Imaging in the surgical management of developmental dislocation of the hip.
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ABSTRACT:
SUBMITTER: Grissom L
PROVIDER: S-EPMC2504666 | biostudies-other | 2008 Apr
REPOSITORIES: biostudies-other
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Project description:BackgroundFemoroacetabular impingement (FAI) is a condition that has become increasingly identified as abnormal, repetitive abutment of the proximal femur and acetabular rim. Safe surgical dislocation of the hip has been popularized as a technique that allows surgeons to not only improve joint preservation procedures but also understand disease patterns more clearly.Questions/purposesWe describe the technique of surgical dislocation as well as review the indications, results, and complications that are associated with the procedure. We also present various case examples to highlight this technique.Search strategiesWe performed a systematic review of the literature to define the indications, clinical outcomes, and complications associated with surgical dislocation of the hip for the treatment of FAI.ResultsClinical success rates vary in the literature between 64% and 96% of patients with good results, and conversion to total hip arthroplasty ranging between 0% and 30% in patients who underwent FAI treatment with surgical dislocation. Reported major complication rates have ranged from 3.3% to 6%, most commonly in the form of trochanteric nonunion, neurapraxia, or heterotopic ossification.ConclusionsFAI deformities encompass a wide spectrum of disease patterns. Surgical dislocation allows full access to the hip in addition to observing its pathomechanics. Strict adherence to proper technique allows the surgeon to minimize complication rates while treating the deformity at hand.
| S-EPMC3640725 | biostudies-literature
Project description:The surgical dislocation approach is useful in assessing and treating proximal femoral hip deformities commonly due to pediatric conditions. We sought to demonstrate the efficacy and problems associated with this technique. Diagnoses included slipped capital femoral epiphysis, Perthes disease, developmental dysplasia of the hip, osteonecrosis, and exostoses. Through this approach, femoral head-neck osteoplasty (22), intertrochanteric osteotomy (eight), femoral head-neck osteoplasty plus intertrochanteric osteotomy (15), femoral neck osteotomy (five), open reduction and internal fixation of an acute slipped capital femoral epiphysis with callus resection (five), open reduction and internal fixation of an acetabular fracture (one), trapdoor procedure (one), and acetabular rim osteoplasty (one) were performed. The average patient age was 16 years. The minimum followup was 12 months (average, 41.6 months; range, 12-73 months). Patients with Perthes disease and SCFE had preoperative and postoperative WOMAC scores of 9.6 and 5.1, and 7.9 and 3.5 respectively. In patients with unstable SCFEs, the average postoperative WOMAC score was 1.2. Seven patients underwent THAs and two patients underwent hip fusion. Complications in the 58 procedures included four cases of osteonecrosis: three after femoral neck osteotomy and one after intertrochanteric osteotomy. The surgical dislocation technique can be utilized to effectively treat these deformities and improve short-term symptoms. Although the technique is demanding, we believe surgical dislocation offers sufficient advantages in assessing and treating these complex deformities that it justifies judicious application.
| S-EPMC2635463 | biostudies-other
Project description:The purpose of this study is to report a rare case of acetabular osteochondroma with a unique clinical presentation occurring in an adult with normally developed hips. The distinctive size and location of the lesion required an open approach with surgical dislocation of the hip for complete resection.
| S-EPMC5547726 | biostudies-other
Project description:PURPOSE:Congenital dislocation of the knee and hip is a rare congenital disorder. The specific aim of the study was to evaluate the clinical and radiological outcomes of the children with congenital dislocation of the knee and hip who presented after six months of age. METHODS:All the consecutive children with congenital dislocation of the knee and hip joints were retrospectively reviewed. We included cases that were treated after six months of age and followed up for a minimum of two years. Twenty-four children with congenital dislocation of the knee and hip (thirteen with ligamentous laxity, eleven children with stiff joints) were included. The knee was dislocated in 45 limbs; the hip was dislocated in 40 instances. The knee joint dislocation was treated with quadricepsplasty in all twenty-four children (45 knees). The hip dislocation (n = 32) was addressed with either closed reduction (n = 8) or open reduction of the hip (n = 24). Eight hip dislocations were not addressed. The outcome of the hip and knee was evaluated. RESULTS:The clinical and radiological outcomes were better in children with ligamentous laxity than without laxity. Twenty-two children were community walkers. An orthosis was needed in eight children. The frequency of spontaneous reduction of unreduced dislocation of the hip was noted in three children (5/8 hips). CONCLUSION:Outcome in combined dislocation of knee and hip is good in most cases with surgical interventions. The outcome is better in children with ligamentous laxity. Spontaneous reduction of the dislocated hips might be achieved after gaining knee flexion following knee surgery for congenital the knee in a few cases.
