical records and plain radiographs. The modes of presentation and diagnostic processes for both hip dislocations and Kabuki syndrome were investigated. The management and treatment outcomes of hip dislocations in patients with Kabuki syndrome were evaluated. RESULTS: The average age of patients at the time of diagnosis of hip dislocation was 7.7 months (range, 1 week to 22 months). None of the patients were diagnosed as having Kabuki syndrome at that time. Two patients were treated with a Pavlik harness; one, with closed reduction; two, with open reduction and later pelvic and/or femoral osteotomies; and one, with open reduction combined with pelvic osteotomy. The patients were followed up for 5.8 years on average (range, 2.0 to 10.5 years). The radiologic outcome was graded as Severin IA or IB for three patients who were older than 6 years at the latest follow-up (mean age, 9.9 years; range, 7.8 to 12.4 years). In the remaining three patients younger than 6 years (mean age, 3.8 years; range, 2.7 to 5.3 years), the lateral center edge angle was more than 15°. The clinical diagnosis of Kabuki syndrome was made during follow-up after hip dislocation treatment and confirmed by mutational analysis at a mean age of 4.7 years. The mean interval between the diagnosis of hip dislocation and Kabuki syndrome was 4.0 years. CONCLUSIONS: The management of hip dislocation by conservative or surgical method showed successful results. Awareness of Kabuki syndrome could lead to an early diagnosis of this rare disease in patients with hip dislocation and allow for early detection of other underlying conditions and multidisciplinary management.