Surgical Hip Dislocation for Management of Acetabular Osteochondroma in an Adult.
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ABSTRACT:
SUBMITTER: Nehme AH
PROVIDER: S-EPMC5547726 | biostudies-other | 2017
REPOSITORIES: biostudies-other
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Project description:We present a case of isolated intra-acetabular osteochondroma in a 21 year-old male who presented with history of right hip pain for 5 years and difficulty in walking. Patient was managed with excision of intra-articular exostoses through surgical hip dislocation. Intra-articular hip osteochondromas can be a rare cause of hip pain in patients with unexplained etiology, and their diagnosis and management can be challenging.
| S-EPMC6197156 | biostudies-other
Project description: Not available
| S-EPMC4171447 | biostudies-literature
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:UNLABELLED: Although the use of ultrasound in the diagnosis and early treatment of developmental dysplasia of the hip (DDH) has reduced the number of patients diagnosed late and decreased the number of operative procedures, surgical treatment is still needed in some patients. Late cases continue to occur as a result of missing the screening examination, being normal at initial screening and missing followup. Dysplasia may persist despite appropriate nonoperative or operative treatment. Many of these patients subsequently undergo closed or open reduction and femoral or acetabular reconstruction. Ultrasound of the hips is generally used up to 6 or 8 months of age, during which time the hips are largely cartilaginous, and radiographs after that time when bony development is more complete. Options to supplement ultrasound and radiography include arthrography, computed tomography, and magnetic resonance imaging. Several advances have been made in the imaging of DDH and its complications including acetabular labral pathology and of femoroacetabular impingement (FAI). We review imaging techniques other than ultrasound used in the management of DDH. LEVEL OF EVIDENCE: Level V, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.
| S-EPMC2504666 | biostudies-other
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:Background and purpose - Hip dislocation is one of the most common complications following total hip arthroplasty (THA). Several factors that affect dislocation have been identified, including acetabular cup positioning. Optimal values for cup inclination and anteversion are debatable. We performed a systematic review to describe the different methods for measuring cup placement, target zones for cup positioning, and the association between cup positioning and dislocation following primary THA. Methods - A systematic search of literature in the PubMed database was performed (January and February 2016) to identify articles that compared acetabular cup positioning and the risk of dislocation. Surgical approach and methods for measurement of cup angles were also considered. Results - 28 articles were determined to be relevant to our research question. Some articles demonstrated that cup positioning influenced postoperative dislocation whereas others did not. The majority of articles could not identify a statistically significant difference between dislocating and non-dislocating THA with regard to mean angles of cup anteversion and inclination. Most of the articles that assessed cup placement within the Lewinnek safe zone did not show a statistically significant reduction in dislocation rate. Alternative target ranges have been proposed by several authors. Interpretation - The Lewinnek safe zone could not be justified. It is difficult to draw broad conclusions regarding a definitive target zone for cup positioning in THA, due to variability between studies and the likely multifactorial nature of THA dislocation. Future studies comparing cup positioning and dislocation rate should investigate surgical approach separately. Standardized tools for measurement of cup positioning should be implemented to allow comparison between studies.
| S-EPMC5251254 | biostudies-literature
Project description:In our case study, we examine a case of catastrophic failure of a total hip arthroplasty acetabular component leading to complete central wear by the ceramic femoral head, requiring revision total hip arthroplasty. Despite subtle clinical findings, initial orthopaedic evaluation and treatment yielded a diagnosis of total hip arthroplasty dislocation. While a much more common phenomenon, the diagnosis led to futile initial attempts at closed reduction. Our index of suspicion must remain high to pick up on subtle, less common diagnoses we will encounter.
| S-EPMC5365403 | biostudies-literature
Project description:Treatment of hip joint chondral damage is a well-recognized aspect of the arthroscopic management of femoroacetabular impingement syndrome. Hip chondral resurfacing has evolved from microfracture to different forms of cartilage grafting, all with variable long-term outcomes. Recent literature has focused on techniques using different cartilage sources (native and synthetic products) that are available for clinicians to choose from during hip arthroscopy. None of the published reports on cartilage grafts have commented on hip joint capsular management as part of the procedure. This is likely because of the increased difficulty of capsular closure in the dry arthroscopic environment required for graft stabilization. However, potential iatrogenic hip instability induced by an unrepaired interportal capsulotomy can be detrimental to the existing joint architecture and possibly to the cartilage graft. This article presents a step-by-step approach, including tips and pearls, for capsular closure during arthroscopic acetabular chondral resurfacing with BioCartilage (Arthrex, Naples, FL). This method is a safe and reproducible way to close the joint capsule during chondral resurfacing in patients undergoing hip preservation that can potentially enhance the chances of a successful outcome.
