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1

Screening for congenital dislocation of the hip  

International Nuclear Information System (INIS)

Although the prevalence of (idiopathic) congenital dislocation of the hip (CDH) within the Member States of the European Community is not exactly known, it must be considered as a major problem of public health care and protection. By assessment of available data one can assume that between 1 and 2% of all newborns have dislocation or instability of one or both hips. There is a female predominance of 4:1 and some risk factors are known. The reasons of a higher prevalence in some areas are not yet well understood. Most of instable hips will spontaneously become stable within the first days or weeks of life. However, a considerable number of infants (less than 1%) will remain with instable hips which may dislocate. Dislocation either present at birth or as a result of persistent instability leads to subsequent hip deformation. This is a serious event for each affected individual, and is a heavy load on health care and social costs for the public. Treatment of CDH is easy and usually effective when started early, i.e. before the fourth month of life. The earlier treatment is started the easier, shorter, safer and less expensive it is and its impairment on child development and mother-child interaction can be held to a minimum. Screening for CDH is therefore the most important part of health protection in early infancy. However, this paper concludes that neither sonography nor X-ray examinations are appropriate for CDH screening

1987-01-01

2

Breech position, delivery route and congenital hip dislocation.  

UK PubMed Central (United Kingdom)

The purpose of this study was to investigate whether the mode of delivery for fetuses in breech presentation in any way influenced the frequency of congenital hip dislocation. In 13,559 singleton births 583 fetuses were in breech position, and the cesarean section rate was 39.1%. Eighty-three infants were born with congenital hip dislocation, 11 of whom had been in breech position. Of these 11, cesarean section was required in 5 cases. There was no difference in frequency of congenital hip dislocation between fetuses in breech presentation delivered by cesarean section vs. by the vaginal route. The frequency of breech presentation in congenital hip dislocation was 13.3%. Including 7 external versions, the rate was 21.7%. Female to male ratio was 4:1. The frequency of congenital hip dislocations in infants born in vertex presentation was 5.5 per mille and for infants born in breech presentation it was 18.9 per mille.

Clausen I; Nielsen KT

1988-01-01

3

Surgical treatment of congenital dislocation of the hip.  

UK PubMed Central (United Kingdom)

The results of two collective studies on congenital dislocation of the hip (CDH) from a number of hospitals are reported here, including general trends in the Federal Republic of Germany and the author's personal methods and preferences. In the first collective study group, the rate of ischemic necrosis in open reductions was 8.2% for anterolateral approaches, 9.6% for inguinal, 16.7% for Ludloff's operation, and only 5.5% when shortening osteotomy was combined with open reduction. A simultaneous Salter osteotomy or acetabuloplasty increased the rate to 10.3% and a concomitant varus osteotomy to 22.2%. The author prefers an inguinal approach to the hip joint, first laterally and then medially of the iliopsoas muscle and femoral nerve, for optimal visualization of the acetabulum. Stability of the joint is increased by a girdle-like flap from the dorsolateral capsule, which is drawn anteriorly and prevents dorsal redislocation. Acetabuloplasty should also be used, even during the first year of life, in joints in which stability may only be guaranteed by extreme abduction and internal rotation. Salter's and Pemberton's osteotomies are used in Germany with good results. However, the author prefers a lateral Albee-Lance acetabuloplasty modified to a complete osteotomy for lateral levering of the acetabular roof. Long-term results show measurements between 82% and 93% of normal and slightly pathologic values. Simultaneous or single varus osteotomies lead to subcapital coxa valga and should no longer be used routinely. In adolescents and adults up to 45 years of age, as long as osteoarthritis is not too advanced and the femoral head is not too deformed, triple pelvic osteotomy with the author's type of modification has a number of advantages.

Tönnis D

1990-09-01

4

Weaver syndrome associated with bilateral congenital hip and unilateral subtalar dislocation  

Science.gov (United States)

Background: Weaver syndrome is a congenital paediatric syndrome characterized by mental, respiratory and musculoskeletal manifestations. The coexisting deformities of the skull, the face, fingers and toes are typical. We report a case of a girl with Weaver syndrome associated with rare bilateral congenital dislocation of the hips associated with congenital hypoplastic talus and subtalar dislocation of her ankle joint. Case Report: A 3-year old girl was admitted in our department with typical manifestations of Weaver syndrome, associated with congenital dislocation of bilateral hips, hypoplastic talus and subtalar dislocation of her right ankle. She was in pain while standing upright and incapable of independent walking. Both hips were treated operatively with open reduction and bilateral iliac osteotomy. Two years afterwards she had an open reduction of her talus and extraarticular arthrodesis of her subtalar joint in her right ankle. Six years postoperatively after the hip operations and four years after the ankle operation the girl is ambulant with a painless independent and unaided walking with a mild limp and full range of movements in all the operated joints. Conclusions: We suggest that children with Weaver syndrome and disabling musculosceletal deformities, particularly affecting their ability to stand up and walk should be treated early, before bone maturity, in order to achieve the best potential musculoskeletal as well as developmental outcome.

Mikalef, P; Beslikas, T; Gigis, I; Bisbinas, I; Papageorgiou, T; Christoforides, I

2010-01-01

5

Treatment of congenital dislocation of the hip. Management before walking age.  

UK PubMed Central (United Kingdom)

Neonatal infants with Ortolani-positive dislocated hips are easily managed by reduction and maintenance of the reduction using a divarication splint, cast, or Pavlik harness. Sixty-six patients with 85 complete, congenitally dislocated hips (Ortolani negative) unassociated with other neuromuscular disorders were examined to assess a method of prereduction traction in the treatment of congenital dislocation of the hip. Forty of the 66 patients were six months of age or younger at the beginning of traction treatment. The remaining 26 were younger than 12 months of age prior to the treatment protocol. Overhead traction with the hip flexed to 90 degrees was employed. Gradual hip abduction to 70 degrees (140 degrees combined abduction) was accomplished over the next ten to 14 days. If the dislocated hip was still in a station above Hilgenreiner's line, then cross traction was applied to add another vector of force to pull the femoral head distally. At an average of 18 days into the treatment protocol, an examination under anesthesia with closed reduction was performed and the patient immobilized in a double hip spica in the "human" position for six to eight weeks. This was followed by use of an Ilfeld divarication splint for nine months. This traction/reduction program was effective in 91% of these cases (60 of 66). Six patients (ten hips) required an open procedure because of persistent instability in spite of reducibility. To date, there is no incidence of avascular necrosis using the criteria of Salter for whole head avascular necrosis and the criteria of Kalamchi and MacEwen for partial head avascular necrosis.

DeRosa GP; Feller N

1987-12-01

6

Ultrasound screening and follow-up of congenital hip dislocation  

International Nuclear Information System (INIS)

US screening for hip dysplasia was performed on 1421 full-term newborns. The study was aimed at: 1) evaluating US feasibility in an unselected maternity ward population; 2) determining the frequency of the different types of hips, and correlating ours with literature data; 3) evaluating the efficacy of both an early prevention and treatment. All US examination were performed within the first week of life and the 2842 hips classified according to Graf. At birth, normal hips (Ia, Ib) were 2064 (72.6%) (group I); Physiologically immature hips (IIa) were 721 (25.4%) (group II); pathological hips (group III) were: 43 (1.5%) IIc, 8 (o.3%) IId, 6 (0.2%) III. Hips in group B were cheked at 3 months: 502 were normal, 51 were type IIb, and 1 was type IId: the latter 52 hips were treated and normalized in the following months. Hips in group C (types IIc, IId, and III=57 hips) were treated and cheked every seventh week until normalization. Our experience confirm US value in the evaluation of hip dysplasia in the newborn. In our opinion, the use of this method shoul be encouraged, although US screening of all newborns remains controversial on a cost-benefit ratio. Multicentric studies will better define US sensitivity, specificity and reliability. The correlation of ours results with literature data was difficult, because study populations are not always homogeneous. As for therapy, we found the plastic splint very effective and easy to use: In 2 cases, Milgram devices were used for a few months

1990-01-01

7

Hip-spine syndrome: total sagittal alignment of the spine and clinical symptoms in patients with bilateral congenital hip dislocation.  

UK PubMed Central (United Kingdom)

STUDY DESIGN: The influence of the pathologic state of the hip joint on the total sagittal alignment of the spine was investigated in patients with congenital hip dislocation retrospectively OBJECTIVE: The purpose of this study was to analyze the total sagittal alignment of the spine and the clinical symptoms in patients with bilateral congenital hip dislocation. SUMMARY OF BACKGROUND OF DATA: Abnormality in the hip joint causes abnormal curvature of the sagittal alignment of the spine and induces lumbago or lower leg pain. However, there have been no reports on the influence of bilateral congenital hip dislocation on the sagittal alignment of the spine. MATERIALS AND METHODS: A total of 9 patients (8 females and 1 male) were analyzed. Their average age was 57 years (range, 46-68 years). We measured the thoracic kyphosis (T1-T12), the lumbar lordosis (L1-S), the sacral inclination (SI), the femoral flexion angle (FFA), pelvic angulation (PA), and the distances from the pelvic hip axis (HA) to the C7 plumb line and from the promontorium to the C7 plumb line. To evaluate clinical symptoms, we used the Japanese Orthopedic Association (JOA) score of low back pain (full score is 29 points) and Visual Analog Scale (VAS) for lower back pain and lower leg pain, and the possible time of walking without rest. RESULTS: The average thoracic kyphosis, lumbar lordosis, SI, and PA were 42 degrees , -78 degrees , 68 degrees , and 27 degrees , respectively. The FFA averaged 10 degrees , leading to a duck-like posture. The distances from HA and, promontorium to the C7 plumb line averaged -2 cm and 4 cm, respectively. A posterior shift of the gravity line with respects to the hips was compensated for by lumbar hyperlordosis, which led to a posterior shift of the center of the spine. Regarding the clinical symptoms, the JOA score averaged 20 points and the VAS for lower back pain (lumbago) and lower leg pain averaged 6.4 and 3.1, respectively. The average possible walking time without rest was 20 minutes. CONCLUSION: The total sagittal alignment of the spine in patients with bilateral hip dislocation was compensated for by anterior angulation of the pelvis and by lumbar hyperlordosis. The main clinical symptoms were lower back pain, and not lower leg pain.

Matsuyama Y; Hasegawa Y; Yoshihara H; Tsuji T; Sakai Y; Nakamura H; Kawakami N; Kanemura T; Yukawa Y; Ishiguro N

2004-11-01

8

Total hip arthroplasty in the neglected congenital dislocation of the hip. A five- to 14-year follow-up study.  

UK PubMed Central (United Kingdom)

A retrospective study was performed on 34 hips of 28 patients with neglected congenital dislocation of the hip after cemented total hip arthroplasty (THA) using a straight-stem prosthesis in 21 and a curve-stem prosthesis in 13 hips. The mean age at operation was 49 years (28-72 years) and the mean follow-up period was 9.4 years (5.6-14 years). Functional evaluation using Merle d'Aubigné Hip Score showed 71% success rate. Radiographic loosening occurred in three femoral and eight acetabular components attributable to poor cementing in all stems and three sockets, and to dislocation due to trauma and graft collapse in two sockets. Marked acetabular deficiency showed increased incidence of socket loosening. Both types of prostheses showed the same statistical results. Localized endosteal osteolysis appeared in five hips at the sites of less than 1-mm cement thickness. Greater trochanter nonunion reduced the functional status evidenced by pain, limping, and a statistically significant Trendelenburg sign. Proper cementing, effective acetabular reconstruction, and prevention of trochanter nonunion can produce excellent long-term results.

Anwar MM; Sugano N; Masuhara K; Kadowaki T; Takaoka K; Ono K

1993-10-01

9

Total hip arthroplasty in the neglected congenital dislocation of the hip. A five- to 14-year follow-up study.  

Science.gov (United States)

A retrospective study was performed on 34 hips of 28 patients with neglected congenital dislocation of the hip after cemented total hip arthroplasty (THA) using a straight-stem prosthesis in 21 and a curve-stem prosthesis in 13 hips. The mean age at operation was 49 years (28-72 years) and the mean follow-up period was 9.4 years (5.6-14 years). Functional evaluation using Merle d'Aubigné Hip Score showed 71% success rate. Radiographic loosening occurred in three femoral and eight acetabular components attributable to poor cementing in all stems and three sockets, and to dislocation due to trauma and graft collapse in two sockets. Marked acetabular deficiency showed increased incidence of socket loosening. Both types of prostheses showed the same statistical results. Localized endosteal osteolysis appeared in five hips at the sites of less than 1-mm cement thickness. Greater trochanter nonunion reduced the functional status evidenced by pain, limping, and a statistically significant Trendelenburg sign. Proper cementing, effective acetabular reconstruction, and prevention of trochanter nonunion can produce excellent long-term results. PMID:8403636

Anwar, M M; Sugano, N; Masuhara, K; Kadowaki, T; Takaoka, K; Ono, K

1993-10-01

10

METHOD OF TREATING CONGENITAL DISLOCATED HIP IN CHILDREN  

UK PubMed Central (United Kingdom)

FIELD: medicine. ^ SUBSTANCE: invention refers to medicine, namely to paediatric surgery, orthopaedics and can be used for treatment of said congenital pathology. An additional iliofemoral ligament is formed of an autologous joint capsule with its principal attachment point at a cavity edge to preserve blood supply and innervation that leads to its complete engraftment, performing a function of stable strong hold of the femoral head in the cavity. ^ EFFECT: prevented lateroposition of the femoral head. ^ 1 ex, 6 dwg

KOZHEVNIKOV VADIM VITAL EVICH; OSIPOV ARSEN ASHOTOVICH

11

Three-dimensional CT and MR imaging in congenital dislocation of the hip: Technical considerations  

International Nuclear Information System (INIS)

Two-dimensional (2D) software techniques were developed to generate diagnostic-quality three-dimensional (3D) MR studies in two patients with congenital dislocation of the hip. Comparable 3D CT studies were obtained in two other patients. Unsharp masks were divided into the original MR images to correct for local variations in signal intensity. Combinations of first- and second-echo images improved the object contrast. Pixels with insufficient homogeneity relative to their neighboring data were excluded. CT did not require 2D preprocessing. Three-dimensional CT and MR images demonstrated subluxation and dislocation. 3D MR, in contrast to CT, demonstrated the cartilaginous femoral head. The described 2D MR preprocessing provides diagnostic-quality 3D MR studies. It will be useful for generating 3D MR images of other anatomic structures

1987-12-04

12

[Use of the Pavlik harness before the age of 3 months in congenital hip dislocation  

UK PubMed Central (United Kingdom)

The authors report 128 cases of reduction of congenital dislocation of the hip by the Pavlik harness with more than one year of follow-up. They studied 60 patients who had less than 3 months of age at the beginning of the treatment. They obtain 59 reductions (98%) without necrosis of femoral heads. The only case of unsuccess, treated after by continuous extension, has doubtful femoral heads at 15 months of age. The femoral heads appear in normal delay and walk was normal between 10 and 18 months. Only a strict watchfulness, as strict as a continuous extension, can obtain good results with progressive flexion. Bath is not authorized and harness is not removed before stable reduction. Parents are taught how to hold their infant without bringing his knees together. The most important thing is the X-ray control on D8, D21, and D60, the prevent the trap of too much flexion, too nice penetration or persistent eccentration. Under these conditions, the authors think that the treatment of congenital dislocation of the hip by the Pavlik harness is the safest method especially before 3 months of age.

Saint-Supery G; Wallon P; Bucco P; Rivet D

1986-01-01

13

[Clinical and ultrasonic diagnosis of congenital hip dislocation (dynamics of changes in early therapy)  

UK PubMed Central (United Kingdom)

The authors present part of their prospective epidemiological study of congenital dysplasia of hip joints within which newborns were examined by ultrasonogram prior to the beginning of the therapy. Apart from the standard examination in the frontal plane after Graf they examined on principle also the ultrasonographic stability by the dynamic test after Schuler as well as by the application of the probe anteriorly with the simultaneous provocation according to Palmén. The authors have processed pathological ultrasonographic findings in 53 newborns (64 hip joints). The technique of the examination by ultrasound from the anterior approach is explained in detail. The comparison of both dynamic tests has shown that the examination from the anterior approach is considerably more sensitive than Schuler's dynamic test and also fully correlates with the clinical finding. It is a fact that the shift of the head in the flexion dorsally represents the most important component of the movement in unstable hip joint during provocation, it is far more noticeable than the lateralization of the head or the shift in the cranial direction. After achieving ultrasonographic stability the classical Graf method is sufficient for the registration of residual changes on the acetabular rim. The follow-up of patients until their complete healing has shown a surprisingly rapid remodellation of hip joints. The whole complex of clinically unstable hip joints has been divided into subgroups according to Graf classification. In type IIc or IId on the basis of ultrasonographic examination from the anterior approach the stable joints from the ultrasonographic viewpoint have been distinguished from unstable ones. The follow-up carried out in short intervals has shown that of longest duration is the remodellation of total dislocation and, on the contrary, of shortest duration is the healing of joints in the IIc or IId type. An absolute majority of affected hip joints have become normal until 3rd month of the age. The complex does not include two patients with teratological dislocation, the incidence of which has been determined in our study by the ratio of 2 cases in 35,550 of timely examined newborns. The role of the factor of spontaneous stabilization cannot be in this part of the study completely discounted. However, herewith we present part of an accomplished epidemiological study where the number of timely diagnosed patients including late diagnoses corresponds to the number of dislocations and subluxations determined within the conventional late diagnosis.

Poul J; Procházka J; Klimsová J; Janovec M; Bajerová J; Jíra I; Straka M; Sommernitz M

1990-08-01

14

Total hip arthroplasty for congenital hip disease.  

UK PubMed Central (United Kingdom)

BACKGROUND: It is generally agreed that the clinical and radiographic results of total hip replacement performed for degenerative arthritis secondary to congenital hip disease vary depending on the severity of the anatomical abnormality. In this study, we report the mid-term and long-term clinical and radiographic results of total hip arthroplasty performed for each of the three different types of congenital hip disease. METHODS: Between 1976 and 1994, the senior author performed 229 consecutive primary total hip arthroplasties in 168 patients with osteoarthritis secondary to congenital hip disease. Seventy-six hips were dysplastic, sixty-nine had a low dislocation, and eighty-four had a high dislocation. The Charnley low-friction technique was performed in 178 hips, and the so-called hybrid technique was performed in forty-six hips. Cementless arthroplasty was used in only five hips. RESULTS: After a minimum of seven years of follow-up, the rates of revision of the acetabular components were 15% in the dysplastic hips, 21% in the hips with a low dislocation, and 14% in those with a high dislocation. The rates of revision of the femoral components were 14%, 14%, and 16%, respectively. Survivorship analysis predicted an overall rate of prosthetic survival at fifteen years of 88.8% +/- 4.8% in the dysplastic hips, 73.9% +/- 7.2% in the hips with a low dislocation, and 76.4% +/- 8.1% in those with a high dislocation. CONCLUSIONS: An understanding of the anatomical abnormalities and the use of appropriate techniques and implants make total hip arthroplasty feasible for treatment of the three types of congenital hip disease. In patients with a low dislocation, the major technical problem is reconstruction of the natural acetabulum. In those with a high dislocation, the challenge is to place the acetabular component inside the reconstructed true acetabulum and to use an appropriate femoral implant in the hypoplastic narrow femoral diaphysis.

Hartofilakidis G; Karachalios T

2004-02-01

15

A new open reduction treatment for congenital hip dislocation: long-term follow-up of the extensive anterolateral approach.  

Directory of Open Access Journals (Sweden)

Full Text Available Congenital hip dislocation, which is conservatively unmanageable, has usually been treated using open reduction. However, a long-term follow-up study of the results suggests that this procedure is unsatisfactory. Since 1973, Tanabe has used a new open reduction procedure that circumferentially dissects the joint capsule and produces sufficient concentric reduction of the femoral head in the acetabulum immediately after the surgery. Fifty-six children (65 hips) from the age of 1 to 3 years were treated by this procedure, and fifty-one of them were clinically and roentgenographically followed up from 6.3 to 12.4 years after the surgery. At the final follow-up session, all children had grown to be over 9 years of age, and no patient had clinically significant symptoms. According to Severin's classification, 33 hips were rated in Group I, and 14 hips in Group II. Another 10 hips were in Group III, and one hip was in Group IV. The incidence of avascular necrosis was 5.2 per cent. These data suggest that our procedure is more useful than the previous ones.

Akazawa,Hirofumi; Tanabe,Gozo; Miyake,Yoshimasa

1990-01-01

16

Aetiology and interrelationship of some common skeletal deformities. (Talipes equinovarus and calcaneovalgus, metatarsus varus, congenital dislocation of the hip, and infantile idiopathic scoliosis).  

Digital Repository Infrastructure Vision for European Research (DRIVER)

The Edinburgh Register of the Newborn 1964-1968 and the Edinburgh Scoliosis Clinic 1964-1971 have been used to establish the population frequency in the city of the idiopathic forms of talipes equinovarus and calcaneovalgus, metatarsus varus, congenital dislocation of the hip, and infantile scoliosi...

Wynne-Davies, R; Littlejohn, A; Gormley, J

17

Congenital dislocation of the knee.  

UK PubMed Central (United Kingdom)

Congenital dislocation of the knee is a very rare condition, the incidence in Scandinavia hitherto not being known with certainty. Thirteen patients treated during the years 1960 to 1983 with 19 affected knees were reviewed and followed up. Findings of muscular imbalances in nine of these cases and of spinal abnormalities in four cases strongly indicate neuromuscular imbalance as an aetiological factor. The minimum incidence was estimated to be 0.017 per mille or approximately 1 per cent of the incidence of congenital dislocation of the hip. Recommendations for treatment are that manipulation should be carried out gently, and if not successful within 2-3 months and in all cases of Grade III, an operation is indicated. Too many newborn children in this series had manipulation fractures or slipped epiphyses. However, signs of fracture had disappeared at follow-up in most cases.

Jacobsen K; Vopalecky F

1985-02-01

18

Congenital knee dislocation in a 49,XXXXY boy.  

Digital Repository Infrastructure Vision for European Research (DRIVER)

We report on a 12 year old mentally retarded boy who presented at birth with bilateral knee dislocations, dislocation of the right hip, and general joint laxity. Cytogenetic studies showed a 49,XXXXY karyotype. Hyperlaxity of joints is known to occur in 49,XXXXY patients, but congenital knee disloca...

Sijmons, R H; van Essen, A J; Visser, J D; Iprenburg, M; Nelck, G F; Vos-Bender, M L; de Jong, B

19

Morphology of untreated bilateral congenital dislocation of the hips in a seventy-four-year-old man.  

UK PubMed Central (United Kingdom)

Two untreated completely dislocated hips were examined pathologically in a 74-year-old male dissecting room cadaver. The femoral heads bilaterally were 9 cm above the acetabular fossae. They lay adjacent to each ilium with no secondary acetabulum formation. A thickened and markedly elongated fibrous capsule appeared to be the major structure that had checked further migration of the femoral heads during weight-bearing. The femoral heads, although slightly flattened medially and somewhat smaller in size than in the normal adult, showed no degenerative arthritis. Dysplastic acetabular fossae were filled with soft tissue. Bone-to-bone contact with secondary degenerative changes was present only where the femurs, at the level of the lesser trochanters, rubbed against the overhanging superior acetabular rims.

Milgram JW

1976-09-01

20

Traumatic hip dislocation in childhood.  

Science.gov (United States)

Traumatic dislocation of the hip in childhood is uncommon and can be a consequence of minor trauma. The authors report a series of 35 dislocations in skeletally immature patients. Most were isolated posterior dislocations without acetabular lesions. In 75% of cases, reduction of the dislocation was easy. Nine children required surgery to remove interposed joint capsule and/or osteochondral fragments to achieve anatomic reduction. Outcomes were generally good, except in one patient in whom a displaced fracture of the femoral physis was followed by total head avascular necrosis. One case of partial necrosis had a satisfactory outcome. Epiphyseal necrosis, though uncommon, appeared to be inconsistent to prevent and hard to predict. Bone scan seems to be more effective than MRI for the detection of necrosis. PMID:15718889

Vialle, Raphaël; Odent, Thierry; Pannier, Stéphanie; Pauthier, François; Laumonier, Frédéric; Glorion, Christophe

 
 
 
 
21

Traumatic hip dislocation in childhood.  

UK PubMed Central (United Kingdom)

Traumatic dislocation of the hip in childhood is uncommon and can be a consequence of minor trauma. The authors report a series of 35 dislocations in skeletally immature patients. Most were isolated posterior dislocations without acetabular lesions. In 75% of cases, reduction of the dislocation was easy. Nine children required surgery to remove interposed joint capsule and/or osteochondral fragments to achieve anatomic reduction. Outcomes were generally good, except in one patient in whom a displaced fracture of the femoral physis was followed by total head avascular necrosis. One case of partial necrosis had a satisfactory outcome. Epiphyseal necrosis, though uncommon, appeared to be inconsistent to prevent and hard to predict. Bone scan seems to be more effective than MRI for the detection of necrosis.

Vialle R; Odent T; Pannier S; Pauthier F; Laumonier F; Glorion C

2005-03-01

22

Congenital knee dislocation in a 49,XXXXY boy.  

Science.gov (United States)

We report on a 12 year old mentally retarded boy who presented at birth with bilateral knee dislocations, dislocation of the right hip, and general joint laxity. Cytogenetic studies showed a 49,XXXXY karyotype. Hyperlaxity of joints is known to occur in 49,XXXXY patients, but congenital knee dislocation has not been reported. Rarely in 49,XXXXY and 49,XXXXX syndromes Larsen-like features may be seen. Patients with congenital joint dislocation or laxity, combined with other malformations, especially if psychomotor development is delayed, should be karyotyped to exclude chromosomal abnormalities. PMID:7643364

Sijmons, R H; van Essen, A J; Visser, J D; Iprenburg, M; Nelck, G F; Vos-Bender, M L; de Jong, B

1995-04-01

23

Congenital knee dislocation in a 49,XXXXY boy.  

UK PubMed Central (United Kingdom)

We report on a 12 year old mentally retarded boy who presented at birth with bilateral knee dislocations, dislocation of the right hip, and general joint laxity. Cytogenetic studies showed a 49,XXXXY karyotype. Hyperlaxity of joints is known to occur in 49,XXXXY patients, but congenital knee dislocation has not been reported. Rarely in 49,XXXXY and 49,XXXXX syndromes Larsen-like features may be seen. Patients with congenital joint dislocation or laxity, combined with other malformations, especially if psychomotor development is delayed, should be karyotyped to exclude chromosomal abnormalities.

Sijmons RH; van Essen AJ; Visser JD; Iprenburg M; Nelck GF; Vos-Bender ML; de Jong B

1995-04-01

24

Epidemiology, demographics, and natural history of congenital hip disease in adults.  

UK PubMed Central (United Kingdom)

This study examined the epidemiology and demographics of congenital hip disease in 468 (660 hips) patients who were examined between 1970 and 1996. In 356 (54%) hips, the diagnosis was secondary osteoarthritis due to congenital hip disease, and in 272 (41%) hips, the diagnosis was idiopathic osteoarthritis. In the remaining 32 (5%) hips, the diagnosis was uncertain. Of the hips with congenital hip disease, 170 (47.7%) hips were dysplastic, 85 (23.9%) had low dislocation, and 101 (28.4%) high dislocation. The majority of patients with congenital hip disease were women (338 [95%] hips). The natural history of the three types of congenital hip disease was studied in 157 patients (202 hips: 102 dysplastic, 42 low dislocation, and 58 high dislocation) who had received no treatment before the initial examination. Average length of follow-up was 17 years. In dysplastic hips, the disease remained undiagnosed until the onset of symptoms at an average age of 34.5 years. In patients with low dislocation, pain had started at an average of 32.5 years due to progressive degenerative arthritis within the false acetabulum. In patients with high dislocation, in the presence of a false acetabulum, pain started at an average age of 31.2 years, while in its absence, pain started at an average age of 46.4 years due to muscle fatigue. These findings suggest dysplasia, low dislocation, and high dislocation in adults are the results of untreated dysplasia, subluxation, and complete dislocation in infancy, respectively.

Hartofilakidis G; Karachalios T; Stamos KG

2000-08-01

25

Dislocation after total hip arthroplasty.  

UK PubMed Central (United Kingdom)

Dislocation is one of the most common complications after total hip arthroplasty (THA). Risk factors include neuromuscular and cognitive disorders, patient non-compliance, and previous hip surgery. Surgical considerations that must be addressed include approach, soft-tissue tension, component positioning, impingement, head size, acetabular liner profile, and surgeon experience. Recent improvements in posterior soft-tissue repair after primary THA have shown a reduced incidence of dislocation. When dislocation occurs, a thorough history, physical examination, and radiographic assessment help in choosing the proper intervention. Closed reduction usually is possible, and nonsurgical management frequently succeeds in preventing recurrence. When these measures fail, first-line revision options should target the underlying etiology. This most often involves tensioning or augmentation of soft tissues, as in capsulorrhaphy or trochanteric advancement; correction of malpositioned components; or improving the head-to-neck ratio. If instability persists, or if a primary THA repeatedly dislocates without a clear cause, a constrained cup or bipolar femoral prosthesis may be as effective as a salvage procedure.

Soong M; Rubash HE; Macaulay W

2004-09-01

26

Traumatic anterior hip dislocation in a 12-year-old child.  

UK PubMed Central (United Kingdom)

Hip dislocation in children can occur congenitally in isolation or in conjunction with other congenital abnormalities. Traumatic hip dislocations in children are relatively uncommon and anterior dislocation of hip joint is even rarer. We report such a case following unusual mode of injury in a 12-year-old child. The patient underwent successful emergent closed reduction of left hip. The clinical course and follow-up assessment of the patient was otherwise uneventful. At 2 years?follow-up there was no evidence of osteoarthritis, coxa magna, heterotrophic calcification, in congruency of the joints or avascular necrosis of the head of femur.

Gupta V; Kaur M; Kundu ZS; Kaplia A; Singh D

2013-04-01

27

Dislocation after bipolar hemiarthroplasty of the hip.  

UK PubMed Central (United Kingdom)

Although bipolar hemiarthroplasty of the hip is a frequently performed procedure, little information is available about the frequency of postoperative dislocation and its treatment. For this study, 1,934 hips treated consecutively with primary bipolar hemiarthroplasty were reviewed. A postoperative dislocation developed in 29 patients (1.5%): during the first month after surgery in 24 patients and between 1 month and 5 years after surgery in five patients. Of the 29 dislocations, 25 were successfully reduced with with routine closed methods. Among these 25 hips, 13 (52%) subsequently redislocated, and 7 of these required operative treatment for the recurrent dislocation. Dislocation after primary bipolar hemiarthroplasty is infrequent, can usually be reduced by routine closed methods, but is associated with a high rate of recurrent dislocation.

Barnes CL; Berry DJ; Sledge CB

1995-10-01

28

Traumatic hip dislocation: early MRI findings  

Energy Technology Data Exchange (ETDEWEB)

Objective of this study was to present the spectrum of early magnetic resonance imaging (MRI) findings following traumatic dislocation of the femoral head, and to identify any associated injuries. Prospective MRI of both hips was performed on 18 patients within 5 weeks of a traumatic femoral head dislocation. The interval between the time of injury and the imaging studies ranged from 2 to 35 days. Posterior dislocation was present in 14 patients and anterior dislocation in 4 patients. In the majority of cases, we performed axial T1, coronal T1, and coronal T2{sup *} (MPGR) sequences. MRI can effectively identify and quantify the muscle injury and joint effusion that invariably accompany traumatic hip dislocations. It is also useful for demonstrating trabecular bone contusion (trabecular injury) and iliofemoral ligament injury, which occur commonly with acute hip dislocation. (orig./VHE)

Laorr, A. [Dept. of Radiology, Univ. of California, Davis Medical Center, Sacramento, CA (United States); Greenspan, A. [Dept. of Radiology, Univ. of California, Davis Medical Center, Sacramento, CA (United States)]|[Dept. of Orthopaedics, Univ. of California, Davis Medical Center, Sacramento, CA (United States); Anderson, M.W. [Dept. of Radiology, Univ. of California, Davis Medical Center, Sacramento, CA (United States); Moehring, H.D. [Dept. of Orthopaedics, Univ. of California, Davis Medical Center, Sacramento, CA (United States); McKinley, T. [Dept. of Orthopaedics, Univ. of California, Davis Medical Center, Sacramento, CA (United States)

1995-05-01

29

Traumatic hip dislocation: early MRI findings  

International Nuclear Information System (INIS)

[en] Objective of this study was to present the spectrum of early magnetic resonance imaging (MRI) findings following traumatic dislocation of the femoral head, and to identify any associated injuries. Prospective MRI of both hips was performed on 18 patients within 5 weeks of a traumatic femoral head dislocation. The interval between the time of injury and the imaging studies ranged from 2 to 35 days. Posterior dislocation was present in 14 patients and anterior dislocation in 4 patients. In the majority of cases, we performed axial T1, coronal T1, and coronal T2* (MPGR) sequences. MRI can effectively identify and quantify the muscle injury and joint effusion that invariably accompany traumatic hip dislocations. It is also useful for demonstrating trabecular bone contusion (trabecular injury) and iliofemoral ligament injury, which occur commonly with acute hip dislocation. (orig./VHE)

1995-01-01

30

Outcome of traumatic hip dislocation in children.  

Science.gov (United States)

We reviewed 13 patients without an underlying syndrome with traumatic hip dislocation between 3 and 10 years of age (mean 4.8 years) at the time of injury. The final reviews were between 1 and 11 years (mean 6 years). All children had posterior dislocation, except one, who had an anterior dislocation. Time taken from trauma to reduction was less than 6 h in three patients, 6 h to 1 day in two patients, 1 day to 3 weeks in seven patients, and 4 weeks in one. All of them underwent closed reduction, except two, who required open reduction through a posterior approach. All patients had excellent hip function and radiographic result on the basis of Garret classification, except for one with limping at 4 years after trauma. The patients treated with hip spica after reduction (10 patients) did not have recurrent dislocation whereas two out of three patients who were treated without postreduction hip spica developed recurrent dislocation. One out of 13 patients without an underlying syndrome and a 6-year-old patient with Down syndrome with neglected hip dislocation and radiological avascular necrosis at presentation recovered with congruent hip following a complete and maintained reduction. This case series suggested that closed reduction was possible for cases of neglected hip dislocation for up to 3 weeks. Open reduction through the posterior approach was safe in neglected irreducible posterior hip dislocation. Those hips that underwent complete reduction and were maintained reduced with hip spica had an excellent functional outcome even in the presence of avascular necrosis. This is a level IV study. PMID:23838854

Sulaiman, Abdul R; Munajat, Ismail; Mohd, Fazliq E

2013-11-01

31

Dislocation of the hip in a patient with von Recklinghausen disease.  

UK PubMed Central (United Kingdom)

Neurofibromatosis type 1 (NF-1) is one of the most common autosomal dominant disorders affecting humans. Patients with NF-1 may present with characteristic orthopaedic manifestations such as scoliosis, congenital pseudoarthrosis and limb hyperttrophy. Dislocation of the hip associated with NF-1 is a rare occurrence. There is a relative paucity of reported cases of pathological hip dislocation in patients with NF-1, with 13 documented cases found in the published literature. Seven dislocations occurred following trivial trauma and 6 cases were deemed atraumatic. We report a case of hip dislocation in a 26 years old male with NF-1 and scoliosis, that was treated successfully by closed reduction and skin traction.

Del Bosque-Herrero A; Ezquerra-Herrando L; Albareda-Albareda J

2013-10-01

32

Epidemiology, demographics, and natural history of congenital hip disease in adults.  

Science.gov (United States)

This study examined the epidemiology and demographics of congenital hip disease in 468 (660 hips) patients who were examined between 1970 and 1996. In 356 (54%) hips, the diagnosis was secondary osteoarthritis due to congenital hip disease, and in 272 (41%) hips, the diagnosis was idiopathic osteoarthritis. In the remaining 32 (5%) hips, the diagnosis was uncertain. Of the hips with congenital hip disease, 170 (47.7%) hips were dysplastic, 85 (23.9%) had low dislocation, and 101 (28.4%) high dislocation. The majority of patients with congenital hip disease were women (338 [95%] hips). The natural history of the three types of congenital hip disease was studied in 157 patients (202 hips: 102 dysplastic, 42 low dislocation, and 58 high dislocation) who had received no treatment before the initial examination. Average length of follow-up was 17 years. In dysplastic hips, the disease remained undiagnosed until the onset of symptoms at an average age of 34.5 years. In patients with low dislocation, pain had started at an average of 32.5 years due to progressive degenerative arthritis within the false acetabulum. In patients with high dislocation, in the presence of a false acetabulum, pain started at an average age of 31.2 years, while in its absence, pain started at an average age of 46.4 years due to muscle fatigue. These findings suggest dysplasia, low dislocation, and high dislocation in adults are the results of untreated dysplasia, subluxation, and complete dislocation in infancy, respectively. PMID:10952045

Hartofilakidis, G; Karachalios, T; Stamos, K G

2000-08-01

33

Hip dislocation in spina bifida: when is surgery required  and what type of surgery should be performed?  

UK PubMed Central (United Kingdom)

Children with spina bifida develop a wide variety of congenital and acquired hip joint deformities. Among these are contractures, subluxation or dislocation. This paper will review both the overall orthopedic care of a spina bifida patient with hip problems and provide a focused review of surgery management of hip deformities. Special emphasis is placed on the indications and contraindications to surgery based on a literature review and the author's personal experience.

Dias L

2011-03-01

34

The natural history of a posteriorly dislocated total hip replacement.  

UK PubMed Central (United Kingdom)

A retrospective review was conducted to delineate the natural history of the posteriorly dislocated total hip replacement. A total of 1,036 consecutive total hip replacements were performed between 1989 and 1992. Forty (3.9%) were known to have dislocated posteriorly. Twenty-four of these dislocations occurred after primary replacements, and 16 occurred after revision. Eighty-five percent of the dislocations occurred within 2 months and were reduced closed. No statistical differences were noted between these 2 groups with respect to height, weight, sex, age, and femoral and acetabular anteversion. Nonunion of the greater trochanter, modular femoral neck length, and operative approach appeared to affect hip stability. Twenty-three of the 40 dislocated hips (57.5%) redislocated. Sixteen of the 40 hips (40%) required reoperation for recurrent dislocation. Thirteen of the 16 revisions (81.3%) were successful. A dislocated total hip replacement that has been rendered stable does not preclude one from having a successful total hip replacement, and it does not appear to affect survivorship at intermediate follow-up.

Li E; Meding JB; Ritter MA; Keating EM; Faris PM

1999-12-01

35

Congenital subtalar dislocation--a case report.  

Science.gov (United States)

Congenital dislocation of the subtalar joint is one of the rarest forms of presentation of a calcaneo-valgus foot. We report the second case of this type published; an 18-month female child aged was seen with calcaneo-valgus deformity of left foot since birth. She was walking over the medial malleolus and medial border of foot. Radiographs and 3D CT scan of the left foot confirmed the diagnosis of a congenital subtalar dislocation. Surgical correction was achieved through a posterolateral incision, and the reduced joint was fixed with a k-wires for 6 weeks; the foot was immobilized in below knee cast for another 6 weeks, and an ankle foot orthosis was used for another 3 years. At 3 years post-surgical follow up, the child has a plantigrade foot with no functional impairment. Follow up radiographs and 3D CT scan confirmed the maintenance of well aligned talo-calcaneal joint. This type of dislocation should be considered in the differential diagnosis of calcaneo-valgus foot; a clear understanding of the pathology, a precise operative reduction, and long-term use of orthosis results in a favourable outcome. PMID:20307473

Saini, Raghav; Dhillon, M S; Gill, S S

2009-02-04

36

[Dislocation of a total hip prosthesis: etiology and treatment  

UK PubMed Central (United Kingdom)

Dislocation of a total hip prosthesis is a substantial burden in terms of morbidity and health care costs. The incidence of dislocation is highest during the first postoperative months but the risk persists throughout the entire life of the patient. The first dislocation is treated by an emergency closed reduction of the hip undergeneral anaesthesia, following which about three out of four patients will have a stable hip. In cases of recurrent dislocation the treatment is difficult, depending upon the time between surgery and dislocation, the identification of an etiologic factor, and the general status of the patient. Patients in which a specific cause can be identified have better results after surgical revision. When no causal factor is detected several surgical options are possible, but the results are less consistent.

Suva D; Lübbeke A; Pagano F; Dayer R; Hoffmeyer P

2009-12-01

37

Traumatic bilateral knee dislocations, unilateral hip dislocation, and contralateral humeral amputation: a case report.  

Science.gov (United States)

Bilateral traumatic knee dislocations are a rarity. We report a case of bilateral traumatic knee dislocations with concomitant right hip dislocation and complete traumatic amputation of the left, nondominant upper extremity at the level of the proximal one-third of the humerus. Angiograms revealed no evidence of popliteal artery injury. Orthopedic treatment consisted of immediate reduction of the dislocations and urgent revision amputation of the upper extremity. Staged, bilateral knee ligamentous reconstructions were performed on hospital days 24 and 29, respectively. Despite this constellation of devastating injuries, the patient had a satisfactory outcome. In patients with high-energy hip or knee dislocations, the bilateral hips and knees should be carefully examined to check for associated fractures and/or dislocations. PMID:19052715

Voos, James E; Heyworth, Benton E; Piasecki, Dana P; Henn, R Frank; MacGillivray, John D

2008-12-04

38

Traumatic bilateral knee dislocations, unilateral hip dislocation, and contralateral humeral amputation: a case report.  

UK PubMed Central (United Kingdom)

Bilateral traumatic knee dislocations are a rarity. We report a case of bilateral traumatic knee dislocations with concomitant right hip dislocation and complete traumatic amputation of the left, nondominant upper extremity at the level of the proximal one-third of the humerus. Angiograms revealed no evidence of popliteal artery injury. Orthopedic treatment consisted of immediate reduction of the dislocations and urgent revision amputation of the upper extremity. Staged, bilateral knee ligamentous reconstructions were performed on hospital days 24 and 29, respectively. Despite this constellation of devastating injuries, the patient had a satisfactory outcome. In patients with high-energy hip or knee dislocations, the bilateral hips and knees should be carefully examined to check for associated fractures and/or dislocations.

Voos JE; Heyworth BE; Piasecki DP; Henn RF 3rd; MacGillivray JD

2009-02-01

39

Traumatic dislocation of the hip joint in children  

Scientific Electronic Library Online (English)

Full Text Available Abstract in english Two cases of acute traumatic dislocation of the hip joint are reported. This is a rare injury and the literature on this subject is limited to either case reports or combined multicentre studies. The aim is to report on two cases of acute dislocation of the hip joint treated by us and to review the literature on this injury.

Firth, GB; Mazibuko, AD; Munir, M

2010-01-01

40

Disassembly and dislocation of a bipolar hip prosthesis.  

Science.gov (United States)

Dislocation of a hip prosthesis is a common complication. In usual cases of hip prosthesis dislocation, the prosthetic femoral head comes out from either the natural acetabular cavity in a bipolar hemiarthroplasty or the prosthetic acetabulum in a total hip arthroplasty. Only a few cases of bipolar hip prosthesis dislocation due to dissociation between the polyethylene and inner head of the prosthesis have been reported. We describe a rare case of disassembly of the inner head from the bipolar outer prosthesis in an osteoarthritic acetabulum. A 72-year-old woman had undergone bipolar hemiarthroplasty due to fracture of the left femoral neck about 10 years previously. Recently, she sustained an injury after falling from a chair, and examinations revealed an unusual disassembly-dislocation of the bipolar hip prosthesis. We classified this failure in our patient as a type II failure, representing extreme varus position of the outer head in the acetabulum, dislocation of the inner head from the outer head, and a detached locking ring around the stem neck. This mechanism of failure as shown in our patient rarely occurs in the bipolar prosthesis of the self-centering system. Osteoarthritic change of the acetabulum would place the outer head in the varus position, increasing wear on the beveled rim by impinging the femoral stem neck and causing dislodgment of the inner locking ring and consequent disassembly-dislocation of the inner head. PMID:18218583

Lee, Hsieh-Hsing; Lo, Yung-Chih; Lin, Leou-Chyr; Wu, Shing-Sheng

2008-01-01

 
 
 
 
41

Total dislocation of the hip joint after arthroscopy and ileopsoas tenotomy.  

UK PubMed Central (United Kingdom)

The hip is a highly stable joint. Non-traumatic dislocation of the hip is extremely uncommon. In this article, we report two cases of non-traumatic hip dislocations following hip arthroscopy. In both cases, capsulotomy and ileopsoas tenotomy had been performed. These cases raise questions about the importance of the natural stabilisers of the hip. Level of evidence V.

Sansone M; Ahldén M; Jónasson P; Swärd L; Eriksson T; Karlsson J

2013-02-01

42

[Cup dissociation after reduction of a dislocated hip hemiarthroplasty  

UK PubMed Central (United Kingdom)

PURPOSE OF THE STUDY: Close reduction of a bipolar hemiarthroplasty dislocation may induce dissociation between the cup and the prosthetic ball head. This rare complication leads to reoperation. CASE REPORT: Two women 84 and 85 years' old suffering from femoral head fracture were treated by bipolar hemiarthroplasty through a postero-lateral approach. After the first post-operative month, a posterior dislocation has occurred. Close reduction, without anesthesia dislocated the intraprosthetic joint. DISCUSSION: Dislocation rate is lower for bipolar hemiarthroplasty than for total hip arthroplasty. Reason for these two dislocation was supposed to be a "bottle-opener" effect's by locking the cup on to the posterior acetabular rim. Limb traction is responsible for intra-prosthetic iatrogenic dislocation. CONCLUSION: Anesthesia should be considered as necessary for prosthesis bipolar hemiarthroplasties dislocation treatment. The authors have moved to a different implant and modified their surgical approach (antero lateral). These modifications were introduced in order to reduce the rate of hip dislocation and above all the event of intraprosthetic dislocation when close reduction was necessary.

Loubignac F; Boissier F

1997-01-01

43

Total hip replacement for high dislocated hips without femoral shortening osteotomy.  

UK PubMed Central (United Kingdom)

When performing total hip replacement (THR) in high dislocated hips, the presence of soft-tissue contractures means that most surgeons prefer to use a femoral shortening osteotomy in order to avoid the risk of neurovascular damage. However, this technique will sacrifice femoral length and reduce the extent of any leg-length equalisation. We report our experience of 74 THRs performed between 2000 and 2008 in 65 patients with a high dislocated hip without a femoral shortening osteotomy. The mean age of the patients was 55 years (46 to 72) and the mean follow-up was 42 months (12 to 78). All implants were cementless except for one resurfacing hip implant. We attempted to place the acetabular component in the anatomical position in each hip. The mean Harris hip score improved from 53 points (34 to 74) pre-operatively to 86 points (78 to 95) at final follow-up. The mean radiologically determined leg lengthening was 42 mm (30 to 66), and the mean leg-length discrepancy decreased from 36 mm (5 to 56) pre-operatively to 8.5 mm (0 to 18) postoperatively. Although there were four (5%) post-operative femoral nerve palsies, three had fully resolved by six months after the operation. No loosening of the implant was observed, and no dislocations or infections were encountered. Total hip replacement without a femoral shortening osteotomy proved to be a safe and effective surgical treatment for high dislocated hips.

Zhao X; Zhu ZA; Xie YZ; Yu B; Yu DG

2011-09-01

44

Resection arthroplasty of the hip in paralytic dislocations.  

UK PubMed Central (United Kingdom)

The chronically dislocated paralytic hip causes postural difficulties, nursing and hygiene problems, and pain. Therapeutic options are limited. This study reviews the results of resection arthroplasty on 18 hips of 15 such patients. This procedure has many complications, including hip ankylosis, heterotopic ossification, abduction contracture and bony overgrowth. Despite this, all of the nursing goals were achieved and most patients had relief of pain. The operation is most successful in the skeletally mature patients, and it relies on soft-tissue interposition between the bony fragments and postoperative positioning to ensure optimum posture.

Kalen V; Gamble JG

1984-06-01

45

Traumatic hip dislocation in children: the role of MRI  

Scientific Electronic Library Online (English)

Full Text Available Abstract in english We report a case of traumatic left hip dislocation in a nine-year-old child following the article: Firth GB, Mazibuko AD, Munir M. Traumatic dislocation of the hip joint in children. SAOJ Autumn 2010; 9(1):68-71. This article, as do others, refers to the use of MRI and CT scan in investigating young patients with hip dislocations. These authors conclude that a CT scan or MRI is probably always indicated.¹ In this case report and literature review, we focus on the role of (more) special investigations and the indication to perform either a CT scan or MRI in this young age group. The routine use of MRI and CT scan following hip dislocations in children is probably unnecessary and should only be done when indicated. This includes incongruent joint reduction noted on postreduction plain films and instability after reduction. There is not enough evidence to perform further investigations routinely without indication as they are costly, CT scans expose the child to radiation and MRI may involve anaesthesia or sedation of the child. If indicated, especially in the young child, an MRI scan provides more information and is the investigation of choice.

Sprong, F; Snyckers, C

2010-01-01

46

Simultaneous traumatic posterior dislocation of both hips. A case report.  

Science.gov (United States)

Simultaneous traumatic posterior dislocation of both hips, uncomplicated by fracture, is an exceptionally rare entity. The authors could not find any record of a similar case in the world medical literature up till now, and are therefore reporting this case with special consideration of the mechanism of injury and the management. PMID:696270

Bose, R; Zabihi, T; Omarie, M

1978-08-01

47

Simultaneous traumatic posterior dislocation of both hips. A case report.  

UK PubMed Central (United Kingdom)

Simultaneous traumatic posterior dislocation of both hips, uncomplicated by fracture, is an exceptionally rare entity. The authors could not find any record of a similar case in the world medical literature up till now, and are therefore reporting this case with special consideration of the mechanism of injury and the management.

Bose R; Zabihi T; Omarie M

1978-08-01

48

Congenital hip disease in adults. Classification of acetabular deficiencies and operative treatment with acetabuloplasty combined with total hip arthroplasty.  

UK PubMed Central (United Kingdom)

We describe three distinct types of congenital hip disease in adults. The first type is dysplasia, in which the femoral head is contained within the original true acetabulum. The second type is low dislocation, in which the femoral head articulates with a false acetabulum, the inferior lip of which contacts or overlaps the superior lip of the true acetabulum, giving the appearance of two overlapping acetabula. The third type is high dislocation, in which the femoral head has migrated superoposteriorly and there is no contact between the true and the false acetabulum. We describe and classify the acetabular abnormalities and deficiencies found with these three types. If the anterior, posterior, and superior aspects of the acetabular component cannot be covered during a total hip arthroplasty because of a deficient acetabulum in an adult who has congenital hip disease, we advocate and acetabuloplasty technique (which we have named a cotyloplasty) that involves medial advancement of the acetabular floor by the creation of a controlled comminuted fracture of its medial wall, autogenous bone-grafting, and the implantation of a small acetabular component with cement. This procedure was performed in sixty-six patients (eighty-six hips). Forty-nine of the hips had a high dislocation, thirty-one had a low dislocation, and six were dysplastic. Two to fifteen years (mean, seven years) after the operation, the clinical and radiographic results were satisfactory. Only two acetabular components needed to be revised for aseptic loosening, at 5.3 and 7.5 years postoperatively. Moreover, the cumulative success rate for the acetabular components was 100 percent at five years and 93.2 percent at ten years.

Hartofilakidis G; Stamos K; Karachalios T; Ioannidis TT; Zacharakis N

1996-05-01

49

Total hip arthroplasty after treatment of pseudojoint infection in a patient with a highly dislocated hip.  

