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PubMed2004

Chiropractic management of patients with bilateral congenital hip dislocation with chronic low back and leg pain.

OBJECTIVE: To discuss conservative methods for treating patients with chronic low back and leg pain associated with the biomechanical and postural alterations related to bilateral congenital hip dislocation. CLINICAL FEATURES: This report describes the cases of 2 adult female subjects with bilateral congenital hip dislocation without acetabula formation who suffered from chronic low back and leg pain managed conservatively by chiropractic methods. The first subject is a 45-year-old woman with a 9-month history of right buttock pain and radiating right leg pain and paresthesia down to the first 2 toes, with a diagnosis of a herniated L4 intervertebral disk. The second subject is a 53-year-old woman who complained of chronic intermittent low back pain and constant unremitting pain on her right leg for the last 3 years. INTERVENTION AND OUTCOME: Chiropractic manipulation utilizing Logan Basic apex and double notch contacts, as well as sacroiliac manipulation on a drop table with a sacrum contact and with a posterior to anterior and superior to inferior (PA-SI) rocking thrust, together with a spinal stabilization exercise program, were used on these 2 patients. Both patients had significant clinical improvement, with reduction on the Visual Analogue Scale (VAS) of 67% and 84%, Oswestry Disability Index improvement of 73% and 81%, and an improvement on the Harris hip score of 71% and 44%, respectively. CONCLUSION: A conservative management approach, including specific chiropractic manipulation and a spinal stabilization exercise program, can help manage the treatment of adult patients with chronic low back and leg pain related to bilateral congenital dislocation of the hips.

Chronic Disease↗
PubMed1999

Treatment of congenital dislocated hip by arthroplasty with femoral shortening.

This was a retrospective study of 15 hips in 11 patients with complete congenital dislocation of the hip treated by total hip arthroplasty and femoral shortening with a subtrochanteric double chevron derotation osteotomy. The mean age at the time of surgery was 51 years (range, 21-74 years), and the mean followup was 5.5 years (range, 2-8.5 years). Functional evaluation using the modified Harris hip rating system showed an excellent result in five hips and a good result in seven hips (80% success rate). The location of the hip center was lowered by a mean of 8.3 cm (range, 5.7-10.4 cm). Leg length discrepancy in seven patients with unilateral involvement was reduced from a mean of 3.9 cm (range, 1.7-8.2 cm) before surgery to a mean of 1.4 cm at the latest followup (range, 0-4 cm). The Trendelenburg sign was assessed in 10 of 15 hips and was corrected from a positive preoperative status to a negative postoperative status in eight of these 10 hips. There were no cases of nonunion, dislocation, nerve palsy, or radiographic loosening. The only complications were a supracondylar fracture below the femoral component in a patient with severe osteoporosis 6 months after surgery and loosening of the cemented titanium metal backed acetabular component in the same patient 1.5 years after surgery. The current series showed that total hip arthroplasty in combination with a subtrochanteric double chevron derotation osteotomy has promising short to midterm results in the treatment of complete congenital dislocation of the hip in adults.

Adult↗
PubMed1977

The changing signs of congenital hip dislocation.

A total of 36 patients (42 hips) with frank congenital hip dislocation were studied. The initial clinical and x-ray signs were evaluated according to the age at which the patient was first seen and treatment started.

Age Factors↗
PubMed1978

Malignant hyperthermia and central core disease in a child with congenital dislocating hips.

We describe a development of a malignant hyperthermia (MH) syndrome, partially aborted by therapy, in a child with central core disease and congenital dislocating hips. Patients with central core disease appear to be more susceptible to MH; possibly those with elevated serum creatine phosphokinase levels, as in our patient, are especially susceptible. We review the clinical and pathologic aspects, possible pathogenesis, and treatment of the MH syndrome. An increased calcium level within the muscle fiber is suggested as the major cytodestructive factor, and that increase could be consequent to a plasmalemmal susceptibility to the provoking drugs hypothesized to be the basic defect in MH. Prevention of the full manifestations of MH is predicated on (1) a high index of suspicion in the search for history of anesthetic complications in the patient and his family, with or without evident neuromuscular disease, (2) recognition that there is a somewhat greater risk of MH developing in a patient who has certain "musculoskeletal" abnormalities or muscle weakness but that is not-except for central core disease-a classic clinicopathologically defined disease, (3) close monitoring of patients during anesthesia, and (4) if the syndrome develops, prompt therapeutic measures, including cessation of anesthesia.

Adult↗
PubMed1990

[Natural history of congenital hip dislocation during the first year of life].

