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At least 91 records · Page 5Linked to original sources
PubMed2003

Proximal femoral resection for subluxation or dislocation of the hip in spastic quadriplegia.

Management of a painful or contracted hip dislocation in individuals with severe spastic quadriplegia is difficult. Clinical and radiographic results of 12 proximal femoral resection-interposition operations performed in seven non-ambulatory persons (five males, two females; mean age 14 years, 8 months; age range 6 years 11 months to 19 years 8 months) with severe spasticity were reviewed to determine if pain relief and restoration of motion were maintained. At a mean follow-up of 7 years 7 months (median 9 years 6 months) all participants maintained a good sitting position and a functional range of motion with improved hygiene. Hip pain was improved in all participants compared with their preoperative status. Proximal femur migration occurred causing slight pain in one person. Heterotopic ossification was observed but was not clinically significant. Complications included traction pin loosening and infection and a late supracondylar femur fracture 3 months after the operation. Proximal femoral resection effectively decreased pain and restored hip motion in those with severe spastic quadriplegia leading to improved sitting and perineal care.

Activities of Daily Living↗
PubMed2003

Iliopsoas haemorrhage in patients with bleeding disorders--experience from one centre.

Iliopsoas haemorrhage in patients with bleeding disorders is a potentially life-threatening condition, with significantly associated morbidity. Despite its clinical importance, little has been published on the frequency, complications or outcomes of this entity since the advent of modern therapies for haemophilia. In a retrospective review of 297 patients with bleeding disorders followed at our centre, we identified 46 episodes of iliopsoas haemorrhage in 31 patients. Patients presented primarily with thigh, hip and/or groin pain, and frequently had flexion hip contracture, femoral nerve paresthesia, and >2 g dL(-1) haemoglobin drop. The duration of symptoms prior to seeking medical attention was 3.8 +/- 4 days. Nineteen of 155 patients (12.3%) with haemophilia A had 28 episodes of iliopsoas bleed; 52.6% of these patients had severe haemophilia. Of these 19 patients with haemophilia A who had iliopsoas haemorrhage, seven (36.8%) had an inhibitor to factor VIII (FVIII), and accounted for one-half of the bleeding episodes. Nine of 66 patients (13.6%) with haemophilia B had 15 episodes of iliopsoas haemorrhage; 22.2% of these patients had severe haemophilia, including one patient with an inhibitor to FIX who had two iliopsoas bleeds. The mean duration of therapy was 18.7 +/- 11.9 days, and the duration of hospitalization was 12.3 +/- 9.1 days. The length of hospital stay was significantly longer in patients with inhibitors, when compared with patients without inhibitors (19.1 +/- 5.8 days vs. 7.6 +/- 7.8 days; P<0.0001) with higher factor consumption, although the total duration of therapy was not significantly different. Patients with inhibitors were over-represented in the cohort of haemophiliacs with iliopsoas bleed. Patients with inhibitors who had iliopsoas bleeds remained hospitalized longer, although the duration of therapy was the same as patients with no inhibitors. There was a low frequency of recurrent bleed (2.8%).

Adolescent↗
PubMed1975

Evaluation of the hip.

This paper deals with clinical evaluation of the hip. Methods of testing for mobility in the hip joint are discussed. Analysis of gait and functional activities as related to muscle imbalance is presented. Gross techniques of manual muscle testing and basic principles of specific manual muscle testing are presented.

Diagnosis, Differential↗
PubMed1997

Surgery of the spine in myelodysplasia. An overview.

Significant spinal deformity is particularly common in nonambulatory patients with myelodysplasia. Progressive deformity may be caused by congenital anomalies, paralytic collapse, hip contractures, or spinal cord tethering. Existing or projected functional impairment should be the principle indication for treatment. Surgical treatment is complicated by poor soft tissue coverage, associated contractures, lack of sensation, weak bone, and absence of posterior elements. Successful fusion can be achieved by circumferential (anterior and posterior) fusion and current rigid segmental instrumentation. The unique deformities and bony anatomy require individualized techniques to achieve fixation.

Arthrodesis↗
PubMed2004

Evidence-based soft tissue rheumatology: III: trochanteric bursitis.

Trochanteric bursitis is a term used to name a syndrome that features pain and tenderness over the greater trochanter. Present evidence suggests that in the majority of cases, symptoms result from pathology of the gluteus medius or minimus muscles rather than a bursa. Lower limb length discrepancy, iliotibial band contracture, hip osteoarthritis and lumbar spondylosis are often mentioned, but no proved as predisposing factors. After a lumbar spine or hip and other local pathology have been considered and clinically excluded, the clinical features of the syndrome, ie lateral location of pain plus characteristic trochanteric tenderness are usually sufficient to reach a diagnosis. Most patients with trochanteric bursitis can be successfully treated with a NSAID, physiotherapy plus a local corticosteroid injection. The few refractory cases are often treated surgically. Disappointingly, none of the therapeutic interventions used in trochanteric bursitis have been validly assessed.

Journal Article↗
PubMed1981

Hip surgery in the lumbar level myelomeningocele patient.

The ambulatory status of 74 patients with myelomeningocele, 4 years of age or older (average, 10 years, 5 months) was examined to assess the effectiveness of surgery about the hip in improving function. Seventeen of these 74 patients, all with lumbar levels of function, underwent surgery for the purpose of reducing a subluxation or a dislocation. Reduction of a dislocated hip did not improve function, and the failure rate was high (45% redislocation). There was little difference between the nonoperated and operated groups regarding ambulatory capabilities or the percentage of ambulators with a dislocated hip. The most severely impaired patients were those who had complications following hip surgery. The level of the neural deficit was the most important factor in determining ambulatory function.

Adolescent↗
PubMed1984

Adductor tenotomy-obturator neurectomy.

A 3.7-year follow-up study of 25 cerebral palsied children with 41 adductor tenotomies and obturator neurectomies showed significant improvement in hip abduction and acetabular development.

Cerebral Palsy↗
PubMed1995

Ambulation with parapodia and reciprocating gait orthoses in pediatric spinal cord injury.

The use of parapodia and reciprocating gait orthoses (RGOs) was reviewed in 41 children and adolescents with spinal cord injuries. Compared with users of RGOs, users of parapodia were younger when injured and when the orthotic was first used, were more likely to be household ambulators and to have higher neurological levels, and were unlikely to continue their use of the parapodium after early school age. Hip contractures that required surgical releases or contributed to discontinuation of orthotic usage were present in six of 26 parapodium users and 12 of 22 RGO users. RGOs and parapodia have a limited but important role in management of pediatric spinal cord injury, and should be used in a developmentally based program responsive to the changing needs of children and adolescents.

Child↗
PubMed1995

Age and migration percentage as risk factors for progression in spastic hip disease.

Age and migration percentage were evaluated as risk factors for the progression of spastic hip subluxation in patients with cerebral palsy. Three age-groups were defined: group 1 (two to eight years), group 2 (nine to 18 years), and group 3 (over 18 years). Four subluxation groups were defined by migration percentage: group A (< 30 per cent), group B (30 to 60 per cent), group C (60 to 90 per cent), and group D (> 90 per cent). The risk of progression was the same in groups 1A and 2A, and both of these were higher than the risk in group 3A. All group B hips had similar risks for progression, and all group C hips progressed to group D (> 90 per cent migration percentage). Groups 1A, 1B, 2A, 2B and 3B hips need close radiographic follow-up to detect progressive subluxation. All group C hips required surgical treatment for progression to dislocation to be avoided.

Adolescent↗