UK PubMed Central (United Kingdom)

Infection at the pseudoacetabulum in a patient with a high hip dislocation has not been reported previously in the English literature. We report a case of total hip arthroplasty in a 28-year-old female who presented to us with hip pain following debridement of the infected pseudojoint in a case of neglected developmental dysplasia of the hip. The infection was treated with thorough debridement and drainage. However, even after achieving complete infection control, this patient complained of disabling right hip joint pain. Total hip arthroplasty with subtrochanteric osteotomy was performed to relieve the pain and improve gait. After surgery, the patient's symptoms were relieved. We consider that in this case of acute pseudojoint infection simple arthrotomy and debridement combined with irrigation and drainage provide effective treatment. But muscle weakness and more increased joint laxity can cause hip pain even after infection control. So total hip arthroplasty is likely to be necessary after the infection has been controlled in a patient with a highly dislocated hip.

Park KS; Seon JK; Nah SY; Yoon TR

2013-01-01

50

Total hip arthroplasty after treatment of pseudojoint infection in a patient with a highly dislocated hip.  

Science.gov (United States)

Infection at the pseudoacetabulum in a patient with a high hip dislocation has not been reported previously in the English literature. We report a case of total hip arthroplasty in a 28-year-old female who presented to us with hip pain following debridement of the infected pseudojoint in a case of neglected developmental dysplasia of the hip. The infection was treated with thorough debridement and drainage. However, even after achieving complete infection control, this patient complained of disabling right hip joint pain. Total hip arthroplasty with subtrochanteric osteotomy was performed to relieve the pain and improve gait. After surgery, the patient's symptoms were relieved. We consider that in this case of acute pseudojoint infection simple arthrotomy and debridement combined with irrigation and drainage provide effective treatment. But muscle weakness and more increased joint laxity can cause hip pain even after infection control. So total hip arthroplasty is likely to be necessary after the infection has been controlled in a patient with a highly dislocated hip. PMID:23878754

Park, Kyung-Soon; Seon, Jong-Keun; Nah, Seon-Yoon; Yoon, Taek-Rim

2013-06-25

51

Achilles allograft reconstruction for recurrent dislocation in total hip arthroplasty.  

UK PubMed Central (United Kingdom)

Recurrent dislocation secondary to posterior soft tissue deficiency is a challenging complication of total hip arthroplasty. We describe the use of an Achilles allograft sling to improve hip stability. Eight patients treated with the sling were followed an average of 5 years. Seven patients had no recurrent instability and good postoperative range of motion. One graft failed in a patient with a neuropathic hip. Cadaveric biomechanical testing was also performed to investigate the stiffness and torque to failure of the sling in 6 specimens. Allograft slings can be used to improve hip stability. The technique is relatively easy to perform and does not limit postoperative range of motion. The graft decreases joint stiffness and has a greater torque to failure than the intact capsule.

Van Warmerdam JM; McGann WA; Donnelly JR; Kim J; Welch RB

2011-09-01

52

[Locked posterior dislocation of the hip: a case report].  

Science.gov (United States)

Impaction fractures of the femoral head occurring after anterior or posterior hip dislocations are well described. However, locked posterior hip dislocation resulting in sinking of the posterior acetabular rim into the femoral head has hitherto been undescribed. A 26-year-old male patient presented with complaints of severe pain in the left thigh and marked limitation in the movements of the left hip two weeks after an in-car crash. He could only walk with crutches. Shortly after the accident, he was examined at another center with physical examination and plain radiographies and was given bed rest and medications for pain relief. Computed tomography demonstrated the locked posterior hip by the impact of the posterior acetabular rim against the femoral head. At surgery, the posterior acetabular rim was embedded in the anteromedial surface of the femoral head resulting in an osteochondral impaction fracture with a penetration depth of 12 mm. Due to wide destruction to the cartilage surface, an uncemented bipolar hemiarthroplasty was performed. After 28 months of follow-up, he had no complaints and hip movements were painless with full range of motion. PMID:17483654

Esenkaya, Irfan; Elmali, Nurzat

2007-01-01

53

Imaging of traumatic dislocation of the hip in childhood.  

UK PubMed Central (United Kingdom)

BACKGROUND: Traumatic hip dislocation in childhood is a rare consequence of violent trauma. After reduction, outcome is usually favourable although epiphyseal necrosis can occur. Reduction must be carried out as soon as possible and is achieved easily, although if the labrum is involved, surgery may be required to achieve complete reduction. OBJECTIVE: To analyze a retrospective series of traumatic hip dislocations in children, describing the therapeutic and imaging strategy. MATERIALS AND METHODS: A total of 42 patients were studied. Their mean age was 10 years 3 months. All relevant radiographic, CT, MRI and radionuclide bone scan examinations were reviewed. Special attention was paid to associated lesions. RESULTS: In 22 patients the dislocation was caused by low-energy trauma. Road traffic accidents accounted for 17 dislocations. An acetabular fracture was present in six patients and the femoral head was fractured in three. Reduction was easily achieved in 31 patients. In 11 patients the postreduction radiograph and CT showed joint space asymmetry secondary to labral entrapment. Only two patients developed epiphyseal necrosis. CONCLUSIONS: It has been difficult to define and evaluate accurate principles for a medical imaging strategy in this group of patients. Analysis of plain radiographs is essential before and after reduction of the joint, and it is important to perform postreduction CT in every patient whose joint space remains widened. A radionuclide bone scan should be performed between the second and third weeks after injury to assess epiphyseal vascularity. With the use of specific sequences, MRI may be an alternative modality to assess epiphyseal vitality.

Vialle R; Pannier S; Odent T; Schmit P; Pauthier F; Glorion C

2004-12-01

54

Prevention of spastic paralytic dislocation of the hip.  

UK PubMed Central (United Kingdom)

In a retrospective review of 99 children with spastic cerebral palsy, the efficacy of soft-tissue procedures alone in reducing early subluxation of the hip and preventing further subluxation and dislocation was determined. The indication for surgery was early subluxation of one or both hips. Surgery was either adductor tenotomy with or without anterior branch obturator neurectomy, or adductor tenotomy in combination with iliopsoas recession. Results were poor for 64 per cent after adductor tenotomy and anterior branch obturator neurectomy. For patients who also had iliopsoas recession the success rate was 72 per cent. Radiographic analysis showed that uncovering of the femoral head had halted or improved in 80 per cent of patients following iliopsoas recession.

Kalen V; Bleck EE

1985-02-01

55

METHOD OF PREVENTING DISLOCATION OF HIP JOINT ENDOPROSTHESIS  

UK PubMed Central (United Kingdom)

FIELD: medicine. ^ SUBSTANCE: invention relates to medicine, in particular to orthopedics. Longitudinal to hip axis section of wide hip fascia in the middle of greater trochanter is carried out. Joint capsule is dissected on intertrochanteric line in L-like way from the base of femoral neck along its upper edge to upper posterior edge of acetabulum. After dislocation and osteotomy of femoral neck endoprosthesis is installed. After that posterior part of capsule is sewn with its upper-anterior part by means of Z-like sutures. Tendons of short rotators are fixed with double tendon sutures and 2-3 holes are formed in great trochanter, and one hole is formed in trochanteric fossa. If in greater trochanter 2 holes are formed, line on which they are located must cross hip axis at acute angle, of 3 holes are formed, they are located in such way that they form isosceles triangle whose apex is directed to trochanteric fossa Sewn capsule is fixed with ligatures passed through holes in greater trochanter, double tendon sutures being passed through hole in triochanteric fossa. After that in position of external rotation and maximal abduction of extremity, knots are tightened on the surface of greater trochanter. ^ EFFECT: method ensures reduction of traumaticity and elimibnation of possibility to displace endoprosthesis head due to strengthening hip joint capsule. ^ 1 ex, 4 cl

ABDULNASYROV RADIK KAZYEVICH; MARKOV DMITRIJ ALEKSANDROVICH; NAM ALEKSANDR VLADIMIROVICH; LIKHACHEV SERGEJ VJACHESLAVOVICH; EMKUZHEV OLEG LEONOVICH

56

Surgical management of congenital radial head dislocation: a case report.  

UK PubMed Central (United Kingdom)

Congenital radial head dislocation is a rare condition which is, however, the most common of all congenital pathologies of the elbow joint. This paper is a case report on a patient presenting with moderate pain and discomfort in one of his elbow joints, both of which were found to be affected by this condition. He was treated by surgery which consisted of resection of the proximal radius and partial anterior capsulectomy of the elbow joint. This treatment led to a significant improvement in pain and elbow function compared to the preoperative status.

B?o?ski M; Podgórski A; Zakrzewski P; Pomianowski S

2012-07-01

57

Can posterior hip fracture-dislocation occur in indoor football (futsal)? A report of two cases  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Hip fracture-dislocation is extremely rare in sports and is most frequently seen after road traffic accidents. This injury is associated with considerable long-term disability and rapidly progressive joint degeneration. This case report illustrates two cases of hip fracture dislocation that occurred...

Yasin, Faissal Nor; Singh, Vivek Ajit

58

Neglected congenital permanent dislocation of the patella: a case report.  

UK PubMed Central (United Kingdom)

A 50-year-old man with asymptomatic bilateral congenital permanent dislocation of the patella had never been treated until two years following a fall on his left knee, on which occasion he had torn the lateral meniscus. In this unusual case, surgical treatment was performed to restore the power of the active extension in the left knee by removal of the torn meniscus. The results at 28 months following up were satisfactory for normal occupational activities.

Torisu T

1981-03-01

59

Surgical hip dislocation versus hip arthroscopy for femoroacetabular impingement: clinical and morphological short-term results.  

UK PubMed Central (United Kingdom)

INTRODUCTION: Surgical hip dislocation (SHD) is an accepted standard to treat femoroacetabular impingement (FAI). However, arthroscopic techniques have gained widespread popularity and comparable results are reported. The purpose of this prospective comparative study was to test the hypothesis that, when compared to SHD, hip arthroscopy (HA) results in faster recovery, better short-term outcome, and equivalent morphological corrections. MATERIALS AND METHODS: 38 patients presenting with clinically and morphologically verified isolated FAI were allocated to either HA or SHD. Morphological evaluation consisted of pre- and postoperative X-rays, and arthro-MRI. Demographic data, sport activities, hospital stay, complications, and the time off work were recorded. The subjective hip value, WOMAC, HHS, and hip abductor strength were measured up to 1 year. RESULTS: Shorter hospital stay and time off work, less pain at 3 months and 1 year, higher subjective hip values at 6 weeks and 3 months, and better WOMAC at 3 months were seen after HA. The HHS and the hip abductor strengths were higher in the HA group. However, morphological corrections at the head-neck-junction achieved by HA showed some overcorrection when compared to SHD. Labral refixation was performed less frequent in the HA group. CONCLUSION: When compared to SHD, HA results in faster recovery and better short-term outcome. However, some overcorrection of the cam deformity and limited frequency of labrum refixation with HA in this study may have a negative impact on long-term outcome.

Zingg PO; Ulbrich EJ; Buehler TC; Kalberer F; Poutawera VR; Dora C

2013-01-01

60

Total hip arthroplasty in a patient with congenital insensitivity to pain: a case report.  

UK PubMed Central (United Kingdom)

INTRODUCTION: Congenital insensitivity to pain, a rare neurological entity, is characterized by varying degrees of sensory loss and autonomic dysfunction. Orthopedic manifestations of congenital insensitivity to pain include delayed diagnosis of fractures, nonunions, malunions, Charcot arthropathy, acro-osteolysis, avascular necrosis, osteomyelitis, heterotopic ossification and joint dislocations. We here report the case of a patient with congenital insensitivity to pain who had multiple lower extremity fractures at varying intervals, the most recent being a femoral neck fracture managed by total hip replacement. To the best of our knowledge, this is the first report of cementless hip arthroplasty in such a patient. CASE PRESENTATION: A 37-year-old Caucasian woman was admitted to our hospital complaining of painless swellings in her lower limb and limping. She had been diagnosed with multiple lower extremity fractures at different times. On physical examination, we found multiple perioral mucosal ulcers, shortening of her nails and acro-osteolysis, a prematurely aged facial appearance, undersized skeletal structure, Charcot arthropathy of her right ankle, anosmia, insensitivity to temperature differences and evidence of mild intellectual disability. A right subtrochanteric femur fracture was treated with an intramedullary nail. Eighteen months later, she presented with similar symptoms and we diagnosed a right femoral neck fracture. We removed the nail and performed cementless total right hip arthroplasty. CONCLUSIONS: Congenital insensitivity to pain is a rare condition that is associated with severe orthopedic problems. This case report, which will be of particular interest to orthopedic surgeons, presents several difficulties in the management of patients with congenital insensitivity to pain and notes the importance of close follow-up and early recognition of complications. Cementless total hip arthroplasty may be a good therapeutic option for femoral neck fracture in these patients.

Erdil M; Bilsel K; Imren Y; Ceylan HH; Tuncay I

2012-01-01

 
 
 
 
61

Total hip arthroplasty in a patient with congenital insensitivity to pain: a case report  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Introduction Congenital insensitivity to pain, a rare neurological entity, is characterized by varying degrees of sensory loss and autonomic dysfunction. Orthopedic manifestations of congenital insensitivity to pain include delayed diagnosis of fractures, nonunions, malunions, Charcot arthropathy, acro-osteolysis, avascular necrosis, osteomyelitis, heterotopic ossification and joint dislocations. We here report the case of a patient with congenital insensitivity to pain who had multiple lower extremity fractures at varying intervals, the most recent being a femoral neck fracture managed by total hip replacement. To the best of our knowledge, this is the first report of cementless hip arthroplasty in such a patient. Case presentation A 37-year-old Caucasian woman was admitted to our hospital complaining of painless swellings in her lower limb and limping. She had been diagnosed with multiple lower extremity fractures at different times. On physical examination, we found multiple perioral mucosal ulcers, shortening of her nails and acro-osteolysis, a prematurely aged facial appearance, undersized skeletal structure, Charcot arthropathy of her right ankle, anosmia, insensitivity to temperature differences and evidence of mild intellectual disability. A right subtrochanteric femur fracture was treated with an intramedullary nail. Eighteen months later, she presented with similar symptoms and we diagnosed a right femoral neck fracture. We removed the nail and performed cementless total right hip arthroplasty. Conclusions Congenital insensitivity to pain is a rare condition that is associated with severe orthopedic problems. This case report, which will be of particular interest to orthopedic surgeons, presents several difficulties in the management of patients with congenital insensitivity to pain and notes the importance of close follow-up and early recognition of complications. Cementless total hip arthroplasty may be a good therapeutic option for femoral neck fracture in these patients.

Erdil Mehmet; Bilsel Kerem; Imren Yunus; Ceylan Hasan; Tuncay Ibrahim

2012-01-01

62

Detecting cause of dislocation after total hip arthroplasty by patient-specific four-dimensional motion analysis.  

UK PubMed Central (United Kingdom)

BACKGROUND: Dislocation is a major complication after total hip arthroplasty. Prosthesis impingement is considered to be an important cause of dislocation because impingement marks are more frequently found on retrieved cups or liners in patients who have undergone revision surgery because of dislocation (80%-94%) than in those who have undergone reoperation for other reasons (51%-56%). However, it remains a question whether impingement marks are the cause of dislocation or are instead its result. To clarify the issue, it is necessary to confirm noninvasively whether the point of impingement matches the patient's hip position when dislocation occurs. METHODS: Using four-dimensional patient-specific analysis, we recorded prosthesis impingement in 10 hips with instability after primary total hip arthroplasty when the patients reproduced the dislocation-causing motion. FINDINGS: We found prosthesis impingement to be related to at least instability in 6 of 10 hips with dislocation after primary total hip arthroplasty and in 4 of 4 hips that underwent revision surgery for recurrent dislocation. All impingements occurred between the anterior wall of the liner and the stem neck in posterior dislocation and between the posterior wall of the liner and the stem neck in anterior dislocation. Revision surgery in 1 of those 4 hips revealed 2 impingement marks on the retrieved liner that closely matched the prosthesis impingement point and the dislocation pathway of the metal head on the liner that were detected earlier during motion analysis. INTERPRETATION: Prosthesis impingement is an important factor in dislocation after total hip arthroplasty.

Miki H; Sugano N; Yonenobu K; Tsuda K; Hattori M; Suzuki N

2013-02-01

63

Whistler technique used to reduce traumatic dislocation of the hip in the emergency department setting.  

UK PubMed Central (United Kingdom)

The authors appraised the effectiveness of an in-line traction technique developed to reduce posteriorly dislocated hips. We had found certain application difficulties with the Allis, or modified Allis, technique, and subsequently developed a method that was easier to implement for the physician. The dislocated hip is relocated using the physician's arm to raise and maneuver the affected leg as the physician's shoulder is raised. Patient data for the case series were collected from March 1994 to March 1998.

Walden PD; Hamer JR

1999-05-01

64

Dual mobility cups for preventing early hip arthroplasty dislocation in patients at risk: experience in a county hospital  

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Dislocation remains a major concern after hip arthroplasty. We asked whether dual mobility cups (DMC) would improve early hip stability in patients with high risk of dislocation. We followed 34 patients (21 females, 13 males) treated between 2009 and 2012 with cemented DMC for hip revisions caused r...

Sebastian S. Mukka; Sarwar S. Mahmood; Göran O. Sjödén; Arkan S. Sayed-Noor

65

Flexion reminder device to discourage recurrent posterior dislocation of a total hip replacement: a case report  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Introduction Recurrent dislocation of a total hip replacement prosthesis is a frustrating complication for both the surgeon and the patient. For positional dislocations with no indications for revision surgery, the current best treatment is physiotherapy, the use of abduction braces and avoidance of unsafe hip positions. Abduction braces can be cumbersome and have poor compliance. We report the successful use of a new lightweight flexion reminder device that can be used to treat people with this condition. Case presentation A 64-year-old British woman experienced recurrent positional posterior dislocation after primary hip replacement, particularly when involved in activities involving unsafe flexion of the operated hip. She disliked using an abduction brace and hence was given a simple 'flexion reminder device' that could be strapped to the thigh. Beyond the safe flexion limit, the padded top end of the device hitched against the groin crease and reminded her not to flex further, to avoid dislocation. She experienced no discomfort in wearing the device continuously throughout the day and was very satisfied. She has had no further dislocations in the 2 years since she began using it. Conclusion In cases of arthroplasty dislocation caused mainly by an unsafe hip position, and with no indication for revision surgery, this new lightweight and easily worn flexion reminder device may be a good option for avoiding such positional dislocations, particularly those caused by unsafe flexion.

Wong King; Sivan Manoj; Matthews Gordon

2008-01-01

66

Large femoral heads decrease the incidence of dislocation after total hip arthroplasty: a randomized controlled trial.  

UK PubMed Central (United Kingdom)

BACKGROUND: The use of larger femoral heads has been proposed to reduce the risk of dislocation after total hip arthroplasty, but there is a lack of evidence to support this proposal. The aim of this multicenter randomized controlled trial was to determine whether the incidence of dislocation one year after total hip arthroplasty is significantly lower in association with the use of a 36-mm femoral head articulation as compared with a 28-mm articulation. METHODS: Six hundred and forty-four middle-aged and elderly patients undergoing primary or revision arthroplasty were randomized intraoperatively to receive either a 36 or 28-mm metal femoral head on highly cross-linked polyethylene. Patients who were at high risk of dislocation (including those with dementia and neuromuscular disease) and those undergoing revision for the treatment of recurrent hip dislocation or infection were excluded. Patients were stratified according to other potential risk factors for dislocation, including diagnosis and age. Diagnosis of hip dislocation required confirmation by a physician and radiographic evidence of a dislocation. RESULTS: Overall, at one year of follow-up, hips with a 36-mm femoral head articulation had a significantly lower incidence of dislocation than did those with a 28-mm articulation (1.3% [four of 299] compared with 5.4% [seventeen of 316]; difference, 4.1% [95% confidence interval, 1.2% to 7.2%]) when controlling for the type of procedure (primary or revision) (p = 0.012). The incidence of dislocation following primary arthroplasty was also significantly lower for hips with a 36-mm femoral head articulation than for those with a 28-mm articulation (0.8% [two of 258] compared with 4.4% [twelve of 275]; difference, 3.6% [95% confidence interval, 0.9% to 6.8%]) (p = 0.024). The incidence of dislocation following revision arthroplasty was 4.9% (two of forty-one) for hips with a 36-mm articulation and 12.2% (five of forty-one) for hips with a 28-mm articulation; this difference was not significant with the relatively small sample size of the revision group (difference, 7.3% [95% confidence interval, -5.9% to 21.1%]) (p = 0.273). CONCLUSIONS: Compared with a 28-mm femoral head articulation, a larger 36-mm articulation resulted in a significantly decreased incidence of dislocation in the first year following primary total hip arthroplasty. However, before a 36-mm metal-on-highly cross-linked polyethylene articulation is widely recommended, the incidence of late dislocation, wear, periprosthetic osteolysis, and liner fracture should be established.

Howie DW; Holubowycz OT; Middleton R

2012-06-01

67

Risk of dislocation using large- vs. small-diameter femoral heads in total hip arthroplasty  

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Abstract Background Dislocation remains a difficult problem in total hip arthroplasty. Large-diameter femoral heads may lower the incidence of dislocation by enhancing the jump distance and decreasing impingement, but their performance against small-diameter heads has not been asses...

Plate Johannes F; Seyler Thorsten M; Stroh D; Issa Kimona; Akbar Michael; Mont Michael A

68

Posterior acetabular arc angle of unstable posterior hip fracture-dislocation.  

UK PubMed Central (United Kingdom)

PURPOSE: Posterior hip fracture-dislocation needs stability evaluation. A previous study in the normal acetabulum has shown that the coronal posterior acetabular arc angle (PAAA) could be used to assess an unstable posterior hip fracture. Our study was designed to assess PAAA of unstable posterior hip fracture-dislocation and whether posterior acetabular wall fracture involves the superior acetabular dome. METHODS: Using coronal computed tomography (CT) of the acetabulum and 3D reconstruction of the lateral pelvis, we measured coronal, vertical PAAA and posterior acetabular wall depth of 21 unstable posterior hip fracture-dislocations and of 50 % normal contralateral acetabula. Posterior acetabular wall fracture was assessed to determine whether the fracture involved the superior acetabular dome and then defined as a high or low wall fracture using vertical PAAA in reference to the centroacetabulo-greater sciatic notch line. RESULTS: The coronal PAAA of unstable posterior hip fracture-dislocations and of 50 % of the posterior acetabular wall of normal the contralateral acetabulum were 54.48° (9.09°) and 57.43° (5.88°) and corresponded to 15.06 (4.39) and 15.61 (2.01) mm of the posterior acetabular wall without significant difference (p?>?0.05). The vertical PAAA of unstable posterior hip fracture-dislocation was 101.67° (20.44°). There were 16 high posterior acetabular wall fractures with 35.00 (16.18) vertical PAAA involving the acetabular dome and 5 low wall fractures. High posterior wall fractures resulted in four avascular necroses of the femoral head, three sciatic nerve injuries and one osteoarthritic hip. CONCLUSION: Coronal and vertical PAAA of unstable posterior hip fracture-dislocations were 54.48° and 101.67°. Vertical PAAA assesses high or low posterior acetabular wall fracture by referring to the centroacetabulo-greater sciatic notch line. High posterior wall fracture seems to be the most frequent and is involved with many complications.

Harnroongroj T; Riansuwan K; Sudjai N; Harnroongroj T

2013-09-01

69

Total hip arthroplasty with shortening subtrochanteric Z osteotomy in the treatment of developmental dysplasia with high hip dislocation.  

UK PubMed Central (United Kingdom)

BACKGROUND: The work presents the results of total hip arthroplasty in the treatment of arthrosis secondary to for developmental dysplasia with high hip dislocation or corollary to previous surgery of dysplastic high riding hips. In all patients the cup was placed in its anatomical position. In order to avoid excessive lengthening of the operated limb and the associated complications, the femoral shaft was shortened by subtrochanteric Z osteotomy. The osteotomy site was stabilised with a cementless CDH stem. MATERIAL AND METHOD: The technique was used in 10 women at an average age of 53. 4 years between 2006 and 2011. Five patients were operated on due to the degenerative changes secondary to developmental dysplasia with high dislocation of hip joint. The remaining patients had undergone surgery before. Angular osteotomy of the proximal femur was performed in four patients and total hip arthroplasty with high placement of the acetabular component in one. The average preoperative Harris Hip Score was 43.7. Preoperative shortening of the limb ranged from 4 to 10 cm, with an average of 6. 1 cm. RESULTS: The patients were followed up for a mean of 28. 3 months. No postoperative nerve damage has been observed. The operated limb was lengthened in all patients (range: 2.5 to 5 cm, mean: 3.4 cm). Radiographic union at the osteotomy site was obtained after an average of 4.5 months. All patients reported complete or near-complete pain relief and improved function of the operated limb. By the last follow-up visit, the Harris Hip Score had increased to 86 points on average. CONCLUSIONS: Subtrochanteric osteotomy of the femur reduces the risk of postoperative complications associated with excessive limb lengthening and facilitates access to the acetabulum. Total hip arthroplasty with shortening subtrochanteric Z-type osteotomy is a safe method in the treatment of degenerative changes secondary to developmental dysplasia with high hip dislocation.

Semenowicz J; Szyma?ski S; Walo R; Czuma P; Pijet B

2012-07-01

70

Inverted cup prosthesis to treat recurrent hip dislocation in frail elderly patients.  

UK PubMed Central (United Kingdom)

Recurrent hip dislocation has become an increasing problem in patients who had multiple component revision in total hip arthroplasty. These are often frail elderly patients with loss of constraining soft tissue envelope around the hip and an excessive weakness of the abductor mechanism. We present a simple technique for open reduction of a dislocated hip using a custom-made fully constrained construct with potential for preserving the well fixed femoral implant and parts of the acetabular component. The custom-made constrained construct consists of the application of an inverted cup over the femoral neck or head, the cup being fixed to the acetabular insert with screws. Three frail elderly patients have been successfully treated. One specific case is described in detail. In frail elderly patients who may have undergone several revision surgeries, it is important to preserve components of the total hip replacement when possible. The proposed technique may be an alternative solution for these patients.

Harake R; Colen S; Mulier M

2012-03-01

71

Risk of dislocation using large- vs. small-diameter femoral heads in total hip arthroplasty  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Dislocation remains a difficult problem in total hip arthroplasty. Large-diameter femoral heads may lower the incidence of dislocation by enhancing the jump distance and decreasing impingement, but their performance against small-diameter heads has not been assessed. This study compared the mid-term radiographic and functional outcomes of two matched cohorts of patients undergoing total hip arthroplasty who had a high pre-operative risk for dislocation and who received either small-diameter (26- or 28-millimeters) or large-diameter (?36-millimeters) femoral heads. Methods All patients who received large-diameter heads (?36-millimeter) between 2002 and 2005, and who had pre-operative risk factors for dislocation, were identified in the institution’s joint registry. Forty-one patients (52 hips) who received large-diameter heads were identified, and these patients were matched to 48 patients (52 hips) in the registry who received small-diameter femoral heads. Results At mean final follow-up of 62 months (range, 49 to 101 months), both groups achieved excellent functional outcomes as measured by Harris Hip scores, with slightly better final scores in the large-diameter group (90 vs. 83 points). No patient showed any radiographic signs of loosening. No patient dislocated in the large-diameter femoral head group; the smaller-diameter group had a greater rate of dislocation (3.8%, 2 out of 52). Conclusions Large-diameter femoral head articulations may reduce dislocation rates in patients who have a high pre-operative risk for dislocation while providing the same functional improvements and safety as small-diameter bearings.

Plate Johannes F; Seyler Thorsten M; Stroh D; Issa Kimona; Akbar Michael; Mont Michael A

2012-01-01

72

Changes of the hip joints associated with chronic subluxation and dislocation: CT and plain radiography analysis  

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Secondary osteoarthritis of the hip joint is a common disease and is frequently followed by chronic subluxation and dislocation. Twenty four cases of the secondary osteoarthritis associated with chronic subluxation and dislocation of the hip joints were evaluated with plain radiography and computed tomography. We retrospectively analyzed 1) the osteoarthritis and calcification of the acetabular labrum, 2) the thickness of the quadrilateral plate of the ilium, and 3) anteroposterior diameter of the acetabulum. The changes of the hip joints in subluxation (n=14) revealed ossification of the acetabular labrum in 12 cases (86%), thickening of the quadrilateral plate of the ilium in 11 cases (78%) but anteroposterior diameter of the acetabulum was not changed. The changes of the hip joints in dislocation (n=10) revealed no evidence of the ossification of the acetabular labrum, thickening of the quadrilateral plate of the ilium in 10 cases (100%) and decreased anteroposterior diameter of the acetabulum. We conclude that CT findings of subluxation and dislocation of the hip joints can be helpful in the evaluation of the secondary osteoarthritis of the hip joints.

Yang, Ik; Ryu, Kyung Nam; Lee, Sun Wha; Choi, Woo Suk; Lee, Eil Seong [Kyung Hee University Hospital, Seoul (Korea, Republic of)

1993-05-15

73

Changes of the hip joints associated with chronic subluxation and dislocation: CT and plain radiography analysis  

International Nuclear Information System (INIS)

Secondary osteoarthritis of the hip joint is a common disease and is frequently followed by chronic subluxation and dislocation. Twenty four cases of the secondary osteoarthritis associated with chronic subluxation and dislocation of the hip joints were evaluated with plain radiography and computed tomography. We retrospectively analyzed 1) the osteoarthritis and calcification of the acetabular labrum, 2) the thickness of the quadrilateral plate of the ilium, and 3) anteroposterior diameter of the acetabulum. The changes of the hip joints in subluxation (n=14) revealed ossification of the acetabular labrum in 12 cases (86%), thickening of the quadrilateral plate of the ilium in 11 cases (78%) but anteroposterior diameter of the acetabulum was not changed. The changes of the hip joints in dislocation (n=10) revealed no evidence of the ossification of the acetabular labrum, thickening of the quadrilateral plate of the ilium in 10 cases (100%) and decreased anteroposterior diameter of the acetabulum. We conclude that CT findings of subluxation and dislocation of the hip joints can be helpful in the evaluation of the secondary osteoarthritis of the hip joints.

1993-01-01

74

Primary total hip arthroplasty with dual mobility socket to prevent dislocation: a 22-year follow-up of 240 hips.  

UK PubMed Central (United Kingdom)

PURPOSE: The longest follow-up dual mobility series from inventor Gilles Bousquet focussing on implant survival and the incidence of dislocation. METHODS: This was a retrospective study from 1985 to 1990, on 240 hips using a PF® modular femoral stem and a dual mobility Novae® tripodal socket (SERF). RESULTS: The 22-year follow-up global survival rate was 74%. No dislocation occurred, 41 hips were revised, including ten retentive failures (RF), 12 hips were lost to follow-up, 87 patients (99 hips) died without revision, and 90 hips were still in situ. CONCLUSION: The dual mobility socket global survival rate is comparable to similar series. The 0% dislocation rate demonstrates the success of dual mobility with regard to implant stability. The main issues were cup fixation, which might be improved by the use of macrostructures and HA coating, and osteolytic lesions, caused by polyethylene wear. Traditionally suitable for patients older than 60 years, dual mobility might be extended for use in patients over 50.

Boyer B; Philippot R; Geringer J; Farizon F

2012-03-01

75

Efficacy of an Abduction Brace in Preventing Initial Dislocation in the Early Postoperative Period after Primary Total Hip Arthroplasty  

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We hypothesized that a hip brace may prevent the initial dislocation in the early postoperative period after total hip arthroplasty (THA). We performed a prospective evaluation of the efficacy of a brace in preventing dislocation in 54 primary THAs in 43 patients. All of the patients wore braces for...

Yoshinori Ishii; Hideo Noguchi; Mitsuhiro Takeda; Junko Sato; Yoichiro Domae

76

Surgical indications for treatment for femoroacetabular impingement with surgical hip dislocation.  

UK PubMed Central (United Kingdom)

PURPOSE: There is a lack of detailed information about the indications of surgical treatment for femoroacetabular impingement (FAI), particularly using open surgical dislocation. The purpose of this review was to systematically review the reported indications for surgical dislocation of the hip for FAI. METHODS: Two databases (MEDLINE and EMBASE) were screened for clinical studies involving the treatment for FAI with surgical hip dislocation. We conducted a full-text review and the references for each included paper were hand-searched for other eligible studies. Papers published until September 2011 were included in this review. Two individuals reviewed all identified studies independently, and any disagreement was resolved through consensus. RESULTS: Fifteen studies met the eligibility criteria, which included a total of 822 patients. We identified a lack of consensus for clinical and radiographic indications for surgical hip dislocation to treat FAI. The most common clinical indications reported were clinical symptoms such as hip pain in 10 papers (67 %), a positive impingement sign in 9 papers (60 %), painful/reduced range of motion in 9 papers (60 %), activity-related groin pain in 4 papers (27 %), and non-responsive to non-operative treatment in 4 papers (27 %). The most commonly reported radiographic indicators for surgical hip dislocation were a variety of impingement findings from radiographs in all 15 included papers (100 %), a combination of radiographs and MRA in 5 papers (33 %) or radiographs and MRI in 3 papers (20 %). CONCLUSIONS: These results showed that that there was an inconsistency between the clinical and radiographic indications for surgical hip dislocation as a treatment for femoroacetabular impingement. This review suggests that there is a need for the development of standardized clinical and radiological criteria that serve as guidelines for surgical treatment for FAI. LEVEL OF EVIDENCE: Systematic review, Level IV.

Ayeni OR; Naudie D; Crouch S; Adili A; Pindiprolu B; Chien T; Beaulé PE; Bhandari M

2013-07-01

77

Sonographic detection of unilateral hip dislocation in a spica cast after closed reduction for developmental dysplasia of the hip.  

UK PubMed Central (United Kingdom)

OBJECTIVES: To determine the value of sonography for evaluating unilateral hip dislocation in a spica cast after closed reduction for developmental dysplasia of the hip. METHODS: Seventy-three cases of unilateral hip dislocation were detected by sonography after closed reduction and monitored through the perineal opening of the cast during follow-up. The transinguinal approach was used first to determine the position of the femoral head. Then a sonogram of the bilateral hips was obtained by transverse scanning on the lower margin of the pubic symphysis. To determine the status of the affected femoral head, a bilateral comparison of the femoral head positions was made by measuring the horizontal distance from the medial rim of each femoral head to a center line through the pubic symphysis. RESULTS: In all 73 cases, the femoral head position after reduction could be identified by sonography. With the transinguinal approach, the reduction was successful in 69 cases and unsuccessful in 4. On the sonograms of the bilateral hips, the dislocated femoral heads were repositioned in the acetabular fossa in the successful cases and redislocated posterolaterally in the unsuccessful cases. Among the successful cases, the position differences were less than 2 mm in 61, 3 to 4 mm in 7, and 5 mm in 1. In the unsuccessful cases, the positions of the bilateral hips were asymmetric; the differences were indecipherable after an unsuccessful first reduction but were 3 to 5 mm after a successful second reduction. During follow-up, the differences were never greater than 2 mm in the cases with initial differences of less than 2 mm and gradually decreased to less than 2 mm in those with initial differences of greater than 2 mm. CONCLUSIONS: Sonography can be considered as the first imaging tool for evaluating the effect of closed reduction for developmental dysplasia of the hip.

Teng JB; Yu CW; Wang YZ; Mu KX

2012-06-01

78

Operative treatment of bilateral hip dislocation in children with arthrogryposis multiplex congenita.  

Directory of Open Access Journals (Sweden)

Full Text Available PURPOSE. Arthrogryposis multiplex congenita (AMC) is a rare syndrome with multiple joint contractures. It is commonly believed that bilaterally dislocated hips associated with joint contractures should not be reduced, because movement is satisfactory, while open reduction leads to poor results. This report presents our experience with surgical management of bilateral dislocation of hips in children with AMC. METHODS. During the period 1990 to 2000, we performed open reduction on 8 hips of 4 children with AMC. The mean age at surgery was 23 months (range, 5-48 months). Open reduction and capsular plication without any bony procedure were performed in 4 hips (2 patients). De-rotation and varus osteotomy of the femur was performed in 4 hips, and Salter osteotomy of the innominate bone in 2 hips. The average acetabular index was 44 degrees, and the mean centreedge angle was -41 degrees preoperatively. RESULTS. The average follow-up period was 4 years (range, 2-9 years). The average acetabular index and centre-edge angle were 19 and 18 degrees, respectively at the time of last follow-up. All children could walk without support. One child required re-opening for redislocation of hip joint. The clinical results were good in 6 hips and fair in 2 hips, according to Severin's and McKay's classifications. CONCLUSION. Our experience shows that open reduction for bilateral dislocation of hips in children with AMC is a suitable option with generally good results. Surgery performed at earlier age gives the best functional outcome.

Asif S; Umer M; Beg R; Umar M

2004-01-01

79

Can posterior hip fracture-dislocation occur in indoor football (futsal)? A report of two cases.  

UK PubMed Central (United Kingdom)

Hip fracture-dislocation is extremely rare in sports and is most frequently seen after road traffic accidents. This injury is associated with considerable long-term disability and rapidly progressive joint degeneration. This case report illustrates two cases of hip fracture dislocation that occurred while playing recreational indoor football (futsal). Futsal is a fast-emerging recreational sport in Malaysia and we are now beginning to see high-impact injuries rarely encountered in recreational sports. Therefore, futsal cannot be taken lightly and it is important to take adequate precautions to prevent serious injuries when participating in such sports.

Yasin FN; Singh VA

2009-01-01

80

Can posterior hip fracture-dislocation occur in indoor football (futsal)? A report of two cases.  

Science.gov (United States)

Hip fracture-dislocation is extremely rare in sports and is most frequently seen after road traffic accidents. This injury is associated with considerable long-term disability and rapidly progressive joint degeneration. This case report illustrates two cases of hip fracture dislocation that occurred while playing recreational indoor football (futsal). Futsal is a fast-emerging recreational sport in Malaysia and we are now beginning to see high-impact injuries rarely encountered in recreational sports. Therefore, futsal cannot be taken lightly and it is important to take adequate precautions to prevent serious injuries when participating in such sports. PMID:21686368

Yasin, Faissal Nor; Singh, Vivek Ajit

2009-06-01

 
 
 
 
81

Femoral stem displacement during closed reduction of a dislocated bipolar hemiarthroplasty of the hip.  

Science.gov (United States)

This article describes a case of femoral stem displacement during closed reduction of a redislocated bipolar hemiarthroplasty of the hip in a 72-year-old woman who had undergone bipolar hemiarthroplasty using a polished, tapered cemented femoral stem. The polished, tapered cemented femoral stem is vulnerable to displacement when exposed to traction forces. Six days after bipolar hemiarthroplasty, the patient experienced her first dislocation, and immediate reduction of the dislocated hip was easily achieved. However, on the ninth postoperative day, redislocation occurred, and this time, reduction was not achieved. Subsequent radiographs revealed an unreduced state with posterosuperior dislocation of the hip and dissociation of the femoral stem at the cement-stem interface with proximal migration. Open reduction was then performed, and it was noted that the bipolar prosthesis had dislocated posterosuperiorly, the neck of the femoral stem was incarcerated between the short external rotators, and the femoral stem had migrated proximally by approximately 8 cm. The femoral stem was repositioned by freeing it from the short external rotators and gently tapping it into the cement mantle. Our surgical solution is questionable, because the stability of the stem is likely to be inadequate. According to the established study, no difference in stuffiness was observed before extraction and after reinsertion, which supports the surgical solution we chose. Pre-reduction analysis should be conducted to determine the cause and status of a dislocation, and open reduction should be performed if closed reduction fails when treating dislocated bipolar hemiarthroplasty patients. PMID:20192150

Yun, Ho Hyun; Park, Jung Ho; Park, Jong Woong; Lee, Jae Wook

2010-02-01

82

Femoral stem displacement during closed reduction of a dislocated bipolar hemiarthroplasty of the hip.  

UK PubMed Central (United Kingdom)

This article describes a case of femoral stem displacement during closed reduction of a redislocated bipolar hemiarthroplasty of the hip in a 72-year-old woman who had undergone bipolar hemiarthroplasty using a polished, tapered cemented femoral stem. The polished, tapered cemented femoral stem is vulnerable to displacement when exposed to traction forces. Six days after bipolar hemiarthroplasty, the patient experienced her first dislocation, and immediate reduction of the dislocated hip was easily achieved. However, on the ninth postoperative day, redislocation occurred, and this time, reduction was not achieved. Subsequent radiographs revealed an unreduced state with posterosuperior dislocation of the hip and dissociation of the femoral stem at the cement-stem interface with proximal migration. Open reduction was then performed, and it was noted that the bipolar prosthesis had dislocated posterosuperiorly, the neck of the femoral stem was incarcerated between the short external rotators, and the femoral stem had migrated proximally by approximately 8 cm. The femoral stem was repositioned by freeing it from the short external rotators and gently tapping it into the cement mantle. Our surgical solution is questionable, because the stability of the stem is likely to be inadequate. According to the established study, no difference in stuffiness was observed before extraction and after reinsertion, which supports the surgical solution we chose. Pre-reduction analysis should be conducted to determine the cause and status of a dislocation, and open reduction should be performed if closed reduction fails when treating dislocated bipolar hemiarthroplasty patients.

Yun HH; Park JH; Park JW; Lee JW

2010-02-01

83

True congenital dislocation of shoulder: A case report and review of the literature  

Directory of Open Access Journals (Sweden)

Full Text Available The dislocation of a shoulder joint in infancy is extremely rare and is usually the result of traumatic birth injuries, a sequel to brachial plexus injury, or a true congenital dislocation of shoulder. With more advanced obstetric care, the incidence of first two types has drastically decreased. We report a case of true congenital dislocation of shoulder, second of its kind, in a child who was delivered by cesarean section thereby negating any influence of trauma. We report the case because of its rarity, and review the available literature on this topic. We also discuss the management options when encountered with such a rare case scenario.

Sudesh Pebam; Rangdal Sushil; Bali Kamal; Kumar Vishal; Gahlot Nitesh; Patel Sandeep

2010-01-01

84

Our approach to the spastic hip subluxation and dislocation in children with cerebral palsy.  

UK PubMed Central (United Kingdom)

The purpose of this study was to evaluate the effectiveness of our approach to the spastic hip subluxation and dislocation in children with cerebral palsy. We evaluated 56 hips in our consecutive patients who had been operated on at our department between January 2003 and December 2005. There were done soft-tissue release procedures in 42 hips, osseous reconstructive surgery in 11 hips and osseous palliative surgery in 3 hips. The duration of follow-ups was 1-3 years after surgery. We achieved good result in 15 hips after soft-tissue release, fifteen hips had a fair result, nine a poor result and three a failure. No redislocation was observed after osseous surgery in our patients. Two patients observed no pain after osseous palliative surgery, transient pain in the hip was in one case. In all hips the range of motion (abduction) was increased. The personal hygiene and possibilities of rehabilitation were improved. Childhood is the optimal time to intervene to maximize the function of the patient with cerebral palsy. The musculoskeletal treatment of the child prevents future problems with pain and deformity.

Sponer P; Pellar D; Kucera T; Karpas K

2006-01-01

85

Low Rate of Dislocation of Dual-mobility Cups in Primary Total Hip Arthroplasty.  

UK PubMed Central (United Kingdom)

BACKGROUND: Dual-mobility (DM) cups were introduced to minimize the risk of THA dislocation. The overall rate of dislocation of DM cups (including both large and small articulations) is controversial and ranges from 0% to 5% in previous studies. QUESTIONS/PURPOSES: We therefore recorded (1) the dislocation rate, (2) loosening and osteolysis, and (3) subsequent related revisions with DM cups. METHODS: Between 1998 and 2003, 2480 primary THAs with DM cups were undertaken in 2179 patients. The mean age was 69 years (range, 19-94 years). This group underwent specific clinical and radiographic evaluation at a minimum followup of 0.17 years (mean, 7 years; range, 0.17-11 years) to assess dislocation, reoperation, osteolysis, and cup fixation. RESULTS: There were 22 dislocations (0.88%): 15 dislocations of large articulations (0.6%), with two (0.08%) recurring but only one requiring revision (0.04%), and seven intraprosthetic small articulation dislocations (0.28%), all needing revision surgery. At last followup, mean Harris hip score was 91 (range, 60-100); 2439 cups (98%) showed no signs of loosening; and 141 patients (145 hips) had osteolysis (6%). Osteolysis and cup loosening were more frequent in patients younger than 50 years at the time of surgery. The 10-year survivorship considering revision for any reason was 93% (95% CI, 91%-95%). CONCLUSIONS: DM cups had a low dislocation rate in primary THA, with a limited frequency of adverse effects. We recommend DM cups to minimize dislocation in populations at high risk for instability, but they should be avoided in younger, active patients at higher risk for osteolysis. LEVEL OF EVIDENCE: Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

Combes A; Migaud H; Girard J; Duhamel A; Fessy MH

2013-03-01

86

Modified osteotomy (Kanaya's procedure) for congenital proximal radioulnar synostosis with posterior dislocation of radial head.  

UK PubMed Central (United Kingdom)

Outcomes of Kanaya's procedure for congenital proximal radioulnar synostosis varied depending on the type of radial head dislocation. In our series of 14 patients with 17 forearms who underwent Kanaya's original procedure, the postoperative total rotation arc of the forearm was unsatisfactory in cases with posterior radial head dislocation. We examined the outcomes with respect to the type of radial head dislocation and radial shaft curvature. Radial shafts with a posterior radial head dislocation had only one curve and the radii of the curve were statistically smaller than those in anterior dislocated or enlocated heads, which had two curves. As a result, we modified the osteotomy site for proximal radioulnar synostosis with posterior radial head dislocation and achieved improved forearm rotation and physiological rotation of the radial head in our latest two cases.

Sakamoto S; Doi K; Hattori Y; Dodakundi C; Montales T

2013-07-01

87

Primary total hip arthroplasty revision due to dislocation: prospective French multicenter study.  

UK PubMed Central (United Kingdom)

INTRODUCTION: Dislocation following total hip arthroplasty (THA) may require surgical revision, and is one of the most frequent causes for revision in national registers. The goals of this study were to determine the characteristics of revision THA for dislocation and identify the typical features of hips revised due to dislocation. MATERIALS AND METHODS: A prospective multicenter study (30 centers) was performed in first revision THA performed between January 1, 2010 and December 31, 2011 (multiple revisions were excluded). RESULTS: Two hundred nineteen (10.4%) of all first revisions (2153 cases in 2107 patients) were for dislocation, which was the fifth cause of revision. There were 135 men and 84 women, mean age 65.9 years old (24.3-92.4) at primary THA and 72.9 years old (31.9-98.8) at revision. Revision surgery was performed a mean 7.1 years (± 7.1) after primary THA. The predictive risk factors for dislocation were: a 22.2mm diameter femoral head (risk × 2.4), a posterolateral approach (risk × 1.7), older age (risk × 1.1), an elevated rim liner for primary THA (risk × 6.6). The use of a dual mobility cup did not influence the rate of revision for dislocation (8.8%) compared to the use of a flat rim liner (9.1%). DISCUSSION: The 10.4% rate of revision of THA for dislocation seems markedly lower than the results in the literature both for frequency and ranking. The use of elevated rim or constrained liners designed to decrease the risk of dislocation does not improve results compared to standard liners. LEVEL OF EVIDENCE: Level IV, prospective prognostic study without a control group.

Girard J; Kern G; Migaud H; Delaunay C; Ramdane N; Hamadouche M

2013-09-01

88

Dual mobility design use in preventing total hip replacement dislocation following tumor resection.  

UK PubMed Central (United Kingdom)

INTRODUCTION: Total hip replacement (THR) following hip tumor resection incurs a high risk of dislocation. We assessed the incidence of dislocation associated with use of a dual mobility cup,and the functional results achieved. HYPOTHESIS: Use of a dual mobility cup would reduce the risk of THR instability following hip tumor resection. MATERIAL AND METHODS: We analyzed dislocation rates in a retrospective series of 71 dual mobility cup THRs implanted following the resection of a tumor hip condition: 33 primary bone tumors and 38 bone metastases. The presenting pathology was diagnosed anatomically, and surgery classified in terms of adopted abductor system strategy. Functional results were assessed in terms of pain (analgesia on the World Health Organisation [WHO] scale), assisted walking and Musculoskeletal Tumor Society (MSTS) score. RESULTS: An overall rate of 9.8% dislocation was observed, taking into account all etiologies and contexts together. More precisely, this rate resulted from a compound figure of 5.2% in bone metastasis and 15% in primitive bone tumor. Dislocation risk depended lesson etiology than on the surgical management of the abductor system, being 3.5% in the case of abductor conservation, 9.5% in the case of abductor sectioning/reinsertion, and 18%in case of gluteus medius muscle or nerve resection. Functional improvement was consistently observed, especially in bone metastasis. At the maximal follow-up, 32 patients were not using analgesics, six were taking WHO class III analgesics, 10 class II and 23 class I. Mean MSTS score was 68.1% +/- 23.5% in bone metastasis and 59.6% +/- 17.5% in primary bone tumor.Fourteen patients could walk without assistance, 33 with a single cane, 15 with two canes and eight with a walker; one patient had not been able to resume walking. DISCUSSION: In these indications, dual mobility cups use lead to lower dislocation rates than those reported in the literature. It proved especially effective in the case of bone metastasis and consolidation surgery. In the case of primary bone tumor, it failed to prevent dislocation following acetabular resection, especially when involving the abductor muscles and/or abductor innervation, although it provided lower dislocation rates, comparable to those experienced with other techniques, when applied to limited resection. LEVEL OF EVIDENCE: IV. Retrospective therapeutic study.

Philippeau JM; Durand JM; Carret JP; Leclercq S; Waast D; Gouin F

2010-02-01

89

The risk of dislocation after total hip arthroplasty for fractures is decreased with retentive cups.  

UK PubMed Central (United Kingdom)

PURPOSE: Total hip arthroplasty (THA) has been efficacious for treating hip fractures in healthy older patients. However, in those patients with fractures a widely variable prevalence of dislocation has been reported, partly because of varying durations of follow up for this specific end-point. The purpose of the present study was to determine the cumulative risk of dislocation in these patients with fractures and to investigate if retentive cups decrease the risk of dislocation. METHODS: Between 2000 and 2005, 325 patients with neck fracture underwent primary THA using a retentive (325 hips) cup. The results of these 325 acetabular cups were compared to 180 THA without retentive cups performed for neck fractures in the same hospital between 1995 and 2000 by the same surgical team. The mean age of the 505 patients was 75 years (range 65-85). All patients were followed for a minimum of five years for radiographic evidence of implant failure. The patients were followed at routine intervals and were specifically queried about dislocation. The cumulative risk of dislocation and recurrent dislocation was calculated with use of the Kaplan-Meier method. RESULTS: For patients without retentive cups, the cumulative risk of a first-time dislocation was 5 % at one month and 12 % at one year and then rose at a constant rate of approximately 1 % every year to 16 % at five years. For patients with retentive cups, the cumulative risk of a first-time dislocation was 1 % at one month, 2 % at one year and then did not changed at five years. There were no differences in the mortality rates or in loosening rates among the treatment groups. The rate of secondary surgery was highest in the group without retentive (10 % for recurrent dislocation) compared with 1 % in the group treated with retentive cups. In absence of retentive cups, multivariate analysis revealed that the relative risk of dislocation for female patients (as compared with male patients) was 2.1 and that the relative risk for patients who were 80 years old or more (as compared with those who were less than 80 years old) was 1.5. Two underlying diagnoses occurring during follow up-cognitively impaired patients or neurologic disease-were also associated with a significantly greater risk of dislocation in absence of retentive cup. For these patients the risk was also decreased with a retentive cup. CONCLUSION: With standard cups the incidence of dislocation is highest in the first year after arthroplasty and then continues at a relatively constant rate for the life of the arthroplasty. Patients at highest risk are old female patients and those with a diagnosis of neurologic disease. Retentive cups in these patients are an effective technique to prevent post-operative hip dislocation.

Hernigou P; Ratte L; Roubineau F; Pariat J; Mirouse G; Guissou I; Allain J; Lachaniette CH

2013-07-01

90

Acetabular osteoid osteoma excision by controlled hip dislocation: a case report.  