It seems obvious that congenital hip dislocation is determined by perinatal factors that are all the more "pathogenic" that the baby presents laxity (female sex or family laxity of the joints) and the hip is less mature (hereditary factor?). In our population, at the time of birth less than one child out of 1000 presents a dislocated hip that can be reduced (typical standard Ortolani sign). One or two percent present unstable hips that stabilize spontaneously in most cases. This stabilization can be expedited by correct diapering in abduction or may be hindered by such practices as wrapping infants from birth with their legs stretched and adducted, strapping the baby to a cradle-board, or perhaps even by putting the child to bed on its side. Stabilization may even be hindered by spontaneous asymmetrical postures that maintain the hip of the concave side of the baby in adduction, as in the pelvic obliquity syndrome of the newborn. The remaining children have a so-called stable hip which presents a variable degree of laxity on clinical examination and a variable degree of maturity on ultrasonography. The observation of established congenital dislocations in children who have been followed since birth (and such cases escape the most meticulous screening) suggests that in some hips there is no clear-cut dividing line between instability and laxity. Hips either stabilize or evolve into a fixed dislocation within the first three months, whereas it is only during the fourth month that X-ray examination may confirm the normality of such at-risk hips. Nevertheless, at that age, normality criteria are not very accurate.(ABSTRACT TRUNCATED AT 250 WORDS)

Environment↗
PubMed1995

[The surgical treatment of congenital hip dislocation in young children].

New methods of operative treatment of congenital dislocations in children are proposed as well as the methods of restoration of motility in the hip joint. All these developed methods tested in 300 patients (380 joints) exclude recurrent deformities and delay the development of coxarthrosis.

Acetabulum↗
PubMed1992

[Overhead extension in delayed diagnosis of congenital hip dislocations in children, following failure of treatment with the Pavlik harness].

Authors report, based on a retrospective examination of 103 dislocated hips of 85 children, on experiences with the overhead treatment of congenital hip dislocations, resistant to Pavlik harness or lately recognized. The results are compared with those of 23 hips of 20 children treated with Pavlik harness and plaster casts. Follow-up time was 3-15, in average 7 years. It is stated that the overhead extension treatment not followed by stiff fixation resulted in 92 per cent reduction in resistant and lately recognized hip dislocations. This procedure has caused in only 4 per cent severe necrosis of the femoral head with lasting consequences. Their experience with Pavlik harness combined with plaster cast are unfavourable as in 4 of 23 hips treated subtotal, in another 7 partial femoral head necrosis has developed.

Adolescent↗
PubMedDate not supplied

The Pavlik harness in the treatment of congenital dislocating hip: report on a multicenter study of the European Paediatric Orthopaedic Society.

The results of functional treatment using the Pavlik harness in congenital dislocation and congenital dysplasia of the hip in children aged less than 11 months were examined by an EPOS study group. This study was conducted on 3,611 hips in 2,636 patients for a period of 1-9 years after treatment. The reduction rate was 92% in grade Tonnis 2 and 3; the healing rate was 80%. In children with dysplastic hips, the healing rate was 95.35%. Avascular necrosis of the femoral head was observed in 2.38%. The Pavlik harness is designed for outpatient treatment if the parents are compliant.

Hip Dislocation, Congenital↗
PubMedDate not supplied

Congenital hip dislocation or dysplasia with subluxation: a radiologic study.

We studied the behavior of hips in congenital hip dislocation. Two types were identified: those that developed normally after closed reduction and those that required an osteotomy. Children with hips that required an osteotomy were older at presentation and at follow-up had worse subluxation, with shallower acetabula. In this group, the younger the age at which reduction was achieved, the less the residual subluxation of the hip at follow-up. The age at which the late osteotomy was performed did not appear to affect the residual hip subluxation or the acetabular development. We could not find any radiologic parameter that would predict the need for an osteotomy.

Child, Preschool↗
PubMedDate not supplied

[Salter's pelvic osteotomy in the treatment of congenital hip dislocation and hip dysplasia with special reference to pelvic tilt].

On the basis of 63 Salter pelvic osteotomies which were performed in 57 patients with congenital dislocation and subluxation of the hip between 1970 and 1986 at the Orthopaedic University Clinic of Vienna, we tried to work out the reasons for the rate of failures of 29% in our material. The mean age at operation was 4.1 years (1.5-18), that at follow up 15.7 years (4.6-28). We based our assessments on the clinical and radiological criteria of the Commission for the Study of Hip Dysplasia of the German Society of Orthopaedics and Traumatology. The number of failures at follow up (hip value III + IV) increased from 25%, if the operation was done before the age of four years, to 41%, if it was performed at a later age. In the latter group we were not able to observe any spontaneous improvement, which was typical for the younger age group. A moderately pathologic hip dysplasia (hip value III) could be improved to a normal value at follow up in 87%, an extremely pathologic one just in 50% of the cases. In just some of the patients we found postoperatively a tilt of the distal pelvic fragment, which could be registered by the oval shape of the foramen obturatum. Above all in young children a pelvic tilt was rare because of the elasticity of the triradiate cartilage. Out of 37 evaluable cases a tilt of the distal pelvic fragment by the operation could be verified in only 12 cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1976

Total avascular necrosis of the capital femoral epiphysis in congenital dislocated hips.