| S-EPMC7679307 | biostudies-literature
Project description:UNLABELLED: Because not all infants can be screened for DDH by experts, early diagnosis of developmental dysplasia of the hip (DDH) by primary health care professionals is important. We developed a broadband electroacoustic sound transmission-detection (sonospectrography) system and explored its utility in 22 patients (average age, 5.9 years; range, 0.3-14 years) with unilateral DDH in this preliminary study. Distinct from ultrasonography, the sonospectrography system functions by sound transmission and recording through tissues to differentiate between normal and abnormal hips. All hips were examined at four different hip and knee positions. The normal hip served as the control. The sonospectrography system was able to detect unilateral DDH. Dysplastic hips had lower sound transmission values when compared to normal hips in all patients and all four positions; however, the highest (X = 88.8 +/- 30.2 Hz) and lowest (X = 8.3 +/- 5.4 Hz) sound transmission mean values were obtained at different positions in the normal hips and those with DDH. Sound transmission values of dysplastic hips were always lower than that of normal hips when the hip and knee was flexed during measurements. Sound transmission values decreased with age. The sonospectrography system may offer a new noninvasive method in the diagnosis of unilateral DDH but requires further study of sensitivity and specificity of detecting dysplastic hips without subluxation in newborn infants. LEVEL OF EVIDENCE: Level IV, case series. See the Guidelines for Authors for a complete description of levels of evidence.
| S-EPMC2504664 | biostudies-other
Project description:PURPOSE:To compare the efficacy and safety of intraocular lens (IOL) repositioning and IOL exchange for the treatment of patients with IOL dislocation. METHODS:We systematically searched for relevant publications in English or Chinese in MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, WHO International Clinical Trial Registration Platform, Clinical Trial.gov, China Biology Medicine Database, China National Knowledge Infrastructure Database and grey literature sources. Study quality was assessed using the STROBE template for observational studies and the Cochrane template for randomized controlled trials (RCTs). Data were meta-analyzed using RevMan 5.3. RESULTS:The review included 14 English-language studies reporting 1 RCT and 13 retrospective case series involving 1,082 eyes. Average follow-up time was 13.7 months. Pooled analysis of 10 studies showed that the two procedures had a similarly effect on best corrected visual acuity (MD -0.00, 95%CI: -0.08 to 0.08, P = 0.99). Pooled analysis of nine studies showed no significant difference in incidence of IOL redislocation (RR 2.12, 95%CI 0.85 to 5.30, P = 0.11); pooled analysis of seven studies showed greater extent of incidence of cystoid macular edema in IOL exchange (RR 0.47, 95%CI 0.21 to 1.30, P = 0.06). Pooled analysis of three studies showed greater extent of incidence of anterior vitrectomy in IOL exchange (RR 0.11, 95%CI 0.04 to 0.33, P<0.0001). Pooled analysis of two studies showed greater postoperative spherical equivalents in IOL repositioning (MD 1.02, 95%CI 0.51 to 1.52, P<0.0001). pooled analysis suggested no significant differences between the two procedures in terms of intraocular pressure, endothelial cell density, surgically induced astigmatism, or incidence of retinal detachment, intraocular hemorrhage or pupillary block. CONCLUSION:IOL repositioning and exchange are safe and effective procedures for treating IOL dislocation. Neither procedure significantly affects best corrected visual acuity and IOL redislocation. IOL exchange was superior to repositioning in terms of postoperative SE, but IOL repositioning was associated with lower incidence of anterior vitrectomy, potentially lower incidence of cystoid macular edema.
| S-EPMC6382138 | biostudies-literature
Project description:Surgical hip dislocation (SHD) is a powerful and safe approach used to address pathologic lesions around the hip joint, and therefore, many studies have been conducted in this field. However, no bibliometric studies regarding the global research trend concerning SHD have been studied yet. This study aims to determine the research status in the field of SHD research between 2001 and 2021. The publications related to SHD from 2001 to 2021 were retrieved from the Web of Science Core Collection. Three bibliometric tools were used for this study. The main analyses include publication counts, contributions of countries, institutions, authors, journals and funding agencies, as well as analyses on clustering of references and keywords. In total, 498 articles were identified. The annual publication counts of SHD showed an ascending tendency as a whole. The United States has the most prominent contributions, with the most number of publications and the highest value of H-index. The University of Bern was the organization that produced the most literature. Professors Ganz R, Siebenrock KA, Tannast M, Steppacher SD and Leunig M were the core authors in this field. The most productive journal was Clinical Orthopaedics and Related Research. Burst keyword detection suggested that the following research directions, including 'surgical hip dislocation', 'outcome', 'fixation' and 'pain', are considered the research hotspots and deserve more attention. In conclusion, this is the first bibliometric analysis that provides a comprehensive overview of SHD research, which may assist investigators in exploring new directions for this technique.