UK PubMed Central (United Kingdom)

Osteoid osteoma of the acetabulum is rare and its treatment represents a challenge for the orthopedic surgeon. We report a case of a 12-year-old boy with osteoid osteoma in the acetabulum who was treated with a controlled hip dislocation and a gamma probe guide to facilitate excision. The diagnosis was confirmed by pathology. The patient was asymptomatic immediately after surgery and remained so at long-term follow-up.

de Los Santos O; Filomeno P; Rey R; Cúneo A

2013-05-01

91

Traumatic anterior hip dislocation associated with anterior and inferior iliac spines avulsions and a capsular–labral lesion  

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A 16-year-old man had a traumatic accident during motor-cross racing and sustained an anterior hip dislocation with fracture of anterior superior and anterior inferior iliac spines. The hip was emergently reduced and further imaging was obtained to evaluate the lesion and bony fragments. Computed to...

Reggiori, A.; Brugo, G.

92

Intrapelvic Dislocation of a Femoral Trial Head During Primary Total Hip Arthroplasty Requiring Laparotomy for Retrieval  

Science.gov (United States)

Background and Purpose: Total hip arthroplasty (THA) is a safe and reliable surgical procedure. However, THA also has intra- and postoperative complications. A dreaded and frustrating intraoperative complication during total hip arthroplasty is dislocation of the femoral trial head from the neck into the pelvis. Methods: Here, we report on the case of a 71-year old female patient with osteoarthritis of the left hip. Total hip arthroplasty was performed in a lateral position through a standard posterior approach. During intraoperative trial reduction, the femoral trial head dissociated from the taper and dislocated into the psoas compartment. Several unsuccessful attempts, including an additional ventral approach, were made to immediately retrieve the femoral trial head. Results and interpretation: Postoperative a Computerized Tomography (CT) was performed to locate the trial head, a secondary explorative laparotomy was undertaken to retrieve it. The retrieval of the femoral trial head should be performed in a planned second surgical procedure to avoid possible complications during the manipulation necessary for retrieval.

Citak, Mustafa; Klatte, Till Orla; Zahar, Akos; Day, Kimberly; Kendoff, Daniel; Gehrke, Thorsten; Dorner, Arnulf; Gebauer, Matthias

2013-01-01

93

Intrapelvic dislocation of a femoral trial head during primary total hip arthroplasty requiring laparotomy for retrieval.  

UK PubMed Central (United Kingdom)

BACKGROUND AND PURPOSE: Total hip arthroplasty (THA) is a safe and reliable surgical procedure. However, THA also has intra- and postoperative complications. A dreaded and frustrating intraoperative complication during total hip arthroplasty is dislocation of the femoral trial head from the neck into the pelvis. METHODS: Here, we report on the case of a 71-year old female patient with osteoarthritis of the left hip. Total hip arthroplasty was performed in a lateral position through a standard posterior approach. During intraoperative trial reduction, the femoral trial head dissociated from the taper and dislocated into the psoas compartment. Several unsuccessful attempts, including an additional ventral approach, were made to immediately retrieve the femoral trial head. RESULTS AND INTERPRETATION: Postoperative a Computerized Tomography (CT) was performed to locate the trial head, a secondary explorative laparotomy was undertaken to retrieve it. The retrieval of the femoral trial head should be performed in a planned second surgical procedure to avoid possible complications during the manipulation necessary for retrieval.

Citak M; Klatte TO; Zahar A; Day K; Kendoff D; Gehrke T; Dörner A; Gebauer M

2013-01-01

94

High hip center technique using a biconical threaded Zweymuller cup in osteoarthritis secondary to congenital hip disease.  

UK PubMed Central (United Kingdom)

BACKGROUND: The high hip center technique used for a deficient acetabulum is reconstruction of the hip at a high center of rotation. In the literature, there is no consensus regarding the value of this technique. QUESTIONS/PURPOSES: We investigated whether the new-generation biconical threaded Zweymüller cup fixed in a high nonanatomic position in patients with arthritis secondary to congenital hip disease experienced different rates of polyethylene wear and long-term survivorship when compared with anatomically positioned cups. PATIENTS AND METHODS: We studied the polyethylene wear rate and Kaplan-Meier survivorship of 104 titanium threaded Zweymüller cups in 88 patients (81 females), placed in 70 hips at near-normal hip center and in 34 hips at a high hip center position at a distance of 31.1 to 60 mm (mean, 39.7 mm) from the interteardrop line. Minimum followup was 2 years (mean +/- SD, 8.6 +/- 3.5 years; range, 2-15 years). RESULTS: The mean linear polyethylene wear rates in the near-normal and high hip center groups were not different (0.110 +/- 0.050 mm and 0.113 +/- 0.057 mm, respectively). The Kaplan-Meier 15-year cup survivorship rates with revision for any reason as an event of interest in the near-normal and high hip center groups also were not different (97.2% [95% confidence interval, 88.5%-99.3%] and 97.1% [95% confidence interval, 73.8%-99.3%], respectively). CONCLUSIONS: The high hip center technique using a biconical threaded Zweymüller cup in patients with arthritis secondary to congenital hip disease results in a polyethylene wear rate and long-term cup survivorship comparable to those observed in anatomically positioned cups. LEVEL OF EVIDENCE: Level III, therapeutic study. See the Guidelines for Authors for a complete description of level of evidence.

Christodoulou NA; Dialetis KP; Christodoulou AN

2010-07-01

95

Reliability and validity of the Hartofilakidis classification system of congenital hip disease in adults  

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The reliability and validity of the Hartofilakidis et al. classification system in adults with congenital hip disease (CHD) were examined. The radiographs of 102 adult patients (158 hips) with CHD were independently assessed by three senior surgeons. Interobserver variability was assessed by examini...

Yiannakopoulos, C. K.; Xenakis, T.; Karachalios, T.; Babis, G. C.; Hartofilakidis, G.

96

Efficacy of an Abduction Brace in Preventing Initial Dislocation in the Early Postoperative Period after Primary Total Hip Arthroplasty  

Directory of Open Access Journals (Sweden)

Full Text Available We hypothesized that a hip brace may prevent the initial dislocation in the early postoperative period after total hip arthroplasty (THA). We performed a prospective evaluation of the efficacy of a brace in preventing dislocation in 54 primary THAs in 43 patients. All of the patients wore braces for 3 weeks postoperatively. The occurrence of dislocation was evaluated six months postoperatively. There were no cases of dislocation while wearing a brace, while two posterior dislocations occurred 8 and 12 days postoperatively while picking something up from the floor without a brace in so-called provocative positions. The results of this study suggest that a hip brace helps patients to recognize careless provocative positions and prevents the initial hip dislocation in this period instead of usual postoperative management for an average of 6 weeks after discharge, such as a high toilet seat, restricted hip flexion in the activities of daily living, use of a reacher or grabber, an abduction pillow, and a high chair.

Yoshinori Ishii; Hideo Noguchi; Mitsuhiro Takeda; Junko Sato; Yoichiro Domae

2012-01-01

97

Congenital hip disease in adults: terminology, classification, pre-operative planning and management.  

UK PubMed Central (United Kingdom)

This paper reviews the current knowledge relating to the management of adult patients with congenital hip disease. Orthopaedic surgeons who treat these patients with a total hip replacement should be familiar with the arguments concerning its terminology, be able to recognise the different anatomical abnormalities and to undertake thorough pre-operative planning in order to replace the hip using an appropriate surgical technique and the correct implants and be able to anticipate the clinical outcome and the complications.

Karachalios T; Hartofilakidis G

2010-07-01

98

Congenital hip disease in adults: terminology, classification, pre-operative planning and management.  

Science.gov (United States)

This paper reviews the current knowledge relating to the management of adult patients with congenital hip disease. Orthopaedic surgeons who treat these patients with a total hip replacement should be familiar with the arguments concerning its terminology, be able to recognise the different anatomical abnormalities and to undertake thorough pre-operative planning in order to replace the hip using an appropriate surgical technique and the correct implants and be able to anticipate the clinical outcome and the complications. PMID:20595107

Karachalios, T; Hartofilakidis, G

2010-07-01

99

Treatment of high dislocation of the hip in adults with total hip arthroplasty. Operative technique and long-term clinical results.  

UK PubMed Central (United Kingdom)

The clinical results of eighty-four total hip arthroplasties performed through a transtrochanteric approach in sixty-seven patients who had a high dislocation of the hip (the femoral head completely out of the acetabulum), from 1976 to 1994, were reviewed. The acetabular component was placed in the true acetabulum and the femur was shortened at the level of the femoral neck, along with release of the psoas tendon and the small external rotators, in order to facilitate reduction of the components and to avoid neurovascular complications. Eleven hip prostheses (13 per cent) failed at a mean of 6.4 years (range, two months to sixteen years) postoperatively; the failure was due to aseptic loosening of both components in four hips, aseptic loosening of the stem only in three, late infection in three, and malpositioning of the acetabular component that caused recurrent dislocations in one. The other seventy-three hips were functioning well at the latest follow-up examination, two to twenty years (mean, 7.1 years) postoperatively. The overall cumulative rate of success was 92.4 per cent (95 per cent confidence interval, 89.5 to 95.3 per cent) at five years and 88.0 per cent (95 per cent confidence interval, 82.2 to 93.8 per cent) at ten years. We believe that this operative technique of total hip arthroplasty is effective for the treatment of the difficult condition of high dislocation of the hip.

Hartofilakidis G; Stamos K; Karachalios T

1998-04-01

100

Dual mobility cups for preventing early hip arthroplasty dislocation in patients at risk: experience in a county hospital.  

UK PubMed Central (United Kingdom)

Dislocation remains a major concern after hip arthroplasty. We asked whether dual mobility cups (DMC) would improve early hip stability in patients with high risk of dislocation. We followed 34 patients (21 females, 13 males) treated between 2009 and 2012 with cemented DMC for hip revisions caused recurrent hip prosthetic dislocation or as a primary procedure in patients with high risk of instability. Functional outcome and quality of life were evaluated using Harris Hip Score and EQ-5D respectively. We found that the cemented DMC gave stability in 94%. Seven patients (20%) were re-operated due to infection. One patient sustained a periprosthetic fracture. At follow-up (6 to 36 months, mean 18), the mean Harris hip score was 67 (standard deviation: 14) and mean EQ-5D was 0.76 (standard deviation: 0.12). We concluded that treating patients with high risk of dislocation with DMC can give good stability. However, complications such as postoperative infection can be frequent and should be managed carefully.

Mukka SS; Mahmood SS; Sjödén GO; Sayed-Noor AS

2013-06-01

 
 
 
 
101

Dual mobility cups for preventing early hip arthroplasty dislocation in patients at risk: experience in a county hospital.  

Science.gov (United States)

Dislocation remains a major concern after hip arthroplasty. We asked whether dual mobility cups (DMC) would improve early hip stability in patients with high risk of dislocation. We followed 34 patients (21 females, 13 males) treated between 2009 and 2012 with cemented DMC for hip revisions caused recurrent hip prosthetic dislocation or as a primary procedure in patients with high risk of instability. Functional outcome and quality of life were evaluated using Harris Hip Score and EQ-5D respectively. We found that the cemented DMC gave stability in 94%. Seven patients (20%) were re-operated due to infection. One patient sustained a periprosthetic fracture. At follow-up (6 to 36 months, mean 18), the mean Harris hip score was 67 (standard deviation: 14) and mean EQ-5D was 0.76 (standard deviation: 0.12). We concluded that treating patients with high risk of dislocation with DMC can give good stability. However, complications such as postoperative infection can be frequent and should be managed carefully. PMID:23888200

Mukka, Sebastian S; Mahmood, Sarwar S; Sjödén, Göran O; Sayed-Noor, Arkan S

2013-06-11

102

Dual mobility cups for preventing early hip arthroplasty dislocation in patients at risk: experience in a county hospital  

Directory of Open Access Journals (Sweden)

Full Text Available Dislocation remains a major concern after hip arthroplasty. We asked whether dual mobility cups (DMC) would improve early hip stability in patients with high risk of dislocation. We followed 34 patients (21 females, 13 males) treated between 2009 and 2012 with cemented DMC for hip revisions caused recurrent hip prosthetic dislocation or as a primary procedure in patients with high risk of instability. Functional outcome and quality of life were evaluated using Harris Hip Score and EQ-5D respectively. We found that the cemented DMC gave stability in 94%. Seven patients (20%) were re-operated due to infection. One patient sustained a periprosthetic fracture. At follow-up (6 to 36 months, mean 18), the mean Harris hip score was 67 (standard deviation: 14) and mean EQ-5D was 0.76 (standard deviation: 0.12). We concluded that treating patients with high risk of dislocation with DMC can give good stability. However, complications such as postoperative infection can be frequent and should be managed carefully.

Sebastian S. Mukka; Sarwar S. Mahmood; Göran O. Sjödén; Arkan S. Sayed-Noor

2013-01-01

103

Derotational femoral shortening for developmental dislocation of the hip: special indications and results in the child younger than 2 years.  

Science.gov (United States)

Combining derotational femoral shortening osteotomy with open reduction to reduce the incidence of redislocation and avascular necrosis (AVN) in developmental dislocation of the hip (DDH) was first used only for older children. In special circumstances (teratologic dislocation, syndrome-related DDH, difficult home environment), we have combined femoral shortening with open reduction in 15 children (20 hips) ranging in age from 5 to 23 months old. Fourteen hips required concurrent pelvic osteotomy. Complications included partial AVN in two hips, residual subluxation requiring acetabular osteotomy in two hips, and residual dysplasia in two hips. Radiographic evaluation by the Severin method revealed 15 good or excellent hips and five hips rated fair or less. Hips reduced without pelvic osteotomy produced better radiographic results than those treated with a concomitant augmentation acetabuloplasty (Albee). This procedure can injure the growth centers of the acetabular rim in a very young child. Derotational femoral shortening can be used in special circumstances to achieve reduction in DDH in children younger than 2 years. The surgery is technically demanding, and the surgeon should have extensive prior experience using this method in older children. PMID:8543606

Wenger, D R; Lee, C S; Kolman, B

104

Derotational femoral shortening for developmental dislocation of the hip: special indications and results in the child younger than 2 years.  

UK PubMed Central (United Kingdom)

Combining derotational femoral shortening osteotomy with open reduction to reduce the incidence of redislocation and avascular necrosis (AVN) in developmental dislocation of the hip (DDH) was first used only for older children. In special circumstances (teratologic dislocation, syndrome-related DDH, difficult home environment), we have combined femoral shortening with open reduction in 15 children (20 hips) ranging in age from 5 to 23 months old. Fourteen hips required concurrent pelvic osteotomy. Complications included partial AVN in two hips, residual subluxation requiring acetabular osteotomy in two hips, and residual dysplasia in two hips. Radiographic evaluation by the Severin method revealed 15 good or excellent hips and five hips rated fair or less. Hips reduced without pelvic osteotomy produced better radiographic results than those treated with a concomitant augmentation acetabuloplasty (Albee). This procedure can injure the growth centers of the acetabular rim in a very young child. Derotational femoral shortening can be used in special circumstances to achieve reduction in DDH in children younger than 2 years. The surgery is technically demanding, and the surgeon should have extensive prior experience using this method in older children.

Wenger DR; Lee CS; Kolman B

1995-11-01

105

Luxação congénita do joelho: que abordagem? Revisão teórica e experiência de um Hospital Pediátrico/ Congenital dislocation of the knee: what approach? Review and experience of a pediatric hospital  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese Introdução e objectivos: A luxação congénita do joelho é uma anomalia rara que se integra no grupo das deformidades de hiperextensão do joelho. A sua incidência é cerca de 1% da displasia do desenvolvimento da anca. Associa-se com frequência a outras anomalias músculo-esqueléticas, sendo as mais comuns a displasia do desenvolvimento da anca e o pé equino-varo. Em geral, o diagnóstico é estabelecido imediatamente após o nascimento. O tratamento pode ser con (more) servador ou cirúrgico, sendo que o primeiro habitualmente resulta em melhor prognóstico. Os autores relatam a sua experiência no tratamento da luxação congénita do joelho e os resultados favoráveis nos doentes submetidos a redução conservadora imediata nas primeiras horas de vida. Material e métodos: Realizou-se um estudo retrospectivo descritivo com base na análise dos processos clínicos dos doentes com o diagnóstico de luxação congénita do joelho tratados no Serviço de Ortopedia Pediátrica do Hospital Maria Pia, entre 1990 e 2008. Resultados: Apresentam-se quatro casos de luxação congénita do joelho: três tratados por métodos conservadores e um submetido a tratamento cirúrgico. Discussão e conclusões: Os autores salientam a importância da redução imediata da luxação nas primeiras horas de vida como fronteira de atitude terapêutica e prognóstico, onde o pediatra pode assumir um papel determinante no reconhecimento e referenciação atempadas. Destacam a importância do exame ortopédico completo, para exclusão de outras deformidades associadas e a aparente irrelevância da patologia de base para o sucesso do tratamento conservador precoce. A propósito dos casos clínicos apresentados, faz-se uma revisão sumária desta patologia. Abstract in english Background and objective: Congenital dislocation of the knee is a rare anomaly that includes a group of hyperextension deformities of the knee. Its incidence is about 1% of the developmental dysplasia of the hip. It is often associated with other musculoskeletal anomalies, the most common being the developmental dysplasia of the hip and clubfoot. In general, the diagnosis is established immediately after birth. Treatment can be conservative or surgical, and the first one (more) usually results in better prognosis. The authors report their experience in the treatment of congenital dislocation of the knee and the favorable outcome in patients undergoing early reduction. Material and methods: A retrospective descriptive study was conducted based upon the analysis of medical records of patients diagnosed with congenital dislocation of the knee, treated at the Department of Pediatric Orthopedics of Hospital Maria Pia between 1990 and 2008. Results: Four patients with congenital dislocation of the knee are presented: three treated by conservative methods and one that required surgery. Discussion and conclusions: The authors highlight the importance of early reduction of congenital dislocation of the knee in the first hours of life as a frontier of therapeutic approach and prognosis. Pediatricians can play a key role in timely recognition and referral. They also emphasize the importance of complete orthopedic examination in order to exclude other associated deformities, and the apparent irrelevance of the underlying pathology for the success of early conservative treatment. A brief review of congenital dislocation of the knee is presented.

Araújo, Luísa Neiva; Almeida, Eduardo

2012-01-01

106

Klippel-Feil syndrome associated with congenital cervical dislocation: report of an autopsy case.  

UK PubMed Central (United Kingdom)

Klippel-Feil syndrome is an uncommon congenital anomaly that is characterized by abnormal fusion of the cervical vertebrae and occasionally accompanied by various anomalies of other bones and internal organs. We report the autopsy case of a 5-year-old girl with this syndrome ssociated with congenital cervical dislocation, with special reference to the pathological findings of the vertebral column and spinal cord. Principal anomalies of the cranio-spinal axis were as follows: partial defect of the clivus, scoliosis, hypoplasia of the whole cervical vertebrae, anterior dislocation of C7 with S-shaped deformity of the spinal canal, fusion of the spinous processes of the cervical and thoracic vertebrae, fusion of the vertebral bodies of C6 and C7 with collapse of C7, and spina bifida occulta of L5 and S1. In addition to these skeletal anomalies, subarachnoid vascular malformation in the medulla oblongata, a bronchogenic cyst in the posterior mediastinum, anomalous lobation of the lungs, and the mobile cecum were found at autopsy. The cervical cord showed an increase of the antero-posterior diameter, multifocal spongy changes of the white matter, and partial branching or duplication of the central canal. The brain showed features of anoxic encephalopathy. The partial defect of the clivus, C7 dislocation, and various lesions of the medulla oblongata and cervical cord were interpreted as integral components of, or lesions closely associated with, Klippel-Feil syndrome.

Shintaku M; Wada K; Koyama T; Kohno H; Sakamoto T; Hida S

2013-01-01

107

Klippel-Feil syndrome associated with congenital cervical dislocation: report of an autopsy case.  

Science.gov (United States)

Klippel-Feil syndrome is an uncommon congenital anomaly that is characterized by abnormal fusion of the cervical vertebrae and occasionally accompanied by various anomalies of other bones and internal organs. We report the autopsy case of a 5-year-old girl with this syndrome ssociated with congenital cervical dislocation, with special reference to the pathological findings of the vertebral column and spinal cord. Principal anomalies of the cranio-spinal axis were as follows: partial defect of the clivus, scoliosis, hypoplasia of the whole cervical vertebrae, anterior dislocation of C7 with S-shaped deformity of the spinal canal, fusion of the spinous processes of the cervical and thoracic vertebrae, fusion of the vertebral bodies of C6 and C7 with collapse of C7, and spina bifida occulta of L5 and S1. In addition to these skeletal anomalies, subarachnoid vascular malformation in the medulla oblongata, a bronchogenic cyst in the posterior mediastinum, anomalous lobation of the lungs, and the mobile cecum were found at autopsy. The cervical cord showed an increase of the antero-posterior diameter, multifocal spongy changes of the white matter, and partial branching or duplication of the central canal. The brain showed features of anoxic encephalopathy. The partial defect of the clivus, C7 dislocation, and various lesions of the medulla oblongata and cervical cord were interpreted as integral components of, or lesions closely associated with, Klippel-Feil syndrome. PMID:22762890

Shintaku, Masayuki; Wada, Kyosuke; Koyama, Takashi; Kohno, Hiroaki; Sakamoto, Takeshi; Hida, Shinya

108

Effect of femoral head size on risk of revision for dislocation after total hip arthroplasty  

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Background and purpose Previous population-based registry studies have shown that larger femoral head size is associated with reduced risk of revision for dislocation. However, the previous data have not included large numbers of hip resurfacing arthroplasties or large metal-on-metal (> 36-mm) femoral head arthroplasties. We evaluated the association between femoral component head size and the risk of revision for dislocation after THA by using Finnish Arthroplasty Register data. Patients and methods 42,379 patients who were operated during 1996–2010 fulfilled our criteria. 18 different cup/stem combinations were included. The head-size groups studied (numbers of cases) were 28 mm (23,800), 32 mm (4,815), 36 mm (3,320), and > 36 mm (10,444). Other risk factors studied were sex, age group (18–49 years, 50–59 years, 60–69 years, 70–79 years, and > 80 years), and time period of operation (1996–2000, 2001–2005, 2006–2010). Results The adjusted risk ratio in the Cox model for a revision operation due to dislocation was 0.40 (95% CI: 0.26–0.62) for 32-mm head size, 0.41 (0.24–0.70) for 36-mm head size, and 0.09 (0.05–0.17) for > 36-mm head size compared to implants with a head size of 28 mm. Interpretation Larger femoral heads clearly reduce the risk of dislocation. The difference in using heads of > 36 mm as opposed to 28-mm heads for the overall revision rate at 10 years follow-up is about 2%. Thus, although attractive from a mechanical point of view, based on recent less favorable clinical outcome data on these large heads, consisting mainly of metal-on-metal prostheses, one should be cautious using these implants.

Kostensalo, Inari; Junnila, Mika; Virolainen, Petri; Remes, Ville; Matilainen, Markus; Vahlberg, Tero; Pulkkinen, Pekka; Eskelinen, Antti; Makela, Keijo T

2013-01-01

109

Effect of femoral head size on risk of revision for dislocation after total hip arthroplasty.  

UK PubMed Central (United Kingdom)

Background and purpose Previous population-based registry studies have shown that larger femoral head size is associated with reduced risk of revision for dislocation. However, the previous data have not included large numbers of hip resurfacing arthroplasties or large metal-on-metal (> 36-mm) femoral head arthroplasties. We evaluated the association between femoral component head size and the risk of revision for dislocation after THA by using Finnish Arthroplasty Register data. Patients and methods 42,379 patients who were operated during 1996-2010 fulfilled our criteria. 18 different cup/stem combinations were included. The head-size groups studied (numbers of cases) were 28 mm (23,800), 32 mm (4,815), 36 mm (3,320), and > 36 mm (10,444). Other risk factors studied were sex, age group (18-49 years, 50-59 years, 60-69 years, 70-79 years, and > 80 years), and time period of operation (1996-2000, 2001-2005, 2006-2010). Results The adjusted risk ratio in the Cox model for a revision operation due to dislocation was 0.40 (95% CI: 0.26-0.62) for 32-mm head size, 0.41 (0.24-0.70) for 36-mm head size, and 0.09 (0.05-0.17) for > 36-mm head size compared to implants with a head size of 28 mm. Interpretation Larger femoral heads clearly reduce the risk of dislocation. The difference in using heads of > 36 mm as opposed to 28-mm heads for the overall revision rate at 10 years follow-up is about 2%. Thus, although attractive from a mechanical point of view, based on recent less favorable clinical outcome data on these large heads, consisting mainly of metal-on-metal prostheses, one should be cautious using these implants.

Kostensalo I; Junnila M; Virolainen P; Remes V; Matilainen M; Vahlberg T; Pulkkinen P; Eskelinen A; Mäkelä KT

2013-08-01

110

Palliative surgery for acetabular metastasis with pathological central dislocation of the hip joint after radiation therapy. A case report  

International Nuclear Information System (INIS)

Orthopedic surgery for bone metastases is mainly a palliative treatment. Pathological central dislocation of the hip joint secondary to osteonecrosis of acetabular metastasis after radiation therapy brings severe suffering to cancer patients. We performed minimally invasive palliative surgery for an elderly woman, and excellent pain relief was achieved. An 80-year-old female suffering from right hip pain was referred to our hospital. She had undergone surgery for lung cancer 5 years previously and her right acetabulum was subsequently affected by metastasis. With the aim of controlling the metastasis, radiation therapy was performed. Two years later, pathological central dislocation of the hip joint occurred with sudden onset of severe pain, and she was unable to maintain a sitting position and became bedridden. After she was referred to our hospital, we created an intentional pseudarthrosis in the femoral neck for palliation. After the surgery, excellent pain relief and remarkably improved mobility were achieved during her limited remaining lifetime. In this report, we introduce a novel method of producing a pseudarthrosis in the femoral neck for pathological dislocation. This procedure is a minimally invasive treatment and an alternative option for palliative surgery for pathological dislocation of the hip joint due to osteonecrosis after radiation therapy. (author)

2012-01-01

111

The blood supply to the femoral head after posterior fracture/dislocation of the hip, assessed by CT angiography.  

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The femoral head receives blood supply mainly from the deep branch of the medial femoral circumflex artery (MFCA). In previous studies we have performed anatomical dissections of 16 specimens and subsequently visualised the arteries supplying the femoral head in 55 healthy individuals. In this further radiological study we compared the arterial supply of the femoral head in 35 patients (34 men and one woman, mean age 37.1 years (16 to 64)) with a fracture/dislocation of the hip with a historical control group of 55 hips. Using CT angiography, we identified the three main arteries supplying the femoral head: the deep branch and the postero-inferior nutrient artery both arising from the MFCA, and the piriformis branch of the inferior gluteal artery. It was possible to visualise changes in blood flow after fracture/dislocation. Our results suggest that blood flow is present after reduction of the dislocated hip. The deep branch of the MFCA was patent and contrast-enhanced in 32 patients, and the diameter of this branch was significantly larger in the fracture/dislocation group than in the control group (p = 0.022). In a subgroup of ten patients with avascular necrosis (AVN) of the femoral head, we found a contrast-enhanced deep branch of the MFCA in eight hips. Two patients with no blood flow in any of the three main arteries supplying the femoral head developed AVN. Cite this article: Bone Joint J 2013;95-B:1453-7. PMID:24151262

Zlotorowicz, M; Czubak, J; Caban, A; Kozinski, P; Boguslawska-Walecka, R

2013-11-01

112

Prevention of dislocation in total hip revision surgery using a dual mobility design.  

UK PubMed Central (United Kingdom)

BACKGROUND: Postoperative dislocation is the commonest complication following revision total hip arthroplasty (THA). HYPOTHESIS AND TYPE OF STUDY: Dual mobility cups are supposed to reduce the risk of THA instability. The present retrospective study tested this hypothesis on revision THAs and also, assessed this design contribution to acetabular fixation longevity. MATERIALS AND METHODS: The series was homogeneous and continuous, comprising a total of 163 revision THAs: 110 of them were bipolar revisions and 53 were restricted to the acetabular component exchange. Mean patient age was 68.7 years (range: 34-92 years). Novae (SERF, Décines) dual mobility cups were used in all cases: 110 cementless cups were used and 53 cups were cemented in a Kerboull reinforcement ring due to severe acetabular bone loss. RESULTS: Mean patients' follow-up (FU) was 60.4 + or - 17.6 months. There were six early dislocations (which were reduced without additional surgery and remained recurrence-free) and two cases of acetabular loosening. The total postoperative dislocation rate at the end of follow-up was 3.7% and the 7-year cup survivorship rate was 96.1% (95% CI: 92.8-99.2%). In revision for aseptic loosening, the instability rate was 2.9%; in the higher instability risk groups (i.e., revision for infection and or recurrent instability) the dislocation rate was respectively 9% and 0%. DISCUSSION: Dual mobility cups provided a dislocation rate of only 3.7% in revision THA, comparable to the one reported with standard implants for primary THA. This kind of cup design is especially suited to deal with high instability risk revision cases, where constrained components are generally recommended. It can also be indicated in cases of aseptic loosening, where it resulted in a 2.9% dislocation rate and only two impending failures of fixation. In terms of mechanical failure rate, these numbers compare well to the ones pertaining to tripolar and constrained implants. These later alternatives remain possible options but are not fully efficient in terms of long-term stability and fixation longevity. LEVEL OF STUDY: Level IV, retrospective or records-based.

Philippot R; Adam P; Reckhaus M; Delangle F; Verdot F-; Curvale G; Farizon F

2009-10-01

113

Dissociation of modular hip arthroplasty components after dislocation. A report of three cases at differing dissociation levels.  

UK PubMed Central (United Kingdom)

Modular hip arthroplasty systems, currently widely employed, offer the advantage of increased intraoperative flexibility in component selection with reduced inventory, as well as the disadvantage of modular component dissociation. Dissociation during closed reduction for dislocation is reported in three patients at three different interface levels: (1) fixed acetabular shell-polyethylene linear interface, (2) bipolar acetabular component-femoral head interface, and (3) femoral head-neck interface. Subsequent open reduction was required in each case. Although this potential disadvantage of modular hip systems does not outweigh the benefits, it does warrant that certain precautions be taken when implanting modular components. The acetabular linear should lie flush within the metallic shell after impaction. The femoral head should be firmly impacted onto the neck. Both should resist reasonable manual force of disassembly. Should a modular hip arthroplasty component dislocate, gentle reduction under general anesthesia and fluoroscopic control is warranted. Careful inspection of pre- and postreduction roentgenograms for signs of modular component dissociation is mandatory.

Star MJ; Colwell CW Jr; Donaldson WF 3rd; Walker RH

1992-05-01

114

Recurrence of dislocation following total hip arthroplasty revision using dual mobility cups was rare in 180 hips followed over 7 years.  

UK PubMed Central (United Kingdom)

BACKGROUND: Dual mobility (DM) cups of mobile polyethylene were introduced to prevent total hip arthroplasty (THA) dislocation, but no large series with this design to treat recurrent instability have been reported. PURPOSE: Our retrospective investigation ascertained the efficiency of DM cups in correction of recurrent dislocation and assessed any adverse effects. METHODS: One hundred eighty THAs with recurrent instability were revised to DM cups in 180 patients (mean age, 67.4?±?11.7 years; range, 19 to 92 years). Thirty-one patients (17.2%) underwent at least one earlier THA revision, and 15 (10.3%) incurred non-union of the greater trochanter. Of the initial group in 2009, 145 patients had completed evaluations which included assessment of the Harris Hip Score and a radiographic assessment at a mean follow-up of 7.7?±?2.2 years (range, 4 to 14 years). The rate of survival was calculated considering any reason for revision as failure. RESULTS: At follow-up, Harris hip score was 83.9?±?16.1 (range, 21 to 100). Dislocation of the large articulation occurred in seven hips (4.8%), and only two recurred (1.4%) (one requiring additional revision). In addition, two intra-prosthetic dislocations of the small articulation (1.4%) were observed and needed revision surgery. The large number of earlier surgeries and non-union of the greater trochanter were related to recurrent instability. Two cups (1.4%) showed signs of definite loosening; six (4.1%) presented signs of possible loosening. Twenty-nine hips manifested femoral or acetabular osteolysis (20%), but only three were severe. Eight-year survival rate considering revision for any reason was 92.6% (95% CI, 85.5-96.4%). CONCLUSIONS: This series indicates that DM cups are a viable option to treat recurrent THA instability. Their design provides a low risk of recurrent instability without increasing mechanical complications.

Mertl P; Combes A; Leiber-Wackenheim F; Fessy MH; Girard J; Migaud H

2012-10-01

115

Redução cirúrgica da luxação do quadril em pacientes com artrogripose múltipla congênita: acesso anteromedial Open reduction of hip dislocation in patients with arthrogryposis multiplex congenita: an anteromedial approach  

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Full Text Available OBJETIVO: Avaliar os resultados do tratamento cirúrgico da luxação do quadril através do acesso anteromedial em pacientes com artrogripose múltipla congênita (AMC). MÉTODOS: Retrospectivamente foram revisados os prontuários e radiografias de sete crianças com AMC que apresentavam luxação do quadril, totalizando 10 quadris luxados. Foi avaliada a mobilidade articular pré e pós-operatória através da somatória do arco de mobilidade articular em flexão e abdução. Radiograficamente foram avaliados, no pré-operatório, o ângulo acetabular e a altura do colo do fêmur e, no pós-operatório, a continuidade do arco de Shenton, ângulo de Sharp e ângulo CE (centro borda). Quando foi identificada a necrose avascular, esta foi classificada segundo Ogden e Bucholz. RESULTADOS: A média de idade das crianças na ocasião da cirurgia era de 5,5 meses (três a 11 meses). O seguimento médio dos pacientes foi de 9,5 anos (dois a 13 anos). A média de amplitude de movimento da somatória do arco de mobilidade articular em flexão e abdução no exame pré-operatório foi de 108° (70 a 155°) e no pós-operatório foi de 125° (75° a 175°). Na última avaliação, oito quadris estavam centrados e dois subluxados. Dois quadris foram submetidos a uma osteotomia de ilíaco do tipo Salter. Dois quadris apresentaram sinais significativos de necrose avascular Ogden tipo IV. Oito quadris foram considerados como bons resultados e dois como regulares. CONCLUSÃO: Consideramos a via anteromedial uma boa opção para tratamento da luxação de quadril em pacientes de baixa idade com artrogripose múltipla congênita.OBJECTIVE: To evaluate the results of the surgical treatment of hip dislocation through the anteromedial approach in patients with arthrogryposis multiplex congenita (AMC). METHODS: A retrospective review of the charts and radiographs of 7 children with AMC that presented dislocation of the hiprevised, totalling 10 dislocated hips. : Pre and postoperative articular mobility, was evaluated by summing the joint range-of-motion arc of flexion and abduction. , Pre-operatively, the acetabular angle and height of the neck of femur were evaluated radiographically and postoperatively, the continuity of the arc of Shenton, acetabular angle, Sharp angle and CE angle. The presence of avascular necrosis was classified according to Ogden and Bucholz. RESULTS: The average of age of the children at the time of the surgery was 5.5 months (3 to 11 months). The average follow-up time for the patients was 9.5 years (2 to 13 years). The average of the amplitude of movement of the sum of the joint mobility arc in flexion and abduction in the pre-operative examination was 108° (70° to 155 °) and postoperatively it was 125° (75° 175°). In the last evaluation, eight hips were centered and two were subluxated. Two hips had been submitted to a Salter iliac osteotomy. Two hips (20%) had presented significant signs of Ogden type IV avascular necrosis . Eight hips had good results while two were fair. CONCLUSION: We consider the antero-medial approach a good option for the treatment of the dislocation of the hip in patients of low congenital age with arthrogryposis multiplex congenita.

Luis Eduardo Munhoz da Rocha; Fábio Koiti Nishimori; Daniel Carvalho de Figueiredo; Dulce Helena Grimm; Luiz Antonio Munhoz da Cunha

2010-01-01

116

Traumatic anterior dislocation of the hip associated with ipsilateral femoral shaft fracture in a child: A case report.  

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Full Text Available Traumatic anterior dislocation of the hip joint in children is rare, and only one case with ipsilateral femoral fracture has been reported in Japan. We report a case of such dislocation and a review of the literature. The patient was a 31-month-old girl who was injured in a car accident while asleep on a tilted front passenger seat. Radiographic examination showed dislocation of the right obturator foramen and transverse fracture of the ipsilateral femoral shaft. The dislocation of the right hip was easily reduced without anaesthesia during radiography. We applied Bryant traction after reduction for 4 weeks, followed by cast application for 3 weeks. Walking with support and full weightbearing were permitted 14 weeks and 16 weeks after the injury, respectively. Radiography at 4.5 years after the injury showed a mildly enlarged right femoral head and femur overgrowth of approximately 8 mm. Magnetic resonance imaging showed no evidence of suspected avascular necrosis of the femoral head. The patient has no subjective or objective symptoms, and is able to engage in all usual activities. The detailed mechanism of the injury is unknown. We assume that the lower leg was dislocated through abduction during flexion, or abducent, external flexion, considering that the child was sleeping at the time of the accident. Since she was hurled to the back seat, it was assumed that strong external force was vertically added to the femur, which caused the abducent force.

Yamamoto K; Ko M; Masaoka T; Shishido T; Imakiire A

2004-01-01

117

C1-C2 rotary subluxation following posterior stabilization for congenital atlantoaxial dislocation.  

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Full Text Available The authors report a rare complication of C1-C2 rotary subluxation in two children following posterior stabilization for congenital atlantoaxial dislocation (AAD). A patient, with mobile AAD, underwent Brook?s C1-C2 fusion while the other, with fixed AAD, underwent transoral decompression followed by Jain?s occipitocervical fusion. A pre-existing ligamentous laxity associated with an asymmetrical wire tightening or slippage of the wires due to rotation of the neck in the former, and the drilling of the C1-C2 lateral joints during the transoral procedure in the latter, could have contributed to the rotary subluxation. Both patients presented with persistent torticollis due to fusion in an asymmetrical position with dislocated facet joints. Rotary C1-C2 subluxation, when coexisting with anterior dislocation, has the potential to cause severe and occasionally fatal cord compression. Well defined criteria to diagnose this entity by conventional radiology exist, however, due to the overlap of anatomy, the condition is often overlooked. In the present study, three dimensional reconstruction images using helical computerized tomography were very useful in delineating the subluxation and in planning its surgical reduction and arthrodesis.

Behari S; Jain V; Phadke R; Banerji D; Kathuria M; Chhabra D

2000-01-01

118

Simultaneous shoulder and hip dislocation in a 12-year-old girl with Hutchinson-Gilford progeria syndrome.  

UK PubMed Central (United Kingdom)

Hutchinson-Gilford progeria syndrome (HGPS) is a rare premature ageing disorder that is characterized by accelerated degenerative changes of the cutaneous, musculoskeletal and cardiovascular systems. Mean age at diagnosis is 2.9 years and generally leading to death at approximately 13 years of age due to myocardial infarction or stroke. Orthopedic manifestations of HGPS are multiple and shoulder dislocation is a rare skeletal trauma in progeria syndrome. Our patient had simultaneous shoulder and hip dislocation associated with a low energy trauma. This subject has not been reported. Treatment accomplished as close reduction under general anesthesia and immobilization.

Espandar R; Eraghi AS; Mardookhpour S

2012-01-01

119

Dissociation of bipolar hemiarthroplasty of the hip after dislocation. A report of five different cases and review of literature.  

UK PubMed Central (United Kingdom)

Little information is available about the rare but serious disadvantage of dissociation of modular components during dislocation or after close reduction in the bipolar hemiarthroplasty of the hip. In most cases, simple dislocation after primary bipolar hemiarthroplasty can safely be reduced by close methods. Dissociation leads almost always to reoperation and possible revision of the prosthesis. To avoid this complication, strict adherence to the surgical technique during the initial procedure and extra precaution during close reduction are recommended, in order to provide enhanced security over component disassembly. In the five cases presented in this study, dissociation is reported at different circumstances, along with the different methods of treatment required in each patient.

Georgiou G; Siapkara A; Dimitrakopoulou A; Provelengios S; Dounis E

2006-02-01

120

Simultaneous Shoulder and Hip Dislocation in a 12-Year-Old Girl with Hutchinson-Gilford Progeria Syndrome  

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Full Text Available Hutchinson-Gilford progeria syndrome (HGPS) is a rare premature ageing disorder that is characterized by accelerated degenerative changes of the cutaneous, musculoskeletal and cardiovascular systems. Mean age at diagnosis is 2.9 years and generally leading to death at approximately 13 years of age due to myocardial infarction or stroke. Orthopedic manifestations of HGPS are multiple and shoulder dislocation is a rare skeletal trauma in progeria syndrome. Our patient had simultaneous shoulder and hip dislocation associated with a low energy trauma. This subject has not been reported. Treatment accomplished as close reduction under general anesthesia and immobilization.

Ramin Espandar; Amir Sobhani Eraghi; Shirin Mardookhpour

2012-01-01

 
 
 
 
121

Evaluation of the effect of the reduction of the hip spastic dislocation in adolescent and young adult with cerebral paralysis  

International Nuclear Information System (INIS)

We present the results obtained in the Instituto de Ortopedia Infantil Roosevelt for the treatment of the hip dislocation in adolescent patients and young adults with spastic cerebral palsy with the open reduction of the hip, accompanied by femoral osteotomy and, if as necessary, pelvic osteotomy. 14 hips (10 patients) were intervened from January of 1996 to July of 2003. Pain was completely released in 54 percent and improved in 36 percent of cases. Abduction improved in 63 percent of patients allowing the perinea cleaning in 63 percent and better tolerance to scar in 64% of the cases. Our complications were one patient developed a sacred pressure ulcer with the spica cast treated with a free flap transposition; one hip had redislocation at 31 months from surgery; another hip had instability without clinical repercussion; one patient had a not displaced supracondylar femoral fracture treated with immobilization. The results of our study showed that the open reduction of the spastic hip in adolescents and young adults is a procedure that improves, in most of the cases, the stability, mobility and pain of the hip and provides better quality life for these patients.

2006-01-01

122

Arthroplasty in patients with congenital hip dysplasia--early evaluation of a treatment method.  

UK PubMed Central (United Kingdom)

BACKGROUND: Developmental hip dysplasia (DHD) is the most common cause of secondary hip osteoarthritis (OA). It often leads to OA in young, active and working adults. The aim of our study is to evaluate the results of THA in patients with DHD. MATERIAL AND METHODS: Total hip arthroplasty was performed in 15 patients with DHD - 13 women (average age - 39) and 2 men (average age - 44) between June 2010 to June 2011. Patient's hips were estimated by Crowe classification to evaluate the severity of degenerative arthritis. Patients we reassessed with Harris Hip Score before and after the surgery. RESULTS: The mean preoperative score was 44.6 points, directly after surgery 62.4 pts., 6 months after 78.6 points. After artrhroplasty, improvement was noted in walking stairs without railing, walking without support, sitting on chair for more than 1 hour. Before the surgery average difference in limbs" length was 4 cm After the treatment it was reduced to 0.5 cm. Mean hip flexion was 40 ° before, 90 ° after the surgery, mean abduction was respectively 0° and 25°. Our study proves that total hip arthroplasty in patients with developmental dysplasia of hip helps to improve stability and mobility of joint and to reduce the pain. CONCLUSIONS: 1. In the type 1 and 2 according to Crow's classification, good clinical results may be achieved using standard prosthesis stem sizes and press-fit acebutalar component with possibly the smallest diameter providing stable placing. 2. In the case of ty pe III good results are observed using acetabular press-fit method for fixing, after reconstruction of bone defects with osteogenous bone graft. 3. The usage of big head dimensions gives beneficial effects on the osseointegration of the acetabular component and reduces the risk of dislocation. 4. A short follow-up period of the group of patients presented requires further prospective study to evaluate the long-term results.

Bo?ek M; Bielecki T; Nowak R; ?elawski M

2013-01-01

123

One-stage combined surgery with or without preoperative traction for developmental dislocation of the hip in older children.  

UK PubMed Central (United Kingdom)

PURPOSE: To compare one-stage combined surgery with and without preoperative traction, in older children with developmental dislocation of the hip (DDH). METHODS: Records of 9 children who underwent combined surgery for DDH with preoperative traction in 12 hips (group 1) and 12 undergoing the same procedure without preoperative traction in 16 hips (group 2) were retrospectively reviewed. The surgery consisted of open reduction, Salter's innominate osteotomy and femoral shortening with derotation varus osteotomy. The mean age of the patients at the time of operation was 5.8 years. The mean follow-up period was 5.9 years. RESULTS: At final follow-up, clinical outcome in group 1 was worse than that in group 2, though radiographic assessment demonstrated no significant difference between the groups. CONCLUSION: One-stage combined surgery without preoperative traction is effective in the treatment of DDH in older children, and has a lower complication rate, but radiographically the groups did not differ.

Tezeren G; Tukenmez M; Bulut O; Cekin T; Percin S

2006-12-01

124

Neurovascular lesion after total hip arthroplasty in congenital hip dysplasia: Case report  

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Full Text Available Introduction. Nowadays, the total hip arthroplasty is a very frequent surgical intervention. In some cases, vascular and nerve injuries may happen around the hip with total hip arthroplasty. Although they are very rare, they may be very dangerous for the patient in some cases. This paper presents a case of a female patient, in whom the nervous fibularis lesion was detected after the total hip arthroplasty, and the occlusion of the iliac femoral artery was revealed later during physical therapy. Case Report. We described a case of a 32-year-old female patient, in whom the nervous fibularis lesion was detected after the total hip arthroplasty. The patient was referred to a ward for physical therapy. On the 19th postoperative day, she felt a vigorous ache and numbness on the left operated leg during stimulation of the paretic fibular musculature. Clinically weak inguinal arterial pulse was detected. After the examination, iliac-femoral occlusion was diagnosed. The patient was referred to the vascular surgeon. In the next few months, she was treated conservatively and eventually underwent surgery. The revascularization was achieved with a satisfactory effect. A year after the total hip replacement, the patient continued with rehabilitation and physical treatment, which lasted one and a half month and had an incomplete functional result - the patient walked with a walking stick and had weak fibular musculature of a severe degree. The vascular status of the leg was good. Conclusion. In this case, neurovascular lesions led to an incomplete functional recovery of the patient and compromised the expected treatment outcome. According to the scoring system used to assess the functionality, the result was marked as poor.

Stojkovi?-Jovanovi? Tatjana; Martinov Dobrivoje; Boškovi? Ksenija

2013-01-01

125

Traumatic hip dislocation with fracture of the ipsilateral femoral shaft in childhood. Report of a case and review of the literature.  

UK PubMed Central (United Kingdom)

Ipsilateral concomitant hip dislocation and femoral shaft fracture in childhood is extremely rare. A further case and a literature review, with 35 additional observations are presented. The dislocation was initially missed in more than 50% of cases, but when immediately diagnosed, closed reduction manoeuvres were effective in all observations but one, and results were rated normal. As delayed reduction predisposes to avascular necrosis, every child with a femoral shaft fracture should be given a routine X-rays of pelvis, including lateral hip views, as a safeguard against missing an associated hip dislocation. If present, its urgent closed reduction is imperious. In case of failure, closed or open purchasing of the proximal shaft fragment to allow a sort of skeletal-handling is to be used. Open reduction of the dislocation is to be regarded as the third-line procedure.

Barquet A

1981-01-01

126

Dissociation of modular hip arthroplasty components after dislocation. A report of three cases at differing dissociation levels.  

Science.gov (United States)

Modular hip arthroplasty systems, currently widely employed, offer the advantage of increased intraoperative flexibility in component selection with reduced inventory, as well as the disadvantage of modular component dissociation. Dissociation during closed reduction for dislocation is reported in three patients at three different interface levels: (1) fixed acetabular shell-polyethylene linear interface, (2) bipolar acetabular component-femoral head interface, and (3) femoral head-neck interface. Subsequent open reduction was required in each case. Although this potential disadvantage of modular hip systems does not outweigh the benefits, it does warrant that certain precautions be taken when implanting modular components. The acetabular linear should lie flush within the metallic shell after impaction. The femoral head should be firmly impacted onto the neck. Both should resist reasonable manual force of disassembly. Should a modular hip arthroplasty component dislocate, gentle reduction under general anesthesia and fluoroscopic control is warranted. Careful inspection of pre- and postreduction roentgenograms for signs of modular component dissociation is mandatory. PMID:1563139

Star, M J; Colwell, C W; Donaldson, W F; Walker, R H

1992-05-01

127

Reliability and validity of the Hartofilakidis classification system of congenital hip disease in adults.  

Science.gov (United States)

The reliability and validity of the Hartofilakidis et al. classification system in adults with congenital hip disease (CHD) were examined. The radiographs of 102 adult patients (158 hips) with CHD were independently assessed by three senior surgeons. Interobserver variability was assessed by examining the agreement between the three raters while validity of the classification system was assessed by examining the agreement between the assessment by either one of the three raters and the intraoperative finding (reference standard). The interobserver agreement between the three observers was high ranging from 0.720 to 0.854 (substantial to excellent) while the agreement of the preoperative prediction with the intraoperative findings was 87.4% (K = 0.823, excellent agreement). The Hartofilakidis et al. classification system reliably predicts from preoperative pelvis radiographs the bone deficiencies encountered during the operation. PMID:17985130

Yiannakopoulos, C K; Xenakis, T; Karachalios, T; Babis, G C; Hartofilakidis, G

2007-11-06

128

Reliability and validity of the Hartofilakidis classification system of congenital hip disease in adults.  

UK PubMed Central (United Kingdom)

The reliability and validity of the Hartofilakidis et al. classification system in adults with congenital hip disease (CHD) were examined. The radiographs of 102 adult patients (158 hips) with CHD were independently assessed by three senior surgeons. Interobserver variability was assessed by examining the agreement between the three raters while validity of the classification system was assessed by examining the agreement between the assessment by either one of the three raters and the intraoperative finding (reference standard). The interobserver agreement between the three observers was high ranging from 0.720 to 0.854 (substantial to excellent) while the agreement of the preoperative prediction with the intraoperative findings was 87.4% (K = 0.823, excellent agreement). The Hartofilakidis et al. classification system reliably predicts from preoperative pelvis radiographs the bone deficiencies encountered during the operation.

Yiannakopoulos CK; Xenakis T; Karachalios T; Babis GC; Hartofilakidis G

2009-04-01

129

Role of the limbus in femoral-head deformation in developmental dislocation of the hip: findings of two-directional hip arthrography.  

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Full Text Available Two-directional arthrographic findings made during conservative treatment of developmental dislocation of the hip were compared with the femoral-head configurations and radiological results obtained from long-term follow-up examinations in this retrospective study. Sixty hips were followed until at least age 14. Arthrography was carried out according to Terazawa's method. The shape of the superior, anterior, and posterior limbus was evaluated based on a modified Fujii's classification. The femoral-head configuration was classified into 4 groups, and the radiological results were evaluated using Severin's classification at the final observation. There was a statistically significant relationship between the shape of the anterior limbus, the number of portions of deformed limbus (superior, anterior, posterior), and the femoral-head configuration. Also, a statistically significant relationship between the shape of the limbus and Severin's classification was observed. These results suggest that the deformed limbus seems to play an important role in triggering femoral-head deformities, possibly via mechanical compression, and negatively affects development of the hip joint.

Hara S; Akazawa H; Mitani S; Oda K; Inoue H

2002-01-01

130

Congenital lens dislocation and fatal cerebral vein thrombosis in a patient with homocysteinemia: a lesson for urgent screening of pediatric population.  

UK PubMed Central (United Kingdom)

Congenital homocysteinemia is a genetic disease with various clinical manifestations such as thrombosis, lens dislocation and mental retardation and osteoporosis, so early diagnosis is important for decreasing the mortality and morbidity especially in pediatric populations. Here we describe a child with a presentation of coma with a past history of lens operation with unfortunate fatal clinical course, and a final diagnosis of congenital homocysteinemia.

Nourani Khojasteh H; Amiri A

2013-05-01

131

Total hip arthroplasty dislocation rate following isolated cup revision using Hueter's direct anterior approach on a fracture table.  