| S-EPMC7917387 | biostudies-literature
Project description:PurposeThe acetabulum interacts with the femoral head in daily activities and may exhibit structural changes in the presence of hip disorders. This study aims to redefine hip disorders in children with cerebral palsy by structural characteristics of the acetabulum in relation to the degree of the migration percentage.MethodsThe clinical and radiographic data of 70 patients (36 males, 34 females; mean age 8.2 years) with spastic cerebral palsy were retrospectively analyzed. The acetabular structure was measured by the acetabular index on reconstructed three-dimensional computerized tomography for precision of measurement. Any significant change in acetabular index measured on the reconstructive computerized tomography related to every 10% increment of migration percentage was regarded as clinically significant in hip disorders.ResultsThe acetabular index measured on the reconstructive computerized tomography showed an increasing trend with the increment of migration percentage. The most significant acetabular index measured on the reconstructive computerized tomography change occurred between the 20%-29% and 30%-39% migration percentage groups (p < 0.001), suggesting that a migration percentage of 30% is the starting point of hip disorder. A significant increase in the posterolateral acetabular index measured on the reconstructive computerized tomography occurred in migration percentages >50%, indicating posterolateral acetabular dysplasia. Hips with migration percentages from 80% to 100% had consistent acetabular indexes measured on the reconstructive computerized tomography values, suggesting complete dislocation and no more contact and interaction between the femoral head and acetabular fossa.ConclusionStructural characteristics in the acetabulum reflect hip dysfunction and potentially classify hip disorders. Results suggest the migration percentage 30% as a starting point of hip disorder and 80% as a turning point of hip dislocation in children with cerebral palsy.Level of evidencelevel IV, diagnostic study.
| S-EPMC10411378 | biostudies-literature
Project description:BACKGROUND: Surgical hip dislocation allows for a 360° view of the acetabulum and may facilitate a reduction in selected acetabular fractures. To our knowledge there is no description in the literature of the different techniques used to reduce acetabular fractures through this approach. The aims of this study are to describe a technique of hip surgical dislocation to treat a variety of acetabular fracture patterns and to ascertain the early results with this technique, including the quality of fracture reductions achieved, clinical results, operative time, and complications such as avascular necrosis and heterotopic ossification. DESCRIPTION OF TECHNIQUE: The procedure involves digastric trochanteric flip osteotomy and safe dislocation of the femoral head, preserving its vessels. T-type, transverse fractures alone or associated with posterior wall could be reduced with specific clamps and reduction adequacy can be judged by direct view. Anterior column fixation could be performed with one or two screws; the posterior column could be fixed with a single posterior plate or with two plates if a transverse fracture is associated with a posterior wall fracture. METHODS: Between 2005 and 2011, we used this approach selectively to manage those types of fractures; during the period in question, we treated 312 acetabular fractures surgically, of which 31 (10%) were treated using this approach. Patient demographic, injury, and surgical variables as well as complications were recorded. Outcomes were evaluated with the Merle d'Aubigné and Postel system. Radiographic outcome was scored according to Matta's criteria on postoperative radiographs (AP and Judet views). Minimum followup was 24 months (mean, 43 months; range, 24-87 months). RESULTS: Fracture reduction was defined as anatomic in 65% cases, imperfect in 16%, and poor in 19%. Mean Merle d'Aubigné score was 15 points (out of 18, with higher scores being better). Two patients developed symptomatic femoral head avascular necrosis. CONCLUSIONS: In complex cases, surgical dislocation presents several advantages; a single approach may reduce surgical time, permit direct intraarticular assessment, and facilitate screw placement closer to the articular surface. It also presents several limitations; some difficulties with bone-reduction clamp positioning, limited fixation of the anterior column, and a small risk of greater trochanter malunion.
| S-EPMC3825905 | biostudies-other