Ninety-four hips involved with total avascular necrosis in the treatment of congenital dislocation of the hips were reviewed in a search for etiological factors and effective salvage procedures. Pre-reduction traction and adductor tenotomy did not prevent avascular necrosis. Abduction of the hip in the "frog" position was the incriminating common denominator. This position may cause (1) interference of the blood supply to the femoral head by compression of the medial branch of the deep profundus artery; and (2) pressure on the intraepiphyseal grooves by the glenoid labrum. The containment of the femoral head by acetabuloplasty (preferably) below age 8, followed at a later date (over age 10) by transfer distally of the greater trochanter, with the abductor muscles, offers a satisfactory salvage procedure.

Acetabulum↗
PubMedDate not supplied

[Long-term follow-up of 166 surgically treated patients with congenital hip dislocation].

UNLABELLED: 166 patients with congenital dislocation of the hip, ranging from 10 months to 5 years old, were operated between 1958 and 1971. 140 patients were women (84%) and 26 patients were men (16%). 96 patients had unilateral and 70 patients had bilateral dislocation; that makes a total of 236 dislocated hips. 61 patients with bilateral hip dislocation were operated simultaneously on both hips. All the patients were treated with adductor tenotomy and open reduction through Smith Petersen incision with section or elongation of the psoas tendon. The postoperative immobilization consisted in a period of one month pelvic toecast followed by 2 plaster casts with abduction rod during 3 to 5 months. The postoperatory follow-up ranged from 9 years to 26 years, 2 months; average 14 years, 5 months. The clinical evaluation comprises pain, hip mobility, gait and muscle power. RESULTS: excellent 138 (59%); good 66 (28%); fair 29 (12%); and poor 3 (1%). The radiological evaluation considered: Mose; acetabular femoral head index; Wiberg's CD-angle; cervico-diaphysiary angle and radial quotient. RESULTS: normal 5 (2%); excellent 44 (19%); good 78 (33%); subtotal 54%; fair 90 (38%), and poor 19 (8%). Complications (hips); infections 12 (5%); 3 of them deep ones (1%); residual subluxation 19 (8%); reluxation 1 (0.5%). Isquemic necrosis Grade II of Tönnis 31 (13%); Grade III 2 (1%) and Grade IV 1 (0.5%).

Adolescent↗
PubMed1989

[Seasonal incidence of congenital hip dislocation. A risk factor].

The congenital dislocation of the hip stational variation frequency is a known anecdotical data in various screening, but its etiology is unknown. Several authors had reported an increase of CDH during fall or winter time. The theory that they support for this finding is the wear use in some countries for the newborn, inducing extension and approximation of the limbs, which could justify the hip dislocation. Another etiological factors proposed by some authors is the climatical influence in mothers hormonal secretion. We have studied 33,000 alive newborns with a CDH frequency about 9.78 per thousand. The new fact that we report is an increase of CDH cases during springtime, without parallel increase in births. The hypothesis we support is: stational variations of CDH is not caused by mechanical factors instead there are another unknown agents. Nevertheless we advocate the springtime as a "risk factor" in our region.

Hip Dislocation, Congenital↗
PubMed1978

[The inguinal incision for the open reduction of congenital hip dislocation (author's transl)].

Operative reductions of congenital hip dislocation are sometimes difficult when lateral incisions are used since the medial part of the acetabulum and the lower limbus are difficult to visualize. In the Ludloff technique this part of the acetabulum is seen excellent, but not the lateral part. High dislocations with inverted limbus are difficult to reduce and only with partial excision of the limbus. An inguinal incision beginning lateral at the spina ilica ventralis offers the best view and can be used for all different degrees of dislocation and age groups. The technique is described, the advantages and the rate of avascular necrosis compared with other incisions. Femoral osteotomies and acetabular or pelvic osteotomies should not be done at the same time because of a higher percantage of avascular necrosis. In high dislocaitons shortening osteotomies should not be done in the intertrochanteric region but deeper in the shaft to avoid additional disturbances of the vascular system of the proximal femur.

Femur Head Necrosis↗