UK PubMed Central (United Kingdom)

INTRODUCTION: Instability is a major complication after revision total hip arthroplasty. Studies in the literature have shown that the dislocation rate after primary arthroplasties by anterior approach on a fracture table is satisfactory, but the rate of instability following revision surgery is not known. HYPOTHESIS AND AIMS: We hypothesized that the Hueter direct anterior approach would result in a lower rate of postoperative dislocation following revision surgery. This hypothesis was tested in a series of isolated acetabular component replacements. PATIENTS AND METHODS: Seventy-three consecutive isolated acetabular component replacements were performed between January 2000 and December 2007. Twelve revisions using constrained liners or dual mobility cups were excluded, thus 61 revisions in 59 patients, mean age 65.8-year-old (range 27-86) were included. The indications for revision arthroplasty were: 51 (83.6%) cases of aseptic loosening, five (8.2%) non-integration of cementless cups, three (4.9%) cases of instability, one (1.6%) case of impingement with the psoas and one (1.6%) case of excessive (3cm) lengthening. Acetabular bone defects were moderate, with 12 stage I, 26 stage II, 19 stage III, and only four stage IV defects on the SOFCOT bone stock deficiency score. There was no acetabular reconstruction in 18 cases, while there were four isolated reconstruction cages and 39 cages with a graft. The replacement cup was cemented in 52 cases and cementless in nine. Inclination and anteversion were measured by the Pradhan method on standard X-rays. RESULTS: Results were evaluated after a mean follow-up of 2.4 years±1.7 years (1-7 years). Four dislocations were observed (6.6%) all anterior and early in the postoperative period (less than 2 months): three patients had a single episode of dislocation and one patient again underwent revision cup replacement by Hueter anterior approach for recurrent anterior dislocation. The only factor associated with a risk of dislocation was a high body mass index: 29.7±0.8 in the group with dislocation compared to 25.6±3.2 in the group without (P=0.008). A high number of prior interventions was also a significant risk factor (P=0.045). On the other hand, there was no difference in cup inclination or femoral offset between the group with dislocation and that without. DISCUSSION: Although the rate of dislocation is higher than after primary THA by anterior approach, it remains acceptable for revision THA and is similar to rates observed with other approaches. The literature does not clearly establish that one surgical approach is better than another in terms of instability. This study was limited by the absence of CT-scan measurements of component orientation both preoperatively to evaluate the femoral component which is preserved, as well as during follow-up to evaluate cup angle and compare the groups with and without dislocation. CONCLUSION: The Hueter direct anterior approach is a viable option for isolated cup revision, as long as femoral loosening has been excluded, and the orientation of the preserved femoral component is known. LEVEL OF EVIDENCE: Level IV; retrospective study.

Cogan A; Klouche S; Mamoudy P; Sariali E

2011-09-01

132

Arthroscopic-assisted surgical treatment for developmental dislocation of the hip before the age of 18 months.  

UK PubMed Central (United Kingdom)

PURPOSE: The purpose of this study is to evaluate the results of arthroscopy assisted surgical treatment of developmental dislocation of the hip (DDH). METHODS: Arthroscopic assisted surgical treatment was performed on nine hips of nine female children with DDH using our method, published previously, between January 2001 and December 2005. Their ages ranged from 9 to 16 months. Percutaneous adductor tenotomies were performed in seven cases. A spica cast and abduction splint were used for 11-17 weeks postoperatively. Acetabular index and Shenton line were used for preoperative and postoperative radiologic evaluation. Also, the cases were evaluated postoperatively with respect to range of motion restriction, and the leg length discrepancy. RESULTS: The average follow-up was 47.7 months (range 22-79 months). Acetabular index measurements of cases in the preoperative/postoperative periods were as follows: preoperative mean angle 39.9° (range 34°-52°)/postoperative mean angle 26° (range 22°-34°). Hip joint restriction and leg length discrepancy were not observed postoperatively. However, two patients had acetabular dysplasia. Acetabular dysplasia was completely resolved in one patient in the third year of follow-up, whereas Salter innominate osteotomy, required in another patient, was in the second year of follow-up. The latter patient was the oldest case (16-month-old) in our series. CONCLUSIONS: Based on the results of this study, treatment of developmental hip dysplasia with arthroscopic-assisted surgical treatment technique may be safe and effective method. Further clinical studies will be required to confirm this study.

Oztürk H; Oztemür Z; Bulut O; Tezeren G; Bulut S

2013-09-01

133

Luxación asimétrica traumática bilateral de cadera. Presentación de un caso/ Asymmetric traumatic bilateral dislocation of hip. Case report  

Scientific Electronic Library Online (English)

Full Text Available Abstract in spanish Se presenta el caso de un paciente masculino de 26 años de edad que en un accidente de transito sufrió una luxación asimétrica bilateral de cadera. Fue tratado con reducción a cielo cerrado y tracción esquelética por seis semanas. Porque la literatura revisada solo reconoce 6 casos publicados con este tipo de lesión y por ser una emergencia médica resultado de traumatismos de alta energía, con la osteonecrosis aséptica como la complicación más frecuente y más grave, se decidió publicar este caso. Abstract in english A male (26 years) suffered an asymmetric bilateral dislocation of hip as a result of a car accident. The patient was treated with closed reduction and bone traction for six weeks. We present this report since the reviewed literature only include six cases with this kind of lesion and because this is a medical emergency resulting from high impact trauma, being the aseptic osteonecrosis the most significant and serious complication.

González González, Pedro; Morales Perez, Tamara

2009-04-01

134

Some effects of position on the roentgenographic diagnosis of dislocation at the infant hip  

International Nuclear Information System (INIS)

[en] X-ray findings in the examination of the hips in infants depend upon the position of the infant during the examination. Each of three variables of position, (1) pelvic tilt, (2) abduction of the femurs, and (3) external rotation of the femurs, affects the apparent relation but not the real relation between the acetabulum and the femur. (orig.)

1981-01-01

135

Total hip arthroplasty in patients with high dislocation: a concise follow-up, at a minimum of fifteen years, of previous reports.  

Science.gov (United States)

We report the updated results at a minimum of fifteen years after eighty-four consecutive total hip arthroplasties performed in sixty-seven female patients with high dislocation of the hip. Sixty-four arthroplasties were performed in forty-nine patients, between 1976 and 1994, with Charnley low-friction acetabular and femoral components inserted with cement; nineteen arthroplasties were performed in seventeen patients, between 1990 and 1994, with the hybrid technique (acetabular component inserted without cement and femoral component inserted with cement); and one arthroplasty was done in 1991, with cementless acetabular and femoral components. All patients were followed prospectively on the basis of clinical assessment according to the Merle D'Aubigné and Postel scoring system, as modified by Charnley, and with radiographic analysis. At the time of the latest follow-up, twenty-six hips (41%) in the low-friction arthroplasty series, ten hips (53%) in the hybrid series, and the one hip with the cementless components had been revised for various reasons. The primary reason for revision in the low-friction arthroplasty group was aseptic loosening of the components (twenty-four hips), whereas the predominant reason for the revisions in the hybrid series and in the hip with cementless components was progressive polyethylene liner wear (six hips). After the minimal follow-up of fifteen years, twenty-five low-friction hip replacements and eight hybrid-type hip replacements had remained intact for an average of twenty-one years (range, seventeen to thirty-two years) and sixteen years (range, fifteen to nineteen years), respectively. These findings may be used in comparisons of results with newer techniques and designs. PMID:21915576

Hartofilakidis, George; Karachalios, Theofilos; Georgiades, George; Kourlaba, Georgia

2011-09-01

136

Total hip arthroplasty in patients with high dislocation: a concise follow-up, at a minimum of fifteen years, of previous reports.  

UK PubMed Central (United Kingdom)

We report the updated results at a minimum of fifteen years after eighty-four consecutive total hip arthroplasties performed in sixty-seven female patients with high dislocation of the hip. Sixty-four arthroplasties were performed in forty-nine patients, between 1976 and 1994, with Charnley low-friction acetabular and femoral components inserted with cement; nineteen arthroplasties were performed in seventeen patients, between 1990 and 1994, with the hybrid technique (acetabular component inserted without cement and femoral component inserted with cement); and one arthroplasty was done in 1991, with cementless acetabular and femoral components. All patients were followed prospectively on the basis of clinical assessment according to the Merle D'Aubigné and Postel scoring system, as modified by Charnley, and with radiographic analysis. At the time of the latest follow-up, twenty-six hips (41%) in the low-friction arthroplasty series, ten hips (53%) in the hybrid series, and the one hip with the cementless components had been revised for various reasons. The primary reason for revision in the low-friction arthroplasty group was aseptic loosening of the components (twenty-four hips), whereas the predominant reason for the revisions in the hybrid series and in the hip with cementless components was progressive polyethylene liner wear (six hips). After the minimal follow-up of fifteen years, twenty-five low-friction hip replacements and eight hybrid-type hip replacements had remained intact for an average of twenty-one years (range, seventeen to thirty-two years) and sixteen years (range, fifteen to nineteen years), respectively. These findings may be used in comparisons of results with newer techniques and designs.

Hartofilakidis G; Karachalios T; Georgiades G; Kourlaba G

2011-09-01

137

Histomorphologic Characteristics of Newly Formed Cavity of a Hip Joint in Dislocation in Experiment  

Directory of Open Access Journals (Sweden)

Full Text Available The aim of the investigation was to study in experiment the head of femur dislocation, which is a variety of transchondral damages, and the process of chondro- and osteogenesis in articular surface formation to create optimal conditions for their reparation and new formation.Materials and Methods. The experiment was carried out on 20 reproductive chinchilla rabbits. The head of femur was dislocated in experiment after joint capsule transaction, and exposed to dosing impact and force effect in the area of its upper pole. A blow was stricken by the device looking like an impact machine. The blow energy was regulated by changing load weight and the pendulum height. The animals were removed from the experiment 3, 7, 14, 30 days and 3 months after the injury.Results. For the initial few days in the dislocation area there were found fibrin effusions, hemorrhage, periosteal edema, and granulation tissue. In 2 weeks in fibrous tissue there were determined focal clusters of chondroblasts. By the end of the first month, near the head of femur, connective tissue was underlaid by newly formed fibrous cartilage with the areas of young hyaline cartilage forming a free margin. In 3 months a submarginal zone was formed of hyaline cartilage with ordered cytoarchitectonics of chondrocytes. Different-sized margins of the newly formed hyaline cartilage with the foci of complete osteogenesis in the wall of forming cavity (in the form of osseous tissue of sponge structure with the blood-forming bone marrow in interjoist) were observed in close connection with periosteum of acetabular roof.Conclusion. A joint cavity forms on the basis of the mechanisms of pluripotent development of cambial cell elements towards chondro- and osteogenesis. Its successful formation can be accompanied by the mass of well blood-supplied muscles surrounding the dislocated head, periosteum of acetabular roof, as well as the capability of active movements the head of femur dislocated into supra-acetabular area in the absence of axial bearing on the operated extremity during the whole postoperative period. Thus, an articular cartlage has significant potential for recovery, and the obtained results enable to help lay down optimal conditions for such a recovery.

I.Y. Ezhov; Y.I. Bushuev; Y.I. Ezhov

2013-01-01

138

The surgical treatment of developmental dislocation of the hip in older children: a comparative study.  

Science.gov (United States)

The aim of this retrospective study was to compare simultaneous open reduction and Salter innominate osteotomy versus one-stage combined surgical treatment including femoral shortening. A total of 24 patients were studied. Group 1 included 16 hips in 14 patients treated by simultaneous open reduction and Salter innominate osteotomy; Group 2 included 13 hips in 10 patients treated by one-stage open reduction, Salter innominate osteotomy and femoral shortening. The average age at the time of operation was 4.1 years (range: 3.3 to 5.1). Average follow-up was 5.3 years (range: 2.7 to 9.0). Clinical and radiological assessment at final follow-up showed that the outcome was not significantly different between the two groups. The duration of operation, however, was significant different between the groups. Patients with DDH between 3 and 5 years of age were treated successfully with either simultaneous open reduction and Salter innominate osteotomy or a one-stage combined surgical procedure including femoral shortening. Clinical and radiological outcomes were similar. Nevertheless, after this follow-up period, the rate of avascular necrosis was slightly higher in Group 1; on the other hand, one-stage combined surgical treatment including femoral shortening significantly prolonged the operative time. PMID:16459857

Tezeren, Gunduz; Tukenmez, Mehmet; Bulut, Okay; Percin, Sitki; Cekin, Tacettin

2005-12-01

139

The surgical treatment of developmental dislocation of the hip in older children: a comparative study.  

UK PubMed Central (United Kingdom)

The aim of this retrospective study was to compare simultaneous open reduction and Salter innominate osteotomy versus one-stage combined surgical treatment including femoral shortening. A total of 24 patients were studied. Group 1 included 16 hips in 14 patients treated by simultaneous open reduction and Salter innominate osteotomy; Group 2 included 13 hips in 10 patients treated by one-stage open reduction, Salter innominate osteotomy and femoral shortening. The average age at the time of operation was 4.1 years (range: 3.3 to 5.1). Average follow-up was 5.3 years (range: 2.7 to 9.0). Clinical and radiological assessment at final follow-up showed that the outcome was not significantly different between the two groups. The duration of operation, however, was significant different between the groups. Patients with DDH between 3 and 5 years of age were treated successfully with either simultaneous open reduction and Salter innominate osteotomy or a one-stage combined surgical procedure including femoral shortening. Clinical and radiological outcomes were similar. Nevertheless, after this follow-up period, the rate of avascular necrosis was slightly higher in Group 1; on the other hand, one-stage combined surgical treatment including femoral shortening significantly prolonged the operative time.

Tezeren G; Tukenmez M; Bulut O; Percin S; Cekin T

2005-12-01

140

The risk of revision due to dislocation after total hip arthroplasty depends on surgical approach, femoral head size, sex, and primary diagnosis. An analysis of 78,098 operations in the Swedish Hip Arthroplasty Register.  

UK PubMed Central (United Kingdom)

BACKGROUND AND PURPOSE: The effects of patient-related and technical factors on the risk of revision due to dislocation after primary total hip arthroplasty (THA) are only partly understood. We hypothesized that increasing the femoral head size can reduce this risk, that the lateral surgical approach is associated with a lower risk than the posterior and minimally invasive approaches, and that gender and diagnosis influence the risk of revision due to dislocation. PATIENTS AND METHODS: Data on 78,098 THAs in 61,743 patients performed between 2005 and 2010 were extracted from the Swedish Hip Arthroplasty Register. Inclusion criteria were a head size of 22, 28, 32, or 36 mm, or the use of a dual-mobility cup. The covariates age, sex, primary diagnosis, type of surgical approach, and head size were entered into Cox proportional hazards models in order to calculate the adjusted relative risk (RR) of revision due to dislocation, with 95% confidence intervals (CI). RESULTS: After a mean follow-up of 2.7 (0-6) years, 399 hips (0.5%) had been revised due to dislocation. The use of 22-mm femoral heads resulted in a higher risk of revision than the use of 28-mm heads (RR = 2.0, CI: 1.2-3.3). Only 1 of 287 dual-mobility cups had been revised due to dislocation. Compared with the direct lateral approach, minimally invasive approaches were associated with a higher risk of revision due to dislocation (RR = 4.2, CI: 2.3-7.7), as were posterior approaches (RR = 1.3, CI: 1.1-1.7). An increased risk of revision due to dislocation was found for the diagnoses femoral neck fracture (RR = 3.9, CI: 3.1-5.0) and osteonecrosis of the femoral head (RR = 3.7, CI: 2.5-5.5), whereas women were at lower risk than men (RR = 0.8, CI: 0.7-1.0). Restriction of the analysis to the first 6 months after the index procedure gave similar risk estimates. INTERPRETATION: Patients with femoral neck fracture or osteonecrosis of the femoral head are at higher risk of dislocation. Use of the minimally invasive and posterior approaches also increases this risk, and we raise the question of whether patients belonging to risk groups should be operated using lateral approaches. The use of femoral head diameters above 28 mm or of dual-mobility cups reduced this risk in a clinically relevant manner, but this observation was not statistically significant.

Hailer NP; Weiss RJ; Stark A; Kärrholm J

2012-10-01

 
 
 
 
141

Incidence of piriformis tendon preservation on the dislocation rate of total hip replacement following the posterior approach: a series of 226 cases.  

UK PubMed Central (United Kingdom)

BACKGROUND: Dislocation is a feared complication following total hip replacement (THR). While repairing the piriformis tendon after THR reduces dislocation, we analyze in this study the effect of piriformis tendon preservation on reducing the dislocation rate. MATERIAL AND METHODS: 226 THRs were done following the usual posterior approach and by the same surgeon. All patients received the same prosthetic design. All cases were primary THR. After reaching the external rotators, the piriformis muscle was identified and dissected on its inferior border from the gemellus superior and elevated by a retractor. Further stages were performed in the usual manner. Patients were followed up for a mean of 3 years. RESULTS: 226 THRs were done for 217 patients, 118 of whom were females and 99 were males with a mean age of 62. Nine patients received bilateral THRs. 112 procedures were performed on the right side and 114 on the left side. THR was performed in 70 cases following femoral neck fractures and in 156 cases due to osteoarthritis. No intraoperative or long-term complications were found while preserving the piriformis. Postoperative hip X-rays showed good positioning of both the femoral and acetabular components. No cases of dislocation were identified after a mean follow-up of 3 years. CONCLUSION: Preservation of the piriformis tendon during the postero-lateral approach in THR is a possible surgical technique that is easy to use and reproducible in both arthritic and traumatic conditions. It follows an anatomical intermuscular plan and permits full exposure of both the proximal femur and the acetabulum. Compared to the literature, preserving the piriformis tendon seems to be superior to repairing it in terms of dislocation of THR.

Moussallem CD; Hoyek FA; Lahoud JC

2012-01-01

142

Contribution of hospital characteristics to the volume-outcome relationship: dislocation and infection following total hip replacement surgery.  

UK PubMed Central (United Kingdom)

OBJECTIVE: Mortality and complication rates after total hip replacement (THR) are inversely associated with the volume of THRs performed at hospitals and by individual surgeons. It is not clear, however, why a higher volume of such procedures is associated with better outcomes. We evaluated the contribution of hospital structural characteristics to the volume-outcome relationship in THR by examining the rates and predictors of postoperative complications. METHODS: We analyzed data pertaining to 5,211 Medicare patients who underwent primary THR in 1995 or 1996 at 167 hospitals in Colorado, Pennsylvania, and Ohio. Data were derived from several sources, including Medicare Part A and Part B claims, the American Board of Medical Specialties, a hospital survey regarding institution-specific characteristics and structural aspects of the care setting, and the American Hospital Association 1995 Annual Survey. Multivariate models were constructed to determine whether hospital structure or surgeon-associated factors may underlie the relationship between volume of THRs and the occurrence of perioperative orthopedic adverse events, defined as deep wound infection or hip dislocation within 90 days of surgery. RESULTS: Of the patients studied, 2.6% experienced an orthopedic adverse event after THR. Sixty-nine percent fewer events occurred in hospitals where >100 THRs in Medicare patients were performed annually, compared with hospitals where

Solomon DH; Losina E; Baron JA; Fossel AH; Guadagnoli E; Lingard EA; Miner A; Phillips CB; Katz JN

2002-09-01

143

Congenital Dislocation of Knee: Results of the Treatment in 29 Cases Between 1970 and 2010 Years at Shafa Yahyaian Hospital in Tehran  

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Full Text Available Background: There are not many reports regarding the treatment approaches of congenital dislocation of the knee in the literature. Therefore, the preferred method of treatment of this rare congenital disease is still controversial. Hereby, we report the treatment outcome of 29 patients admitted in Shafa Yahyaian Hospital during 40 years. Methods: In this retrospective study done in Shafa Yahyaian Hospital in Tehran, Iran during 2010, we retrospectively reviewed the medical records of 29 patients treated conservatively or surgically for congenital dislocation of the knee. Patients had been evaluated for an average follow-up of 8.5 years. Results: Overall, 54 knee dislocations had been treated surgically (58%) or conservatively (42%). Range of knee motion, persistent recurvatum, instability, valgus deformity after treatment and limping were the more important factors reported in the two surgically or conservatively treated groups. Knee function was satisfactory in patients with conservative treatment. Despite 80% of instability in the operated knees, patients could ambulate with or without braces and had a range of motion equal to 80 degrees. Knee function was also good after quadricepsplasty with transarticular pins in selected cases. Conclusion: We recommend a conservative approach to the disease, regardless of the patients age at the time of treatment and subsequent surgery in patients with dissatisfactory recovery. Quadricepsplasty with transarticular fixation is recommended as a good option in treating these patients. Posterior capsulorrhaphy for patients with CDK and ligamentous laxity is also recommended.

M Rahbar; M Jabalameli; N Aqajani; R Shafipour

2012-01-01

144

Dual mobility cups hip arthroplasty as a treatment for displaced fracture of the femoral neck in the elderly. A prospective, systematic, multicenter study with specific focus on postoperative dislocation.  

UK PubMed Central (United Kingdom)

INTRODUCTION: Displaced fractures of the femoral neck in the elderly are best treated with arthroplasty. The type of arthroplasty to be used, either hemi- or total hip arthroplasty, remains controversial as total hip replacements potentially have a higher rate of dislocation. HYPOTHESIS: Dual mobility cups have a low dislocation rate when used to manage acute fractures of the femoral neck. PATIENTS AND METHODS: In a multicenter prospective study conducted in France over an inclusion time of 3 months, all displaced fractures of the femoral neck treated with arthroplasty were operated on with insertion of a dual mobility cup. Patients had clinical and radiological assessment at 3, 6, and 9 months postoperative. RESULTS: Two hundred and fourteen hips in 214 patients with a mean age of 83 years (range, 70-103 years) were included. None of the patients was lost to follow-up. The mortality rate after 9 months was 19%. Two patients (1%) had early postoperative infection successfully treated with lavage and antibiotics. Three patients (1.4%), operated through a posterior approach, presented one postoperative dislocation, all of which were posterior. Reduction was performed through closed external manipulation under general anesthesia. There was no recurrence of dislocation. DISCUSSION: This low rate of dislocation after acute total hip replacement using dual mobility design cups favorably compares with hemiarthroplasties. Dual mobility cups might therefore be considered a valuable option to prevent postoperative dislocation when treating displaced intracapsular fractures of the proximal femur in elderly patients if a total hip replacement is recommended. Further study is needed before extending the indications for total hip arthroplasty following a fracture of the femoral neck, to assess the potential cost and complications of a longer procedure with its potential acetabular complication, and weigh them against the potential benefits.

Adam P; Philippe R; Ehlinger M; Roche O; Bonnomet F; Molé D; Fessy MH

2012-05-01

145

Hip Replacement - Physical Therapy  

Medline Plus

Full Text Available ... hip joint joins the pelvis to the femur, or thighbone. It is similar to a ball and ... the femur from coming out of the socket, or dislocating. Even though the joint allows the hip ...

146

A influência da via de acesso na luxação das artroplastias totais do quadril The influence of the surgical approach concerning dislocation in total hip arthroplasty  

Directory of Open Access Journals (Sweden)

Full Text Available OBJETIVO: Avaliar a ocorrência de luxação nas artroplastias totais do quadril não cimentadas, comparando-se os acessos posterior e lateral direto. Métodos: Estudo retrospectivo comparativo com 232 pacientes submetidos à artroplastia total do quadril não cimentada, por diagnóstico de osteoartrose primária e secundária, sendo 105 submetidos ao acesso posterior e 127 ao acesso lateral. O modelo protético utilizado foi único, assim como o protocolo de reabilitação e cuidados pós-operatórios. Foram verificados ocorrência de luxação, posicionamento acetabular e componentes utilizados. RESULTADOS: Ocorreu um caso isolado de luxação no grupo do acesso lateral direto (0,8%) contra 0% no grupo de pacientes submetidos ao acesso posterior, sem diferença significativa (p = 1). A luxação ocorreu em uma paciente de 47 anos de idade, que foi tratada com redução incruenta sem recidiva da luxação após três anos e um mês de seguimento. O tempo de seguimento dos dois grupos variou entre seis e 42 meses, com média de 23,7 meses. CONCLUSÃO: Os autores concluem que a prevalência de luxação nas artroplastias totais do quadril é similar nos dois acessos estudados e que medidas educativas, técnica cirúrgica adequada e utilização de próteses com offsets maiores podem diminuir o risco dessa complicação.OBJECTIVES: Our primary aim was to evaluate the occurrence of dislocation of non-cemented total hip arthroplasty, when using the posterior and the direct lateral approaches. METHODS: We performed a comparative retrospective study with 232 patients submitted to non-cemented total hip arthroplasty, due to the diagnosis of primary or secondary osteoarthritis. The posterior approach was used in 105 patients while direct lateral approach was used in 127 patients. There was only one prosthesis model and the same rehabilitation program and post-operative care was used for all patients. We checked the occurrence of dislocation, the acetabular positioning and also the size of the components. RESULTS: There was only one case of dislocation, treated with closed reduction successfully. This was a 47 year-old female, submitted to direct lateral approach. The mean follow-up time for both groups was 23.7 months, ranging from six to 42 months. Conclusion: The authors conclude that the prevalence of total hip arthroplasty dislocation is similar for both approaches, and educational measures besides the use of a higher femoral offset seem to reduce the risk of this complication.

José Ricardo Negreiros Vicente; André Fernandes Pires; Bruno Takasaki Lee; Marcos Camargo Leonhardt; Leandro Ejnisman; Alberto Tesconi Croci

2009-01-01

147

A influência da via de acesso na luxação das artroplastias totais do quadril/ The influence of the surgical approach concerning dislocation in total hip arthroplasty  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese OBJETIVO: Avaliar a ocorrência de luxação nas artroplastias totais do quadril não cimentadas, comparando-se os acessos posterior e lateral direto. Métodos: Estudo retrospectivo comparativo com 232 pacientes submetidos à artroplastia total do quadril não cimentada, por diagnóstico de osteoartrose primária e secundária, sendo 105 submetidos ao acesso posterior e 127 ao acesso lateral. O modelo protético utilizado foi único, assim como o protocolo de reabilitaç? (more) ?o e cuidados pós-operatórios. Foram verificados ocorrência de luxação, posicionamento acetabular e componentes utilizados. RESULTADOS: Ocorreu um caso isolado de luxação no grupo do acesso lateral direto (0,8%) contra 0% no grupo de pacientes submetidos ao acesso posterior, sem diferença significativa (p = 1). A luxação ocorreu em uma paciente de 47 anos de idade, que foi tratada com redução incruenta sem recidiva da luxação após três anos e um mês de seguimento. O tempo de seguimento dos dois grupos variou entre seis e 42 meses, com média de 23,7 meses. CONCLUSÃO: Os autores concluem que a prevalência de luxação nas artroplastias totais do quadril é similar nos dois acessos estudados e que medidas educativas, técnica cirúrgica adequada e utilização de próteses com offsets maiores podem diminuir o risco dessa complicação. Abstract in english OBJECTIVES: Our primary aim was to evaluate the occurrence of dislocation of non-cemented total hip arthroplasty, when using the posterior and the direct lateral approaches. METHODS: We performed a comparative retrospective study with 232 patients submitted to non-cemented total hip arthroplasty, due to the diagnosis of primary or secondary osteoarthritis. The posterior approach was used in 105 patients while direct lateral approach was used in 127 patients. There was onl (more) y one prosthesis model and the same rehabilitation program and post-operative care was used for all patients. We checked the occurrence of dislocation, the acetabular positioning and also the size of the components. RESULTS: There was only one case of dislocation, treated with closed reduction successfully. This was a 47 year-old female, submitted to direct lateral approach. The mean follow-up time for both groups was 23.7 months, ranging from six to 42 months. Conclusion: The authors conclude that the prevalence of total hip arthroplasty dislocation is similar for both approaches, and educational measures besides the use of a higher femoral offset seem to reduce the risk of this complication.

Vicente, José Ricardo Negreiros; Pires, André Fernandes; Lee, Bruno Takasaki; Leonhardt, Marcos Camargo; Ejnisman, Leandro; Croci, Alberto Tesconi

2009-01-01

148

Fratura-luxação traumática do quadril no futebol: relato de caso/ Traumatic hip fracture-dislocation in soccer: a case report  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese De ocorrência rara no futebol, esporte coletivo mais praticado no mundo, as fraturas de acetábulo que se associam às luxações da articulação do quadril são lesões com grande potencial de gerar seqüelas graves e limitantes. O rápido atendimento, a precisão do diagnóstico e procedimentos de salvamento da articulação pela redução e correta fixação são essenciais para perspectiva de retomar a atividade física regular praticada anteriormente ou outra que se adapte à nova situação. Abstract in english Uncommon in soccer, the world's most popular sport, the acetabular fractures with hip dislocation are injuries with high incidence of long-term serious sequelae. Prompt attending with accurate diagnosis and reduction and fixation are important to produce a stable and congruent joint for returning to the usual sports practice prior the injury.

Nahas, Ricardo Munir; Netto, Eliseu; Chikude, Takechi; Ikemoto, Roberto

2007-08-01

149

Posterior approach and dislocation rate: a 213 total hip replacements case-control study comparing the dual mobility cup with a conventional 28-mm metal head/polyethylene prosthesis.  

UK PubMed Central (United Kingdom)

INTRODUCTION: Dislocation is a frequent complication of total hip arthroplasties (THA) especially in older patients, especially when using a posterior approach. In these cases, dual mobility (DM) cups developed by Gilles Bousquet in 1975 can be indicated to reduce this complication risk. HYPOTHESIS: Dual mobility cups reduce the rate of dislocation in primary total hip arthroplasty using posterior approach in a single-surgeon series. AIM: Test this hypothesis in a controlled study to compare the rate of dislocation in primary total hip arthroplasties done in patients over 50 years old either with a dual mobility cup or a conventional metal-on-polyethylene 28-mm diameter head. PATIENTS AND METHODS: Two consecutive series of primary total hip replacements were performed by a single surgeon using a posterolateral approach. The piriformis tendon was left intact. The DM series included 105 patients who underwent arthroplasty between January 2005 and June 2007 with a dual mobility cup (60 women and 45 men, mean age 76.6±5.65 years old [53-93]). The control series (S series) included 108 patients who underwent arthroplasty (56 women and 52 men, mean age 74.2±5.9 years old [53-87]) with a conventional 28-mm polyethylene cup between January 2003 and June 2005. All hip replacements included a 28-mm metal-polyethylene cup and a 12-14-mm Morse taper. Both groups were comparable for gender, diagnosis, body mass index, type of anesthesia and ASA score distribution. All patients included in this series had a minimum follow-up of 1 year. RESULTS: There were no dislocations in the DM series and five early dislocations (before the third month) in the S series for a rate of 4.63%. Although the rate of dislocation was higher in the S series (4.63% vs 0%), the difference was barely significant (P=0.0597). DISCUSSION: This study comparing the incidence of dislocations after THA with conventional or dual mobility cups, shows that even using a posterior approach and in older patients, dual mobility cups increase stability with no postoperative dislocations. Although results are barely significant, a larger series should confirm the benefit of this implant. In this series, morbidity was not increased with dual mobility cups. LEVEL OF EVIDENCE: Level III: retrospective case-control study.

Bouchet R; Mercier N; Saragaglia D

2011-02-01

150

Association between ASA grade and complication rate in patients receiving procedural sedation for relocation of dislocated hip prostheses in a UK emergency department.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To determine the association between the American Society of Anesthiologists (ASA) grade and the complication rate of patients receiving procedural sedation for relocation of hip prosthesis in an adult emergency department (ED) in the UK. DESIGN: Retrospective study of registry data from a large UK teaching hospital ED. Consecutive adult patients (aged 16 years and over) in whom ASA grade could be calculated, with an isolated dislocation of a hip prosthesis between 8 September 2006 and 16 April 2010 were included for analyses (n=303). The primary outcome measure was association between ASA and complication rate (any of desaturation <90%; apnoea; vomiting; aspiration; hypotension <90 mm Hg; cardiac arrest). Secondary outcome measures were relationship between ASA grade and procedural success, choice of sedative agent and sedation depth, and complications and choice of sedative agent, arrival time and sedation depth. RESULTS: There was no significant difference between ASA grade and the risk of complication (p=0.800). Moreover, there was no significant difference between ASA grade and procedural success (p=0.284), ASA and choice of sedative agent (p=0.243), or ASA and sedation depth (p=0.48). There was no association between complications and sedative agent (p=0.18), or complications and arrival time (p=0.12). There was a significant difference between sedative depth and complications (p<0.001). CONCLUSIONS: There is no clear association between a patient's physical status (ASA grade) and the risk of complications, chance of procedural success or choice of sedative agent in relocation of hip prostheses. There is a higher rate of complications with higher levels of sedation (p<0.001).

Dawson N; Dewar A; Gray A; Leal A

2013-02-01

151

The utility of ultrasonography for the diagnosis of developmental dysplasia of hip joint in congenital muscular torticollis.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To determine whether a routine ultrasonography (US) is necessary for diagnosis of developmental dysplasia of hip (DDH), presenting with congenital muscular torticollis (CMT). METHODS: Cases of 133 patients (81 males, 52 females) diagnosed as CMT were reviewed, retrospectively. We reviewed the medical charts and diagnostic examination. We also assessed the coincidence of CMT and DDH, and investigated the clinical features of CMT related to DDH. RESULTS: Twenty (15.0%) patients out of 133 CMT patients were diagnosed as having DDH by US. Of whom, 8 patients were radiographically positive and 4 patients were both clinically and radiographically positive. Nine patients were treated with a harness and 1 of them needed closed reduction and casting. Out of 9 patients treated with a harness, only 4 were clinically positive. The difference and ratio of the sternocleidomastoid (SCM) muscle thickness between the normal and abnormal side was significantly greater in DDH patients (p=0.014). Further, receiver operating characteristic analysis showed when the SCM ratio is greater than 2.08 and the SCM difference is greater than 6.1 mm, the efficiency of US for the diagnosis of the DDH was found to be the best (p<0.05). CONCLUSION: To evaluate DDH, physical examination showed low sensitivity and radiologic study has limitation for the child before 4 to 6 months of age. Therefore, we recommend that hip is screened by US for the diagnosis of DDH associated with CMT when physical examination is positive or CMT patients with large SCM difference and high SCM ratio.

Park HK; Kang EY; Lee SH; Kim KM; Jung AY; Nam DH

2013-02-01

152

Dual-mobility cups for revision due to instability are associated with a low rate of re-revisions due to dislocation: 228 patients from the Swedish Hip Arthroplasty Register.  

UK PubMed Central (United Kingdom)

BACKGROUND AND PURPOSE: Revision total hip arthroplasty (THA) due to recurrent dislocations is associated with a high risk of persistent instability. We hypothesized that the use of dual-mobility cups would reduce the risk of re-revision due to dislocation after revision THA. PATIENTS AND METHODS: 228 THA cup revisions (in 228 patients) performed due to recurrent dislocations and employing a specific dual-mobility cup (Avantage) were identified in the Swedish Hip Arthroplasty Register. Kaplan-Meier survival analysis was performed with re-revision due to dislocation as the primary endpoint and re-revision for any reason as the secondary endpoint. Cox regression models were fitted in order to calculate the influence of various covariates on the risk of re-revision. RESULTS: 58 patients (25%) had been revised at least once prior to the index cup revision. The surgical approach at the index cup revision was lateral in 99 cases (44%) and posterior in 124 cases (56%). Median follow-up was 2 (0-6) years after the index cup revision, and by then 18 patients (8%) had been re-revised for any reason. Of these, 4 patients (2%) had been re-revised due to dislocation. Survival after 2 years with the endpoint revision of any component due to dislocation was 99% (95% CI: 97-100), and it was 93% (CI: 90-97) with the endpoint revision of any component for any reason. Risk factors for subsequent re-revision for any reason were age between 50-59 years at the time of the index cup revision (risk ratio (RR) = 5 when compared with age > 75, CI: 1-23) and previous revision surgery to the relevant joint (RR = 1.7 per previous revision, CI: 1-3). INTERPRETATION: The risk of re-revision due to dislocation after insertion of dual-mobility cups during revision THA performed for recurrent dislocations appears to be low in the short term. Since most dislocations occur early after revision THA, we believe that this device adequately addresses the problem of recurrent instability. Younger age and prior hip revision surgery are risk factors for further revision surgery. However, problems such as potentially increased liner wear and subsequent aseptic loosening may be associated with the use of such devices in the long term.

Hailer NP; Weiss RJ; Stark A; Kärrholm J

2012-12-01

153

[Effect of fascia iliaca compartment block with ropivacaine on early analgesia in children with development dislocation of the hip received salter arthroplasty treatment].  

UK PubMed Central (United Kingdom)

OBJECTIVE: To observe the efficacy and safety of fascia iliaca compartment block (FICB) with 0.2% ropivacaine in the early analgesia of children with development dislocation of the hip (DDH) undergoing Salter arthroplasty. METHODS: Approved by the hospital ethics committee, a total of 64 DDH children were divided randomly into 2 groups: group F (FICB with ropivacaine 0.2%, 1 ml/kg, max. 30 ml) and group C (FICB with 0.9% normal saline 1 ml/kg, max. 30 ml). The intra-operative doses of fentanyl, PACU (post-anesthesia care unit), CRIES pain score at 1, 4 and 24 h postoperatively, patient satisfaction score and side effects were recorded. RESULTS: The intra-operative doses of fentanyl and PACU were lower. Pain scores at 1, 4 and 24 h postoperatively were lower. And the patient satisfaction score was significantly higher in the FICB group. CONCLUSION: The administration of ropivacaine (0.2%) for FICB in the early analgesia of DDH children has the advantages of safety, precision, long-lasting and convenience.

Wang G; Wang XL; Li SZ

2011-10-01

154

Tratamiento quirúrgico de la luxación congénita de rótula con técnica de Stanisavljevic/ Congenital dislocation of the patella: surgical treatment with Stanislavljevic technique  

Scientific Electronic Library Online (English)

Full Text Available Abstract in spanish Introducción: La luxación congénita de la rótula (LCR) es una entidad infrecuente que produce diversos grados de discapacidad de rodilla en los niños. Existe cierta controversia con respecto a su tratamiento; mientras algunos autores apoyan la realineación quirúrgica del aparato extensor, otros recomiendan sólo la observación afirmando que los resultados quirúrgicos suelen ser malos. Materiales y métodos: Se analizaron 8 pacientes consecutivos (8 rodillas) con (more) luxación congénita permanente irreducible de rótula tratados en el período 1993-2006. El promedio de edad fue de 7,8 años. El seguimiento promedio fue de 67 meses (r, 7-173 meses). Cinco casos presentaron asociaciones sindrómicas. Los resultados funcionales subjetivos fueron evaluados con la Tegner-Lysholm Knee Scoring Scale y el score de Kujala. Resultados: Todos los pacientes poseen un buen centrado de la rótula, mejoraron la amplitud de movimiento y la capacidad para la deambulación. Seis de los 8 pacientes recuperaron la extensión completa. Siete pacientes presentaron resultados funcionales entre buenos y excelentes y uno, regular. No se observaron infecciones de la herida ni lesiones neurovasculares en el posoperatorio. Ninguno de los pacientes presentó recidiva de la luxación ni requirió cirugías adicionales en la rodilla tratada. Conclusiones: En nuestra serie la técnica de Stanisavljevic permitió una marcada mejoría de la amplitud de movimiento y de la capacidad para la deambulación. En los casos de deformidad moderada podría ser suficiente un procedimiento más limitado. El tratamiento quirúrgico debe realizarse de manera precoz para obtener los mejores resultados. Abstract in english Background: Congenital dislocation of the patella is a rare condition. Controversy exists regarding treatment. Some authors recommend observation alone while others recommend early surgical intervention. Methods: We analyzed retrospectively 8 consecutive patients (8 knees) surgically treated for congenital dislocation of the patella between 1993 and 2006, followed up for at least 12 months post-op. Mean age was 7.8 years. Mean follow-up was 67 months (range: 7-173 months) (more) . All patients had fixed painful lateral dislocation of the patella that could not be reduced by closed means, associated with valgus and fixed flexion contracture of the knee. Five patients presented associated syndromes. Results: In the last follow-up, all patients had increased tolerance to activity and pain relief. The extension lag improved in all but two patients (oldest patients in the series). There were no postoperative complications or redislocation of the patella. Conclusions: Stanisavljevic's surgical technique of extensive quadriceps release and derotation yielded satisfactory results. A more limited procedure may suffice in moderately severe cases. Surgical treatment should be approached early to achieve better results.

Masquijo, Julio Javier; Innocenti, Sergio; Baroni, Eduardo

2009-09-01

155

Hip Replacement - Physical Therapy  

Medline Plus

Full Text Available ... as well. Please discuss this with your doctor, nurse, and physical therapist. A dislocation usually happens if: • ... motion in your new hip. The surgeon, the nurse and the physical therapist will guide and help ...

156

Hip Revision Surgery  

Medline Plus

Full Text Available ... a fracture dislocation of her hip. At that time, or a year or two later, she underwent ... many of your questions as possible. At this time, we'd like to join Dr. Pearson in ...

157

Hip Revision Surgery  

Medline Plus

Full Text Available ... motor vehicle accident and had some type of pelvis acetabular, possibly a fracture dislocation of her hip. ... when you get up this far on a pelvis typically is when you're up at the ...

158

Hip Revision Surgery  

Medline Plus

Full Text Available ... Indianapolis, Indiana March 23, 2010 Welcome to this OR Live Webcast presentation, brought to you by Zimmer. ... fracture dislocation of her hip. At that time, or a year or two later, she underwent a ...

159

Hip Replacement - Physical Therapy  

Medline Plus

Full Text Available ... couple weeks after surgery. Using a high-rise toilet seat also helps prevent dislocation. Over time, as ... not sit on the floor, low stools or toilet seats; this bends the hip more than 90 ...

160

Hip harness  

UK PubMed Central (United Kingdom)

A flexible hip restraint for patient's recovering from hip surgery having a waist belt, a thigh belt and a plurality of substantially inelastic flexible and adjustable straps connected to the thigh and waist belts for limiting the movement of a patient's thigh to prevent inadvertent dislocation of the femur from the pelvic socket. The straps include a posterior strap extending over the gluteus maximus, a medial strap extending over the greater trochanter and an anterior strap extending along the anterior superior iliac spine of the pelvis.

THOMPSON JOHN K; KEITH RANDALL B

 
 
 
 
161

Congenital Anomalies in Infant with Congenital Hypothyroidism  

Directory of Open Access Journals (Sweden)

Full Text Available bjective: Congenital hypothyroidism is characterized by inadequate thyroid hormone production in newborn infants. Many infants with CH have co-occurring congenital malformations. This is an investigation on the frequency and types of congenital anomalies in infants with congenital hypothyroidism born from May 2006-2010 in Hamadan, west province of Iran.Methods: The Iranian neonatal screening program for congenital hypothyroidism was initiated in May 2005. This prospective descriptive study was conducted in infants diagnosed with congenital hypothyroidism being followed up in Pediatric Endocrinology Clinicof Besat Hospital, a tertiary care centre in Hamadan. Cases included all infants with congenital hypothyroidism diagnosed through newborn screening program or detected clinically. Anomalies were identified by clinical examination, echocardiography, and X-ray of the hip during the infant’s first year of life.Results: A total of 150 infants with biochemically confirmed primary congenital hypothyroidism (72 females and 78 males) were recruited during the period between May 2006-2010. Overall, 30 (20%) infants had associated congenital anomalies. The most common type of anomaly was Down syndrome. Seven infants (3.1%) had congenital cardiac anomalies such as: ASD (n=3), VSD (n=2), PS (n =1), PDA (n=1). Three children (2.6%) had developmental displasia of the hip (n=3).Conclusion: The overall frequency of Down syndrome, cardiac malformation and other birth defect was high in infants with CH. This reinforces the need to examine all infants with congenital hypothyroidism for the presence of associated congenital anomalies.

Zahra Razavi; Alireza Yavarikia; Saadat Torabian

2012-01-01

162

Congenital anomalies in infant with congenital hypothyroidism.  

UK PubMed Central (United Kingdom)

OBJECTIVE: Congenital hypothyroidism is characterized by inadequate thyroid hormone production in newborn infants. Many infants with CH have co-occurring congenital malformations. This is an investigation on the frequency and types of congenital anomalies in infants with congenital hypothyroidism born from May 2006-2010 in Hamadan, west province of Iran. METHODS: The Iranian neonatal screening program for congenital hypothyroidism was initiated in May 2005. This prospective descriptive study was conducted in infants diagnosed with congenital hypothyroidism being followed up in Pediatric Endocrinology Clinic of Besat Hospital, a tertiary care centre in Hamadan. Cases included all infants with congenital hypothyroidism diagnosed through newborn screening program or detected clinically. Anomalies were identified by clinical examination, echocardiography, and X-ray of the hip during the infant's first year of life. RESULTS: A total of 150 infants with biochemically confirmed primary congenital hypothyroidism (72 females and 78 males) were recruited during the period between May 2006-2010. Overall, 30 (20%) infants had associated congenital anomalies. The most common type of anomaly was Down syndrome. Seven infants (3.1%) had congenital cardiac anomalies such as: ASD (n=3), VSD (n=2), PS (n =1), PDA (n=1). Three children (2.6%) had developmental dysplasia of the hip (n=3). CONCLUSION: The overall frequency of Down syndrome, cardiac malformation and other birth defect was high in infants with CH. This reinforces the need to examine all infants with congenital hypothyroidism for the presence of associated congenital anomalies.

Razavi Z; Yavarikia A; Torabian S

2012-09-01

163

Sonography in the diagnosis and follow-up of congenital acetabular dysplasia during treatment  

International Nuclear Information System (INIS)

Since 1987 the authors have used sonography (US) as the means to detect dysplasia and congenital dislocation of infants hips, to define severity of the disease, and to monito the results during treatment. In this paper the authors report their experience in 2000 examined babies. In 20 young patients, mainly females, 25 pathologic joints were detected and classified as 2c-4 hips. Orthopedic treatment employed Pavlick harness and, in case of partial success, Milgram abduction pillow too. This treatment has always been successful, except for a case with severe dislocation with echostructural changes in the acetabular cartilage. In this case, surgery was necessary. 'Delayed ossification' (type 2b hips) and physiological immaturity (type 2a hips) with alpha angle ?55 were not splinted in abduction: normal maturity has always been attained without dysplastic involutions. Our experience confirmed US value in the early diagnosis of congenital acetabular dysplasia, when clinics exhibited evident limitations. Nonetheless, management and economical problems are still to be solved, due to the relationship of the widespread use of US in infant population and to its successful results, also considering the low incidence of the examined pathologic condition

1991-01-01

164

[A modified procedure for repositioning shoulder dislocation  

UK PubMed Central (United Kingdom)

A new method is presented for the reduction of shoulder dislocations and dislocation fractures, together with the follow-up results. This procedure is a modification of a method for reduction of the hip. Examination of our patients 1-3 years after the accident showed no sign of nerve lesions and little residual discomfort.

Sinkwitz KD; Sennewaldt J

1992-06-01

165

Dislocation of the shoulder  

International Nuclear Information System (INIS)

There are various opinions regarding the aetiology and pathogenesis of dislocation of the shoulder. Various aspects of these theories and their clinical significance have been examined in the course of a clinical and radiological follow-up. Crucial to the development of subluxation is the occurrence of trauma. The age of the patient is important in the prognosis; more than 60% of patients under the age of 30 develop recurrent or persistent dislocation. Apart from a congenital disposition and inadequate treatment, accompanying injuries are primarily responsible for the development of persistent dislocation. Late follow-up has shown that radiologically recognisable post-traumatic changes are apparent in at least one-third of the patients. Persistent symptoms are much more common and consist of pain, limitation of movement, weakness and paraesthesia. In evaluating the late results, one should distinguish between objective functional limitation of movement and subjectively felt reduction in function. (orig.)

1987-01-01

166

Finger Dislocation  

Science.gov (United States)

... caused by trauma, and there is often an open wound in the location of the dislocation. Proximal interphalangeal ... not fractured. A dislocated joint that has an open wound should not be moved. It should be carefully ...

167

Appendicular joint dislocations.  

UK PubMed Central (United Kingdom)

This study defines the incidence and epidemiology of joint dislocations and subluxations of the appendicular skeleton. All patients presenting acutely to hospital with a dislocation or subluxation of the appendicular skeleton from a defined population were included in the study. There were 974 dislocations or subluxations over one year between the 1st November 2008 and the 31st October 2009. There was an overall joint dislocation incidence of 157/10(5)/year (188/10(5)/year in males and 128/10(5)/year in females). Males demonstrated a bimodal distribution with a peak incidence of 446/10(5)/year at 15-24 years old and another of 349/10(5)/year in those over 90 years. Females demonstrate an increasing incidence from the seventh decade with a maximum incidence of 520/10(5)/year in those over 90 years. The most commonly affected joints are the glenohumeral (51.2/10(5)/year), the small joints of the hand (29.9/10(5)/year), the patellofemoral joint (21.6/10(5)/year), the prosthetic hip (19.0/10(5)/year), the ankle (11.5/10(5)/year), the acromioclavicular joint (8.9/10(5)/year) and the elbow (5.5/10(5)/year). Unlike fractures, dislocations are more common in the both the most affluent and the most socially deprived sections of the population. Joint disruptions are more common than previously estimated.

Hindle P; Davidson EK; Biant LC; Court-Brown CM

2013-08-01

168

Appendicular joint dislocations.  

Science.gov (United States)

This study defines the incidence and epidemiology of joint dislocations and subluxations of the appendicular skeleton. All patients presenting acutely to hospital with a dislocation or subluxation of the appendicular skeleton from a defined population were included in the study. There were 974 dislocations or subluxations over one year between the 1st November 2008 and the 31st October 2009. There was an overall joint dislocation incidence of 157/10(5)/year (188/10(5)/year in males and 128/10(5)/year in females). Males demonstrated a bimodal distribution with a peak incidence of 446/10(5)/year at 15-24 years old and another of 349/10(5)/year in those over 90 years. Females demonstrate an increasing incidence from the seventh decade with a maximum incidence of 520/10(5)/year in those over 90 years. The most commonly affected joints are the glenohumeral (51.2/10(5)/year), the small joints of the hand (29.9/10(5)/year), the patellofemoral joint (21.6/10(5)/year), the prosthetic hip (19.0/10(5)/year), the ankle (11.5/10(5)/year), the acromioclavicular joint (8.9/10(5)/year) and the elbow (5.5/10(5)/year). Unlike fractures, dislocations are more common in the both the most affluent and the most socially deprived sections of the population. Joint disruptions are more common than previously estimated. PMID:23433660

Hindle, Paul; Davidson, Eleanor K; Biant, Leela C; Court-Brown, Charles M

2013-02-21

169

Relevance of a press-fit dual mobility cup to deal with recurrent dislocation of conventional total hip arthroplasty: a 29-case series.  

UK PubMed Central (United Kingdom)

The aim of this paper was to assess the impact on stability of revision of 29 standard acetabular cups to press-fit uncemented dual mobility (DM) cups in THAs with recurrent dislocation. This series was composed of 17 women and 12 men aged on average 75.6 ± 8.1 years (55-88), operated on between November 2000 and July 2010. The average number of dislocations before revision surgery was 3.87 ± 1.79 (2-10), and the average time from primary procedure to revision was 6.6 ± 4.3 years (45-15 years). 9 patients (31.03 %) had already undergone one or more procedures for instability prior to revision to DM cup. All patients were reviewed at an average time of 46 ± 28 months (range: 17 months-11 years). Only one patient had redislocated in this time (3.4 %). This patient underwent a simple closed reduction and did not dislocate again. Level of evidence: IV retrospective cohort study.