| S-EPMC10234387 | biostudies-literature
Project description:Femoral head fractures are rare injuries; incongruency and instability are indications for surgical intervention. Anterior, posterior, and transtrochanteric surgical approaches have been proposed, but the exposure is limited with classical approaches. Surgical hip dislocation allows for a 360° view of the head and may facilitate a reduction in selected head fractures, but to our knowledge, few studies have reported on the results with this technique. We therefore report on the (1) quality of fracture reduction; (2) modified Harris hip score at a minimum of 2 years (mean, 6 years, range, 26-122 months); and (3) frequency of complications, including avascular necrosis (AVN), arthritis development, and heterotopic ossification, in a case series of patients with femoral head fractures treated with this approach.The procedure involves digastric trochanteric flip osteotomy and safe dislocation of the femoral head, preserving its vessels. Using this technique we are able to reduce all displaced femoral head fractures under direct view. Definitive fixation is performed through this approach with 2.7-mm nonabsorbable screws. The same technique may be used also for Pipkin IV fractures to fix transverse, T-type, posterior wall, or posterior column acetabular fracture.Between 2004 and 2011, we used this approach to manage all displaced femoral head fractures in patients younger than 55 years old. A total of 17 patients were thus treated; of those three were lost to followup before 2 years, and one was excluded from study because of severe preoperative neurological impairment, leaving 13 for analysis here. Patient demographic, injury, and surgical variables as well as complications were recorded and retrospectively evaluated. Radiographic outcome was scored according to Matta's criteria on postoperative radiographs. Outcomes were evaluated with the modified Harris hip score. Minimum followup was 24 months (mean, 77 months; SD, 32.8 months).Fracture reduction was anatomic in eight hips and imperfect in five. Mean clinical score was 82 points (SD, 7.7). One patient developed symptomatic femoral head AVN and underwent total hip arthroplasty 4 years after the index procedure; no other patient underwent arthroplasty. Besides this patient, signs of arthritis (Grade I according to Tönnis classification) were found in one patient and heterotopic ossification was recorded in two patients, but neither was symptomatic.Our experience with surgical dislocation shows clinical results comparable to previously reported outcomes in femoral head fractures treated with common approaches; we also present a similar rate of AVN and a lower rate of posttraumatic arthritis, but a higher risk of heterotopic ossification. Further case-control studies are necessary to confirm these statements.Level IV, therapeutic study.
| S-EPMC4626487 | biostudies-literature
Project description:This study aimed to measure femoral head perfusion during hip resurfacing arthroplasty through a trochanter-sparing modified direct lateral approach. High-power laser Doppler probes were inserted into the femoral heads of 26 patients (26 hips, age range 35-70 years). Changes in blood flow were recorded (1) pre-capsulectomy (reference), (2) post-capsulectomy, and (3) following femoral head dislocation and reduction. There were no statistically significant changes in perfusion amplitudes post-capsulectomy and following femoral head dislocation and reduction (mean -10%, P = .134 and +27%, P = .166, respectively). Prolonged dislocation with the hip maximally flexed and externally rotated resulted in significantly decreased perfusion (mean -28%, P = .002). This study provides in vivo evidence that surgical hip dislocation is feasible using a modified direct lateral approach.
| S-EPMC6728437 | biostudies-literature
Project description:Chondral lesions of the hip in young patients are frequently associated with additional articular pathology. Parafoveal osteochondral lesions have been reported to be a manifestation of cam lesions in the setting of femoroacetabular impingement (FAI). Although arthroscopic surgery is useful to treat intra- and extra-articular pathology, large lesions located in areas that are difficult to access represent a limitation of the technique. Open surgical dislocation and osteochondral allograft transplantation (OCA) allow treatment of larger surface areas and underlying morphologic abnormalities such as cam lesions. We present our technique for open surgical dislocation of the hip through a stepped trochanteric osteotomy, osteochondral transplantation of fresh-stored femoral head allograft, and osteoplasty of the head/neck junction.
| S-EPMC7768051 | biostudies-literature