Saragaglia D; Ruatti S; Refaie R

2013-05-01

170

The unstable total hip replacement  

Directory of Open Access Journals (Sweden)

Full Text Available Background: Dislocation is one of the most common complications of total hip arthroplasty with a reported dislocation rate of 3.2%. Despite increased experience with hip replacement, the overall rate has not yet changed. The aim of this paper is to review the most recent literature published on this topic and indexed in Medline, in order to clarify the main risk factors, and to standardize a treatment protocol of such an important complication of prosthetic surgery. Materials and Methods: Medline database was searched using key words: "hip dislocation", "hip instability" from 1980-2007. Studies were eligible for review and included if they met the following criteria: (1) publication in English, (2) clinical trials (3) review papers. Results: The risk of first-time dislocation as a function of time after the surgery is not well understood. Most, but not all, series have demonstrated that the risk of dislocation is highest during the first few months after hip arthroplasty; however, first-time late dislocation can also occur many years after the procedure. Several risk factors were described, including the surgical approach, the diameter of the head, impingement, component malposition, insufficient abductor musculature. In addition, there are also many treatment options, such as long-term bracing after closed reduction, component reorientation, capsulorraphy, trochanteric advancement, increasing offset, exchange of the modular head and the polyethylene liner, insertion of constrained liner. Conclusion: Preventing hip dislocation is obviously the best strategy. Surgeons must take into account patient and surgical risk factors. For patients at high risk for dislocation the surgeon should accurately restore leg length and femoral offset; the use of larger femoral heads, posterior transosseous repair of the capsulotendinous envelope if posterior approach is chosen or the use of a lateral approach should be considered. Proper patient education and postoperative care are very important.

D?Angelo F; Murena L; Zatti G; Cherubino P

2008-01-01

171

[Role of echography in the diagnosis and treatment monitoring of congenital acetabular dysplasia. Personal experience with 2000 examined children  

UK PubMed Central (United Kingdom)

Since 1987 the authors have used sonography (US) as the means to detect dysplasia and congenital dislocation of infant hips, to define severity of the disease, and to monitor the results during treatment. In this paper the authors report their experience in 2000 examined babies. In 20 young patients, mainly females, 25 pathologic joints were detected and classified as 2c-4 hips. Orthopedic treatment employed Pavlick harness and, in case of partial success, Milgram abduction pillow too. This treatment has always been successful, except for a case with severe dislocation with echostructural changes in the acetabular cartilage. In this case, surgery was necessary. "Delayed ossification" (type 2b hips) and physiological immatury (type 2a hips) with alpha angle greater than or equal to 55 degrees were not splinted in abduction: normal maturity has always been attained without dysplastic involutions. Our experience confirmed US value in the early diagnosis of congenital acetabular dysplasia, when clinics exhibited evident limitations. Nonetheless, management and economical problems are still to be solved, due to the relationship of the widespread use of US in infant population and to its successful results, also considering the low incidence of the examined pathologic condition.

Borghetti M; Benelli G; Savarese A; Iori M

1991-03-01

172

Subtalar dislocation  

Energy Technology Data Exchange (ETDEWEB)

Over a period of three years we have seen nine patients with subtalar dislocation, all of whom sustained violent trauma to the region of the ankle and hind foot. All but one patient were males. Clinically a subtalar dislocation resembles a complicated fracture dislocation of the ankle but a definitive diagnosis can only be made radiographically. The mechanism of injury and radiographic features of this injury are discussed.

El-Khoury, G.Y.; Yousefzadeh, D.K.; Mulligan, G.M.; Moore, T.E.

1982-05-01

173

Subtalar dislocation  

International Nuclear Information System (INIS)

Over a period of three years we have seen nine patients with subtalar dislocation, all of whom sustained violent trauma to the region of the ankle and hind foot. All but one patient were males. Clinically a subtalar dislocation resembles a complicated fracture dislocation of the ankle but a definitive diagnosis can only be made radiographically. The mechanism of injury and radiographic features of this injury are discussed. (orig.)

1982-01-01

174

Infant hip sonography: current concepts.  

Science.gov (United States)

Sonography of the infant hip has gained wide acceptance in the decade since its introduction. The two principle techniques of Graf and Harcke have been combined with the proposal of a Dynamic Standard Minimum Examination. Whereas sonography is used increasingly to manage developmental dislocation and/or displasia of the hip, there is no agreement on the use of sonography for universal newborn screening. This article describes in detail the Dynamic Standard Minimum Sonographic Examination of the infant hip. In addition, this article reviews the classification and management of infant hip disorders. PMID:7946476

Harcke, H T; Grissom, L E

1994-08-01

175

Stability of hip hemiarthroplasties.  

UK PubMed Central (United Kingdom)

It has been stated in the literature that a bipolar hemiarthroplasty has a lower risk of dislocation compared to a unipolar hemiarthroplasty. As this statement has not been substantiated we undertook a systematic review of the literature of published articles from the last 40 years. In addition we used our own database of hip fractures. One hundred and thirty-three published articles were included in the review to give a total of 23,107 cases. The overall dislocation rate for all types of hemiarthroplasty was 791/23,107 (3.4%). An increased risk of dislocation was associated with a posterior surgical approach and the use of a cemented prosthesis. After adjustment for surgical approach and the use of cement there was no difference in risk of dislocation between unipolar and bipolar hemiarthroplasties. There was an increased risk of open reduction for a bipolar hemiarthroplasty.

Varley J; Parker MJ

2004-10-01

176

The use of a dual-articulation acetabular cup system to prevent dislocation after primary total hip arthroplasty: analysis of 384 cases at a mean follow-up of 15 years.  

UK PubMed Central (United Kingdom)

The concept of a dual articulation acetabular cup was developed by Prof. Bousquet in 1974. This concept has been shown to provide high stability after revision and primary total hip arthroplasty. The aim of our study was to evaluate the incidence of prosthetic instability in a consecutive homogeneous series of 384 primary dual mobility cups. Incidence of instability and implant survival were evaluated. Mean follow-up was 15.3 years (range, 12-20). There was no early or late instability. On the acetabular side there were 13 aseptic loosenings, 14 intraprosthetic dislocations, and seven polyethylene wear cases that required replacement of the liner. The cumulative survival rate of the dual-articulation acetabular cup using surgical revision for aseptic loosening as the endpoint was 95.9% +/- 4.1% at 18 years postoperatively. Our series proves the good long term behaviour of dual-articulation acetabular components in primary arthroplasty. Their excellent survivorship rate and the absence of episodes of prosthetic instability increase our confidence in this concept.

Philippot R; Camilleri JP; Boyer B; Adam P; Farizon F

2009-08-01

177

The use of a dual-articulation acetabular cup system to prevent dislocation after primary total hip arthroplasty: analysis of 384 cases at a mean follow-up of 15 years.  

Science.gov (United States)

The concept of a dual articulation acetabular cup was developed by Prof. Bousquet in 1974. This concept has been shown to provide high stability after revision and primary total hip arthroplasty. The aim of our study was to evaluate the incidence of prosthetic instability in a consecutive homogeneous series of 384 primary dual mobility cups. Incidence of instability and implant survival were evaluated. Mean follow-up was 15.3 years (range, 12-20). There was no early or late instability. On the acetabular side there were 13 aseptic loosenings, 14 intraprosthetic dislocations, and seven polyethylene wear cases that required replacement of the liner. The cumulative survival rate of the dual-articulation acetabular cup using surgical revision for aseptic loosening as the endpoint was 95.9% +/- 4.1% at 18 years postoperatively. Our series proves the good long term behaviour of dual-articulation acetabular components in primary arthroplasty. Their excellent survivorship rate and the absence of episodes of prosthetic instability increase our confidence in this concept. PMID:18521598

Philippot, Remi; Camilleri, Jean Philippe; Boyer, Bertrand; Adam, Philippe; Farizon, Frederic

2008-06-03

178

High dislocation cumulative risk in THA versus hemiarthroplasty for fractures.  

UK PubMed Central (United Kingdom)

BACKGROUND: Although not all elderly patients with femoral neck fractures are candidates for THA, active, mentally competent, independent patients achieve the most durable functional scores with THA compared with hemiarthroplasty. However, a relatively high frequency of early or late dislocation could reduce the potential benefits with THA. QUESTIONS/PURPOSES: We asked whether the incidence of first-time, recurrent dislocation, and revision differed in patients with hip fractures having THA or hemiarthroplasty. PATIENTS AND METHODS: We retrospectively reviewed 380 patients with hip fractures (380 hips) who underwent THAs between 1995 and 1999, and compared them with 412 patients with hip fractures (412 hips) who underwent hemiarthroplasties between 1990 and 1994. The mean followup was 8 years (range, 1-20 years). RESULTS: THA had a higher early risk of first-time dislocation and a higher late risk: 19 (4.5%) of the 412 hips treated with hemiarthroplasty had at least one dislocation whereas 30 (8.1%) of the 380 hips treated with THA had at least one dislocation. The cumulative number of dislocations at the most recent followup (first time and recurrent dislocations) was 58 (13%) for the 380 THAs and 22 (5%) for the 412 hemiarthroplasties. At the 10-year followup, eight THAs (2%) had revision (six recurrent dislocations, two loosenings), and 42 hemiarthroplasties (10%) had revision (40 acetabular protrusions, one recurrent dislocation). CONCLUSIONS: The risk of revision for recurrent dislocation increases with THA, but it remains lower than the risk of revision for wear of cartilage and acetabular protrusion in hemiarthroplasty. LEVEL OF EVIDENCE: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Poignard A; Bouhou M; Pidet O; Flouzat-Lachaniette CH; Hernigou P

2011-11-01

179

Hip Replacement  

Medline Plus

Full Text Available ... hip to relieve their pain and help them move more easily. HipJoint Femur Pelvis If your doctor ... occur in rare cases. The hip may not move as well as a normal hip joint. It ...

180

Modern Dual Mobility Cups for Total Hip Arthroplasty.  

UK PubMed Central (United Kingdom)

Dislocation after total hip arthroplasty remains a primary concern among orthopaedic surgeons. Endeavors to decrease the incidence of dislocation, while maintaining limb function and mobility, have been painstakingly undertaken. Since their advent in the 1970s, dual mobility cups have proven again and again to be effective in reducing dislocation following total hip arthroplasty. The dual mobility cup enables the surgeon to treat patients with an increased risk for dislocation, while maintaining hip stability, favorable wear properties, and an acceptable rate of dislocation. Disadvantages are related to the potential increased wear and surgeon error. With advances in engineering and design, dual mobility cups have proven useful in providing lower dislocation rates for several pathological conditions. As a result, dual mobility cups have moved into the forefront of total hip arthroplasty.

Goyal N; Tripathy MS; Parvizi J

2011-12-01

 
 
 
 
181

Modern Dual Mobility Cups for Total Hip Arthroplasty.  

Science.gov (United States)

Dislocation after total hip arthroplasty remains a primary concern among orthopaedic surgeons. Endeavors to decrease the incidence of dislocation, while maintaining limb function and mobility, have been painstakingly undertaken. Since their advent in the 1970s, dual mobility cups have proven again and again to be effective in reducing dislocation following total hip arthroplasty. The dual mobility cup enables the surgeon to treat patients with an increased risk for dislocation, while maintaining hip stability, favorable wear properties, and an acceptable rate of dislocation. Disadvantages are related to the potential increased wear and surgeon error. With advances in engineering and design, dual mobility cups have proven useful in providing lower dislocation rates for several pathological conditions. As a result, dual mobility cups have moved into the forefront of total hip arthroplasty. PMID:22504995

Goyal, Nitin; Tripathy, Mohan S; Parvizi, Javad

2011-12-01

182

Dislocation kinetics  

International Nuclear Information System (INIS)

A series of investigations have been underway to determine in a more rigorous manner the thermally activated motion of a single dislocation and a group of dislocations through a random array of short range barriers (s.r.b.). This was accomplished by developing computer models to stimulate the motion of dislocations. These models require the use of far fewer assumptions in comparison with analytical solutions. The parameters which were investigated were: the strength and density of s.r.b., criterion for thermal fluctuation over the s.r.b., size and shape of slip plane, the magnitude of the lattice resistance, i.e., the Peierl's stress, and in the case of a group of dislocations the criterion for the dislocation source operation, and the differences between single and group motion on a one and two dimensional slip plane. The results obtained from the investigations of the motion of single dislocation indicate that if the s.r.b. is weak, the numerical results are in agreement with analytical results predicted by Friedel. If the Peierl's stress is non-zero then the s.r.b. can produce a reduction in the stress required to maintain a given dislocation velocity. If a multiple group of dislocations are in motion on the slip plane it is possible to have two types of pile-ups. If the dislocations remove s.r.b., as in channeling of irradiated metals, then a normal pile-up occurs. However, if the s.r.b. are not removed, an inverted pile occurs

1976-04-19

183

Femoral stem dislodgement during bipolar hemiarthroplasty dislocation.  

UK PubMed Central (United Kingdom)

Bipolar hemiarthroplasty remains a treatment option for displaced femoral neck fractures in elderly patients without pre-existing hip disease. Implant-related complications associated with this procedure include acetabular erosion, dislocation, disassembly of the modular components, polyethylene debris-induced osteolysis, metallosis from outer cup impingement, and femoral component loosening. This article presents a case of a patient in whom the polished collarless tapered femoral stem dislodged out of the cement mantle during traumatic bipolar hemiarthroplasty dislocation, 28 days after the index procedure. This complication, associated with bipolar hemiarthroplasty dislocation, was adequately managed by driving the stem back to the original cement mantle, followed by reduction of bipolar component dislocation and placing bone cement over the shoulder of the femoral stem to prevent a new dislodgement episode. Although rare, dislodgement of cemented polished collarless tapered stems from the cement mantle has been recently reported either during dislocation or, more frequently, as a complication of reduction of a dislocated total hip arthroplasty. However, its occurrence in association with bipolar hemiarthroplasty dislocation was not found to have been reported in the literature. The occurrence of femoral stem dislodgement during bipolar hemiarthroplasty dislocation should be considered as a possible complication of such a procedure and may be prevented by routinely placing bone cement over the shoulder of the femoral implant.

Marcelino Gomes LS; do Carmo W; de Souza W

2011-06-01

184

Femoral stem dislodgement during bipolar hemiarthroplasty dislocation.  

Science.gov (United States)

Bipolar hemiarthroplasty remains a treatment option for displaced femoral neck fractures in elderly patients without pre-existing hip disease. Implant-related complications associated with this procedure include acetabular erosion, dislocation, disassembly of the modular components, polyethylene debris-induced osteolysis, metallosis from outer cup impingement, and femoral component loosening. This article presents a case of a patient in whom the polished collarless tapered femoral stem dislodged out of the cement mantle during traumatic bipolar hemiarthroplasty dislocation, 28 days after the index procedure. This complication, associated with bipolar hemiarthroplasty dislocation, was adequately managed by driving the stem back to the original cement mantle, followed by reduction of bipolar component dislocation and placing bone cement over the shoulder of the femoral stem to prevent a new dislodgement episode. Although rare, dislodgement of cemented polished collarless tapered stems from the cement mantle has been recently reported either during dislocation or, more frequently, as a complication of reduction of a dislocated total hip arthroplasty. However, its occurrence in association with bipolar hemiarthroplasty dislocation was not found to have been reported in the literature. The occurrence of femoral stem dislodgement during bipolar hemiarthroplasty dislocation should be considered as a possible complication of such a procedure and may be prevented by routinely placing bone cement over the shoulder of the femoral implant. PMID:21667909

Marcelino Gomes, Luiz S; do Carmo, Wellington; de Souza, Wender

2011-06-14

185

Morphological analysis of the knee joint in patients with hip dysplasia.  

UK PubMed Central (United Kingdom)

PURPOSE: The purpose of this study was to investigate the morphological changes of the knee in patients with untreated developmental dysplasia of the hip. METHODS: Morphological analysis of 150 knee joints in 75 patients with developmental dysplasia of the hip was performed by examining computed tomographic (CT) images. Of these patients, 36 had unilateral developmental dysplasia of the hip and 39 had bilateral developmental dysplasia of the hip. Therefore, 36 hips were normal, and 114 hips were dislocated. CT images ranged from the iliac crest to 2 cm inferior to the tibial tuberosity. RESULTS: Compared with the knees in patients with normal hips, the femoral condyles in patients with dislocated hips were smaller and exhibited greater medial and lateral condylar asymmetry. The anterior femoral condylar angle of the femur was increased, as was the groove angle, while the trochlear groove was shallower in patients with dislocated hips. Furthermore, the lateral patella shift was reduced and the patellar tilt angle was increased in patients with dislocated hips compared with patients with normal hips. The extent of changes in these variables differed with the degree of dislocation. However, the posterior condylar angle of the femur was not affected by the degree of dislocation. CONCLUSION: These findings suggest that developmental dysplasia of the hip is associated with morphological changes in the knee joint. These changes should be considered during hip and knee surgery. LEVEL OF EVIDENCE: Prospective study, Level II.

Li H; Qu X; Wang Y; Dai K; Zhu Z

2013-09-01

186

Developmental dysplasia of the hip in the newborn: A systematic review  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Developmental dysplasia of the hip (DDH) denotes a wide spectrum of conditions ranging from subtle acetabular dysplasia to irreducible hip dislocations. Clinical diagnostic tests complement ultrasound imaging in allowing diagnosis, classification and monitoring of this condition. Classification syst...

Vivek Gulati; Kelechi Eseonu; Junaid Sayani; Nizar Ismail; Chika Uzoigwe; Muhammed Zaki Choudhury; Pooja Gulati; Adeel Aqil

187

The association between clubfoot and developmental dysplasia of the hip.  

Science.gov (United States)

The association between idiopathic congenital talipes equinovarus (CTEV) and developmental dysplasia of the hip is uncertain. We present an observational cohort study spanning 6.5 years of selective ultrasound screening of hips in clubfoot. From 119 babies with CTEV there were nine cases of hip dysplasia, in seven individuals. This suggests that 1 in 17 babies with CTEV will have underlying hip dysplasia. This study supports selective ultrasound screening of hips in infants with CTEV. PMID:21037357

Perry, D C; Tawfiq, S M; Roche, A; Shariff, R; Garg, N K; James, L A; Sampath, J; Bruce, C E

2010-11-01

188

The association between clubfoot and developmental dysplasia of the hip.  

UK PubMed Central (United Kingdom)

The association between idiopathic congenital talipes equinovarus (CTEV) and developmental dysplasia of the hip is uncertain. We present an observational cohort study spanning 6.5 years of selective ultrasound screening of hips in clubfoot. From 119 babies with CTEV there were nine cases of hip dysplasia, in seven individuals. This suggests that 1 in 17 babies with CTEV will have underlying hip dysplasia. This study supports selective ultrasound screening of hips in infants with CTEV.

Perry DC; Tawfiq SM; Roche A; Shariff R; Garg NK; James LA; Sampath J; Bruce CE

2010-11-01

189

Congenital insensitivity to pain with anhidrosis: a case report of a 33-year-old patient.  

UK PubMed Central (United Kingdom)

Congenital insensitivity to pain with anhidrosis is a type IV hereditary sensory and autonomic neuropathy, presenting early in life. This disorder results from defective neural crest differentiation with loss of the first-order afferent system, which is responsible for sensations of pain and temperature; a neuronal loss in the sympathetic ganglia is also present. A case of a 33-year-old patient with congenital insensitivity to pain with anhidrosis is presented. From the time of birth, he did not sweat and did not respond to painful stimuli, although unexplained bouts of fever were often observed in infancy; an extensive workup during childhood helped establish the diagnosis. Throughout childhood and adulthood, the patient presented multiple infections and fractures in various sites of his body, growth disturbances, and avascular necrosis, and Charcot arthropathies and joint dislocations mainly affected his elbow and hip joint. At the final follow-up, at the age of 33 years, he was found to be obese, with a limited social life. A Charcot elbow restricted the activity of his left upper limb, and the dislocated hips combined with the instability of the ankle joints limited the ambulation distance. A specific treatment protocol has not been established in the literature; the main principles that can be applied in patients with normal intelligence include training programs to prevent self-mutilation and accidental injuries and an early diagnosis and treatment of the infections.

Kosmidis I; Krallis P; Tsiamasfirou D; Filiopoulos K

2013-01-01

190

Congenital insensitivity to pain with anhidrosis: a case report of a 33-year-old patient.  

Science.gov (United States)

Congenital insensitivity to pain with anhidrosis is a type IV hereditary sensory and autonomic neuropathy, presenting early in life. This disorder results from defective neural crest differentiation with loss of the first-order afferent system, which is responsible for sensations of pain and temperature; a neuronal loss in the sympathetic ganglia is also present. A case of a 33-year-old patient with congenital insensitivity to pain with anhidrosis is presented. From the time of birth, he did not sweat and did not respond to painful stimuli, although unexplained bouts of fever were often observed in infancy; an extensive workup during childhood helped establish the diagnosis. Throughout childhood and adulthood, the patient presented multiple infections and fractures in various sites of his body, growth disturbances, and avascular necrosis, and Charcot arthropathies and joint dislocations mainly affected his elbow and hip joint. At the final follow-up, at the age of 33 years, he was found to be obese, with a limited social life. A Charcot elbow restricted the activity of his left upper limb, and the dislocated hips combined with the instability of the ankle joints limited the ambulation distance. A specific treatment protocol has not been established in the literature; the main principles that can be applied in patients with normal intelligence include training programs to prevent self-mutilation and accidental injuries and an early diagnosis and treatment of the infections. PMID:22422007

Kosmidis, Ilias; Krallis, Panagiotis; Tsiamasfirou, Damiani; Filiopoulos, Konstantinos

2013-01-01

191

Hip Replacement  

Medline Plus

Full Text Available Hip Replacement Introduction Severe arthritis in the hip can lead to severe pain and inability to walk. Doctors ... weight will also increase the success of the hip replacement This document is for informational purposes and is ...

192

Hip Replacement  

Medline Plus

Full Text Available ... in the hip to relieve their pain and help them move more easily. HipJoint Femur Pelvis If ... in the hip joint. Physical therapy may also help keep the joint as mobile as possible. The ...

193

Outcome of one-stage treatment of developmental dysplasia of hip in older children.  

UK PubMed Central (United Kingdom)

BACKGROUND: The principles of treatment of congenital dislocation of hip in old children are different than those of infants and neonates. The purpose of this study is to evaluate the radiographic and functional results of one-stage treatment (open reduction, femoral shortening derotation, and Salter's osteotomy) of DDH in older children. MATERIALS AND METHODS: Between January 2005 and June 2010, 25 patients (30 hips) underwent one-stage triple procedure of open reduction, femoral shortening derotation, and Salter's osteotomy for the treatment of DDH. Preoperatively, they were classified according to the Tönnis class. Clinical outcomes were assessed using the modified McKay's criteria to measure pain symptoms, gait pattern, Trendelenburg sign status, and the range of hip joint movement. Radiographic assessment was made using Severin's scoring method to measure the centre-edge angle and dysplasia. RESULTS: The mean age at the time of operation was 3.9 years (range 1.6-8 years), and the average duration of followup was 4.1 years (range 2-7.6 years). The McKay's score was excellent in 13 hips, good in 14 hips, fair in 2, and poor in 1 hip. The Severin's class I and II was found in 25 (83.3%) hips at the time of final evaluation as compared to none at the time of presentation. CONCLUSIONS: Young children having DDH can safely be treated with an extensive one-stage triple procedure of open reduction, femoral shortening derotation, and Salter's osteotomy, without increasing the risk of AVN. Early diagnosis and intervention is the successful treatment of patients suffering from DDH.

Bhuyan BK

2012-09-01

194

Congenital vertical talus in multiple pterygium syndrome.  

UK PubMed Central (United Kingdom)

BACKGROUND: Congenital vertical talus (CVT) is a rare foot deformity, but it is a commonly associated anomaly in patients with multiple pterygium syndrome (MPS). If left untreated, it can cause pain and morbidity, which will affect the patient's ambulation and quality of life. The aim of this study was to assess the prevalence of CVT among patients with MPS, to characterize the clinical and radiological features and examine the outcome of treatment. METHODS: We reviewed the medical records from 1969 to 2009, and detected 14 patients with a diagnosis of MPS. Data regarding clinical findings, radiographs, associated anomalies, and treatment were collected and analyzed. RESULTS: CVT was seen in 10 of 14 patients (71%). All of them had bilateral involvement. Eight of the 10 (80%) were girls, and 3 of these 10 (30%) were nonambulatory patients. All 7 ambulatory patients had manipulation and casting, followed by a single-stage surgical release. The mean age at surgery was 3.0 ± 3.7 years (range, 3 mo-9 y 2 mo). At the last follow-up, all of the 7 patients (100%) had painless plantigrade feet and a reduced talonavicular joint, and none had recurrence of the deformity. The overall mean follow-up was 6 years (range, 2-19 y) and the mean age at the last follow-up was 9 years (range, 2-23 y). The commonly associated anomalies were scoliosis (93%), tethered cord (14%), hip dislocation (43%), cardiac (29%), respiratory (43%), and gastrointestinal anomalies (29%). CONCLUSIONS: CVT is common in MPS. The other common anomalies included scoliosis, hip dislocation, and respiratory problems. Treatment with manipulation and casting followed by, a single-stage surgical release resulted in a good outcome.

Angsanuntsukh C; Oto M; Holmes L; Rogers KJ; King MM; Donohoe M; Kumar SJ

2011-07-01

195

Intrauterine Temporomandibular Joint Dislocation: Prenatal Sonographic Evaluation.  

UK PubMed Central (United Kingdom)

Congenital temporomandibular joint (TMJ) diseases are very rare disorders and usually diagnosed in the childhood. Developmental disorders of the TMJ such as hypoplasia, hyperplasia and aplasia of the TMJ compartments are characterized TMJ dysfunction. In the childhood, these patients have a recurrent dislocation, pain and malocclusion. We present a 25-week fetus with unilateral TMJ dislocation with fluid retention in the joint diagnosed by ultrasonography. To the best of our knowledge, this is the first case of the TMJ dislocation diagnosed by ultrasonographic evaluation during the prenatal period.

Cil AS; Bozkurt M; Kara D

2013-05-01

196

Total knee arthroplasty in a pseudoachondroplastic dwarfism patient with bilateral patellar dislocation.  

UK PubMed Central (United Kingdom)

Late presentation of congenital patellar dislocation with advanced osteoarthritis is rare. This article presents a case of a 59-year-old man with underlying pseudoachondroplastic dwarfism. Advanced osteoarthritis due to bilateral neglected congenital patellar dislocation was treated with total knee arthroplasty without patella relocation surgery. Two years later, the patient had an improvement in Knee Society scores, painless function, and stability.

Oh KJ; Yoon JR; Yang JH

2013-01-01

197

Screening programmes for developmental dysplasia of the hip in newborn infants  

Scientific Electronic Library Online (English)

Full Text Available Abstract in english BACKGROUND Uncorrected developmental dysplasia of the hip (DDH) is associated with long term morbidity such as gait abnormalities, chronic pain and degenerative arthritis. OBJECTIVE To determine the effect of different screening programmes for DDH on the incidence of late presentation of congenital hip dislocation. METHODS Search methods: Searches were performed in CENTRAL (The Cochrane Library), MEDLINE and EMBASE (more) (January 2011) supplemented by searches of clinical trial registries, conference proceedings, cross references and contacting expert informants. Selection criteria: Randomized, quasi-randomized or cluster trials comparing the effectiveness of screening programmes for DDH. Data collection and analysis: Three independent review authors assessed study eligibility and quality, and extracted data. MAIN RESULTS No study examined the effect of screening (clinical and/or ultrasound) and early treatment versus not screening and later treatment. AUTHORS' CONCLUSIONS There is insufficient evidence to give clear recommendations for practice. There is inconsistent evidence that universal ultrasound results in a significant increase in treatment compared to the use of targeted ultrasound or clinical examination alone. Neither of the ultrasound strategies have been demonstrated to improve clinical outcomes including late diagnosed DDH and surgery. The studies are substantially underpowered to detect significant differences in the uncommon event of late detected DDH or surgery. For infants with unstable hips or mildly dysplastic hips, use of delayed ultrasound and targeted splinting reduces treatment without significantly increasing the rate of late diagnosed DDH or surgery.

Shorter, Damon; Hong, Timothy; Osborn, David A.

2013-04-01

198

Magnetic resonance imaging of hip joint cartilage and labrum  

Directory of Open Access Journals (Sweden)

Full Text Available Hip joint instability and impingement are the most common biomechanical risk factors that put the hip joint at risk to develop premature osteoarthritis. Several surgical procedures like periacetabular osteotomy for hip dysplasia or hip arthroscopy or safe surgical hip dislocation for femoroacetabular impingement aim at restoring the hip anatomy. However, the success of joint preserving surgical procedures is limited by the amount of pre-existing cartilage damage. Biochemically sensitive MRI techniques like delayed Gadolinium Enhanced MRI of Cartilage (dGEMRIC) might help to monitor the effect of surgical or non-surgical procedures in the effort to halt or even reverse joint damage.

Christoph Zilkens; Falk Miese; Marcus Jager; Bernd Bittersohl; Rüdiger Krauspe

2011-01-01

199

[Subtalar dislocation].  

UK PubMed Central (United Kingdom)

Subtalar dislocations represent uncommon injuries of the foot. Leitner [7] described the relationship between medial and lateral dislocations as 6:1. The mechanism is a trauma in plantar flexion/supination of the forefoot with a fixed hindfoot.Immediate reduction, which can usually be performed as a closed reduction is the aim of the treatment. The reduction should be performed under anesthesia in the operating room (OR) and under OR conditions in case the closed reduction shows no success. Subsequently, x-rays and CT scans should be performed in two planes in order to rule out concomitant injuries at the processus posterior tali and the talar head, as bony fragments can necessitate an operative intervention in the case of an interposition of the articulation.In terms of aftercare an immobilization of 6 weeks with a lower leg cast is suggested in the literature. In the presented case an early functional therapy with 2 weeks cast and 4 weeks with a therapy boot could achieve good clinical results.

Seeger JB; Clarius M

2009-12-01

200

Total hip arthroplasty followed by traction and delayed reduction for Crowe IV developmental dysplasia of the hip.  

UK PubMed Central (United Kingdom)

Hip dislocation secondary to developmental dysplasia of the hip is a debilitating condition. Total hip arthroplasty has proven successful in improving pain, restoring joint function, and correcting leg length discrepancies in this select population. Various techniques have been developed to address the increased complexity inherent to the reconstruction of the severely dysplastic hip. Despite this, femoral and/or sciatic nerve palsy remains a potential catastrophic complication after surgery, with reported rates up to five times that in the general population. We present three cases using a previously unreported technique for performing primary total hip arthroplasty via an anterior approach for Crowe IV hip dysplasia. The goal of this technique is to minimize the risk of postoperative nerve palsy following reconstruction of the severely dysplastic hip. A brief discussion of our technique and the topic of nerve dysfunction after total hip arthroplasty for developmental dysplasia of the hip follows.

Flanagin BA; Dushey CH; Rubin LE; Keggi KJ

2013-06-01

 
 
 
 
201

Importancia de la Relación Anatómica entre el nervio Isquiático y el Margen Posterior del Acetábulo en la Luxación Posterior de la Cadera/ Anatomic Value of the Sciatic Nerve with the Posterior Margin of the Acetabulum in Posterior Dislocation of the Hip  

Scientific Electronic Library Online (English)

Full Text Available Abstract in spanish La luxación posterior de la articulación de la cadera es un trauma que puede sufrir una buena parte de la población, donde se puede comprometer el nervio isquiático, produciendo serios problemas en la vida del individuo afectado. El conocimiento de la relación anatómica entre el nervio isquiático y el margen posterior del acetábulo propiciará um diagnóstico preciso y precoz de esta lesión. Con el objetivo de estudiar la relación topográfica del nervio isquiá (more) tico con el margen posterior del acetábulo y entregar antecedentes anatómicos para las cirugías ortopédicas en caso de luxaciones posteriores de la cadera, se estudiaron 40 miembros inferiores formolizados, de cadáveres humanos, adultos y de ambos sexos, localizados en los laboratorios de anatomía topográfica de la Universidad Estadual de Ciencias de la Salud de Alagoas, Brasil. En 19 miembros inferiores (47,7%) el nervio isquiático pasó directamente sobre el margen posterior del acetábulo y en los 21 restantes (53,3%), el nervio estuvo distante del margen mencionado, distancia que varió de 6 a 49 mm. Los resultados obtenidos muestran la estrecha relación entre el nervio isquiático y el margen acetabular, lo que acrecienta la posibilidad de lesión del nervio em los casos de luxación posterior de la cadera. Abstract in english The posterior dislocation of the hip joint is a trauma that can undergo a large part of the population, which may compromise the sciatic nerve, causing serious problems in the life of the affected individual. Knowledge of the anatomical relationship between the sciatic nerve and the posterior margin of the acetabulum will facilitate accurate diagnosis and early um this injury. In order to study the topographical relationship of the sciatic nerve with the posterior margin (more) of the acetabulum and provide background for orthopedic anatomical in posterior dislocations of the hip were studied 40 lower limbs formolized human cadavers, adults of both sexes , located in the topographical anatomy laboratories of the Universidade Estadual de Ciencias da Saude, Alagoas, Brasil. In 19 limbs (47.7%) sciatic nerve passed directly over the posterior margin of the acetabulum and the remaining 21 (53.3%), the nerve passed distal to the acetabular margin, distance ranging from 6-49 mm. The results show the close relationship between the sciatic nerve and the acetabular margin, which increases the possibility of nerve injury in posterior dislocation of the hip.

da Rocha, A. C; Monte Bispo, R. F; da Cruz, R. D; dos Santos, F. T. A; dos Santos, T. F. A; Olave, E; Sousa-Rodrigues, C. F

2012-09-01

202

Hip Revision  

Medline Plus

Full Text Available ... Revision Featuring the ZMR® Hip System Tapered Distal Stem Zimmer, Inc. Winfield, Illinois September 3, 2009 Welcome ... a hybrid hip arthroplasty with a cemented femoral stem and an acetabular shell. You can see the ...

203

Hip Replacement  

Medline Plus

Full Text Available ... and help them move more easily. HipJoint Femur Pelvis If your doctor recommends surgery for you, the ... The hip joint joins the leg to the pelvis. The head of the femur, or thighbone, has ...

204

Hip Replacement  

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Full Text Available ... and reduce the inflammation. For overweight patients, losing weight may help relieve the stress on the hip joint. If an operation is done, losing weight will also increase the success of the hip ...

205

Hip Replacement  

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Full Text Available ... Replacement Introduction Severe arthritis in the hip can lead to severe pain and inability to walk. Doctors ... can result in severe pain and may even lead to the inability to walk. Hip arthritis can ...

206

Operative treatment of FAI: open hip preservation surgery.  

UK PubMed Central (United Kingdom)

Femoroacetabular Impingement (FAI) is characterized by abnormal contact of the hip joint. Many etiologies cause this painful condition, which leads to early osteoarthritis. While hip arthroscopy has become the most prevalent way to surgically correct a hip, some presentations of FAI require open surgical hip preservation techniques to fully address the pathology at hand. Certain head neck deformities may require open surgical hip dislocation utilizing a trochanteric slide osteotomy. A retroverted acetabulum may require an open periacetabular osteotomy to gain anteversion and eliminate impingement in the hip joint. Acetabular protrusio may require surgical hip dislocation with rim trimming and a possible valgus intertrochanter osteotomy. The sequelae of Legg-Calvé-Perthes disease causes complex abnormalities about the hip joint, which may require open surgery to address both the intra-articular pathology and the extra-articular pathology. Osteotomies of the proximal femur and acetabulum may all be necessary to restore a hip back to normal morphology. Chronic slipped capital femoral epiphysis (SCFE) may also require open surgical hip dislocations and complex intertrochanter osteotomies to recreate normal morphology.

Hellman MD; Riff AJ; Haughom BD; Patel R; Stover MD; Nho SJ

2013-09-01

207

Acetabular reconstruction in patients with low and high dislocation: 20- to 32-year survival of an impaction grafting technique (named cotyloplasty).  

UK PubMed Central (United Kingdom)

We report the results at a mean of 24.3 years (20 to 32) of 61 previously reported consecutive total hip replacements carried out on 44 patients with severe congenital hip disease, performed with reconstruction of the acetabulum with an impaction grafting technique known as cotyloplasty. The mean age of the patients at operation was 46.7 years (23 to 68) and all were women. The patients were followed post-operatively for a mean of 24.3 years (20 to 32), using the Merle d'Aubigné and Postel scoring system as modified by Charnley, and with serial radiographs. At the time of the latest follow-up, 28 acetabular components had been revised because of aseptic loosening at a mean of 15.9 years (6 to 26), and one at 40 days after surgery because of repeated dislocations. The overall survival rate for aseptic failure of the acetabular component at ten years was 93.1% (95% confidence interval (CI) 86.5 to 96.7) when 53 hips were at risk, and at 23 years was 56.1% (95% CI 49.4 to 62.8), when 22 hips remained at risk. These long-term results are considered satisfactory for the reconstruction of an acetabulum presenting with inadequate bone stock and circumferential segmental defects.

Karachalios T; Roidis N; Lampropoulou-Adamidou K; Hartofilakidis G

2013-07-01

208

Acetabular reconstruction in patients with low and high dislocation: 20- to 32-year survival of an impaction grafting technique (named cotyloplasty).  

Science.gov (United States)

We report the results at a mean of 24.3 years (20 to 32) of 61 previously reported consecutive total hip replacements carried out on 44 patients with severe congenital hip disease, performed with reconstruction of the acetabulum with an impaction grafting technique known as cotyloplasty. The mean age of the patients at operation was 46.7 years (23 to 68) and all were women. The patients were followed post-operatively for a mean of 24.3 years (20 to 32), using the Merle d'Aubigné and Postel scoring system as modified by Charnley, and with serial radiographs. At the time of the latest follow-up, 28 acetabular components had been revised because of aseptic loosening at a mean of 15.9 years (6 to 26), and one at 40 days after surgery because of repeated dislocations. The overall survival rate for aseptic failure of the acetabular component at ten years was 93.1% (95% confidence interval (CI) 86.5 to 96.7) when 53 hips were at risk, and at 23 years was 56.1% (95% CI 49.4 to 62.8), when 22 hips remained at risk. These long-term results are considered satisfactory for the reconstruction of an acetabulum presenting with inadequate bone stock and circumferential segmental defects. PMID:23814238

Karachalios, Th; Roidis, N; Lampropoulou-Adamidou, K; Hartofilakidis, G

2013-07-01

209

Total hip arthroplasty following failed fixation of proximal hip fractures  

Directory of Open Access Journals (Sweden)

Full Text Available Background: Most proximal femoral fractures are successfully treated with internal fixation but a failed surgery can be very distressing for the patient due to pain and disability. For the treating surgeon it can be a challenge to perform salvage operations. The purpose of this study was to evaluate the short-term functional outcome and complications of total hip arthroplasty (THA) following failed fixation of proximal hip fracture. Materials and Methods: In a retrospective study, 21 hips in 20 patients (13 females and seven males) with complications of operated hip fractures as indicated by either established nonunion or fracture collapse with hardware failure were analysed. Mean age of the patients was 62 years (range 38 years to 85 years). Nine patients were treated for femoral neck fracture, 10 for intertrochanteric (I/T) fracture and two for subtrochanteric (S/T) fracture of the hip. Uncemented THA was done in 11 cases, cemented THA in eight hip joints and hybrid THA in two patients. Results: The average duration of follow-up was four years (2-13 years). The mean duration of surgery was 125 min and blood loss was 1300 ml. There were three dislocations postoperatively. Two were managed conservatively and one was operated. There was one superficial infection and one deep infection. Only one patient required a walker while four required walking stick for ambulation. The mean Harris Hip score increased from 32 preoperatively to 79 postoperatively at one year interval. Conclusion: Total hip arthroplasty is an effective salvage procedure after failed osteosynthesis of hip fractures. Most patients have good pain relief and functional improvements inspite of technical difficulties and high complication rates than primary arthroplasty.

Srivastav Shekhar; Mittal Vivek; Agarwal Shekhar

2008-01-01

210

Analysis of the acetabulum by CT scan in Japanese with osteoarthritis of the hip  

Energy Technology Data Exchange (ETDEWEB)

The morphology of the acetabulum was analyzed by CT scan in 66 Japanese patients with osteoarthritis of the hip mainly following congenital dislocation or dysplasia. The CT scan data was analyzed to standardize the pelvic inclination in all directions. In these patients, the acetabular floor had thickened and the acetabulum was located in the anterolateral portion. The bilateral difference in the acetabular anteversion angle was not different between patients and normal individuals, but the acetabular sector angle in patients was smaller than in the normal subjects. As the stage of osteoarthritis of the hip advanced, the thickness of the acetabular floor in the center and posterior portions and the anterior sector angle increased, and the lateralization of the acetabulum advanced, but the anteversion angle decreased. A bone-forming change is characteristic of the anterior acetabulum and acetabular fossa in the center and posterior portions in Japanese patients with osteoarthritis of the hip. In comparison with data obtained by standard radiography, these changes detected by CT scan corresponded to an increase of the width of a tear drop, the lateralization of the femoral head and the lack of the support of the femoral head from the acetabulum. (author)

Ishibashi, Masanori [Keio Univ., Tokyo (Japan). School of Medicine

1997-11-01

211

Quantitative measurement and analysis for detection and treatment planning of developmental dysplasia of the hip  

Science.gov (United States)

Developmental dysplasia of the hip is a congenital hip joint malformation affecting the proximal femurs and acetabulum that are subluxatable, dislocatable, and dislocated. Conventionally, physicians made diagnoses and treatments only based on findings from two-dimensional (2D) images by manually calculating clinic parameters. However, anatomical complexity of the disease and the limitation of current standard procedures make accurate diagnosis quite difficultly. In this study, we developed a system that provides quantitative measurement of 3D clinical indexes based on computed tomography (CT) images. To extract bone structure from surrounding tissues more accurately, the system firstly segments the bone using a knowledge-based fuzzy clustering method, which is formulated by modifying the objective function of the standard fuzzy c-means algorithm with additive adaptation penalty. The second part of the system calculates automatically the clinical indexes, which are extended from 2D to 3D for accurate description of spatial relationship between femurs and acetabulum. To evaluate the system performance, experimental study based on 22 patients with unilateral or bilateral affected hip was performed. The results of 3D acetabulum index (AI) automatically provided by the system were validated by comparison with 2D results measured by surgeons manually. The correlation between the two results was found to be 0.622 (p<0.01).

Liu, Xin; Lu, Hongbing; Chen, Hanyong; Zhao, Li; Shi, Zhengxing; Liang, Zhengrong

2009-02-01

212

Bilateral anterior shoulder dislocation.  

UK PubMed Central (United Kingdom)

Shoulder dislocations are the most common major joint dislocations encountered in the emergency departments. Bilateral shoulder dislocations are rare and of these, bilateral posterior shoulder dislocations are more prevalent than bilateral anterior shoulder dislocations. Bilateral anterior shoulder dislocation is very rare. We present a case of 24-year-old male who sustained bilateral anterior shoulder dislocation following minor trauma, with associated greater tuberosity fracture on one side. Prompt closed reduction followed by immobilization in arm sling and subsequent rehabilitation ensured a good outcome.

Meena S; Saini P; Singh V; Kumar R; Trikha V

2013-07-01

213

Acetabular Liner With Focal Constraint to Prevent Dislocation After THA.  

UK PubMed Central (United Kingdom)

BACKGROUND: Dislocation continues to commonly cause failure after primary and revision total hip arthroplasty (THA). Fully constrained liners intended to prevent dislocation are nonetheless associated with a substantial incidence of failure by redislocation, mechanical failure, aseptic loosening, or a combination. Constrained liners with cutouts of the elevated rims can theoretically increase range of movement and therefore decrease the risk dislocation, but it is unclear if they do so in practice and whether they are associated with early wear or loosening. QUESTIONS/PURPOSES: We therefore determined (1) occurrence or recurrence of dislocation and (2) rate of complications associated with constrained implants with cutouts; and (3) assessed for early cup loosening. METHODS: We retrospectively reviewed the records of 81 patients at high risk for dislocation who had 82 constrained liners inserted for primary (n = 10) or revision (n = 72) THA between 2008 and 2010. From the records we extracted demographic and implant data and instances of recurrent dislocation, implant failure, osteolysis, loosening, or construct failure. The minimum followup was 24 months (mean, 34 months; range, 24-49 months). RESULTS: Three liners failed as a result of further dislocation (3%). Three deep infections occurred. One patient had progressive loosening at the shell-bone interface. CONCLUSIONS: Our observations suggest this liner is associated with a relatively low risk of dislocation in patients at high risk for dislocation and those with recurrent dislocation. LEVEL OF EVIDENCE: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Munro JT; Vioreanu MH; Masri BA; Duncan CP

2013-02-01

214

An 8.35 Mb overlapping interstitial deletion of 8q24 in two patients with coloboma, congenital heart defect, limb abnormalities, psychomotor retardation and convulsions.  

UK PubMed Central (United Kingdom)

Chromosome analysis in two young patients with multiple congenital anomalies revealed a de novo interstitial deletion of 8q that has not been reported before. The deletions were overlapping by 8.35 Mb (8q24.21q24.23). The clinical features shared by our patients were coloboma, VSD, digital abnormalities, congenital dislocation of a hip, feeding problems, psychomotor delay and convulsions. The deletion included the region for Langer-Giedion syndrome (TRPS1 and EXT1) in the girl only. However, she is too young to present features of this syndrome, apart from dysmorphic features like a bulbous nose and notched alae nasi. Several genes are present in the commonly deleted region, including genes with unknown function, and genes for which haploinsufficiency is known to have no phenotypic effect in mice (Wnt1). A gene that might play a role in the convulsions of our patients is KCNQ3.

Verheij JB; de Munnik SA; Dijkhuizen T; de Leeuw N; Olde Weghuis D; van den Hoek GJ; Rijlaarsdam RS; Thomasse YE; Dikkers FG; Marcelis CL; van Ravenswaaij-Arts CM

2009-09-01

215

Tratamento da luxação paralítica do quadril na paralisia cerebral tetraparética espástica com osteotomia do fêmur e do ilíaco sem abertura da cápsula articular (capsuloplastia)/ Hip dislocation treatment in cerebral palsy patients with spastic quadriplegia with femoral and pelvic osteotomies, without opening of the joint capsule (capsuloplasty)  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese OBJETIVO: Mostrar o planejamento pré-operatório, e os resultados do tratamento cirúrgico da luxação paralítica do quadril em pacientes com paralisia cerebral. A técnica utilizada foi a osteotomia derrotatória e varizante do fêmur proximal, associada à osteotomia do ilíaco tipo Dega, sem abertura da cápsula articular. MÉTODOS: Realizamos um estudo retrospectivo de 10 quadris em oito pacientes com paralisia cerebral tipo tetraparesia espástico, submetidos a tr (more) atamento cirúrgico entre 2003 e 2005 com a mesma técnica cirúrgica. Foram avaliados parâmetros clínicos e radiográficos pré e pós-operatórios, bem como o planejamento pré-operatório com uso do intensificador de imagem. Os parâmetros clínicos analisados foram: dor, dificuldade de higiene e dificuldade de posicionamento. Os parâmetros radiológicos foram os índices de Reimers, índice acetabular e ângulo cervicodiafisário. Estes resultados foram submetidos a análise estatística. RESULTADOS: Obtivemos bons resultados com esta técnica. Com um seguimento médio de três anos, todos os quadris estavam reduzidos na última consulta, com alto grau de satisfação dos familiares, em relação ao tratamento. Além disso, mostramos que o planejamento pré-operatório com uso do intensificador de imagem nos permite a redução e estabilização desses quadris sem a necessidade de capsuloplastia. CONCLUSÃO: Os autores concluíram que no tratamento da luxação do quadril dos pacientes com paralisia cerebral tetraparéticos espásticos com o planejamento pré-operatório, não é necessária a capsuloplastia para estabilização da articulação coxofemoral. Abstract in english OBJECTIVES: To show the preoperative planning and the results of surgical treatment for paralytic hip dislocation in children with cerebral palsy. The techniques used were proximal femoral varus derotation osteotomy and Dega osteotomy without opening of the joint capsule. METHODS: We performed a retrospective review of ten hips in eight patients with cerebral palsy with spastic quadriplegia treated with surgery from 2003 to 2005, by the same surgical technique. Were asses (more) sed clinical and radiological outcomes before and after surgery, as well as the preoperative planning with the use of fluoroscope. The clinical parameters analyzed were: pain, difficulty performing personal hygiene, and sitting balance. The radiological parameters were Reimer's index, acetabular index and neck-shaft angle. These results were submitted to statistical analysis. RESULTS: We obtained good results with this technique. After an average follow-up of three years, all hips were stable in the last assessment, and there was a high level of satisfaction among the families in relation to the treatment. We also show that preoperative planning with fluoroscopy enables the reduction and stabilization of the hips without the need for capsuloplasty. CONCLUSION: The authors conclude that in the treatment of hip dislocation in patients with Cerebral Palsy with spastic quadriplegia, it is not necessary to open the joint capsule to stabilize the coxofemoral joint.

Farcetta Junior, Fernando; Abreu, Fabio Peluzo; Neves, Daniella Lins; Kertzman, Paulo Facciola; Zuccon, Alexandre; Bittencourt, Simone de Oliveira; Lopes, Davi Moshe Leopold

2010-01-01

216

Total hip arthroplasty using the superior capsulotomy technique.  

UK PubMed Central (United Kingdom)

Dislocation of the native hip during total hip arthroplasty has traditionally been an integral part of all surgical exposures. However, dislocation of the native hip may require greater soft-tissue release than surgical excision of the femoral head during total hip arthroplasty. The superior capsulotomy technique allows preparation of the femur in situ, with excision of the femoral head after femoral component preparation has been completed. The advantages of this technique include preservation of the hip joint capsule and less tissue dissection during surgery; special traction equipment or fluoroscopy is not needed. This technique allows immediate mobilization of patients without motion or weight-bearing precautions, little parental narcotic use, and discharge home within 24 hours of surgery for most patients.

Murphy SB

2013-01-01

217

Anteromedial subtalar dislocation.  

UK PubMed Central (United Kingdom)

Subtalar dislocation is the simultaneous dislocation of the talocalcaneal and talonavicular joints of the foot, typically caused by falls from heights, twisting leg injuries and motor vehicle accidents. The dislocation can occur medially, lateral, anterior or posterior, but most commonly occurs from inversion injury producing a medial dislocation. These dislocations may be accompanied by fractures. Careful physical examination must be performed to assess for neurovascular compromise. Most subtalar dislocations can be treated with closed reduction under sedation. However, if the dislocation is associated with an open fracture it may require reduction in the operating room. Treatment should include postreduction plain x-ray and CT scan to evaluate for proper alignment and for fractures. This article presents a case of medial subtalar dislocation in a 23-year-old football player.

Stafford H; Boggess B; Toth A; Berkoff D

2013-01-01

218

[Traumatic luxation of the hip in children  

UK PubMed Central (United Kingdom)

The authors report the long-term results of the non-surgical treatment of 15 cases of traumatic dislocation of the hip during the growth age, followed-up after an average of 14 years (5-26 years). There were 14 cases of posterior dislocation and 1 case of anterior dislocation (the latter complicated by ischemia due to compression of the common femoral artery), in patients aged from 3.5 to 15 years (average age 11 years). All of the cases were treated by non-surgical reduction under general anesthesia in an emergency situation, and a plaster cast which was worn for 30-55 days. At long-term follow-up the results were evaluated as follows good, with complete healing, in 67% of the cases; fair, with moderate, non-symptomatic radiographic arthritic changes, in 26%; poor in only 1 case (7%) which was complicated by necrosis of the femoral head. Post-traumatic arthrosis and cephalic necrosis were observed in patients aged more than 10 years, and where fracture was associated with the dislocation, indicating trauma of considerable intensity. The duration of immobilization in a plaster cast and no weight-bearing did not influence the results. Traumatic hip dislocation during the growth age has a better prognosis as compared to that occurring during adult age. Particularly favorable prognostic factors are age under 10 years and the absence of fractures associated with the dislocation.

Fama G; Pavanini G; Bonaga S

1989-07-01

219

MR imaging of osseous lesions of the hip.  

UK PubMed Central (United Kingdom)

MR imaging, because of its multiplanar capability and superior soft tissue contrast resolution, is the preferred modality to assess osseous and soft tissue structures around the hip joint. This article reviews the clinical presentation, disease process, and imaging findings of important congenital and acquired osseous disorders of the pediatric and adult hip.

Sheikh A; Koujok K; Sampaio ML; Schweitzer ME

2013-02-01

220

Unilateral hip osteoarthritis: can we predict the outcome of the other hip?  

Energy Technology Data Exchange (ETDEWEB)

The objective of this study was to define, in unilateral hip osteoarthritis (OA), factors predicting the outcome of the other hip. We examined the anteroposterior radiographs of the pelvis of 95 white patients with unilateral idiopathic (56 patients) or secondary to congenital hip diseases (39 patients) OA. The other hip was free from symptoms (pain or limping) at the initial examination and without radiographic evidence of OA; it was what we call a ''normal'' hip. Two parameters were evaluated: (1) the type of osteoarthritis of the involved hip and (2) the range of four radiographic indices of the contralateral hip: the sourcil inclination (weight-bearing surface), the acetabular angle, the Wiberg's center-edge angle, and the neck-shaft angle. Follow-up radiographs for the hips that remained OA-free were available for 10 to 35 years and for those that developed OA, at the time of initial symptoms, range 2 to 31 years. Logistic regression analysis showed that the presence of idiopathic OA in one hip had a statistically significant effect on the development of OA on the other hip (p<0.001). Minor deviations of radiographic indices of the contralateral hip is not a predictive factor for its outcome. When the radiographic indices are examined together with the pathology of the involved hip, only WBS was shown to have a significant effect to the development of OA and its type (p < 0.001). The following conclusions can be drawn from this study: 1. Patient with idiopathic OA of one hip is at increased risk of developing OA in the other hip. 2. The outcome of the other hip cannot be predicted only on the basis of the evaluation of its radiographic indices. 3. Among the different indices, WBS seems to have a strong influence toward the development of OA. (orig.)

Vossinakis, I.C. [General Hospital of Volos, Orthopaedic Department, Volos (Greece); Georgiades, G. [General Hospital of Tripoli, Tripoli Greece, Orthopaedic Department, Athens (Greece); Hartofilakidis, G. [University of Athens Medical School, Department of Orthopaedics, Athens (Greece); Kafidas, D.

2008-10-15

 
 
 
 
221

Total hip arthroplasty in developmental dysplasia of the hip: Review of anatomy, techniques and outcomes.  

Science.gov (United States)

Total hip arthroplasty (THA) in developmental dysplasia of the hip (DDH) presents many challenges to the reconstructive surgeon. The complex femoral and acetabular anatomy makes standard reconstruction technically challenging. Acetabular coverage can be improved by medialization of the component or augmentation of the deficient areas with bone graft. Femoral shortening osteotomies are considered in cases of severe dysplasia and frankly dislocated hips. Each patient's unique anatomy dictates what options of reconstruction are available. The functional outcomes of THA in DDH are generally excellent, though higher rates of mechanical failure have been reported in this group. This article reviews the anatomy, classification, technical considerations, and outcomes of THA in patients with DDH. PMID:22655221

Yang, Scott; Cui, Quanjun

2012-05-18

222

Total hip arthroplasty in developmental dysplasia of the hip: Review of anatomy, techniques and outcomes.  

UK PubMed Central (United Kingdom)

Total hip arthroplasty (THA) in developmental dysplasia of the hip (DDH) presents many challenges to the reconstructive surgeon. The complex femoral and acetabular anatomy makes standard reconstruction technically challenging. Acetabular coverage can be improved by medialization of the component or augmentation of the deficient areas with bone graft. Femoral shortening osteotomies are considered in cases of severe dysplasia and frankly dislocated hips. Each patient's unique anatomy dictates what options of reconstruction are available. The functional outcomes of THA in DDH are generally excellent, though higher rates of mechanical failure have been reported in this group. This article reviews the anatomy, classification, technical considerations, and outcomes of THA in patients with DDH.

Yang S; Cui Q

2012-05-01

223

Palliative hip surgery in severe cerebral palsy: a systematic review.  

UK PubMed Central (United Kingdom)

We performed a systematic review of the results of palliative hip surgery in severe cerebral palsy. Individuals with severe cerebral palsy frequently suffer from pain and other impairments because of dislocation or malformation of the hips. When preventive or reconstructive surgery fails, palliative intervention is performed. A number of salvage interventions have been described. We found articles on resection surgery of the femoral head, arthrodesis of the hip joint, and total hip replacement. The published literature does not clearly favor one procedure over the others. The resection arthroplasty technique developed by Castle is reported to yield the best results and fewer complications, and seems to eventually lead to a good outcome.

Boldingh EJ; Bouwhuis CB; van der Heijden-Maessen HC; Bos CF; Lankhorst GJ

2013-09-01

224

'Inverse' temporomandibular joint dislocation.  

UK PubMed Central (United Kingdom)

Temporomandibular joint (TMJ) dislocation can be classified into four groups (anterior, posterior, lateral, and superior) depending on the direction of displacement and the location of the condylar head. All the groups are rare except for anterior dislocation. 'Inverse' TMJ dislocation is a bilateral anterior and superior dislocation with impaction of the mandible over the maxilla; to the authors' knowledge only two cases have previously been reported in the literature. Inverse TMJ dislocation has unique clinical and radiographic findings, which are described for this case.

Alemán Navas RM; Martínez Mendoza MG

2011-08-01

225

Hip Revision  

Medline Plus

Full Text Available ... which in this case was actually a decent one. I wish we had time to show all ... and your hip construct stability? I would agree one hundred percent with that. Well, do you want ...

226

Hip Arthroscopy  

Science.gov (United States)

... of Orthopaedic Surgeons Hip Arthroscopy Arthroscopy is a surgical procedure that gives doctors a clear view of the ... method is best for you. Top of page Surgical Procedure At the start of the procedure, your leg ...

227

Hip Strains  

Science.gov (United States)

... fibers, the resulting injury is called a strain. Muscle strains frequently occur in the hip area when a ... fibers, resulting in a strain. The risk of muscle strain increases if you had a prior injury in ...

228

Hip Replacement  

Medline Plus

Full Text Available ... increase the success of the hip replacement This document is for informational purposes and is not intended ... to help your doctor detect complications early. This document is for informational purposes and is not intended ...

229

Formation of a large rice body-containing cyst following total hip arthroplasty  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Abstract Background There are several well-described causes of a painful mass following total hip arthroplasty including polyethylene and metal wear debris, infection, expanding hematoma, dislocation, and synovial cysts. In addition to causing pain, these lesions, when large enough,...

Issack Paul S

230

A Randomised Single Centre Study to Compare the Long-term Performance of 4 Designs of the DePuy Ultima LX Stem in Primary Total Hip Replacement  

Science.gov (United States)

Osteoarthritis; Post-traumatic Arthritis; Collagen Disorder; Avascular Necrosis; Traumatic Femoral Fractures; Nonunion of Femoral Fractures; Congenital Hip Dysplasia; Slipped Capital Femoral Epiphysis

2013-05-29

231

A Multi-centre Study to Assess the Long-term Performance of the Pinnacle™ Cup With a Polyethylene-on-metal Bearing in Primary Total Hip Replacement  

Science.gov (United States)

Rheumatoid Arthritis; Osteoarthritis; Post-traumatic Arthritis; Collagen Disorders; Avascular Necrosis; Traumatic Femoral Fractures; Nonunion of Femoral Fractures; Congenital Hip Dysplasia; Slipped Capital Femoral Epiphysis.

2013-02-12

232

Low-dose 3D computed tomography of the pediatric hip  

International Nuclear Information System (INIS)

The purpose of this article was to determine the dependence of three-dimensional computed tomography (3D CT) images on absorbed dose in pediatric patients. While plain radiographs are often used as part of the initial evaluation of patients with congenital hip dislocation, it is well known that the performance of 3D CT may be necessary for a more complete evaluation. Because of special anatomical views, lateral views of the hip joints, which can be evaluated at 3D CT, cannot be seen on plain radiography. But absorbed dose of the reproductive organs of 3D CT is high compared with one of plain radiography. Typical manufactures preprogrammed protocols for 3D CT examinations were designed to produce images with low image noise and with high absorbed dose of organs. The low-dose technique that made use of lower milliampare second in the same incremental manner, could produce 3D CT image that was diagnostically acceptable but that slightly decreased in volume. This low dose technique could make 3D CT images of pediatric pelvis with maintained diagnostic quality at 60% reduction in absorbed dose. (author)

1994-01-01

233

Duration of postoperative antibiotic therapy following revision for infected knee and hip arthroplasties.  

Science.gov (United States)

In the period from 1990 to 1998 28 patients (14 males and 14 females) were treated for infected hip (19 cases) and knee (9 cases) arthroplasties. The median age at index operation was 72 y (range 34-82 y) and at revision surgery 74 y (range 36-83 y). The primary diagnosis was osteoarthritis (16 cases), rheumatoid arthritis (5 cases), failed femoral neck fracture (6 cases) and arthritis secondary to congenital hip dislocation (1 case). Nine cases were infected early, i.e. within 3 months postoperatively, and 19 had late infections. The median interval from index operation to diagnosis of the infected arthroplasty was 18 months (range 1-156 months). Postoperatively, all patients received antibiotics based on susceptibility studies of the causative organism according to culture specimens. The erythrocyte sedimentation rate and CRP level were controlled twice a week during hospitalization and antibiotics were continued until normalization of CRP. The indication for the shift from intravenous to oral antibiotics was a rapid fall in CRP. Antibiotic therapy was terminated when CRP was close to or below 10 mg/l and there was evidence of clinical recovery. Based on the screening of ESR and CRP in this study we believe that CRP is a valuable parameter in deciding when to stop antibiotic therapy. However, it is not clear whether a shorter treatment period is effective or not. PMID:11200382

Houshian, S; Zawadski, A S; Riegels-Nielsen, P

2000-01-01

234

Cyclic deformation dislocation microstructures  

Energy Technology Data Exchange (ETDEWEB)

Single crystals of aluminum and copper were cyclically deformed, in single slip, to presaturation at 77 and 298 K, respectively. The dislocation substructures were carefully analyzed using conventional BF and DF TEM with particular attention directed towards the dislocation dipole spacing. It was found that, in both metals, the dipole spacing was independent of the location in the heterogeneous substructure, which consisted of dense dipole bundles (or veins), and the relatively low dislocation-density channels. Furthermore, the stress to separate the largest spacing dipoles was nearly equal to the applied stress. The stress necessary to pass dislocations through the dense veins was also about equal to the applied stress. The observations and calculations suggest a uniform state of stress throughout the heterogeneous dislocation substructure, without the presence of significant internal stresses. Convergent beam electron diffraction (CBED) experiments were also undertaken. These results will be discussed in terms of dislocation dynamics and their consistency with the absence of long-range internal stresses.

Kassner, M.E.; Perez-Prado, T.; Vecchio, K.S.

1999-07-01

235

[Congenital and acquired chylothorax.  

UK PubMed Central (United Kingdom)

BACKGROUND/PURPOSE: Chylothorax in paediatric age is a life-threatening clinical entity that cause serious respiratory, nutritional and immunologic complications. Chylothorax in the absence of trauma or tumour is uncommon and lymphangiomatosis of the bone, although extremely rare, has been associated with these condition. The authors describe the case of a two-year-old girl who presented with a massive chylothorax associated with hip and paravertebral lymphangioma and spread lymphangiomatosis of the spine. The authors also review the literature and their experience of congenital and postoperative chylothorax in order to establish guidelines for the diagnosis and management of both primary and postoperative chylothorax in paediatric age. METHODS: From 1990 and 1999, 14 children had chylothorax. 9 patients had pleural effusion after surgical procedure, 5 patients had congenital chylothorax (both in prenatal and neonatal time), one of whom with bone lymphangiomatosis associated. RESULTS: Postoperative chylothorax has been successfully treated by conservative approach (starvation, total parenteral nutrition and chest tube) in 6 out of 7 cases (two patients died because of complex cardiac malformation). Conservative approach is useful in case of congenital chylothorax, but not with bone lymphangiomatosis associated. CONCLUSIONS: Postoperative and congenital chylothorax is well managed with conservative treatment. Chylothorax with bone lymphangiomatosis associated needs early and aggressive surgical approach.

Tommasoni N; Mognato G; Gamba PG

2002-01-01

236

A Modified S-ROM Stem in Primary Total Hip Arthroplasty for Developmental Dysplasia of the Hip.  

UK PubMed Central (United Kingdom)

This study examined the clinical outcome of 220 hips in 196 Asian patients who underwent primary total hip arthroplasty (THA) for treatment of developmental dysplasia of the hip (DDH) using a modified S-ROM modular (S-ROM-A) stem designed for Asians, after 2-5years (mean, 3.3years) of follow-up. The stem was placed so that the anteversion angle of the neck was decreased against the sleeve in 56% of the hips and increased in 18% of the hips. Bone ingrown fixation was achieved in 99.5% of the hips on X-ray at final follow-up. There were 2 (0.9%) dislocations postoperatively. In primary THA for treatment of DDH accompanied by femoral rotational deformity, the freely-rotatable modular stem provided favorable short-term outcomes by affording both morphological and functional advantages.

Tamegai H; Otani T; Fujii H; Kawaguchi Y; Hayama T; Marumo K

2013-05-01

237

Epidemiological survey of orthopedic joint dislocations based on nationwide insurance data in Taiwan, 2000-2005  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background The epidemiology of acute orthopedic dislocations is poorly understood. A nationwide database provides a valuable resource for examining this issue in the Taiwanese population. Methods A 6-year retrospective cohort study of 1,000,000 randomly-sampled beneficiaries from the year 2005 was used as the original population. Based on the hospitalized and ambulatory data, the concomitant ICD9-CM diagnosis codes and treatment codes were evaluated and classified into 8 and 3 major categories, respectively. The cases matching both inclusive criteria of dislocation-related diagnosis codes and treatment codes were defined as incident cases. Results During 2000-2005, the estimated annual incidence (per 100,000 population) of total orthopedic dislocations in Taiwan was 42.1 (95%CI: 38.1-46.1). The major cause of these orthopedic dislocations was traffic accidents (57.4%), followed by accident falls (27.5%). The annual incidence dislocation by location was shoulder, 15.3; elbow, 7.7; wrist, 3.5; finger, 4.6; hip, 5.2; knee, 1.4; ankle, 2.0; and foot, 2.4. Approximately 16% of shoulder dislocations occurred with other concomitant fractures, compared with 17%, 53%, 16%, 76% and 52%, respectively, of dislocated elbow, wrist, hip, knee, and ankle cases. Including both simple and complex dislocated cases, the mean medical cost was US$612 for treatment of a shoulder dislocation, $504 for the elbow, $1,232 for the wrist, $1,103 for the hip, $1,888 for the knee, and $1,248 for the ankle. Conclusions In Taiwan, three-quarters of all orthopedic dislocations were of the upper limbs. The most common complex fracture-dislocation was of the knee, followed by the wrist and the ankle. Those usually needed a treatment combined with open reduction of fractures and resulted in a higher direct medical expenditure.

Yang Nan-Ping; Chen Hou-Chaung; Phan Dinh-Van; Yu I-Liang; Lee Yi-Hui; Chan Chien-Lung; Chou Pesus; Renn Jenn-Huei

2011-01-01

238

HIP DISTRACTION  

UK PubMed Central (United Kingdom)

A hip distractor includes a pair of distractor members and a support configured to be fastened to a surgical table. The support includes at least two mounts for coupling to a pair of joints that couple the distractor members to the support. Another hip distractor includes a pair of distractor assemblies that are configured to apply a distraction load to a patient. Each of the assemblies includes a joint for coupling the corresponding assembly to a surgical table. The joint permits vertical and horizontal angular adjustment of the corresponding assembly. A method of distracting a hip includes coupling a patient's legs to a pair of distractor assemblies and simultaneously adjusting a vertical angle and a horizontal angle of at least one of the distractor assemblies.

TORRIE PAUL ALEXANDER; DALEY EDWARD JAMES; SKAVICUS PAUL JOSEPH

239

Sonographic guidance for infant hip reduction under anesthesia  

Energy Technology Data Exchange (ETDEWEB)

An initial attempt to reduce a hip dislocation in a 15-month-old by palpation under general anesthesia led to the subsequent discovery of a posterior subluxation by CT. During the second attempt, sonographic guidance in the operating room was used to show concentric reduction both before and after the application of a spica cast. Successful reduction was later confirmed by CT. Imaging by real-time sonography can be useful in monitoring infant hip reduction.

Keller, M.S.; Weiss, A.A.

1988-02-01

240

Sonographic guidance for infant hip reduction under anesthesia  

International Nuclear Information System (INIS)

An initial attempt to reduce a hip dislocation in a 15-month-old by palpation under general anesthesia led to the subsequent discovery of a posterior subluxation by CT. During the second attempt, sonographic guidance in the operating room was used to show concentric reduction both before and after the application of a spica cast. Successful reduction was later confirmed by CT. Imaging by real-time sonography can be useful in monitoring infant hip reduction. (orig.).

1988-01-01

 
 
 
 
241

Failure Analysis of Alumina on Alumina Total Hip Arthroplasty With a Layered Acetabular Component: Minimum Ten-Year Follow-Up Study.  

UK PubMed Central (United Kingdom)

This prospective study reports the outcome of total hip arthroplasty (THA) performed in a consecutive series of patients using an alumina ceramic on a ceramic-layered component (Alumina-Bearing-Surface system). The cohort consisted of 270 hips in 229 patients. The study evaluated the clinical and radiological results over a mean follow-up of 11.4years. Revision THA was performed on 58 hips, including alumina alternative failure in 50 hips, loosening in 4 hips, recurrent dislocation in 2 hips, stem neck fracture in 1 hip and hematoma in 1 hip. The survival rate was 68% with revision for any reason as the end point. The risk factors of implant failure are the preoperative range of motion of the hip joint and postoperative dislocation.

Kawano S; Sonohata M; Shimazaki T; Kitajima M; Mawatari M; Hotokebuchi T

2013-05-01

242

Hip pointers.  

UK PubMed Central (United Kingdom)

The term, hip pointer, is applied in the setting of a blunt trauma injury to the iliac crest. It typically occurs in contact and collision sports and can cause significant pain and loss of practice or game time. A direct blow results in subperiosteal edema with hematoma formation within surrounding muscle or soft tissue and bone contusion of the iliac crest. Conservative management with compression, ice, antiinflammatories, and rehabilitation exercises are successful in treating hip pointers. Injection therapy with the use of local anesthetic can be helpful in minimizing pain and increasing function to allow more rapid return to play.

Hall M; Anderson J

2013-04-01

243

The Limbus and the Neolimbus in Developmental Dysplasia of the Hip  

Digital Repository Infrastructure Vision for European Research (DRIVER)

The limbus and the neolimbus are both pathological lesions that form in response to a developmentally dislocated hip. An understanding of these structures is integral to treatment of developmental dysplasia of the hip (DDH). Yet, we believe the current peer-reviewed orthopaedic literature and orthop...

Landa, Joshua; Benke, Michael; Feldman, David S.

244

Traumatic dislocation of testes.  

UK PubMed Central (United Kingdom)

Traumatic dislocation of the testicle is characterized by an ectopically displaced testis as the result of closed injury. We report on 1 patient with subcutaneous inguinal dislocation of the testis that was successfully treated by immediate closed reduction. Forty-nine other cases (36 unilateral and 13 bilateral) have been previously cited. Diagnostic guidelines, our therapeutic approach, and the relevant literature are presented.

Singer AJ; Das S; Gavrell GJ

1990-04-01

245

Isolated carpal scaphoid dislocation.  

UK PubMed Central (United Kingdom)

Isolated scaphoid dislocations are very rare. Options for the treatment of dislocation of the scaphoid include closed reduction and casting, closed reduction and percutaneous pinning, and open reduction and ligament repair. We report a case of this rare injury which was treated with open reduction, pinning and ligament repair.

Kiliç M; Kalali F; Unlü M; Yildirim OS

2012-01-01

246

Proximal Femoral Megaprosthesis for Failed Total Hip Arthroplasty  

Directory of Open Access Journals (Sweden)

Full Text Available Background: The purpose of this study was to assess the clinical outcome and complicationsof megaprostheses for massive proximal femoral bone loss after failedtotal hip arthroplasty.Methods: Between June 1997 and December 2002, 12 patients (12 hips) with massiveproximal femoral deficiencies had reconstruction of the hip using proximalfemoral megaprostheses. The average age of the patients was 59 years (range25 to 75).Results: At an average of 5.7 years (range 3.3 to 9) after surgery, eight patients (67%)had a satisfactory result, one had fair and three had poor results. The complicationsincluded dislocation in 5 (42%), deep infection in 4 (33%), ectopicossification in 1 (8%), leg shortening > 3 cm in 2 (16.7%), displacement ofthe greater trochanter in 3 (25%) and aseptic loosening of the megaprosthesisin 1 (8%). The early dislocation rate was 75% but this was subsequentlyreduced to 14% in the later period after use of an abduction brace postoperatively.The average Harris hip score of the 12 patients preoperatively was 30points (range 16-42). The average Harris hip score of the 9 patients with aretained megaprosthesis was 83 points (range 68 to 92).Conclusion: Patients with a failed total hip arthroplasty and massive proximal femoralbone loss can be salvaged with a proximal femoral megaprosthesis if there isno other alternative. However, this procedure is technically demanding andhas a high rate of complications. The routine use of an abduction brace postoperativelyis advised to reduce the dislocation rate.

Shu-Tai Shih; Jun-Wen Wang; Chia-Chen Hsu

2007-01-01

247

Congenital insensitivity to pain with anhidrosis (CIPA): the spectrum of radiological findings  

International Nuclear Information System (INIS)

Background: Congenital insensitivity to pain with anhidrosis (CIPA) is an exceedingly rare, hereditary, sensory autonomic neuropathy (HSAN). Aim: To evaluate the various skeletal manifestations and cranial CT features in children affected by CIPA. Materials and methods: In the semidesert area of the Negev, the Bedouin tribes constitute a closed society where consanguineous marriages are the custom. This has resulted in a group of 20 children being affected by this rare autosomal recessive HSAN. The skeletal surveys and CT scans of these 20 Bedouin patients, 12 girls and 8 boys, ages ranging between 1 month and 8 years, were retrospectively analysed. Cranial CT scans were performed in ten children because of neonatal hypotonia and psychomotor retardation. The skeletal findings were classified as follows: fractures, joint deformities, joint dislocations, osteomyelitis, avascular necrosis and acro-osteolysis. Results: All 20 patients had fractures of the extremities and acro-osteolysis of the fingers. Six had joint deformities. Three children had recurrent hip joint dislocations and another three had avascular necrosis. Ten patients presented with osteomyelitis of the limbs, acetabulum and scapula. The cranial CT scans disclosed mild brain volume loss with some ventriculomegaly. Conclusions: CIPA is a severe autosomal recessive condition that leads to self-mutilation early in life and to fractures, osteomyelitis and limb amputation in older children. Mental retardation is common. Death from hyperpyrexia occurs in almost 20 % of patients in the first 3 years of life. (orig.)

2001-01-01

248

Congenital insensitivity to pain with anhidrosis (CIPA): the spectrum of radiological findings  

Energy Technology Data Exchange (ETDEWEB)

Background: Congenital insensitivity to pain with anhidrosis (CIPA) is an exceedingly rare, hereditary, sensory autonomic neuropathy (HSAN). Aim: To evaluate the various skeletal manifestations and cranial CT features in children affected by CIPA. Materials and methods: In the semidesert area of the Negev, the Bedouin tribes constitute a closed society where consanguineous marriages are the custom. This has resulted in a group of 20 children being affected by this rare autosomal recessive HSAN. The skeletal surveys and CT scans of these 20 Bedouin patients, 12 girls and 8 boys, ages ranging between 1 month and 8 years, were retrospectively analysed. Cranial CT scans were performed in ten children because of neonatal hypotonia and psychomotor retardation. The skeletal findings were classified as follows: fractures, joint deformities, joint dislocations, osteomyelitis, avascular necrosis and acro-osteolysis. Results: All 20 patients had fractures of the extremities and acro-osteolysis of the fingers. Six had joint deformities. Three children had recurrent hip joint dislocations and another three had avascular necrosis. Ten patients presented with osteomyelitis of the limbs, acetabulum and scapula. The cranial CT scans disclosed mild brain volume loss with some ventriculomegaly. Conclusions: CIPA is a severe autosomal recessive condition that leads to self-mutilation early in life and to fractures, osteomyelitis and limb amputation in older children. Mental retardation is common. Death from hyperpyrexia occurs in almost 20 % of patients in the first 3 years of life. (orig.)

Schulman, H.; Tsodikow, V.; Hertzanu, Y. [Dept. of Radiology, Soroka University Medical Centre, Beer-Sheva (Israel); Einhorn, M.; Levy, Y.; Shorer, Z. [Dept. of Pediatrics, Soroka University Medical Centre, Beer-Sheva (Israel)

2001-10-01

249

[Shoulder dislocation and -subluxation  

UK PubMed Central (United Kingdom)

The diagnosis and treatment of shoulder instability require basic differentiation between unidirectional, multidirectional, and voluntary dislocation. Within unidirectional instability primary dislocation, recurrent dislocation, and recurrent subluxation need to be considered separately.--Primary dislocation: In 160 patients with primary dislocation a follow-up was done by questionnaire. In the case of atraumatic primary dislocation the redislocation rate was 100%. Predisposing factors inherent in the bony, cartilaginous, and capsular components of the joint favoured the tendency of primary dislocation. In the case of traumatic primary dislocation the redislocation rate was lower after immobilisation of the joint than without when it had not been immobilised.--Recurrent subluxation: In 52 patients with a clinical diagnosis of recurrent subluxation a tear of the glenoid labrum was found by arthroscopy. In 21 cases the detached labrum was refixed arthroscopically and in 18 cases the repair was done by an open Bankart procedure. Seventy-two percent of the patients who underwent arthroscopic repair showed good to excellent results. In all cases but one in which the Bankart procedure was applied the results were excellent.--Recurrent dislocation: Since 1984 a total of 183 patients were operated on for recurrent shoulder dislocation. All these patients were examined preoperatively by CT scan. The CT findings were used in selection of the appropriate procedure. In 114 patients the Bankart procedure was applied and in 39 cases, a bone-block method. The remaining patients were subjected to various other procedures. Not one of the patients showed postoperative redislocation. (ABSTRACT TRUNCATED AT 250 WORDS)

Resch H; Golser K; Thöni H

1989-08-01

250

Hip Revision  

Medline Plus

Full Text Available ... re going to initially look at Scott's preoperative x-rays and just kind of describe the situation that ... up to that time. Here's Scott's initial preoperative x-ray, where we see a hybrid hip arthroplasty with ...

251

Modified Turco's postero-medial release for congenital talipes equino-varus.  

UK PubMed Central (United Kingdom)

BACKGROUND: Talipes Equino-Varus (TEV) is one of the most common congenital anomaly. It is managed by various methods, i.e., conservative & surgery. Objective of this study was to determine the efficacy of modified Turco's postero-medical release in children's having congenital TEV. METHODS: This descriptive observational study was conducted from June 2004 to June 2008 in the Orthopaedics Unit of Lady Reading Hospital (LRH) Peshawar. The inclusion criteria were children of age 6 months to 3 years of age having moderate and severe club foot. The exclusion criteria were clubfoot secondary to some other disorders such as cerebral palsy, arthrogryphosis multiplex congenita, myelodysplasia or congenital dislocation of the hip. The deformity was treated by modified Turco's one stage release. Follow-up was for one year. Results were graded according to modified McKay rating system. RESULTS: A total 70 patients were included in this study with the age range of 6 months to 3 years with moderate to sever deformity. Thirty-eight, were male (54.2%) and 32 patients (45.72%) were female, twenty three patients (32.85%) had bilateral club foot while the rest of 47 patients (67.15%) had unilateral deformity. Positive family history of club foot was in 10 patients (14.2%). Results were concluded on 52 patients who completed one year follow-up. Excellent results were observed in 34 patients (65.38%), good in 9 patients (17.30%), fair in 2 patients (3.84%), and poor in 7 patients (13.46%). CONCLUSION: Children up to three years age with congenital TEV can be successfully treated in almost all the cases by modified Turco's one stage postero-medial release.

Hussain SA; Khan MS; Ali MA; Shahabuddin

2008-07-01

252

Is surgery recommended in adults with neglected congenital muscular torticollis? A prospective study  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Congenital muscular torticollis is the third most common congenital musculoskeletal anomaly after dislocation of the hip and clubfoot. When diagnosed early, it is obvious that it can be managed with good or excellent results. The aim of this prospective study was to determine the efficacy of surgery in neglected adult cases. Methods From January 2003 to June 2007, 18 adult skeletally matured patients were surgically treated for neglected congenital muscular torticollis and prospectively followed (at least one year). Bipolar release was performed in all patients. Radiography and the modified Lee's scoring system which included function and cosmesis, were used to measure the surgical results. Complications were also recorded. Results Four cases were lost during follow-up. Of the remaining 14 patients, 10 cases were males and 4 females. The age at operation ranged from 18 to 32 (average 21.9) years. The mean follow-up period was 2.5 years (range 1–5 years). Excellent results were noted in 7 patients, good in 5, and poor in 2 patients. Significant improvement (>10°) of the cervico-thoracic scoliosis was noted only in 3 of 10 patients. Conclusion Patients with congenital muscular torticollis can benefit from surgical treatment even in adulthood. Surgical bipolar sectioning of the sternocleidomastoid muscle should be considered even in adults with irreversible facial and skeletal deformities. The surgery restores the range of neck motion and resolves the head tilt; therefore it can improve the quality of life. This procedure is an effective and relatively complication-free method.

Omidi-Kashani Farzad; Hasankhani Ebrahim G; Sharifi Reza; Mazlumi Mahdi

2008-01-01

253

Ceramic-on-ceramic Bearing Decreases the Cumulative Long-term Risk of Dislocation.  

UK PubMed Central (United Kingdom)

BACKGROUND: It is unclear whether late THA dislocations are related to mechanical impingement or to a biological mechanism that decreases the stability provided by the capsule (eg, inflammation secondary to osteolysis). It is also unknown if alumina-on-alumina bearing couples decrease the risk of late dislocation as a result of the absence of wear and osteolysis. QUESTION/PURPOSES: We asked (1) whether the cumulative number of dislocations differed with alumina-on-alumina (AL/AL) or alumina-on-polyethylene bearings (AL/PE); (2) whether patient factors (age, sex, and diseases) affect risk of late dislocation; (3) whether mechanical factors (component malposition, penetration resulting from creep and wear) or (4) biologic hip factors at revision (thickness of the capsule, volume of joint fluid removed at surgery, histology) differed with the two bearing couples. METHODS: One hundred twenty-six patients (252 hips) with bilateral THA (one AL/AL and the contralateral AL/PE) received the same cemented implants except for the cup PE cup or an AL cup. The cumulative risk of dislocation (first-time and recurrent dislocation) was calculated at a minimum of 27 years. We measured cup position, creep and wear, and capsular thickness in the hips that had revision. RESULTS: AL/PE and AL/AL hips differed by the cumulative number of dislocation (31 with AL/PE versus four with AL/AL) and by the number of late dislocations (none with AL/AL, 28 with AL/PE). Cause of osteonecrosis, age, and sex affected the number of dislocations. The frequency of component malposition did not differ between the two bearing couples. The risk of late dislocation appeared less in AL/AL hips with increased capsular thickness (mean, 4.5 mm; range, 3-7 mm) compared with the thinnest (mean, 1.2 mm; range, 0.2-2 mm) capsule of AL/PE hips. CONCLUSIONS: AL/AL bearing couples decreased the cumulative risk of dislocation as compared with AL/PE bearing couples. LEVEL OF EVIDENCE: Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

Hernigou P; Homma Y; Pidet O; Guissou I; Hernigou J

2013-02-01

254

Posterior subtalar dislocation.  

UK PubMed Central (United Kingdom)

A subtalar dislocation of the foot is an uncommon injury, and cases of posterior subtalar dislocation are even rarer. This injury is characterized by a simultaneous dislocation of talocalcaneal and talonavicular joints while tibiotalar and calcaneocuboid articulations remain intact. Subtalar dislocation is commonly accompanied by fractures of the malleoli, talus, or fifth metatarsal and by a rotational component of the subtalar joint. Subtalar dislocation can occur in any direction and produces significant deformity. This article presents a case of pure posterior subtalar dislocation in an 80-year-old man who presented with pain and deformity in his left ankle following a motorcycle accident. Radiographs demonstrated dislocation of both the talonavicular and talocalcaneal joints. The calcaneus was displaced posteriorly without medial or lateral displacement. No rotational component of the calcaneus was noted, suggesting the trauma was in pure hyperplantar flexion. We hypothesize that pure hyperplantar flexion could lead to a progressive subtalar ligament weakening that may result in a complete ligament rupture if the plantar flexion force is prolonged. This could be observed in the presence of good bone quality and if the force is applied distally at the navicular bone.

Camarda L; Martorana U; D'Arienzo M

2009-07-01

255

Complex primary total hip arthroplasty.  

UK PubMed Central (United Kingdom)

Although total hip arthroplasty is now a classic procedure that is well controlled by orthopedic surgeons, some cases remain complex. Difficulties may be due to co-morbidities: obesity, skin problems, muscular problems, a history of neurological disease or associated morphological bone deformities. Obese patients must be informed of their specific risks and a surgical approach must be used that obtains maximum exposure. Healing of incisions is not a particular problem, but adhesions must be assessed. Neurological diseases may require tenotomy and the use of implants that limit instability. Specific techniques or implants are necessary to respect hip biomechanics (offset, neck-shaft angle) in case of a large lever arm or coxa vara. In case of arthrodesis, before THA can be performed, the risk of infection must be specifically evaluated if the etiology is infection, and the strength of the gluteal muscles must be determined. Congenital hip dysplasia presents three problems: the position and coverage of the cup, placement of a specific or custom made femoral stem, with an osteotomy if necessary, and finally lowering the femoral head into the cup by freeing the soft tissues or a shortening osteotomy. Acetabular dysplasia should not be underestimated in the presence of significant bone defect (BD), and reconstruction with a bone graft can be proposed. Sequelae from acetabular fractures presents a problem of associated BD. Internal fixation hardware is rarely an obstacle but the surgical approach should take this into account. Treatment of acetabular protrusio should restore a normal center of rotation, and prevent recurrent progressive protrusion. The use of bone grafts and reinforcement rings are indispensible. Femoral deformities may be congenital or secondary to trauma or osteotomy. They must be evaluated to restore hip biomechanics that are as close to normal as possible. Fixation of implants should restore anteversion, length and the lever arm. Most problems that can make THA a difficult procedure may be anticipated with proper understanding of the case and thorough preoperative planning.

Boisgard S; Descamps S; Bouillet B

2013-02-01

256

Complex primary total hip arthroplasty.  

Science.gov (United States)

Although total hip arthroplasty is now a classic procedure that is well controlled by orthopedic surgeons, some cases remain complex. Difficulties may be due to co-morbidities: obesity, skin problems, muscular problems, a history of neurological disease or associated morphological bone deformities. Obese patients must be informed of their specific risks and a surgical approach must be used that obtains maximum exposure. Healing of incisions is not a particular problem, but adhesions must be assessed. Neurological diseases may require tenotomy and the use of implants that limit instability. Specific techniques or implants are necessary to respect hip biomechanics (offset, neck-shaft angle) in case of a large lever arm or coxa vara. In case of arthrodesis, before THA can be performed, the risk of infection must be specifically evaluated if the etiology is infection, and the strength of the gluteal muscles must be determined. Congenital hip dysplasia presents three problems: the position and coverage of the cup, placement of a specific or custom made femoral stem, with an osteotomy if necessary, and finally lowering the femoral head into the cup by freeing the soft tissues or a shortening osteotomy. Acetabular dysplasia should not be underestimated in the presence of significant bone defect (BD), and reconstruction with a bone graft can be proposed. Sequelae from acetabular fractures presents a problem of associated BD. Internal fixation hardware is rarely an obstacle but the surgical approach should take this into account. Treatment of acetabular protrusio should restore a normal center of rotation, and prevent recurrent progressive protrusion. The use of bone grafts and reinforcement rings are indispensible. Femoral deformities may be congenital or secondary to trauma or osteotomy. They must be evaluated to restore hip biomechanics that are as close to normal as possible. Fixation of implants should restore anteversion, length and the lever arm. Most problems that can make THA a difficult procedure may be anticipated with proper understanding of the case and thorough preoperative planning. PMID:23375960

Boisgard, S; Descamps, S; Bouillet, B

2013-02-01

257

[Disappearing hip--algodystrophy of the hip  

UK PubMed Central (United Kingdom)

Algodystrophy of the hip--also characterized as disappearing hip, transient demineralization of the hip, neurotropic rheumatism of the hips, or osteolytic arthropathy of the hips--is a pseudoinflammatory disease entity with normal inflammatory parameters involving movement- and load-dependent pain and radiologically visible demineralization of the femoral head. The osteolysis may be so pronounced that the femoral head has become virtually invisible (disappearing hip). The wide spectrum of possibilities in differential diagnosis, including inflammatory hip diseases in particular, together with the rarity of "disappearing hip", often allow diagnosis only retrospectively if the condition has not been thought of from the outset. The usually spontaneous course without residues can be markedly shortened by calcitonin treatment, therapy with nonsteroid antirheumatic agents, or by prednisone treatment. We report 2 cases of "disappearing hip" with typical course treated at the Orthopedic Clinic of Olten Cantonal Hospital in the period 1980 to 1988.

Rütschi M

1989-09-01

258

Pediatric transepiphyseal seperation and dislocation of the femoral head.  

Science.gov (United States)

Pediatric hip fractures and dislocations are rare in practice and are related to high-energy trauma. The incidence of postoperative avascular necrosis is increasing, especially in the case of transepiphyseal fractures. Surgery is the most common form of treatment, and its timing is important for prognosis of the fracture. Patients and their families should be informed about the possibility of avascular necrosis and further complications related to the fracture. PMID:23573441

Elmadag, Mehmet; Ceylan, Hasan H; Erdem, Ahmet Can; Bilsel, Kerem; Uzer, Gokcer; Acar, Mehmet Ali

2013-03-14

259

Characteristics of children with hip displacement in cerebral palsy  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Hip dislocation in children with cerebral palsy (CP) is a common and severe problem. The dislocation can be avoided, by screening and preventive treatment of children with hips at risk. The aim of this study was to analyse the characteristics of children with CP who develop hip displacement, in order to optimise a hip surveillance programme. Methods In a total population of children with CP a standardised clinical and radiological follow-up of the hips was carried out as a part of a hip prevention programme. The present study is based on 212 children followed until 9–16 years of age. Results Of the 212 children, 38 (18%) developed displacement with Migration Percentage (MP) >40% and further 19 (9%) MP between 33 and 39%. Mean age at first registration of hip displacement was 4 years, but some hips showed MP > 40% already at two years of age. The passive range of hip motion at the time of first registration of hip displacement did not differ significantly from the findings in hips without displacement. The risk of hip displacement varied according to CP-subtype, from 0% in children with pure ataxia to 79% in children with spastic tetraplegia. The risk of displacement (MP > 40%) was directly related to the level of gross motor function, classified according to the gross motor function classification system, GMFCS, from 0% in children in GMFCS level I to 64% in GMFCS level V. Conclusion Hip displacement in CP often occurs already at 2–3 years of age. Range of motion is a poor indicator of hips at risk. Thus early identification and early radiographic examination of children at risk is of great importance. The risk of hip displacement varies according to both CP-subtype and GMFCS. It is sometimes not possible to determine subtype before 4 years of age, and at present several definitions and classification systems are used. GMFCS is valid and reliable from 2 years of age, and it is internationally accepted. We recommend a hip surveillance programme for children with CP with radiographic examinations based on the child's age and GMFCS level.

Hägglund Gunnar; Lauge-Pedersen Henrik; Wagner Philippe

2007-01-01

260

Osteonecrosis of the Hip  

Science.gov (United States)

... Resources Copyright 2011 American Academy of Orthopaedic Surgeons Osteonecrosis of the Hip Osteonecrosis of the hip is a painful condition that ... Because bone cells die without a blood supply, osteonecrosis can ultimately lead to destruction of the hip ...

 
 
 
 
261

Hip Replacement - Physical Therapy  

Medline Plus

Full Text Available ... and make your hip joint more flexible. Hip Extension – Gluteal Set Lie down flat and squeeze your ... 1-2 seconds; repeat 10-20 times. Hip Extension – Bridging While lying down with knees bent and ...

262

Hip Replacement - Physical Therapy  

Medline Plus

Full Text Available ... it moves in the hip socket. Unlike the knee joint, the hip joint moves in many directions. ... for 5-10 seconds; repeat 15-20 times. Knee & Hip Flexion While lying down flat, slide one ...

263

Hip Replacement - Physical Therapy  

Medline Plus

Full Text Available ... new hip joint. Start slow and progress gradually. Set achievable goals for yourself and discuss them with ... your hip joint more flexible. Hip Extension – Gluteal Set Lie down flat and squeeze your buttock muscles ...

264

Galeazzi fracture-dislocations.  

UK PubMed Central (United Kingdom)

Among 125 patients with the Galeazzi-type fracture-dislocation of the forearm, there were fourteen children and eighty-six adults with the classic Galeazzi lesion, and twenty-five patients with a special type -- fracture of both bones and dislocation of the distal radio-ulnar joint. Conservative management was successful only in children. In adults this method resulted in failure in 80 per cent of cases. The results of operative treatment were much better. The fracture fragments of the radius and the dislocation of the radio-ulnar joint in this complex injury are very unstable, especially in the lesion with fractures of the radius and ulna, and it appears that rigid internal fixation is necessary for the dislocation as well as the fracture. With combined fixation over half of the results were excellent.

Miki? ZD

1975-12-01

265

Total hip replacement in dancers.  

UK PubMed Central (United Kingdom)

A case report of a professional contemporary dancer who successfully returned to the stage after bilateral total hip replacements (THR) for osteoarthritis is presented, together with her own commentary and a retrospective cohort study of total hip replacements in dancers. In the presented cohort, there were no post-operative dislocations or infections, the original pain had been relieved, rehabilitation was objectively normal and all resumed their dance (teaching) activities. Nevertheless, they were disappointed about the prolonged rehabilitation. Due to their high demands as professional dancers, post-operative expectations were too optimistic in view of the usual quick and favourable results of THR in the older and less physically active, general population. In all dancers with unilateral osteoarthritis, the left hip was involved, which may reflect the tendency to use the left leg as standing leg and be suggestive that strenuous physical activity may lead to osteoarthritis. Better rehabilitation guidelines are needed for dancer patients undergoing THR, especially drawing their attention to realistic post-operative expectations.

Buyls IR; Rietveld AB; Ourila T; Emerton ME; Bird HA

2013-04-01

266

Isolated subtalar dislocation.  

UK PubMed Central (United Kingdom)

EDUCATIONAL OBJECTIVES As a result of reading this article, physicians should be able to: 1. Understand the etiology, epidemiology, and importance of treatment of isolated subtalar dislocation. 2. Understand the most common management practices when treating isolated subtalar dislocation and identify variations in management that may affect prognosis. 3. Consolidate reported patient outcomes as they pertain to variations in management strategies to explore which practices may provide the best prognosis after treatment of isolated subtalar dislocation. 4. Highlight the importance of further study to determine the best course of management for isolated subtalar dislocation regarding variables in treatment. This study reviews the literature on isolated subtalar dislocation published within the past 5 years. Variation in management existed mostly in the categories of treatment choice, immobilizer type, and period of immobilization, with closed reduction, closed reduction and percutaneous pinning, below-knee casting, less than 4 weeks of immobilization, and 6 weeks of immobilization reporting good results. The good results described after the addition of percutaneous K-wire fixation to the initial treatment method of isolated subtalar dislocation, immobilization via below-knee casting, and shorter periods of immobilization suggest that these practices may be useful for the treatment of this rare injury.

Byrd ZO; Ebraheim M; Weston JT; Liu J; Ebraheim NA

2013-09-01

267

Congenital epulis.  

Directory of Open Access Journals (Sweden)

Full Text Available A tumor was found to be arising from the right maxillary alveolar margin of a newborn baby. No other congenital abnormality was detected. Following excision and histopathological examination, diagnosis of benign congenital granular cell epulis was made. The post-operative course was uneventful.

Subramaniam R; Shah R; Kapur V

1993-01-01

268

Effective dislocation lines in continuously dislocated crystals II. Congruences of effective dislocations  

CERN Multimedia

The notion of a congruence of effective dislocation lines endowed with the nonvanishing local Burgers vector is introduced. Particularly, the class of congruences of principal Volterra-type effective dislocation lines associated with the dislocation densities (tensorial as well as scalar) is distinguished in order to investigate the geometry of continuized defective crystals in terms of these densities. It is shown that effective dislocation lines can be endowed with the dislocation line tension and with a finite self-energy.

Trzesowski, Andrzej

2007-01-01

269

Pelvic discontinuity in revision total hip arthroplasty.  

UK PubMed Central (United Kingdom)

BACKGROUND: Pelvic discontinuity is a distinct form of bone loss, occurring in association with total hip arthroplasty, in which the superior aspect of the pelvis is separated from the inferior aspect because of bone loss or a fracture through the acetabulum. The purpose of this study was to describe the population of patients who are at risk for this condition, to identify the characteristic radiographic features associated with it, and to report the results of revision total hip arthroplasty for the treatment of pelvic discontinuity. METHODS: The cases of all twenty-seven patients (thirty-one hips) who were identified as having a pelvic discontinuity at the time of a reoperation for a failed hip arthroplasty at one institution were reviewed retrospectively, and demographic information was collected. The preoperative radiographs and the operative notes were reviewed, and the postoperative results and complications were recorded. RESULTS: Pelvic discontinuity was identified in association with thirty-one (0.9 percent) of 3505 acetabular revisions. The mean age of the patients was sixty-one years (range, thirty-eight to eighty years). Twenty-eight hips were in women, and three were in men. Women (p < 0.001) and patients who had rheumatoid arthritis (p = 0.003) had a significantly increased risk of pelvic discontinuity. The radiographic findings included a visible fracture line through the anterior and posterior columns, medial translation of the inferior aspect of the hemipelvis relative to the superior aspect (seen as a break in Kohler's line), and rotation of the inferior aspect of the hemipelvis relative to the superior aspect (seen as asymmetry of the obturator rings) on a true anteroposterior radiograph. Two patients died within two years after the revision, and two had a resection arthroplasty for the treatment of the pelvic discontinuity; thus, twenty-seven hips were reconstructed and were eligible for follow-up at least two years after the operation. A number of different methods were used for reconstruction, but the results were best in patients who did not have severe segmental acetabular bone loss (type IVa [a satisfactory result in three of three hips]) and poorer in those who had severe segmental or combined segmental and cavitary bone loss (type IVb [a satisfactory result in ten of nineteen hips]) and in those who previously had been treated with irradiation to the pelvis (type IVc [a satisfactory result in three of five hips]). Nine of the twenty-seven hips needed another operation: four, because of aseptic loosening of the acetabular component; four, because of recurrent dislocation; and one, because of deep infection. Excluding three hips that were revised early because of infection or dislocation, a mechanically stable construct (that is, a stable socket and a possibly or definitely healed discontinuity) was obtained in seventeen of twenty-four hips. CONCLUSIONS: Pelvic discontinuity is uncommon, and treatment is associated with a high rate of complications. For hips with type-IVa bone loss and selected hips with type-IVb defects, in which a socket inserted without cement can be satisfactorily supported by native bone, we prefer to use a posterior column plate to stabilize the pelvis and a porous-coated socket inserted without cement. For most hips with type-IVb and type-IVc bone loss, we prefer to use particulate bone graft or a single structural bone graft protected with an antiprotrusion cage.

Berry DJ; Lewallen DG; Hanssen AD; Cabanela ME

1999-12-01

270

Degeneration in dysplastic hips. A computer tomography study  

DEFF Research Database (Denmark)

BACKGROUND: Hip dysplasia is considered pre-osteoarthritic, causing degeneration in young individuals. OBJECTIVE: To determine the pattern of degenerative change in moderate to severely dysplastic hips in young patients. DESIGN AND PATIENTS: One hundred and ninety-three consecutively-referred younger patients with hip pain believed to be caused by hip dysplasia constituted the study cohort. The average age was 35.5 years (range, 15-61 years). They were examined by close-cut transverse pelvic and knee computed tomography and antero-posterior radiographs (CT). We identified 197 hips with moderate to severe dysplasia, and 78 hips with normal morphology in the study cohort, whilst 111 hip joints were borderline dysplastic according to preset definitions. Comparative analyses of anatomy and distribution of degeneration between dysplastic and normal hips in the study cohort were performed. RESULTS: In dysplastic hips the anterior acetabular sector angle was significantly and inversely associated to femoral anteversion (p < 0.001). The center-edge (CE) angle, the acetabular angle (AA), and the acetabular depth ratio (ADR) were significantly interrelated (p < 0.001; correlation coefficients ranging from -0.8 to 0.7). Fifty-one hips were subluxated (24R/27L). There were no cases of complete dislocation. The formation of subchondral cysts or osteophytes in dysplastic hips was significantly associated with reduced minimum joint space width (p ranging from 0.005 to 0.02). However, in 67 hips with acetabular cysts, only 6 hips had minimum joint space widths = 2.0 mm (8.9%) in the coronal plane. In 96 cases with acetabular cysts found in the sagittal plane, 43 cases had minimum joint space widths = 2.0 mm (44.7%). Bony rim detachment at the site of labral insertion was recorded in 30 hips. Twenty-three of these were dysplastic (p = 0.01). CONCLUSIONS: Degeneration was most often found in the anterolateral part of the dysplastic hip joints. Most cysts were located above the transition zone between the bony and the fibrocartilaginous acetabulum, and we found a significantly- increased number of cases with avulsed bony fragments at the antero-lateral labral insertion in dysplastic hips compared to normal hips. It seems likely that the early degenerative process in dysplastic hips originates at the watershed zone between the acetabular labrum and the acetabular cartilage in response to subluxation and femoroacetabular impingement.

Jacobsen, Steffen; RØmer, Lone

2005-01-01

271

Dislocations Jam At Any Density  

CERN Multimedia

Crystalline materials deform in an intermittent way via dislocation-slip avalanches. Below a critical stress, the dislocations are jammed within their glide plane due to long-range elastic interactions and the material exhibits plastic response, while above this critical stress the dislocations are mobile (the unjammed phase) and the material fails. We use dislocation dynamics and scaling arguments in two dimensions to show that the critical stress grows with the square root of the dislocation density. Consequently, dislocations jam at any density, in contrast to granular materials, which only jam below a critical density.

Tsekenis, Georgios; Dahmen, Karin A

2011-01-01

272

MRI of cervical facet dislocation  

Energy Technology Data Exchange (ETDEWEB)

The MRI examinations of eight patients with cervical vertebral dislocation demonstrated by conventional radiography were reviewed. All patients had axial and sagittal T 1- and T 2-weighted imaging on a 1.5-T unit. This revealed unilateral partial facet dislocation (in two patients), bilateral partial facet dislocation (in two), unilateral complete dislocation (in two) and bilateral complete facet dislocation (in two). In six patients there was cord contusion, three had focal disc protrusions and four unilateral absence of normal flow void in one of the cervical vertebral arteries. In all cases, the dislocated facets were shown well on the far-lateral sagittal images. (orig.). With 5 figs., 1 tab.

Leite, C.C. [Department of Radiology, The University of Texas Health Science Center, 7703 F. Curl Drive, San Antonio, TX 78284-7800 (United States); Escobar, B.E. [Department of Radiology, The University of Texas Health Science Center, 7703 F. Curl Drive, San Antonio, TX 78284-7800 (United States); Bazan, C. III [Department of Radiology, The University of Texas Health Science Center, 7703 F. Curl Drive, San Antonio, TX 78284-7800 (United States); Jinkins, J.R. [Department of Radiology, The University of Texas Health Science Center, 7703 F. Curl Drive, San Antonio, TX 78284-7800 (United States)

1997-08-01

273

The conversion rate of bipolar hemiarthroplasty after a hip fracture to a total hip arthroplasty.  

UK PubMed Central (United Kingdom)

BACKGROUND: Bipolar hip hemiarthroplasty is used in the management of fractures of the proximal femur. The dual articulation is cited as advantageous in comparison to unipolar prostheses as it decreases acetabular erosion, has a lower dislocation rates and is easier to convert to a total hip arthroplasty (THA) should the need arise. However, these claims are debatable. Our study examines the rate of conversion of the bipolar hemiarthroplasty to THA and the justification for using it on the basis of future conversion to THA. METHODS: All cases of bipolar hemiarthroplasty performed in our unit for hip fractures over a 9-year period (1999-2007) were reviewed. Medical notes and radiographs of all patients were reviewed, and all surviving patients that were contactable received a telephone follow-up. RESULTS: Of all 164 patients reviewed with a minimum of 1 year from date of surgery, 4 patients had undergone a conversion of their bipolar prosthesis to THA. Three conversions were performed for infection, dislocation, and fracture. Only one (0.6%) conversion was performed for groin pain. CONCLUSIONS: Our study show that bipolar hemiarthroplasties for hip fractures have a low conversion rate to THAs and this is comparable to the published conversion rate of unipolar hemiarthroplasties.

Alazzawi S; Sprenger De Rover WB; Brown J; Davis B

2012-06-01

274

Total hip arthroplasty in developmental dysplasia of the hip: Review of anatomy, techniques and outcomes  

Directory of Open Access Journals (Sweden)

Full Text Available Total hip arthroplasty (THA) in developmental dysplasia of the hip (DDH) presents many challenges to the reconstructive surgeon. The complex femoral and acetabular anatomy makes standard reconstruction technically challenging. Acetabular coverage can be improved by medialization of the component or augmentation of the deficient areas with bone graft. Femoral shortening osteotomies are considered in cases of severe dysplasia and frankly dislocated hips. Each patient’s unique anatomy dictates what options of reconstruction are available. The functional outcomes of THA in DDH are generally excellent, though higher rates of mechanical failure have been reported in this group. This article reviews the anatomy, classification, technical considerations, and outcomes of THA in patients with DDH.

Scott Yang; Quanjun Cui

2012-01-01

275

Congenital amastia.  

Science.gov (United States)

A 3-d-old female baby presented with bilateral congenital absence of breast tissue, areolae and nipples. No other anomalies were noted. There was also a history of absence of nipples, areolae and breast tissue in the mother and two other family members of maternal side. Investigations done during the hospital stay including ultrasound of the chest wall, abdomen and head were all normal. Congenital isolated bilateral amastia was diagnosed after complete investigations. PMID:23255076

Patil, Lingaraja Gowda C; Shivanna, Niranjan Hunasanhalli; Benakappa, Naveen; Ravindranath, Hema; Bhat, Rama

2012-12-20

276

Congenital Leukemia  

Directory of Open Access Journals (Sweden)

Full Text Available Congenital leukemia is a rare disease that can manifest soon after birth. Cutaneous involvement consistsof red, brown or purple papules or nodules and purpura. We present a case of congenital myelomonblasticleukemia in a seven week old infant who had petechiae and subcutaneous nodules. Diagnosis was establishedby the presence of leukemic cells in bone marrow and involved skin along with cytochemical characterizationof these cells.

Rupali Bargotra , Jyotsna Suri, Yudhvir Gupta

2010-01-01

277

Is limitation of hip abduction a useful clinical sign in the diagnosis of developmental dysplasia of the hip?  

UK PubMed Central (United Kingdom)

AIM: The relationship between the presence and severity of sonographically diagnosed developmental dysplasia of the hip (DDH) and the clinical abnormality of limitation of hip abduction (LHA) was investigated. METHODS: A prospective, longitudinal, selective 'at risk' and neonatal instability hip ultrasound programme between 1 January 1996 and 31 December 2005. 2876 neonates/infants were initially screened for DDH by clinical examination and by hip ultrasound imaging. Pathological sonographically evaluated DDH was considered to be Graf Type III, IV and irreducible hip dislocation. Inclusion criteria were cases of unilateral or bilateral limitation of hip abduction hip. Exclusion criteria: syndromal, neuromuscular and skeletal dysplasia cases. RESULTS: 492 children presented with LHA (55 unilateral LHA). The mean age of neonates/infants with either unilateral or bilateral LHA was significantly higher than those without (p<0.001). In the sonographic diagnosis of Graf Type III and IV dysplasias, unilateral LHA had a PPV of 40% compared with only 0.3% for bilateral LHA. The sensitivity of unilateral LHA increased to 78.3% and a PPV 54.7% after the age of 8 weeks for Graf Types III, IV and irreducible hip dislocation. CONCLUSIONS: This study identifies a time-dependent association with unilateral LHA in the diagnosis of 'pathological' DDH after the age of 8 weeks. The presence of bilateral LHA in the young infant may be a normal variant and is an inaccurate clinical sign in the diagnosis of pathological DDH. LHA should be actively sought after 8 weeks of age and if present should be followed by a formal ultrasound or radiographic examination to confirm whether or not the hip is developing in a satisfactory manner.

Choudry Q; Goyal R; Paton RW

2013-08-01

278

Incidence and risk factors of hip joint pain in children with severe cerebral palsy.  

UK PubMed Central (United Kingdom)

PURPOSE: Pain is a serious complication associated with hip dislocation in cerebral palsy (CP), limiting patient independence and quality of life. This study aimed to determine the frequency of pain in severe CP patients with hip dislocation and to reveal factors associated with the hip pain. METHODS: Seventy-three consecutive new-intervention CP patients admitted to authors' institution with spastic quadriplegia, mean age 10.8 years (range 4.0-18.0 years) were enrolled: 31 females and 42 males, totally 99 dislocated hips. All patients were assessed level IV or V according to the Gross Motor Function Classification Scale (GMFCS) and had poor communication skills. Pain severity was evaluated according to the Numeric Rating Scale (NRS-11). Data concerning previously applied physiotherapy was collected to divide the patients into subgroups: A - no abduction therapy (n?=?24), B - abduction therapy (n?=?35) and C - abduction therapy and horse-back riding (n?=?13). On the pelvic antero-posterior radiographs head migration percentage was measured to reveal hip dislocation. Femoral head cartilage degenerative lesions were evaluated for size and location in 45 hips undergoing surgical treatment. RESULTS: Overall pain prevalence was 56%. The appearance of pain was associated with the patient age (p?=?0.048), previous abduction physiotherapy (p?hip pain appearance in the dislocated hip of a child with severe spastic CP. Other associated factors are abduction exercise intensity, age, excessive femoral anteversion and size of degenerative cartilage lesions.

Jó?wiak M; Harasymczuk P; Koch A; Kotwicki T

2011-01-01

279

Grain boundary dislocation sources in nanocrystalline copper  

Energy Technology Data Exchange (ETDEWEB)

Atomistic simulations of dislocation nucleation from grain boundaries provide an insight into dislocation sources in nanocrystalline copper. Simulations show that dislocation sources emit single partial dislocation loops, with half absorbed into the boundary and half emitted into the lattice. The specific boundary dislocation content determines whether the absorbed half-loop annihilates pre-existing boundary dislocations or increases boundary dislocations. Atomistic studies of this type provide details of the emission sequence that enhance our understanding of dislocation sources in high angle boundaries.

Tschopp, M.A. [School of Materials Science and Engineering, Georgia Institute of Technology, Atlanta, GA 30332 (United States); Universal Technology Corporation, Dayton, OH 45432 (United States); McDowell, D.L. [School of Materials Science and Engineering, Georgia Institute of Technology, Atlanta, GA 30332 (United States); G.W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA 30332 (United States)], E-mail: david.mcdowell@me.gatech.edu

2008-02-15

280

Dual mobility cup: dislocation rate and survivorship at ten years of follow-up.  

UK PubMed Central (United Kingdom)

PURPOSE: The dual mobility cup introduced in France by Gilles Bousquet has been used in total hip replacement in high-risk patients. This device acts as a large ball implant and significantly reduces the risk of dislocation following hip arthroplasty. Published French literature has focused on low rates of dislocation and long-term follow-up similar to the low-friction arthroplasty. METHODS: We retrospectively reviewed a continuous series of 105 cases of dual mobility cup Quattro (Groupe Lépine, Genay, France) implanted from 2000 to 2002. Selection of the patients requiring a primary hip replacement depended on risk criteria such as age, hip disease and activity score. The dual mobility cup was associated with a modular cemented femoral component and a 22.2-mm stainless steel head. RESULTS: One dislocation occurred one month after the index surgery requiring no revision surgery. According to the Kaplan-Meier method, survival probability was 95.0 % (95 % confidence interval 81.5-98.8) at ten years of follow-up. CONCLUSIONS: Based on clinical outcome and patient assessment we conclude that the dual mobility cup is a reliable option to decrease dislocation risk without increasing polyethylene wear.

Prudhon JL; Ferreira A; Verdier R

2013-09-01

 
 
 
 
281

Quantitative calculation of dislocation mobility  

Energy Technology Data Exchange (ETDEWEB)

The authors present a new method to calculate the response of dislocations to applied stress. This new method, called the dislocation treadmill, can be used to study the effect of vacancies, interstitials, stresses, strain rate, temperature, etc., on the steady state velocity of the dislocation. The authors demonstrate the use of the method by calculating the response of a dislocation to a constant applied shear stress.

Swaminarayan, S.; Preston, D.L.

1999-07-01

282

Neglected irreducible posterolateral knee dislocation  

Directory of Open Access Journals (Sweden)

Full Text Available Knee dislocations are rare injuries. Posterolateral knee dislocations are only a small subset of them. There is a paucity of literature regarding the management of such neglected cases. We report here, a case of neglected irreducible posterolateral knee dislocation treated with open reduction and isolated posterior cruciate ligament reconstruction followed by gradual rehabilitation with good outcome at 3 years followup.

Saini Raghav; Mootha Aditya; Goni Vijay; Dhillon Mandeep

2010-01-01

283

Neglected irreducible posterolateral knee dislocation  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Knee dislocations are rare injuries. Posterolateral knee dislocations are only a small subset of them. There is a paucity of literature regarding the management of such neglected cases. We report here, a case of neglected irreducible posterolateral knee dislocation treated with open reduction and is...

Saini Raghav; Mootha Aditya; Goni Vijay; Dhillon Mandeep

284

Behavior of dislocations in silicon  

Energy Technology Data Exchange (ETDEWEB)

A review is given of dynamic behavior of dislocations in silicon on the basis of works of the author`s group. Topics taken up are generation, motion and multiplication of dislocations as affected by oxygen impurities and immobilization of dislocations due to impurity reaction.

Sumino, Koji [Nippon Steel Corp., Chiba Prefecture (Japan)

1995-08-01

285

Effective dislocation lines in continuously dislocated crystals. III. Kinematics  

CERN Document Server

A class of congruences of principal Volterra-type effective dislocation lines associated with a dislocation density tensor is distinguished in order to investigate the kinematics of continuized defective crystals in terms of their dislocation densities (tensorial as well as scalar). Moreover, it shown, basing oneself on a formula defining the mean curvature of glide surfaces for principal edge effective dislocation lines, that the considered kinematics of continuized defective crystals is consistent with some relations appearing in the physical theory of plasticity (e.g. with the Orowan-type kinematic relations and with the treatment of shear stresses as driving stresses of moving dislocations).

Trzesowski, Andrzej

2007-01-01

286

Gauge theory of dislocations  

International Nuclear Information System (INIS)

In this continuation of work by the author the notion of the distortion of an ideal crystal structure is generalized and the gauge field is defined, fundamental states (vacuum configurations) of which are the crystal structure elementary distortions due to dislocations. The form of the structure equations of the connection form defined by this gauge field is discussed.

1987-01-01

287

Gauge theory of dislocations  

Energy Technology Data Exchange (ETDEWEB)

In this continuation of work by the author the notion of the distortion of an ideal crystal structure is generalized and the gauge field is defined, fundamental states (vacuum configurations) of which are the crystal structure elementary distortions due to dislocations. The form of the structure equations of the connection form defined by this gauge field is discussed.

Trzesowski, A.

1987-11-01

288

Smectic meniscus and dislocations  

Energy Technology Data Exchange (ETDEWEB)

In ordinary liquids the size of a meniscus and its shape is set by a competition between surface tension and gravity. The thermodynamical process of its creation can be reversible. On the contrary, in smectic liquid crystals the formation of the meniscus is always an irreversible thermodynamic process since it involves the creation of dislocations (therefore it involves friction). Also the meniscus is usually small in experiments with smectics in comparison to the capillary length and therefore the gravity does not play any role in determining the meniscus shape. Here we discuss the relation between dislocations and meniscus in smectics. The theoretical predictions are supported by a recent experiment performed on freely suspended films of smectic liquid crystals. In this experiment the measurement of the meniscus radius of curvature gives the pressure difference, {Delta}p, according to the Laplace law. From the measurements of the growth dynamics of a dislocation loop (governed by {Delta}p) we find the line tension ({approx}8 x 10{sup -8} dyn) and the mobility of an elementary edge dislocation ({approx}4 x 10{sup -}7 cm{sup 2} s/g). (author) 15 refs, 5 figs

Geminard, J.C.; Oswald, P. [Laboratoire de Physique de l`Ecole Normale Superieure de Lyon, Lyon (France); Holyst, R. [Laboratoire de Physique de l`Ecole Normale Superieure de Lyon, Lyon (France)]|[Institute of Physical Chemistry, Polish Academy of Sciences, Warsaw (Poland)]|[College of Science, Warsaw (Poland)

1998-06-01

289

[Chronic posterior shoulder dislocation  

UK PubMed Central (United Kingdom)

The posterior dislocation of the shoulder is frequently unrecognized for many days, months or even years after the initial accident. After the presentation of its clinical and radiological features, as the different ways of its treatment, some cases will illustrate this entity, too frequently missed or wrongly treated.

Perrenoud A; Imhoff A

1992-01-01

290

[Different forms of tuberculous hip arthritis (case study)].  

Science.gov (United States)

Tuberculous hip arthritis ranks third in the classification of orthopedic tuberculosis, after tuberculosis of the spine and knee joint. It accounts for about 15 % of all orthopedic tuberculosis. The aim of this paper is to demonstrate the etiology, clinical presentation and forms of disease on the case reports of six patients. The scope of disease is wide - from a mild reversible synovial form, then fibrous or bone ankylosis, to severe destruction of the hip with subluxation or dislocation, pseudoarthrosis or chronic arthritis with a fistula. The wide diversity of clinical findings and difficulties is making diagnosis are often responsible for a late start of therapy. However, only an early and adequate treatment permits the prevention of irreversible damage to the hip joint or further complications. Key words: tuberculous hip arthritis. PMID:17623610

Netval, M; Hudec, T; Hach, J

2007-06-01

291

[Different forms of tuberculous hip arthritis (case study)  

UK PubMed Central (United Kingdom)

Tuberculous hip arthritis ranks third in the classification of orthopedic tuberculosis, after tuberculosis of the spine and knee joint. It accounts for about 15 % of all orthopedic tuberculosis. The aim of this paper is to demonstrate the etiology, clinical presentation and forms of disease on the case reports of six patients. The scope of disease is wide - from a mild reversible synovial form, then fibrous or bone ankylosis, to severe destruction of the hip with subluxation or dislocation, pseudoarthrosis or chronic arthritis with a fistula. The wide diversity of clinical findings and difficulties is making diagnosis are often responsible for a late start of therapy. However, only an early and adequate treatment permits the prevention of irreversible damage to the hip joint or further complications. Key words: tuberculous hip arthritis.

Netval M; Hudec T; Hach J

2007-06-01

292

Statistical dynamics of dislocation systems: The influence of dislocation-dislocation correlations.  

Digital Repository Infrastructure Vision for European Research (DRIVER)

During plastic deformation of crystalline materials, the collective dynamics of interacting dislocations gives rise to various patterning phenomena. A crucial and still open question is whether the long range dislocation-dislocation interactions which do not have an intrinsic range can lead to spati...

Zaiser, Michael; Miguel López, María del Carmen; Groma, I.

293

Computer aided diagnosis and treatment planning for developmental dysplasia of the hip  

Science.gov (United States)

The developmental dysplasia of the hip (DDH) is a congenital malformation affecting the proximal femurs and acetabulum that are subluxatable, dislocatable, and dislocated. Early diagnosis and treatment is important because failure to diagnose and improper treatment can result in significant morbidity. In this paper, we designed and implemented a computer aided system for the diagnosis and treatment planning of this disease. With the design, the patient received CT (computed tomography) or MRI (magnetic resonance imaging) scan first. A mixture-based PV partial-volume algorithm was applied to perform bone segmentation on CT image, followed by three-dimensional (3D) reconstruction and display of the segmented image, demonstrating the special relationship between the acetabulum and femurs for visual judgment. Several standard procedures, such as Salter procedure, Pemberton procedure and Femoral Shortening osteotomy, were simulated on the screen to rehearse a virtual treatment plan. Quantitative measurement of Acetabular Index (AI) and Femoral Neck Anteversion (FNA) were performed on the 3D image for evaluation of DDH and treatment plans. PC graphics-card GPU architecture was exploited to accelerate the 3D rendering and geometric manipulation. The prototype system was implemented on PC/Windows environment and is currently under clinical trial on patient datasets.

Li, Bin; Lu, Hongbing; Cai, Wenli; Li, Xiang; Meng, Jie; Liang, Zhengrong

2005-04-01

294

Is the dislocation rate higher after bipolar hemiarthroplasty in patients with neuromuscular diseases?  

UK PubMed Central (United Kingdom)

BACKGROUND: Patients with neuromuscular disease reportedly have a higher incidence of postoperative dislocation after bipolar hemiarthroplasty. Although the literature has focused on a high prevalence of preoperative neurologic conditions in patients who had dislocations after bipolar hemiarthroplasties, the relative incidence of dislocation in patients with neuromuscular disease and without is unclear. QUESTIONS/PURPOSES: We therefore (1) asked whether the incidence of postoperative dislocation after bipolar hemiarthroplasty was greater in patients with neuromuscular disease than for those without, and (2) whether function differed between the two groups, and (3) explored potential risk factors for dislocation in two groups. METHODS: We retrospectively reviewed 190 patients who underwent bipolar hemiarthroplasties for fracture of the femoral neck between 1996 and 2008. Of the 190 patients, 42 had various neuromuscular diseases and 148 had no history of neuromuscular disease. Intraoperative stability was tested and posterior soft tissue repair was performed in all patients. We determined the incidence of dislocation, postoperative leg length discrepancy, and femoral offset in patients with or without neuromuscular disease. RESULTS: The incidence of dislocation was 2.6% in all patients. We observed similar rates of dislocation in the two groups: 4.8% (two of 42 hips) in patients with neuromuscular disease and 2.0% (three of 148 hips) in patients without neuromuscular disease. CONCLUSIONS: In femoral neck fractures in patients with neuromuscular disease, careful preoperative management and operative technique such as a posterior soft tissue repair might decrease the risk of postoperative dislocation; therefore, we consider the bipolar hemiarthroplasty a reasonable treatment option. LEVEL OF EVIDENCE: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Suh KT; Kim DW; Lee HS; Seong YJ; Lee JS

2012-04-01

295

Congenital chylothorax.  

UK PubMed Central (United Kingdom)

Congenital chylothorax is a rare condition in which chyle accumulates in the pleural space because of an intrauterine obstruction or anomalies of the thoracic duct. This paper presents a case of congenital chylothorax diagnosed antepartum echographically. The patient's history revealed a previous sibling with a similar diagnosis. The baby developed respiratory distress after delivery and the diagnosis was established by thoracentesis. Computed tomography of the chest and nuclear lymphangiography were obtained to evaluate the origin of the pleural effusion, but a congenital fistula or other pathology of the thoracic duct could not be demonstrated. Management of the baby consisted of ventilatory support in the delivery room, repeated thoracentesis and thoracostomy tube drainage, total parenteral nutrition and formula containing medium-chain triglycerides. The infant was discharged six weeks after birth in good condition.

Ozkan H; Ay N; Ozaksoy D; Ercal D; Erata Y; Durak H; Evyapan O; Toprak S

1996-01-01

296

Congenital arhinia.  

UK PubMed Central (United Kingdom)

Congenital absence of the nose or arhinia is a rare defect of embryogenesis, often associated with other anomalies. It is potentially a life-threatening condition and requires the presence of a highly skilled neonatal resuscitation team at the time of delivery. The associated anomalies often have a significant impact on the immediate as well as long-term outcome of the neonate. Parental counselling is thus vital and a multidisciplinary team approach is required to optimise the neonatal outcome. A neonate with congenital arhinia is reported and the literature reviewed to suggest guidelines for the management of such cases.

McGlone L

2003-08-01

297

Ceramic-on-Ceramic Total Hip Arthroplasty: Minimum of Six-Year Follow-up Study.  

UK PubMed Central (United Kingdom)

BACKGROUND: This study examines the clinical and radiologic results of ceramic-on-ceramic total hip arthroplasties with regard to wear, osteolysis, and fracture of the ceramic after a minimum follow-up of six years. METHODS: We evaluated the results of a consecutive series of 148 primary ceramic-on-ceramic total hip arthroplasties that had been performed between May 2001 and October 2005 in 142 patients. The mean age was 57.2 years (range, 23 to 81 years). The mean follow-up period was 7.8 years (range, 6.1 to 10.1 years). Preoperative diagnosis was avascular necrosis in 77 hips (52%), degenerative arthritis in 36 hips (24.3%), femur neck fracture in 18 hips (12.2%), rheumatoid arthritis in 15 hips (10.1%), and septic hip sequelae in 2 hips (1.4%). Clinical results were evaluated with the Harris hip score, and the presence of postoperative groin or thigh pain. Radiologic analysis was done with special attention in terms of wear, periprosthetic osteolysis, and ceramic failures. RESULTS: The mean Harris hip score improved from 58.3 (range, 10 to 73) to 92.5 (range, 79 to 100) on the latest follow-up evaluation. At final follow-up, groin pain was found in 4 hips (2.7%), and thigh pain was found in 6 hips (4.1%). Radiologically, all femoral stems demonstrated stable fixations without loosening. Radiolucent lines were observed around the stem in 25 hips (16.9%), and around the cup in 4 hips (2.7%). Endosteal new bone formation was observed around the stem in 95 hips (64.2%) and around the cup in 88 hips (59.5%). No osteolysis was observed around the stem and cup. There were 2 hips (1.4%) of inclination changes of acetabular cup, 2 hips (1.4%) of hip dislocation, 1 hip (0.7%) of ceramic head fracture, and 1 hip (0.7%) of squeaking. The Kaplan-Meier survival rate of the prostheses was 98.1% at postoperative 7.8 years. CONCLUSIONS: The ceramic-on-ceramic total hip arthroplasty produced excellent clinical results and implant survival rates with no detectable osteolysis on a minimum six-year follow-up study. The ceramic-on-ceramic couplings could be a reasonable option of primary total hip arthroplasty for variable indications.

Choy WS; Kim KJ; Lee SK; Bae KW; Hwang YS; Park CK

2013-09-01

298

Ceramic-on-Ceramic Total Hip Arthroplasty: Minimum of Six-Year Follow-up Study  

Science.gov (United States)

Background This study examines the clinical and radiologic results of ceramic-on-ceramic total hip arthroplasties with regard to wear, osteolysis, and fracture of the ceramic after a minimum follow-up of six years. Methods We evaluated the results of a consecutive series of 148 primary ceramic-on-ceramic total hip arthroplasties that had been performed between May 2001 and October 2005 in 142 patients. The mean age was 57.2 years (range, 23 to 81 years). The mean follow-up period was 7.8 years (range, 6.1 to 10.1 years). Preoperative diagnosis was avascular necrosis in 77 hips (52%), degenerative arthritis in 36 hips (24.3%), femur neck fracture in 18 hips (12.2%), rheumatoid arthritis in 15 hips (10.1%), and septic hip sequelae in 2 hips (1.4%). Clinical results were evaluated with the Harris hip score, and the presence of postoperative groin or thigh pain. Radiologic analysis was done with special attention in terms of wear, periprosthetic osteolysis, and ceramic failures. Results The mean Harris hip score improved from 58.3 (range, 10 to 73) to 92.5 (range, 79 to 100) on the latest follow-up evaluation. At final follow-up, groin pain was found in 4 hips (2.7%), and thigh pain was found in 6 hips (4.1%). Radiologically, all femoral stems demonstrated stable fixations without loosening. Radiolucent lines were observed around the stem in 25 hips (16.9%), and around the cup in 4 hips (2.7%). Endosteal new bone formation was observed around the stem in 95 hips (64.2%) and around the cup in 88 hips (59.5%). No osteolysis was observed around the stem and cup. There were 2 hips (1.4%) of inclination changes of acetabular cup, 2 hips (1.4%) of hip dislocation, 1 hip (0.7%) of ceramic head fracture, and 1 hip (0.7%) of squeaking. The Kaplan-Meier survival rate of the prostheses was 98.1% at postoperative 7.8 years. Conclusions The ceramic-on-ceramic total hip arthroplasty produced excellent clinical results and implant survival rates with no detectable osteolysis on a minimum six-year follow-up study. The ceramic-on-ceramic couplings could be a reasonable option of primary total hip arthroplasty for variable indications.

Choy, Won-Sik; Lee, Sang Ki; Bae, Kyoung Wan; Hwang, Yoon Sub; Park, Chang Kyu

2013-01-01

299

Total hip arthroplasty through anterior minimal incision  

Directory of Open Access Journals (Sweden)

Full Text Available Total hip arthroplasty through minimum anterior incision is a minimally invasive technique that allows access to the joint capsule without posting the skeletal muscle surrounding areas. Anterior surgical approach is advantageous because the hip joint is located closer to the front than the rear part of the limb. The surgical approach follows a internervous plane between superior and inferior gluteal nerves (in the side) and femoral nerve (medially), without involving the muscle removal. This technique provides good access, through the same incision, both to the acetabul and the femur. It also allows better control of the acetabular cup, keeping the limb length, a decrease of dislocations rate and reduced post-operative precautions.

Bogdan Negru-Aman; Fabian Romulus Tatu

2010-01-01

300

Hip Revision Surgery  

Medline Plus

Full Text Available ... we like to put the hip in maximum extension and then externally rotate the hip until it ... great range of motion and the extremes of extension and flexion. So often, you know, we do ...

 
 
 
 
301

Hip Replacement - Physical Therapy  

Medline Plus

Full Text Available X-Plain Hip Replacement – Physical Therapy Reference Summary Introduction Hip replacement surgery is a very successful and safe operation. Long-term success mostly depends on the patient, though. The ...

302

Hip Revision Surgery  

Medline Plus

Full Text Available ... and lower down to the correct center of motion of the hip. Let me see the tubercular ... the concept, Louis, of creating a center of motion that's at a lower hip center. Yes, and ...

303

Hip Replacement - Physical Therapy  

Medline Plus

Full Text Available ... Artificial hips allow a very wide range of motion, even though it is a little less than ... strengthen your leg and improve the range of motion in your new hip. The surgeon, the nurse ...

304

Hip Replacement - Physical Therapy  

Medline Plus

Full Text Available ... new hip. Anatomy The hip joint joins the pelvis to the femur, or thighbone. It is similar ... to move, it is the muscles of the pelvis and legs that make moving possible. There are ...

305

Hip Replacement - Physical Therapy  

Medline Plus

Full Text Available ... socket device. Artificial hips allow a very wide range of motion, even though it is a little ... physical therapy, strengthen your leg and improve the range of motion in your new hip. The surgeon, ...

306

Hip Revision Surgery  

Medline Plus

Full Text Available ... hip. At that time, or a year or two later, she underwent a primary hip replacement. She ... extraction system whereby we can drill a 3.2 hole through the polyethylene and the use a ...

307

Intermediate- to long-term results after hybrid total hip arthroplasty in patients with rheumatoid arthritis.  

UK PubMed Central (United Kingdom)

There have been few reports describing intermediate- to long-term results after hybrid total hip arthroplasty in patients with rheumatoid arthritis. We followed up 52 hips in 44 patients aged 5 men and 39 women, with a mean of 11.5 years (range, 5-23.5 years). Revisions had been performed in 6 hips in 6 patients: 1 both acetabular and femoral components for infection, 1 acetabular component for aseptic loosening, 3 acetabular components for recurrent dislocation, and 1 acetabular component for dislodgement of the polyethylene liner from the metal shell. None of other acetabular or femoral components were revised or found to be loose at the final follow-up. Although postoperative dislocation remains a concern, hybrid total hip arthroplasty had an acceptable result in patients with rheumatoid arthritis.

Ito H; Tanino H; Yamanaka Y; Minami A; Matsuno T

2013-02-01

308

Low revision rate after total hip arthroplasty in patients with pediatric hip diseases  

DEFF Research Database (Denmark)

Background The results of primary total hip arthroplasties (THAs) after pediatric hip diseases such as developmental dysplasia of the hip (DDH), slipped capital femoral epiphysis (SCFE), or Perthes' disease have been reported to be inferior to the results after primary osteoarthritis of the hip (OA). Materials and methods We compared the survival of primary THAs performed during the period 1995-2009 due to previous DDH, SCFE, Perthes' disease, or primary OA, using merged individual-based data from the Danish, Norwegian, and Swedish arthroplasty registers, called the Nordic Arthroplasty Register Association (NARA). Cox multiple regression, with adjustment for age, sex, and type of fixation of the prosthesis was used to calculate the survival of the prostheses and the relative revision risks. Results 370,630 primary THAs were reported to these national registers for 1995-2009. Of these, 14,403 THAs (3.9%) were operated due to pediatric hip diseases (3.1% for Denmark, 8.8% for Norway, and 1.9% for Sweden) and 288,435 THAs (77.8%) were operated due to OA. Unadjusted 10-year Kaplan-Meier survival of THAs after pediatric hip diseases (94.7% survival) was inferior to that after OA (96.6% survival). Consequently, an increased risk of revision for hips with a previous pediatric hip disease was seen (risk ratio (RR) 1.4, 95% CI: 1.3-1.5). However, after adjustment for differences in sex and age of the patients, and in fixation of the prostheses, no difference in survival was found (93.6% after pediatric hip diseases and 93.8% after OA) (RR 1.0, CI: 1.0-1.1). Nevertheless, during the first 6 postoperative months more revisions were reported for THAs secondary to pediatric hip diseases (RR 1.2, CI: 1.0-1.5), mainly due to there being more revisions for dislocations (RR 1.8, CI: 1.4-2.3). Comparison between the different diagnosis groups showed that the overall risk of revision after DDH was higher than after OA (RR 1.1, CI: 1.0-1.2), whereas the combined group Perthes' disease/SCFE did not have a significantly different riskof revision to that of OA (RR 0.9, CI: 0.7-1.0), but had a lower risk than after DDH (RR 0.8, CI: 0.7-1.0). Interpretation After adjustment for differences in age, sex, and type of fixation of the prosthesis, no difference in risk of revision was found for primary THAs performed due to pediatric hip diseases and those performed due to primary OA.

Engesæter, Lars B; Engesæter, Ingvild Ø

2012-01-01

309

Minimally-incision total hip arthoplasty: Complications  

Directory of Open Access Journals (Sweden)

Full Text Available Minimaly invasive hip surgery techniques have been proposed as an alternative to conventional soft tissue exposure total hip arthroplasty. Purpored advantages of the technique included less blood loss, faster recovery, shoter stay in hospital and better cosmetical result. During the years good results have been presented by many authors, and serious complications have been found only in a few articles. But, some papers reported a catastrofic complications of the MIS procedures. Our intention is to present complication which had occurred in our experience with MIS total hip replacement. Retrospective study involved 215 patients (230 hips). All patients, of mean age 55.7 years, obtained fiber metal midcoated or fiber metal taper femoral stem and identical fiber metal coated acetabular shell with polyethylene or ceramic insert. The goal of the study was to evaluate intraoperative and early postoperative complications: bone fractures and/or implant, blood loss, dislocations, prolonged bleeding, loss of component position in 6 week postop. period, infections, and thromboembolism. The complications we had may occur with any type of operating technique. The purpose of the study was not either to condone or condemn MIS techniques but to show the complications that had occurred in our experience.

Baš?arevi? Z.; Vukašinovi? Z.; Timotijevi? S.; Baš?arevi? V.; Trajkovi? G.; Baš?arevi? V.; Stevanovi? V.

2010-01-01

310

Effective dislocation lines in continuously dislocated crystals. I. Material anholonomity  

CERN Multimedia

A continuous geometric description of Bravais monocrystals with many dislocations and secondary point defects created by the distribution of these dislocations is proposed. Namely, it is distinguished, basing oneself on Kondo and Kroner Gedanken Experiments for dislocated bodies, an anholonomic triad of linearly independent vector fields. The triad defines local crystallographic directions of the defective crystal as well as a continuous counterpart of the Burgers vector for single dislocations. Next, the influence of secondary point defects on the distribution of many dislocations is modeled by treating these local crystallographic directions as well as Burgers circuits as those located in such a Riemannian material space that becomes an Euclidean 3-manifold when dislocations are absent. Some consequences of this approach are discussed.

Trzesowski, Andrzej

2007-01-01

311

Congenital arhinia.  

UK PubMed Central (United Kingdom)

In a case of congenital absence of the nose, spiral axial CT showed a tiny piriform anterior aperture on the right that ended blindly. Three-dimensional reformation of CT data showed an atretic bony plate, blind-ending right nostril, absent nasal bones, and inferior continuation of the metopic suture. Noncontrast MR findings in the brain were normal.

Albernaz VS; Castillo M; Mukherji SK; Ihmeidan IH

1996-08-01

312

Hip Replacement - Physical Therapy  

Medline Plus

Full Text Available ... of the femur has a round shape, it moves in the hip socket. Unlike the knee joint, the hip joint moves in many directions. It allows the leg to ... Even though the joint allows the hip to move, it is the muscles of the pelvis and ...

313

Total hip arthroplasty in healed tuberculous hip.  

Directory of Open Access Journals (Sweden)

Full Text Available Total hip arthroplasty was performed in a patient who had tuberculous hip, quiescent for the last 15 years, without pre or postoperative anti-tuberculous chemotherapy. At a 27 month follow up, there has been no evidence of reactivation. A brief review of relevant literature is also presented.

Dogra A; Kulkarni S; Bhosale P

1995-01-01

314

Discrete dislocation simulation of nanoindentation  

Science.gov (United States)

A methodology to describe nanoindentation by means of discrete dislocations is presented. A collocation method is used to calculate the arising contact stresses at each indentation step, which permits to realize an arbitrary shape of the indenter. Distributed dislocation sources are allowed to emit dislocations on predefined slip planes, when the critical value of the local shear stress for the emission is reached. After each indentation step, the newly emitted dislocations are brought to their equilibrium positions under the influence of the stresses induced by the contact stresses and the dislocations. As an application of our model, the plastic behavior of two materials with different densities of dislocation sources will be studied in detail.

Kreuzer, H. G. M.; Pippan, R.

315

MRI of cervical facet dislocation  

International Nuclear Information System (INIS)

[en] The MRI examinations of eight patients with cervical vertebral dislocation demonstrated by conventional radiography were reviewed. All patients had axial and sagittal T 1- and T 2-weighted imaging on a 1.5-T unit. This revealed unilateral partial facet dislocation (in two patients), bilateral partial facet dislocation (in two), unilateral complete dislocation (in two) and bilateral complete facet dislocation (in two). In six patients there was cord contusion, three had focal disc protrusions and four unilateral absence of normal flow void in one of the cervical vertebral arteries. In all cases, the dislocated facets were shown well on the far-lateral sagittal images. (orig.). With 5 figs., 1 tab

1997-01-01

316

[Total hip arthroplasty in patients with cerebral vascular event. Case report].  

UK PubMed Central (United Kingdom)

INTRODUCTION: Associated neurological disorders pose a challenge hip joint reconstruction. The imbalance and poor muscle tone predispose to dislocation and loosening of the prosthesis. CLINICAL CASE: The following is the case of a 67 years old patient with a hemorrhagic cerebral vascular event with a secondary left hemiparesis. Ten years later had a femoral neck fracture on the affected side. Initially she was treated with conservative management resulting in pain and discapacity, valued with WOMAC scale as 12 points. Two years later was treated with total hip arthroplasty with large diameter femoral head. We present the follow up of 41 months, asymptomatic, walking using a cane and a WOMAC score of 41, with no signs of radiological loosening or dislocation. CONCLUSIONS: There is no experience documented in neurological disorders associated with hip diseases that requires a total hip arthroplasty. Loosening of the implants, dislocation and heterotopic ossification has been described as complications of the procedure. Large heads in total hip arthroplasty and a correct surgical technique associated with a multidisciplinary management in patients with neurological disorders offers an opportunity as a treatment in patient with hip disorders.

Camacho-Galindo J; Soria-Bastida Mde L; Torres-Higuita JK; Ilizaliturri-Sánchez VM

2013-01-01

317

Dislocation kinetics behind shear shocks  

Energy Technology Data Exchange (ETDEWEB)

High velocity oblique impact experiments result in both compression and shear shock waves. Behind the shear shock wave the particle velocity is transverse to the shock front. At large transverse particle velocities, dislocation kinetics can contribute a portion of the velocity. Based on a kinematic and thermodynamic model of dislocation kinetics, an analysis is made of the transverse strain and velocity behind a shear shock. Kinematics of dislocations in transverse motion behind the shock is formulated. A solution is given for an ideal case where the dislocation density function propagates as a pulse behind the shear shock. 9 refs.

Stout, R.B.; Anderson, G.D.

1985-06-01

318

[Development of habitual shoulder dislocation  

UK PubMed Central (United Kingdom)

The starting point of the retrospective analysis of 177 primary dislocations was the question of frequency of habitual dislocations, the correlation between habitual dislocation and time of early immobilisation, as well as the search for additional statements which would result in a differentiated therapy. 18.1% habitual dislocations were seen to develop, mostly after immobilisation for less than three weeks. It is an interesting fact that the technique of immobilisation made no difference. We found that after the first even there was generally no loss in function, whereas 14.5% of the men and 34.3% of the women complained of severe subjective symptoms. The 12 patients who underwent an operation because of habitual dislocation suffered neither from dysfunction nor from painful movement, and no dislocation was found. The rate of habitual dislocation in our patients showed a lower rate of dislocation of the shoulder joint. We found 18.1% dislocations, whereas the literature showed an average quota of 30%. To improve the results we recommend a special X-ray technique following the first reposition. In the age group between 20 and 30 years, which is most susceptible, we also recommend arthrography and arthroscopy of the shoulder joint. To improve typical lesions, such as osseous rupture of the capsule or what is known as Hill-Sachs lesions, primary operation is discussed as an alternative treatment.

Müller KH; Dingels WR

1984-06-01

319

Synovial Chondromatosis of the Hip: Management with Arthroscope-Assisted Synovectomy and Removal of Loose Bodies: Report of Two Cases  

Directory of Open Access Journals (Sweden)

Full Text Available Primary synovial chondromatosis is an uncommon disorder, and involvement of the hipjoint is rare. The clinical symptoms are usually non-specific, and a clinical diagnosis of synovialchondromatosis of the hip may be difficult and delayed, especially before the ossifyingnodules become evident. Loose bodies in the joint can cause secondary degenerativeosteoarthritis of the hip. Currently, the recommended management is surgical removal of theloose bodies and a synovectomy without dislocation of the hip joint. Herein we report on 2cases of synovial chondromatosis of the hip, which were managed with an arthroscopeassistedsynovectomy and removal of the loose bodies. We believe this is an easy and safemethod for management of this disorder.

Chun-Yang Chen; Alvin Chao-Yu Chen; Yu-Han Chang; Tsai-Sheng Fu; Mel S. Lee

2003-01-01

320

Readmissions after fast-track hip and knee arthroplasty  

DEFF Research Database (Denmark)

With the implementation of fast-track surgery with optimization of both logistical and clinical features, the postoperative convalescence has been reduced as functional milestones have been achieved earlier and consequently length of stay (LOS) in hospital has been reduced. However, it has been speculated that a decrease in LOS may be associated with an increase in readmissions in general, including risk of dislocation after total hip arthroplasty (THA) or manipulation after total knee arthroplasty (TKA).

Husted, Henrik; Otte, Kristian Stahl

2010-01-01

 
 
 
 
321

Radiographic observation of congenital diaphragmatic hernia  

International Nuclear Information System (INIS)

Five cases of congenital diaphragmatic hernia. Case 1: A female infant, birth weight 2.25 kg, Apgar score 10, normal delivery at 11:33 P.M. on Feb.8, 1972. Lt side congenital diaphragmatic hernia. Case 2: A female infant, birth weight 1.48 kg, Apgar score 5, normal delivery at 11:20 A.M. on Oct.14, 1972. Lt. side congenital diaphragmatic hernia. This infant was twin. this infant's mother was toxemia. Case 3; A 33 years old women was admitted to the our hospital because of Lt.hip joint pain without other symptoms. Date of admission: Jan. 8, 1973. Rt side congenital diaphragmentic hernia. Case 4: A 4 month infant male was admitted to the our hospital because of vomiting, dyspnea and abdominal pain. He had cyanosis intermittently after one month ago. This infant was normal delivered. The family history was not contributory. Date of admission: This infant was normal delivered. The family history was not contributory. Date of admission: Aug. 30, 1971. Rt side congenital diaphragmatic hernia. Case 5: A 13 years old girl was admitted to our hospital because of general weakness without other symptoms. This patient was normal delivered. The family history was not contributory. Date of admission: March. 15, 1973. Lt. side congenital diaphragmentic hernia.

1973-01-01

322

[Congenital hydrocephalus  

UK PubMed Central (United Kingdom)

INTRODUCTION: Congenital hydrocephalus or ventriculomegaly is a disorder that now can be diagnosed in uterus with ultrasonography, this gives the chance of being able to give a treatment the earliest as possible. DEVELOPMENT: The clinical manifestations are reviewed, the diagnosis, the frequent treatment and causes of congenital hydrocephalus, being the first agenesis of the Sylvius' aqueduct, followed by Arnold-Chiari's malformations with mielomeningocele. CONCLUSIONS: In most of the cases the peritoneal-ventricle shunt is the best surgery treatment and now, the treatment with ventriculostomy of third ventricle by endoscopy has fewer complications apparently and in several cases it is the definitive treatment. The evolution of the diagnosis with the support of specific therapies is effective and the early treatment is good, of course taking into account the etiology.

Malagón-Valdez J

2006-04-01

323

[Congenital clubfoot].  

Science.gov (United States)

Congenital clubfoot is one of the most common congenital skeletal deformities with an incidence of 1-2/1000 newborns. The deformity is characterized by pathological changes of joints, bones (especially the talus), muscles, tendons and soft tissues which result in subtalar malpositions known as talipes equinus, varus adductus and cavus. Secondary clubfoot is always part of an underlying systemic or neurologic disease and can occur at birth or develop over time. The treatment of clubfoot should start early after birth and is primarily conservative, involving manipulation and serial casting. Among conservative techniques available today, the Ponseti method is the treatment of choice. Applying this treatment protocol surgical therapy can be reduced in amount and extent. Extensive surgical therapy is only necessary in exceptional cases. PMID:21052630

Weimann-Stahlschmidt, K; Krauspe, R; Westhoff, B

2010-11-01

324

Ceramic liner fatigue fracture: 3-D CT findings in a late recurrent THA dislocation.  

UK PubMed Central (United Kingdom)

Dislocation is one of the most common complications of total hip arthroplasty (THA). To the authors' knowledge, late recurrent dislocation of a THA with a ceramic-on-ceramic coupling secondary to fatigue fracture of the ceramic liner has never been described. A 76-year-old woman with right hip osteoarthritis underwent cementless modular THA with a ceramic-on-ceramic coupling. Approximately 10 years postoperatively, she experienced right hip pain with no trauma, which resolved in 14 days. Family members reported that the patient had shown a progressive cognitive and muscular decline in the previous months. Six months later, the patient was admitted for THA dislocation, which was immediately reduced. Computed tomography revealed that the right acetabular component had a retroversion of 4° and an inclination angle of 45°. An orthopedic brace was applied, but dislocation recurred 2 days after discharge. A 3-dimensional CT reconstruction showed a fracture of the ceramic liner in the posterolateral region. The patient underwent revision surgery, and the ceramic liner breakage was confirmed. After removal of the acetabular components, a cemented polyethylene cup was implanted. The stability of the stem was verified. The existing modular neck was replaced with a chromium-cobalt neck, and a new ceramic head was applied. At 7-month follow-up, the patient had good functional recovery with no hip instability. Fatigue failure of a ceramic liner should be considered as responsible for late dislocation after ceramic-on-ceramic THA. As part of the diagnostic strategy, 3-dimensional CT reconstruction should be used to evaluate ceramic liner breakage.

Trivellin G; Sandri A; Bizzotto N; Marino MA; Mezzari S; Sambugaro E; Regis D

2013-01-01

325

Ceramic liner fatigue fracture: 3-D CT findings in a late recurrent THA dislocation.  

Science.gov (United States)

Dislocation is one of the most common complications of total hip arthroplasty (THA). To the authors' knowledge, late recurrent dislocation of a THA with a ceramic-on-ceramic coupling secondary to fatigue fracture of the ceramic liner has never been described. A 76-year-old woman with right hip osteoarthritis underwent cementless modular THA with a ceramic-on-ceramic coupling. Approximately 10 years postoperatively, she experienced right hip pain with no trauma, which resolved in 14 days. Family members reported that the patient had shown a progressive cognitive and muscular decline in the previous months. Six months later, the patient was admitted for THA dislocation, which was immediately reduced. Computed tomography revealed that the right acetabular component had a retroversion of 4° and an inclination angle of 45°. An orthopedic brace was applied, but dislocation recurred 2 days after discharge. A 3-dimensional CT reconstruction showed a fracture of the ceramic liner in the posterolateral region. The patient underwent revision surgery, and the ceramic liner breakage was confirmed. After removal of the acetabular components, a cemented polyethylene cup was implanted. The stability of the stem was verified. The existing modular neck was replaced with a chromium-cobalt neck, and a new ceramic head was applied. At 7-month follow-up, the patient had good functional recovery with no hip instability. Fatigue failure of a ceramic liner should be considered as responsible for late dislocation after ceramic-on-ceramic THA. As part of the diagnostic strategy, 3-dimensional CT reconstruction should be used to evaluate ceramic liner breakage. PMID:23276339

Trivellin, Giacomo; Sandri, Andrea; Bizzotto, Nicola; Marino, Marco Andrea; Mezzari, Silvio; Sambugaro, Elena; Regis, Dario

2013-01-01

326

Congenital chylothorax.  

UK PubMed Central (United Kingdom)

The objective of this paper is a retrospective study of all infants treated for congenital chylothorax at the Royal Children's Hospital (RCH), Melbourne, Australia and King Fahad National Guard Hospital (KFNGH), Riyadh, Kingdom of Saudi Arabia. The charts of all infants with congenital chylothorax admitted to RCH over a period of 13 years, June 1982-August 1994, and admissions to KFNGH over a 7-year period, June 1992-August 1998 inclusive, were reviewed including management outcome and complications. There were 19 infants, 13 from RCH and 6 from KFNGH; 11 females and 8 males. Three infants were managed antenatally. Fifteen infants presented immediately after birth. Seven were born with hydrops fetalis, 6 infants had syndromes and 10 infants were born prematurely. Regular infant feeding formula and/or breast milk were used successfully in 12 infants, while in 7 infants medium chain triglycerides (MCT) rich formula was used. Sixteen infants were mechanically ventilated with 75% of them ventilated for < or = 28 days. Fifteen infants received total parenteral nutrition (TPN), and in 80% for < or = 32 days. Hydropic infants had longer duration of mechanical ventilation and hospital stay with mean (range) of 33.9 (3-120) and 115 (23-225) days, respectively, compared with 18 (1-62) and 34.3 (14-88) days for nonhydropic infants. Five infants underwent surgery with failure in four. Sepsis and bronchopulmonary dysplasia were the main complications. The survival rate was 100% regardless of the mode of therapy. The prognosis of Isolated congenital chylothorax in term, and preterm infants is good even in the presence of hydrops. Breast milk and/or regular infant feeding formula should be used initially before proceeding to MCT-rich formula, which may be necessary in some cases. Surgery should be considered if conservative management of congenital chylothorax fails after 4-5 weeks.

Al-Tawil K; Ahmed G; Al-Hathal M; Al-Jarallah Y; Campbell N

2000-01-01

327

[Congenital chylothorax  

UK PubMed Central (United Kingdom)

OBJECTIVE: The aim of this study was to study the prenatal diagnosis, clinical manifestations and karyotype results in congenital chylothorax. PATIENTS AND METHODS: A retrospective survey of a 20 year period was carried out. The prenatal diagnosis, maneuvers following delivery, malformations and clinical outcome were studied. RESULTS: We found 10 cases of congenital chylothorax. Four were diagnosed by prenatal ultrasound with pleural effusion and no other signs of hydrops and six were diagnosed postnatally. Of the later, five had respiratory distress and one was diagnosed by radiological procedures. In all 10 cases, postnatal thoracocentesis was performed for diagnosis and therapy, five infants required mechanical ventilation and four parenteral nutrition. One patient died 72 hours after birth and three within 24 hours of birth. The clinical outcome of the rest was successful and were placed on a medium-chain triglyceride formula that was given orally. Of the eight karyotypes studied, six trisomy 21 were found. CONCLUSIONS: The prenatal diagnosis of pleural effusion permits prompt recognition of congenital chylothorax and allow for appropriate treatment upon birth. Medical therapy including pleural drainage and total parenteral nutrition and medium-chain triglyceride formula for oral feedings is successful in the majority of cases. Down's syndrome should be considered in fetuses or newborns with pleural effusion.

Echeverría Lecuona J; Benito A; Arena Ansotegui J; Collado Espiga V; Rey Otero A; Paisán Grisolía L

1998-08-01

328

Congenital toxoplasmosis.  

Science.gov (United States)

Congenital toxoplasmosis results from the transplacental transmission of the parasite Toxoplasma gondii after a maternal infection acquired in pregnancy. Prevalence of congenital infection ranges from 0.1 to 0.3 per 1000 live births. The maternal-fetal transmission rate increases with gestational age at maternal seroconversion, from less than 15% at 13 weeks of gestation to over 70% at 36 weeks. Conversely, the later the maternal infection, the lower the risk of symptomatic congenital infection (infections acquired during the third trimester are most often asymptomatic at birth). Prenatal diagnosis is currently performed by PCR analysis in amniotic fluid. Antenatal management and treatment vary considerably among countries. In some European countries, maternal infections are detected through serological screening allowing a prompt treatment with spiramycin, which is expected to reduce the risk of vertical transmission. If PCR analysis in amniotic fluid is positive or if maternal infection was acquired in the third trimester of pregnancy, a combination with pyrimethamine and sulphonamide is given until delivery. Benefits of antenatal treatments remain controversial. Infected newborns are prescribed pyrimethamine and sulphonamide for 12 months. Despite antenatal and postnatal treatment, chorioretinitis can occur at any age (prevalence>20% at 10 years of age): long-term ophthalmological follow-up remains necessary. PMID:23622316

Kieffer, François; Wallon, Martine

2013-01-01

329

Congenital toxoplasmosis.  

UK PubMed Central (United Kingdom)

Congenital toxoplasmosis results from the transplacental transmission of the parasite Toxoplasma gondii after a maternal infection acquired in pregnancy. Prevalence of congenital infection ranges from 0.1 to 0.3 per 1000 live births. The maternal-fetal transmission rate increases with gestational age at maternal seroconversion, from less than 15% at 13 weeks of gestation to over 70% at 36 weeks. Conversely, the later the maternal infection, the lower the risk of symptomatic congenital infection (infections acquired during the third trimester are most often asymptomatic at birth). Prenatal diagnosis is currently performed by PCR analysis in amniotic fluid. Antenatal management and treatment vary considerably among countries. In some European countries, maternal infections are detected through serological screening allowing a prompt treatment with spiramycin, which is expected to reduce the risk of vertical transmission. If PCR analysis in amniotic fluid is positive or if maternal infection was acquired in the third trimester of pregnancy, a combination with pyrimethamine and sulphonamide is given until delivery. Benefits of antenatal treatments remain controversial. Infected newborns are prescribed pyrimethamine and sulphonamide for 12 months. Despite antenatal and postnatal treatment, chorioretinitis can occur at any age (prevalence>20% at 10 years of age): long-term ophthalmological follow-up remains necessary.

Kieffer F; Wallon M

2013-01-01

330

Annealing of dislocation loops in dislocation dynamics simulations  

Energy Technology Data Exchange (ETDEWEB)

We report of 3-dimensional discrete dislocation dynamics (DDD) simulations of dislocation loops coarsening by vacancy bulk diffusion. The calculation is based upon a model which couples the diffusion theory of vacancies to the DDD in order to obtain the climb rate of the dislocation segments. Calculation of isolated loops agrees with experimental observations, i.e. loops shrink or expand, depending on their type and vacancy supersaturation. When an array of dislocation loops of various sizes is considered, and the total number of vacancies in the simulation is maintained constant, the largest dislocations are found to increase in size at the expense of small ones, which disappear in a process known as Ostwald ripening.

Mordehai, Dan; Clouet, Emmanuel [SRMP, CEA-Saclay, 91191 Gif-sur-Yvette Cedex (France); Fivel, Marc; Verdier, Marc, E-mail: danmord@tx.technion.ac.il [CNRS/SIMAP, INPG, BP 75, 38402 St Martin d' Heres (France)

2009-07-15

331

Severe congenital RYR1-associated myopathy: the expanding clinicopathologic and genetic spectrum.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To report a series of 11 patients on the severe end of the spectrum of ryanodine receptor 1 (RYR1) gene-related myopathy, in order to expand the clinical, histologic, and genetic heterogeneity associated with this group of patients. METHODS: Eleven patients evaluated in the neonatal period with severe neonatal-onset RYR1-associated myopathy confirmed by genetic testing were ascertained. Clinical features, molecular testing results, muscle imaging, and muscle histology are reviewed. RESULTS: Clinical features associated with the severe neonatal presentation of RYR1-associated myopathy included decreased fetal movement, hypotonia, poor feeding, respiratory involvement, arthrogryposis, and ophthalmoplegia in 3 patients, and femur fractures or hip dislocation at birth. Four patients had dominant RYR1 mutations, and 7 had recessive RYR1 mutations. One patient had a cleft palate, and another a congenital rigid spine phenotype-findings not previously described in the literature in patients with early-onset RYR1 mutations. Six patients who underwent muscle ultrasound showed relative sparing of the rectus femoris muscle. Histologically, all patients with dominant mutations had classic central cores on muscle biopsy. Patients with recessive mutations showed great histologic heterogeneity, including fibrosis, variation in fiber size, skewed fiber typing, very small fibers, and nuclear internalization with or without ill-defined cores. CONCLUSIONS: This series confirms and expands the clinical and histologic variability associated with severe congenital RYR1-associated myopathy. Both dominant and recessive mutations of the RYR1 gene can result in a severe neonatal-onset phenotype, but more clinical and histologic heterogeneity has been seen in those with recessive RYR1 gene mutations. Central cores are not obligatory histologic features in recessive RYR1 mutations. Sparing of the rectus femoris muscle on imaging should prompt evaluation for RYR1-associated myopathy in the appropriate clinical context.

Bharucha-Goebel DX; Santi M; Medne L; Zukosky K; Zukosky K; Dastgir J; Shieh PB; Winder T; Tennekoon G; Finkel RS; Dowling JJ; Monnier N; Bönnemann CG

2013-04-01

332

Grain boundary dislocation sources in nanocrystalline copper  

International Nuclear Information System (INIS)

[en] Atomistic simulations of dislocation nucleation from grain boundaries provide an insight into dislocation sources in nanocrystalline copper. Simulations show that dislocation sources emit single partial dislocation loops, with half absorbed into the boundary and half emitted into the lattice. The specific boundary dislocation content determines whether the absorbed half-loop annihilates pre-existing boundary dislocations or increases boundary dislocations. Atomistic studies of this type provide details of the emission sequence that enhance our understanding of dislocation sources in high angle boundaries

2008-01-01

333

Forces between Dislocations due to Dislocation Core Fields  

Energy Technology Data Exchange (ETDEWEB)

Atomistic dislocation models were used to determine the properties of dislocation core fields in Al using an EAM potential. Equilibrium atom configurations were compared with initial configurations displaced according to the Volterra field to determine core displacement fields for edge, screw, and mixed (60? and 30?) geometries. The core field was approximated by a line force defect field lying parallel to the dislocation line direction. Best-fit parameters for the core fields were obtained in terms of the anisotropic elastic solution for a line force defect, from which the line force strengths and the origin of the line forces were determined. The line force stress fields were then used to compute the forces between dislocations for several dislocation configurations. The Volterra field dominates beyond 50b but core field forces modify the equilibrium angle of edge dislocation dipoles and determine the force between otherwise non-interacting edge and screw dislocations at distances out to 50b compared to the Volterra-only forces.

Henager, Charles H.; Hoagland, Richard G.

2001-11-21

334

Congenital syphilis  

Energy Technology Data Exchange (ETDEWEB)

In recent years, marked increase in incidence of congenital syphilis has occurred throughout the world due to changes in social norms and development of penicillin-resistant strains. Early diagnosis plays an important role in congenital syphilis as the clinical manifestations may simulate many other conditions in the paediatric age group. The authors analyzed 52 cases of congenital syphilis admitted to the department of paediatrics, Chosun University Hospital, clinically and radiologically. Among them, 18 cases were born in this hospital and 34 cases were admitted from OPD, during the period of 8 years from January, 1975 to December, 1982. The results obtained were as follows; 1. In 28 of 34 cases (82%), the first clinical manifestations were below the age of 3 months. 2. Among the 52 cases, a male predominance was observed with a male to female ratio of 2 : 1. 3. The serologic test (VDRL) of the 52 studied cases showed reactive response in 49 cases (94%), and that of syphilitic mothers except 6 cases, reactive in all studied cases. 4. The major manifestations of the 52 cases were bone tenderness (12%) and swelling of the joints (7%) in skeletal system, hepatosplenomegaly (79%) and skin lesions (73%) in extraskeletal one. 5. The radiological skeletal changes were detected in 45 of 52 cases (87%), and the commonest findings were detected in 45 of 52 cases (87%), and the commonest findings were metaphysitis (83%) and periostitis (81%). The most characteristic type of metaphysitis were transverse trophic line (74%) and zone of rarefaction (65%). 6. The commonest bones to be affected were growing metaphyses of the long bones, particulary about the wrist and the knee. The order of frequency were radius (80%), uina (80%), tibia (77%), femur (69%) and humerus (40%)

Lee, Sang Wook; Kim, Kyung Soo; Hur, Don [Chosun University College of Medicine, Kwangju (Korea, Republic of)

1983-12-15

335

Congenital epulis  

Directory of Open Access Journals (Sweden)

Full Text Available Congenital epulis of the newborn is a very rare and unique tumor first described in 1871 by Neuman. It has a female predilection. It is a tumor with no tendency to recur after excision. The histogenesis of the lesion is unknown, but it is believed to be of mesenchymal origin. We report a 2-day-old female with tumor mass on the anterior mandibular alveolar ridge, which demonstrated immunoreactivity for vimentin, S-100 and neuron-specific enolase; thus, suggesting a similar histogenesis with granular cell tumor.

Adeyemi Bukola; Oluwasola Abideen; Adisa Akinyele

2010-01-01

336

Disassociation at the head-trunnion interface: an unseen complication of modular hip hemiarthroplasty.  

UK PubMed Central (United Kingdom)

A woman in her mid-90s underwent a left uncemented bipolar hemiarthroplasty for an intracapsular femoral neck fracture. Postoperative radiographs at 48h showed a disassociation of the left femoral prosthesis at the head-trunnion interface, with the bipolar head remaining in the acetabulum. There was no preceding trauma and the patient had mobilised postoperatively. The hip was revised to a monopolar head, and the patient's hip was protected postoperatively in a brace limiting flexion and external rotation. At 30 days following revision she was mobilising pain-free with a stable hip. Disassociation at the head-trunnion interface has never been reported in hip hemiarthroplasty, and is only described in relation to primary or revision total hip replacements (THR) following dislocation or trauma to the THR. This demonstrates a potential complication of modular prostheses for trauma.

Moores TS; Blackwell JR; Chatterton BD; Eisenstein N

2013-01-01

337

Unipolar versus bipolar Exeter hip hemiarthroplasty: a prospective cohort study on 830 consecutive hips in patients with femoral neck fractures.  

UK PubMed Central (United Kingdom)

BACKGROUND: Hip replacement using a hemiarthroplasty (HA) is a common surgical procedure in elderly patients with fractures of the femoral neck. Data from the Swedish Hip Arthroplasty Register suggest that there is a higher risk for revision surgery with the bipolar HA compared with the unipolar HA. PURPOSE: In this study we analysed the reoperation and the dislocation rates for Exeter HAs in patients with a displaced femoral neck fracture, comparing the unipolar and bipolar prosthetic designs. Additionally, we compared the outcome for HAs performed as a primary intervention with those performed secondary to failed internal fixation. METHODS: We studied 830 consecutive Exeter HAs (427 unipolar and 403 bipolar) performed either as a primary operation for a displaced fracture of the femoral neck or as a secondary procedure after failed internal fixation of a fracture of the femoral neck. Cox regression analyses were performed to evaluate factors associated with reoperation and prosthetic dislocation. Age, gender, the surgeon's experience, indication for surgery (primary or secondary) and type of HA (unipolar or bipolar) were tested as independent variables in the model. RESULTS: The prosthetic design (uni- or bipolar) had no influence on the risk for reoperation or dislocation, nor had the age, gender or the surgeon's experience. The secondary HAs were associated with a significantly increased risk for reoperation (HR 2.6, CI 1.5-4.5) or dislocation (HR 3.3, CI 1.4-7.3) compared to the primary HAs. We found no difference in the risk for reoperation or dislocation when comparing Exeter unipolar and bipolar HAs, but special attention is called for to reduce the risk of prosthesis dislocation and reoperation after a secondary HA.

Enocson A; Hedbeck CJ; Törnkvist H; Tidermark J; Lapidus LJ

2012-04-01

338

Galeazzi fractures and dislocations.  

UK PubMed Central (United Kingdom)

In 1934, fractures of the middle and distal third of the radius associated with instability of the distal radial ulnar joint (DRUJ) were described by Galeazzi. This type of lesion is characterized by its unstable nature and the need for open reduction and internal fixation to achieve a satisfactory functional outcome. A high index of suspicion should be maintained by the surgeon, and a thorough examination for instability of the DRUJ must be conducted. The marked instability of this fracture-dislocation complex is further enhanced by the disruption of the triangular fibrocartilage complex, either with or without ulna styloid fracture. Treatment in adults is surgical, and both bone and soft tissue injuries should be addressed.

Giannoulis FS; Sotereanos DG

2007-05-01

339

[Unstable shoulder dislocation].  

UK PubMed Central (United Kingdom)

Shoulder dislocations are a frequent event and the severity is often underestimated. A thorough clinical investigation and adapted imaging diagnostics are able to detect age-dependent injury patterns. A biphasic conservative treatment keeping the arm in a neutral to mild external rotation for 3 weeks has proven to be most effective and should be followed by an intensive physiotherapy. Nevertheless, conservative treatment protocols show unacceptable recurrence rates particularly in young men active in sport, therefore, surgical stabilisation is recommended. In the past open procedures were accepted as the gold standard, but today arthroscopic Bankart repair using suture anchors shows comparable recurrence rates. However, the clinical outcome with respect to the shoulder function is much better without compromising the subscapularis muscle.

Jaeger M; Izadpanah K; Maier D; Südkamp NP

2009-07-01

340

Hip fracture surgery  

Science.gov (United States)

... neck fracture repair; Trochanteric fracture repair; Hip pinning surgery ... You may receive general anesthesia before this surgery. This means ... spinal anesthesia. With this kind of anesthesia, medicine is ...

 
 
 
 
341

Congenital tuberculosis.  

UK PubMed Central (United Kingdom)

This is a retrospective study of congenital tuberculosis in Queen Sirikit National Institute of Child Health from 1979 to 1998. There were 9 patients with a mean birth weight of 2,500 grams (range 1,800-3,300). The onset of symptoms and age of diagnosis ranged from 7 to 42 (mean, 21) days and 14 to 75 (mean, 54) days after birth, respectively. The presenting signs and symptoms were fever (100%), poor feeding (100%), irritability (100%), failure to gain weight (100%), hepatomegaly (100%), splenomegaly (77.8%), cough (88.9%), respiratory distress (66.7%) and abdominal distension (77.8%). The tuberculin skin test reaction with > or = 10 mm induration was found in 2 of 8 patients. Their abnormal chest radiographs revealed bronchopneumonia 66.7 per cent, miliary pattern 33.3 per cent and multiple cystic lesion 11.1 per cent. The bacteriological study from gastric aspirate content for acid-fast bacilli (AFB) staining and culture were positive in 62.5 and 71.4 per cent respectively. Fatality rate was 33.3 per cent with no sequele found in the survivors. Congenital tuberculosis is a rare entity and difficult to give an early diagnosis. There should be a high index of suspicion for tuberculosis in those who had pneumonia and were unresponsive to aggressive antibiotics or had unexplained etiology.

Chotpitayasunondh T; Sangtawesin V

2003-08-01

342

Formation of a large rice body-containing cyst following total hip arthroplasty  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background There are several well-described causes of a painful mass following total hip arthroplasty including polyethylene and metal wear debris, infection, expanding hematoma, dislocation, and synovial cysts. In addition to causing pain, these lesions, when large enough, may cause neurologic and vascular compromise. Rapid growth of the mass may clinically and radiographically resemble a sarcoma. Here, we report a case of a large painful hip mass which developed after total hip arthroplasty. The well-circumscribed mass was overlying and extending into the hip joint containing thousands of highly organized fibrin-containing “rice bodies”. To our knowledge, this is the first report of a large, highly organized (rice-body-containing) cyst complicating total hip arthroplasty. Case presentation A 55-year old Caucasian woman developed a large, slowly enlarging, painful hip mass 2 1/2?years after primary total hip arthroplasty. Clinically and radiographically, the lesion resembled a soft tissue sarcoma. Surgical removal identified a well-circumscribed mass extending into the hip joint containing thousands of highly organized fibrin-containing “rice bodies”. Conclusion Identification and excision of this “pseudotumor” following hip arthroplasty is important for obtaining a definitive diagnosis, ruling out malignancy or infection and relieving any potential compression on surrounding neurovascular structures.

Issack Paul S

2012-01-01

343

Moving Dislocations in Disordered Alloys.  

Energy Technology Data Exchange (ETDEWEB)

Using atomistic simulations of dislocation motion in Ni and Ni-Au alloys we report a detailed study of the mobility function as a function of stress, temperature and alloy composition. We analyze the results in terms of analytic models of phonon radiation and their selection rules for phonon excitation. We find a remarkable agreement between the location of the cusps in the {sigma}-v relation and the velocity of waves propagating in the direction of dislocation motion. We identify and characterize three regimes of dissipation whose boundaries are essentially determined by the direction of motion of the dislocation, rather than by its screw or edge character.

Marian, J; Caro, A

2006-11-18

344

Case report: Painless chronic liner dissociation of a total hip arthroplasty.  

UK PubMed Central (United Kingdom)

BACKGROUND: Dislocation or liner dissociation of a total hip prosthesis usually results in pain and discomfort. Although several reports describe chronic dislocation and its treatment, chronic liner dissociation is an unreported complication. CASE DESCRIPTION: We report an unrecognized dissociation and displacement of the liner of a total hip prosthesis after revision THA. The patient had virtually no pain or functional restrictions. The patient's only complaint was pain on the contralateral side, associated with a leg-length discrepancy. Since the patient had no complaints relative to the liner dissociation we elected not to pursue further treatment. The contralateral pain was treated successfully with a shoe lift. LITERATURE REVIEW: Chronic dislocation of a THA is a rare complication and we found reports of only seven cases in the literature. We found no reports of chronic liner dissociation. CLINICAL RELEVANCE: Orthopaedic surgeons should be aware of the possibility of this rare complication. Our case and the literature suggest treatment can be nonsurgical or surgical.

Nellensteijn JM; Nellensteijn DR; De Jong T

2013-06-01

345

Kinetic Monte Carlo simulation of dislocation dynamics  

Energy Technology Data Exchange (ETDEWEB)

A kinetic Monte Carlo simulation of dislocation motion is introduced. The dislocations are assumed to be composed of pure edge and screw segments only, and are assumed to be confined to a fixed lattice. The stress and temperature dependence of the dislocation velocity is studied. It is also noted that the simulated dislocations display kinetic roughening.

Lin, K.; Chrzan, D.C.

1999-07-01

346

Total hip arthroplasty after failed internal fixation of proximal femoral fractures.  

UK PubMed Central (United Kingdom)

Between February 1987 and October 2008, we performed 102 total hip arthroplasties (THAs) after failed internal fixation of a prior hip fracture. There were 39 intertrochanteric fractures and 63 femoral neck fractures. Etiology of failure included 35 cases of osteonecrosis, 32 cases of arthritis, 25 cases of early failure of fixation, and 10 cases of nonunion. There were 12 patients who had early surgical complications related to the procedure (11.8%, 12/102). These included 5 patients who had dislocations (4.9%), 4 periprosthetic fractures (3.9%), 2 hematomas (2.0%), and 1 infection (1%). Of these 102 THAs, 50 were available for at least 2 years of follow-up (mean, 3.2 years). At a minimum 2-year follow-up, THA after failed internal fixation of hip fracture in these patients was clinically successful with an elevated risk of periprosthetic fracture and dislocation.

Archibeck MJ; Carothers JT; Tripuraneni KR; White RE Jr

2013-01-01

347

Revision total hip arthroplasty using an alumina-on-alumina bearing surface in patients with osteolysis.  

UK PubMed Central (United Kingdom)

We evaluated the outcomes of 64 consecutive revision total hip arthroplasties with an alumina-on-alumina bearing surface in 61 patients with osteolysis. No implants had been rerevised nor was osteolysis detected at a mean of 9.8 years (range, 7.0-13.1 years) postoperatively. There was 1 case of stem loosening but no cup loosening or alumina bearing fractures. Two surgical procedures were performed for an infection in 1 patient. Three dislocations occurred in 3 hips; all were treated with closed reduction and abduction bracing for 3 months. No further dislocations occurred. With any reoperation or radiographic evidence of osteolysis or loosening as the end point, the 7-year survival rate was 96.9% (95% confidence interval, 90.8%-100%). The alumina-on-alumina bearing surfaces used for revision total hip arthroplasty in patients with osteolysis were found to produce encouraging clinical results and implant survival rates at a minimum of 7 years postoperatively.

Yoo JJ; Yoon PW; Lee YK; Koo KH; Yoon KS; Kim HJ

2013-01-01

348

Can vacancies lubricate dislocation motion in aluminum?  

CERN Document Server

The interaction of vacancy with dislocations in Al is studied using the Semidiscrete Variational Peierls-Nabarro model with ab initio determined gamma surface. For the first time, we confirm theoretically the so-called vacancy lubrication effect on dislocation motion in Al, a discovery that can settle a long-standing controversy in dislocation theory for fcc metals. We provide insights on the lubrication effect by exploring the connection between dislocation mobility and its core width. We predict an increased dislocation splitting in the presence of vacancy. We find that on average there is a weak repulsion between vacancies and dislocations which is independent of dislocation character.

Lu, G; Lu, Gang; Kaxiras, Efthimios

2002-01-01

349

Isolated sciatic nerve entrapment by ectopic bone after femoral head fracture-dislocation.  

UK PubMed Central (United Kingdom)

Although posttraumatic pelvic heterotopic ossification (HO) after hip fracture dislocation is well established, and nerve encasement by HO may occur, the development of neurologic deficit is rare. A thorough history and adequate clinical suspicion are imperative in the workup of affected patients. Computed tomography and magnetic resonance imaging provide good visualization and assist in surgical planning. If symptoms persist and are recalcitrant to conservative management, surgical intervention with HO excision and nerve neurolysis can be performed with success.

Anakwenze OA; Kancherla V; Major NM; Lee GC

2013-06-01

350

Isolated sciatic nerve entrapment by ectopic bone after femoral head fracture-dislocation.  

Science.gov (United States)

Although posttraumatic pelvic heterotopic ossification (HO) after hip fracture dislocation is well established, and nerve encasement by HO may occur, the development of neurologic deficit is rare. A thorough history and adequate clinical suspicion are imperative in the workup of affected patients. Computed tomography and magnetic resonance imaging provide good visualization and assist in surgical planning. If symptoms persist and are recalcitrant to conservative management, surgical intervention with HO excision and nerve neurolysis can be performed with success. PMID:23805422

Anakwenze, Oke A; Kancherla, Vamsi; Major, Nancy M; Lee, Gwo-Chin

2013-06-01

351

Intrapelvic dislocation of the head of femur through the obturator foramen associated with ipsilateral fracture femur.  

UK PubMed Central (United Kingdom)

We describe a case of traumatic anterior dislocation of the hip in a 14-year-old boy with associated intrapelvic displacement of the femoral head and ipsilateral fractures of the shaft of the femur and greater trochanter. There was a delay in presentation of eight days. At operation the femoral head was reduced into the acetabulum after enlarging the obturator foramen by performing an osteotomy of the superior pubic ramus.

Farag AW; Shohayeb KA

2003-09-01

352

Intrapelvic dislocation of the head of femur through the obturator foramen associated with ipsilateral fracture femur.  

Science.gov (United States)

We describe a case of traumatic anterior dislocation of the hip in a 14-year-old boy with associated intrapelvic displacement of the femoral head and ipsilateral fractures of the shaft of the femur and greater trochanter. There was a delay in presentation of eight days. At operation the femoral head was reduced into the acetabulum after enlarging the obturator foramen by performing an osteotomy of the superior pubic ramus. PMID:14516047

Farag, A W; Shohayeb, K A

2003-09-01

353

Hip Replacement - Physical Therapy  

Medline Plus

Full Text Available X-Plain Hip Replacement – Physical Therapy Reference Summary Introduction Hip replacement surgery is a very successful and safe ... 1995-2010, The Patient Education Institute, Inc. www.X-Plain.com pt030105 Last reviewed: 11/10/2010 1 ...

354

Hip Revision Surgery  

Medline Plus

Full Text Available ... year or two later, she underwent a primary hip replacement. She then developed problems with that, the details ... we're probably doing better things with revision hip replacements than we've made bigger improvements in that ...

355

Dislocation dynamics and bacterial growth  

Science.gov (United States)

Recent experiments have revealed remarkable phenomena in the growth mechanisms of rod-shaped bacteria: proteins associated with the cell wall growth move at constant velocity in circles oriented approximately along the cell circumference (Garner et al., Science 2011, Dom'inguez-Escobar et al., Science 2011, Deng et al., PNAS 2011). We view these dislocations in the partially ordered peptidoglycan structure, and study theoretically the dynamics of these interacting dislocations on the surface of a cylinder. The physics of the nucleation of these dislocations and the resulting dynamics within the model show surprising effects arising from the cylindrical geometry, which are predicted to have important implications on the growth mechanism. We also discuss how long range elastic interactions affect the dynamics of the fraction of active dislocations in the environment.

Amir, Ariel; Nelson, David

2012-02-01

356

Congenital amusia.  

UK PubMed Central (United Kingdom)

For most people, music, like language, is acquired effortlessly in early life. But a few percent of the population have lifelong difficulties in the perception and production of music. In this chapter we discuss psycho-acoustic and behavioral studies that have attempted to delineate the nature of the auditory perceptual deficits in this group and consider whether these difficulties extend outside the musical domain. Finally, we review structural imaging studies in this group which point to subtle anomalies in temporal and frontal areas. We suggest that amusia can be considered a disorder of neural development, which has relatively specific consequences at the behavioral level. Studies of congenital amusia provide a unique window on the neurocognitive architecture of music processing.

Williamson VJ; Stewart L

2013-01-01

357

HRTEM studies of dislocations in cubic BN  

Energy Technology Data Exchange (ETDEWEB)

The atomic structure of dislocations in cubic boron nitride has been investigated by high resolution transmission electron microscopy. Most of the perfect dislocations, screw and 60 edge, are dissociated. A 60 dislocation which was undissociated has been analysed. Computer simulation is performed in an attempt to characterise the core structure. Twinning dislocations and dislocations resulting from the intersection of stacking faults are also revealed. (copyright 2004 WILEY-VCH Verlag GmbH and Co. KGaA, Weinheim) (orig.)

Nistor, L.C. [National Institute for Materials Physics, P.O. Box MG-7 Magurele, 077125 Bucharest (Romania); Tendeloo, G. van [University of Antwerp, EMAT, Groenenborgerlaan 171, 2020 Antwerp (Belgium); Dinca, G. [Dacia Synthetic Diamond Factory, Timisoara av. 5, P.O. Box 58-52, 077350 Bucharest (Romania)

2004-09-01

358

Contiguous bifacet cervical fracture dislocations  

Scientific Electronic Library Online (English)

Full Text Available Abstract in english Bifacet dislocations of the cervical spine are severe debilitating injuries often associated with complete cord injury. Contiguous bilateral facet dislocations are extremely rare and, to the best of our knowledge, have only been described once before. We present a patient who was involved in a road traffic accident. Pre-operative radiographs suggested contiguous bifacet injury and this was confirmed intra-operatively. This should alert physicians to the possibility of contiguous injuries to the cervical spine.

Kigera, JWM; Nyati, M

2010-01-01

359

The other hip in unilateral hip dysplasia  

DEFF Research Database (Denmark)

We reviewed transverse pelvic computed tomography scans of 197 consecutively referred adult patients with hip pain thought to be secondary to developmental dysplasia. A center-edge angle of 20 degrees or less was considered the upper normal value. Four groups were identified: 69 patients with apparently unilateral right developmental dysplasia (left hip center-edge angles greater than 20 degrees), 26 patients with apparently unilateral left developmental dysplasia (right hip center-edge angles greater than 20 degrees), 68 patients with bilateral developmental dysplasia, and 34 patients with bilateral borderline developmental dysplasia (bilateral center-edge angles less than or equal to 25 degrees). The pelvic computed tomography scans were compared with computed tomography scans of 41 control subjects with healthy hips. The joint anatomy of patients with developmental dysplasia differed from that of control subjects in almost all aspects. Acetabular anteversion was larger in control subjects compared with patients with developmental dysplasia. We found inverse relationships between femoral anteversion and the anterior acetabular sector angle and coronal and sagittal center-edge angles in dysplastic hips, and also between femoral neck-shaft angles and the anterior acetabular sector angle. There was an inverse relationship between reduced anterior support developmental dysplasia in which plain radiographs suggested unilateral dysplastic abnormality only, computed tomography scans revealed both hips to be abnormal. The data suggest that patients referred with seemingly unilateral developmental dysplasia also are at risk of having contralateral dysplastic malformation. Level of Evidence: Diagnostic study, Level II (development of diagnostic criteria on consecutive patients [with universally applied reference "gold" standard]). See the Guidelines for Authors for a complete description of levels of evidence.

Jacobsen, Steffen; RØmer, L

2006-01-01

360

Primary abductor hip contracture as diagnostic, prognostic and therapeutic problem in child hip pathology  

Directory of Open Access Journals (Sweden)

Full Text Available Coxa obliqua represents a special functional entity in the pathology of the child hip. Authors have confirmed the results of S.L. Weissman and B. Strinovic which claimed that the abductor contracture of the hip was a primary congenital condition that developed as a result of intrauterine malposition, leading later to the contralateral adductor contracture. Critical period for the development of complications was between 6 and 8 month after birth, adductor contracture might keep persisting together with the development of acetabular dysplasia, and later on with ipsilateral subluxation. This malformation has usually been diagnosed within 3 and 6 months of age. It could be connected with some other signs of malposition, such as plagiocephaly, torticollis or infantile thoracic C scoliosis. For the diagnosis of coxa obliqua, the examination of hips in the prone position was very important and the ultrasonic and radiological examinations were crucial. The applied treatment used to be exclusively physical rehabilitation. Wide diapering has been contraindicated. In this study, we included 2,500 newborns, 1,300 boys and 1,200 girls (5,000 hips). In 22 cases of coxa obliqua (10‰), the excellent results were obtained in 96% of cases. In two unsuccessfully treated cases, a contralateral dysplasia developed, and in one untreated, subluxation. The authors are advocating a systematic and early detection and treatment of the primary coxa obliqua. .

Paji? Miloš; Vukašinovi? Zoran

2007-01-01

 
 
 
 
361

Dislocation sources in ordered intermetallics  

Energy Technology Data Exchange (ETDEWEB)

An overview on the current understanding of dislocation sources and multiplication mechanisms is made for ordered intermetallic alloys of the L1{sub 2}, B2, and D0{sub 19} structures. In L1{sub 2} alloys, a large disparity of edge/screw segments in their relative mobility reduces the efficiency of a Frank-Read Type multiplication mechanism. In Fe-40%Al of the B2 structure, a variety of dislocation sources are available for <111> slip, including ones resulting from condensation of thermal vacancies. In NiAl with the relatively high APB energy, <100> dislocations may result from the dislocation decomposition reactions, the prismatic punching out from inclusion particles, and/or steps and coated layers of the surface. Internal interfaces often provide sites for dislocation multiplication, e.g., grain boundaries, sub-boundaries in Ni{sub 3}Ga, NiAl and Ti{sub 3}Al, and antiphase domain boundaries in Ti{sub 3}Al. As for the crack tip as a dislocation source, extended SISFs trailed by super-Shockley partials emanating form the cracks in Ni{sub 3}Al and Co{sub 3}Ti are discussed in view of a possible toughening mechanism.

Yoo, M.H. [Oak Ridge National Lab., TN (United States). Metals and Ceramics Div.; Appel, F.; Wagner, R. [GKSS-Research Centre, Geesthacht (Germany). Inst. for Materials Research; Mecking, H. [Technical Univ. Hamburg-Harburg, Hamburg (Germany)

1996-09-01

362

Congenital Contractural Arachnodactyly  

UK PubMed Central (United Kingdom)

DISEASE CHARACTERISTICS: Congenital contractural arachnodactyly (CCA) is characterized by a Marfan-like appearance (tall, slender habitus in which arm span exceeds height) and long, slender fingers and toes (arachnodactyly). Most affected individuals have “crumpled” ears that present as a folded upper helix of the external ear and most have contractures of major joints (knees and ankles) at birth. The proximal interphalangeal joints also have flexion contractures (i.e., camptodactyly), as do the toes. Hip contractures, adducted thumbs, and club foot may occur. The majority of affected individuals have muscular hypoplasia. Contractures usually improve with time. Kyphosis/scoliosis is present in about half of all affected individuals. It begins as early as infancy, is progressive, and causes the greatest morbidity in CCA. Dilatation of the aorta is occasionally present. Infants have been observed with a severe/lethal form characterized by multiple cardiovascular and gastrointestinal anomalies in addition to the typical skeletal findings. DIAGNOSIS/TESTING: CCA is diagnosed on the basis of clinical findings. Mutations in fFBN2 (encoding the extracellular matrix microfibril fibrillin 2) are causative. MANAGEMENT: Treatment of manifestations: Physical therapy for joint contractures beginning in childhood to increase joint mobility and ameliorate the effects of muscle hypoplasia (usually calf muscles); surgical release of contractures as needed; bracing and/or surgical correction of kyphoscoliosis; standard management of aortic root dilation. Surveillance: Echocardiogram every two years until absence of aortic involvement is evident; at least annual physical examination for evidence of kyphosis/scoliosis. GENETIC COUNSELING: Congenital contractural arachnodactyly is inherited in an autosomal dominant manner. Many individuals with CCA have an affected parent, although a proband may have the disorder as the result of a de novo gene mutation. The risk to the sibs of the proband depends on the status of the parents. If the parent of a proband has clinical features of CCA, the risk to the sibs is 50%. Germline mosaicism has been reported. Offspring of affected individuals have a 50% chance of inheriting the abnormal FBN2 allele. Prenatal testing is possible if the disease-causing mutation has been identified in an affected family member.

Godfrey M

363

Metal-on-metal hip resurfacings. A radiological perspective  

Energy Technology Data Exchange (ETDEWEB)

It is important to be aware of the various complications related to resurfacing arthroplasty of the hip (RSA) and the spectrum of findings that may be encountered on imaging. The bone conserving metal-on-metal (MOM) hip resurfacing has become increasingly popular over the last ten years, especially in young and active patients. Initial reports have been encouraging, but long-term outcome is still unknown. Early post operative complications are rare and have been well documented in the literature. Medium and long term complications are less well understood. A rare but important problem seen at this stage is the appearance of a cystic or solid periarticular reactive mass, which occurs predominately in women and usually affects both hips when seen in patients with bilateral RSAs. The following imaging findings are illustrated and their significance discussed; Uncomplicated hip resurfacing arthroplasty, radiolucency around the femoral peg, femoral neck fracture, loosening and infection, suboptimal component position, femoral notching, dislocation, heterotopic ossification, femoral neck thinning and reactive masses. The radiologist should be aware of the normal radiographic appearances and the variety of complications that may occur following RSA and should recommend ultrasound or MRI in patients with an unexplained symptomatic hip and normal radiographs. (orig.)

Chen, Zhongbo [University of Oxford, Medical School, Oxford (United Kingdom); Pandit, Hemant; Taylor, Adrian; Gill, Harinderjit; Murray, David [University of Oxford, Nuffield Department of Orthopaedic Surgery, Oxford (United Kingdom); Ostlere, Simon [Nuffield Orthopaedic Centre, Department of Radiology, Oxford (United Kingdom)

2011-03-15

364

The Locking Compression Paediatric Hip Plate: technical guide and critical analysis.  

UK PubMed Central (United Kingdom)

PURPOSE: Osteotomies of the proximal femur and stable fixation of displaced femoral neck fractures are demanding operations. An LCP Paediatric Hip Plate was developed to make these operations safer and less demanding. The article focuses on the surgical technique and critically analyses the device. METHODS: Between 2006 and 2008, 30 hips in 22 patients underwent surgery. Patients' demographics, perioperative details, postoperative outcome and complications were retrospectively collected and analysed. RESULTS: Patients' diagnoses included persistent congenital hip dysplasia (n = 4), neuropathic hip dysplasia (n = 9), idiopathic ante/retroversion (n = 8), femoral neck fracture (n = 3), Perthes' disease (n = 2), deformity after slipped capital femoral epiphysis (SCFE), congenital femoral neck pseudarthrosis, deformity after pelvic tumour resection and malunion following proximal femoral fracture (one each). In 21 of 22 patients, the postoperative radiographs showed corrections as planned. Two cases had to be revised for screw loosening. Intraoperative handling using the plate was excellent in all cases. CONCLUSIONS: In our case series of 30 hip operations, the LCP Paediatric Hip Plate was shown to be safe and applicable in the clinical setting with excellent results and a low complication rate. We consider that the LCP Paediatric Hip Plate is a valuable device for correction of pathological conditions of the proximal femur and for fixation of displaced femoral neck fractures in children. Larger studies should be carried out to better quantify the risk of clinically relevant complications.

Joeris A; Audigé L; Ziebarth K; Slongo T

2012-11-01

365

Total hip arthroplasty  

Directory of Open Access Journals (Sweden)

Full Text Available Total hip arthroplasty is most common reconstructive hip procedure in adults. In this surgery we replace some parts of the upper femur and acetabulum with biocompatible materials. The main goal of this surgery is to eliminate pain and regain full extent of joint motion, maintaining hip stability. Surgical technique, biomaterials, design of the prosthesis and fixation techniques have evolved with time adjusting to each other. After total hip arthroplasty patients’ quality of life should be improved. There are many various postoperative complications. Some of them are fatal, and some are minor, which may become manifested years after surgery. Each next surgical procedure following previous hip surgery is associated with considerably lower chances to be successful. Therefore, in primary total hip arthroplasty, preoperative evaluation and preparation of patients are essential. Every orthopaedic surgeon needs to improve already adopted surgical skills applying them with precision and without compromise, with the main goal to achieve long-term durability of the selected implant. The number of total hip arthroplasties will also increase in future, and newer and higher quality materials will be used.

Slavkovi? Nemanja; Vukašinovi? Zoran; Baš?arevi? Zoran; Vukomanovi? Boris

2012-01-01

366

[Total hip arthroplasty].  

UK PubMed Central (United Kingdom)

Total hip arthroplasty is most common reconstructive hip procedure in adults. In this surgery we replace some parts of the upper femur and acetabulum with biocompatible materials. The main goal of this surgery is to eliminate pain and regain full extent of joint motion, maintaining hip stability. Surgical technique, biomaterials, design of the prosthesis and fixation techniques have evolved with time adjusting to each other. After total hip arthroplasty patients' quality of life should be improved. There are many various postoperative complications. Some of them are fatal, and some are minor, which may become manifested years after surgery. Each next surgical procedure following previous hip surgery is associated with considerably lower chances to be successful. Therefore, in primary total hip arthroplasty, preoperative evaluation and preparation of patients are essential. Every orthopaedic surgeon needs to improve already adopted surgical skills applying them with precision and without compromise, with the main goal to achieve long-term durability of the selected implant. The number of total hip arthroplasties will also increase in future, and newer and higher quality materials will be used.

Slavkovi? N; Vukašinovi? Z; Baš?arevi? Z; Vukmanovi? B

2012-05-01

367

Congenital hypothyroidism  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Congenital hypothyroidism (CH) occurs in approximately 1:2,000 to 1:4,000 newborns. The clinical manifestations are often subtle or not present at birth. This likely is due to trans-placental passage of some maternal thyroid hormone, while many infants have some thyroid production of their own. Common symptoms include decreased activity and increased sleep, feeding difficulty, constipation, and prolonged jaundice. On examination, common signs include myxedematous facies, large fontanels, macroglossia, a distended abdomen with umbilical hernia, and hypotonia. CH is classified into permanent and transient forms, which in turn can be divided into primary, secondary, or peripheral etiologies. Thyroid dysgenesis accounts for 85% of permanent, primary CH, while inborn errors of thyroid hormone biosynthesis (dyshormonogeneses) account for 10-15% of cases. Secondary or central CH may occur with isolated TSH deficiency, but more commonly it is associated with congenital hypopitiutarism. Transient CH most commonly occurs in preterm infants born in areas of endemic iodine deficiency. In countries with newborn screening programs in place, infants with CH are diagnosed after detection by screening tests. The diagnosis should be confirmed by finding an elevated serum TSH and low T4 or free T4 level. Other diagnostic tests, such as thyroid radionuclide uptake and scan, thyroid sonography, or serum thyroglobulin determination may help pinpoint the underlying etiology, although treatment may be started without these tests. Levothyroxine is the treatment of choice; the recommended starting dose is 10 to 15 mcg/kg/day. The immediate goals of treatment are to rapidly raise the serum T4 above 130 nmol/L (10 ug/dL) and normalize serum TSH levels. Frequent laboratory monitoring in infancy is essential to ensure optimal neurocognitive outcome. Serum TSH and free T4 should be measured every 1-2 months in the first 6 months of life and every 3-4 months thereafter. In general, the prognosis of infants detected by screening and started on treatment early is excellent, with IQs similar to sibling or classmate controls. Studies show that a lower neurocognitive outcome may occur in those infants started at a later age (> 30 days of age), on lower l-thyroxine doses than currently recommended, and in those infants with more severe hypothyroidism.

Rastogi Maynika V; LaFranchi Stephen H

2010-01-01

368

Hip Replacement - Physical Therapy  

Medline Plus

Full Text Available ... moving possible. There are many muscle groups that help the leg move. The ileo-psoas muscle allows ... surgery. Using a high-rise toilet seat also helps prevent dislocation. Over time, as the muscles get ...

369

Socket location in total hip replacement. Preoperative computed tomography and computer simulation.  

Science.gov (United States)

For choosing the size and location of the acetabular component, we have developed a three-dimensional simulation system based on computerized tomography and a microcomputer. In 34 cases of coxarthrosis secondary to congenital dysplasia or dislocation, the system provided valuable preoperative information. PMID:3354315

Lida, H; Yamamuro, T; Okumura, H; Ueo, T; Kasai, R; Tada, K; Tsuji, T

1988-02-01

370

Transient osteoporosis of the hip.  

Directory of Open Access Journals (Sweden)

Full Text Available Transient osteoporosis of the hip is an uncommon cause of hip pain, mostly affecting healthy middle-aged men and also women in the third trimester of pregnancy. We present a case of transient osteoporosis of the hip in a 33-year-old non-pregnant female patient. This case highlights the importance of considering a diagnosis of transient osteoporosis of the hip in patients who present with hip pain.

McWalter Patricia; Hassan Ahmed

2009-01-01

371

The ScanHip total hip arthroplasty: radiographic assessment of 72 hips after 10 years.  

Digital Repository Infrastructure Vision for European Research (DRIVER)

We analyzed the radiographic and clinical outcome of the ScanHip total hip arthroplasty in 70 patients after 10 years. The Swedish National Hip Register, in which the end-point of the survival analysis is defined as revisions, reported a 10-year survival rate of 94% with the ScanHip, but in the pres...

Iwase, Toshiki; Wingstrand, Inga; Persson, Björn M; Kesteris, Uldis; Hasegawa, Yukiharu; Wingstrand, Hans

372

Anterior muscle sparing approach for total hip arthroplasty  

Directory of Open Access Journals (Sweden)

Full Text Available The purpose of this review is to examine the validity of positive claims regarding the direct anterior approach (DAA) with a fracture table for total hip arthroplasty. Recent literature regarding the DAA was searched and specific claims investigated including improved early outcomes, speed of recovery, component placement, dislocation rates, and complication rates. Recent literature is positive regarding the effects of total hip arthroplasty with the anterior approach. While the data is not definitive at present, patients receiving the anterior approach for total hip arthroplasty tend to recover more quickly and have improved early outcomes. Component placement with the anterior approach is more often in the “safe zone” than with other approaches. Dislocation rates tend to be less than 1% with the anterior approach. Complication rates vary widely in the published literature. A possible explanation is that the variance is due to surgeon and institutional experience with the anterior approach procedure. Concerns remain regarding the “learning curve” for both surgeons and institutions. In conclusion, it is not a matter of should this approach be used, but how should it be implemented.

Joseph T Moskal; Susan G Capps; John A Scanelli

2013-01-01

373

Anterior muscle sparing approach for total hip arthroplasty.  

UK PubMed Central (United Kingdom)

The purpose of this review is to examine the validity of positive claims regarding the direct anterior approach (DAA) with a fracture table for total hip arthroplasty. Recent literature regarding the DAA was searched and specific claims investigated including improved early outcomes, speed of recovery, component placement, dislocation rates, and complication rates. Recent literature is positive regarding the effects of total hip arthroplasty with the anterior approach. While the data is not definitive at present, patients receiving the anterior approach for total hip arthroplasty tend to recover more quickly and have improved early outcomes. Component placement with the anterior approach is more often in the "safe zone" than with other approaches. Dislocation rates tend to be less than 1% with the anterior approach. Complication rates vary widely in the published literature. A possible explanation is that the variance is due to surgeon and institutional experience with the anterior approach procedure. Concerns remain regarding the "learning curve" for both surgeons and institutions. In conclusion, it is not a matter of should this approach be used, but how should it be implemented.

Moskal JT; Capps SG; Scanelli JA

2013-01-01

374

Osteoarthritis of the Hip  

Science.gov (United States)

... Resources Copyright 2007 American Academy of Orthopaedic Surgeons Osteoarthritis of the Hip Like other joints that carry ... be at risk for "wear and tear" arthritis (osteoarthritis), the most common form of the disease. The ...

375

Taper Hip Prosthesis  

Medline Plus

Full Text Available ... Hip Prosthesis with Modular Neck Kinectiv® Technology March 12, 2009 7:00 PM EDT Welcome to this " ... size 6. My final templated size is a 12 -- 12.5. Therefore, we'll skip one rasp ...

376

Hip Replacement - Physical Therapy  

Medline Plus

Full Text Available ... summary reviews necessary steps that must be taken in order to get the most out of a ... the femur has a round shape, it moves in the hip socket. Unlike the knee joint, the ...

377

Hip Revision Surgery  

Medline Plus

Full Text Available ... of that rim there, probably some of the effects of the in vivo oxidation. Yeah, you can ... for you with regard to what type of effect, adverse or not, would a high hip center ...

378

Imaging of hip arthroplasty  

International Nuclear Information System (INIS)

[en] Hip arthroplasty has become a common and still increasing procedure for the treatment of osteoarthritis, advanced head necrosis, post-inflammatory arthritis or rheumatoid arthritis.Radiography is the most important imaging modality for monitoring the normal, asymptomatic hip arthroplasty. Radiographs are obtained at the end of a surgical treatment, to exclude complications like fracture or component misplacement. In the follow-up radiographs are used for the diagnosis of loosening and infection of the hip arthroplasty as well as soft tissue ossification. Together with the history and clinical information, the analysis of morphological findings allows to find the grade of loosening. MRI has been advocated in the diagnosis of infection, in particular in the localisation of soft tissue involvement.Imaging, especially by radiographs, is used for the evaluation of the normal and complicated follow-up of hip arthroplasty. (orig.)

2002-01-01

379

The pelvis and hips  

International Nuclear Information System (INIS)

Fractures of the pelvis and hips are often associated with significant morbidity and mortality. Complete evaluation of the complex anatomy and potential complications requires proper diagnostic techniques, including computed tomography and angiography, to determine the best approach to treatment.

1985-01-01

380

Hip Revision Surgery  

Medline Plus

Full Text Available ... careful about making sure we have an adequate range of motion for stability. It's not usual, for ... excellent stability of this hip with really great range of motion and the extremes of extension and ...

 
 
 
 
381

Hip Revision Surgery  

Medline Plus

Full Text Available ... fixed, and has really simplified and increased the margin of safety in some of the very demanding ... done or watched a lot of them. The margin of error for revision hip surgery is right. ...

382

Taper Hip Prosthesis  

Medline Plus

Full Text Available Zimmer M/L Taper Hip Prosthesis with Modular Neck Kinectiv® Technology March 12, 2009 7:00 PM EDT Welcome to this "OR Live" Webcast presentation brought to you by Zimmer. During ...

383

Arthroscopic Hip Labral Repair  

Science.gov (United States)

Labral tears in the hip may cause painful clicking or locking of the hip, reduced range of motion, and disruption to sports and daily activities. The acetabular labrum aids stabilization of the hip joint, particularly during hip motion. The fibrocartilaginous structure extends the acetabular rim and provides a suction seal around the femoroacetabular interface. Treatment options for labral tears include debridement, repair, and reconstruction. Repair of the labrum has been shown to have better results than debridement. Labral refixation is achieved with sutures anchored into the acetabular rim. The acetabular rim is trimmed either to correct pincer impingement or to provide a bleeding bed to improve healing. Labral repair has shown excellent short-term to midterm outcomes and allows patients to return to activities and sports. Arthroscopic rim trimming and labral refixation comprise an effective treatment for labral tears with an underlying diagnosis of femoroacetabular impingement and are supported by the peer-reviewed literature.

Philippon, Marc J.; Faucet, Scott C.; Briggs, Karen K.

2013-01-01

384

Taper Hip Prosthesis  

Medline Plus

Full Text Available ... choke header and the anterior superior at the spine of the right hip. And at this point ... on their side, placing both anterior superior iliac spines against that post, which then assures me that ...

385

Arthroscopic hip labral repair.  

UK PubMed Central (United Kingdom)

Labral tears in the hip may cause painful clicking or locking of the hip, reduced range of motion, and disruption to sports and daily activities. The acetabular labrum aids stabilization of the hip joint, particularly during hip motion. The fibrocartilaginous structure extends the acetabular rim and provides a suction seal around the femoroacetabular interface. Treatment options for labral tears include debridement, repair, and reconstruction. Repair of the labrum has been shown to have better results than debridement. Labral refixation is achieved with sutures anchored into the acetabular rim. The acetabular rim is trimmed either to correct pincer impingement or to provide a bleeding bed to improve healing. Labral repair has shown excellent short-term to midterm outcomes and allows patients to return to activities and sports. Arthroscopic rim trimming and labral refixation comprise an effective treatment for labral tears with an underlying diagnosis of femoroacetabular impingement and are supported by the peer-reviewed literature.

Philippon MJ; Faucet SC; Briggs KK

2013-05-01

386

Indications, cost and safety implications of traditional post-operative radiography following total hip replacement  

Energy Technology Data Exchange (ETDEWEB)

Purpose: As routine check radiographs obtained in the recovery room following total hip arthroplasty present issues of concern regarding quality, cost and safety of both staff and patient, we wished to determine the usefulness and indications for this investigation as a screening tool for post-operative dislocation. MethodsA 10-year retrospective analysis of all total hip replacements performed in a single Regional Orthopaedic Hospital, considering the total number of hip arthroplasties performed and the number of acute recovery room dislocations using theatre records and patient notes. We then randomly selected the recovery room and departmental radiographs of 100 patients and compared them with regard to the need for repeat radiographs and subsequent costs generated. ResultsRecovery room radiographs were not statistically superior to clinical assessment in the diagnosis of acute post-operative dislocations (P=0.7), and these were associated with increased costs because it was necessary to repeat poor quality films (P=0.008). The use of recovery room radiography was also therefore associated with significant safety implications for patients and staff. ConclusionsThe conclusion was that recovery room radiographs are neither a safe, effective nor economical method of screening for dislocation. Furthermore, they fail to provide reliable or reproducible information and expose patients and staff to extra radiation. It is recommended therefore that recovery room radiographs should only be obtained for clinical indications, with most routine post-operative radiography being performed in a standardised fashion in the radiology department.

Mulhall, K.J. E-mail: kjm@indigo.ie; Khan, Y.; Masterson, E.; Burke, T.E

2003-05-01

387

Indications, cost and safety implications of traditional post-operative radiography following total hip replacement  

International Nuclear Information System (INIS)

[en] Purpose: As routine check radiographs obtained in the recovery room following total hip arthroplasty present issues of concern regarding quality, cost and safety of both staff and patient, we wished to determine the usefulness and indications for this investigation as a screening tool for post-operative dislocation. MethodsA 10-year retrospective analysis of all total hip replacements performed in a single Regional Orthopaedic Hospital, considering the total number of hip arthroplasties performed and the number of acute recovery room dislocations using theatre records and patient notes. We then randomly selected the recovery room and departmental radiographs of 100 patients and compared them with regard to the need for repeat radiographs and subsequent costs generated. ResultsRecovery room radiographs were not statistically superior to clinical assessment in the diagnosis of acute post-operative dislocations (P=0.7), and these were associated with increased costs because it was necessary to repeat poor quality films (P=0.008). The use of recovery room radiography was also therefore associated with significant safety implications for patients and staff. ConclusionsThe conclusion was that recovery room radiographs are neither a safe, effective nor economical method of screening for dislocation. Furthermore, they fail to provide reliable or reproducible information and expose patients and staff to extra radiation. It is recommended therefore that recovery room radiographs should only be obtained for clinical indications, with most routine post-operative radiography being performed in a standardised fashion in the radiology department

2003-01-01

388

Hip arthroplasty for ochronosis  

International Nuclear Information System (INIS)

[en] Alkaptonuria is a metabolic disorder in which homogentisic acid oxidase is absent. Therefore, homogentisic acid accumulates in cartilage and connective tissues. We can diagnose ochronotic arthropathy, a manifestation of long standing alkaptonuria, through careful radiological, physical, and laboratory examination. In this report, we describe 4 cases of ochronotic arthropathy to which we applied cementless total hip prosthesis due to severe hip involvement. (author)

2005-01-01

389