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The Bone & Joint Journal
Vol. 106-B, Issue 5 Supple B | Pages 59 - 65
1 May 2024
Liu WKT Cheung A Fu H Chan PK Chiu KY

Aims

Isolated acetabular liner exchange with a highly crosslinked polyethylene (HXLPE) component is an option to address polyethylene wear and osteolysis following total hip arthroplasty (THA) in the presence of a well-fixed acetabular shell. The liner can be fixed either with the original locking mechanism or by being cemented within the acetabular component. Whether the method used for fixation of the HXLPE liner has any bearing on the long-term outcomes is still unclear.

Methods

Data were retrieved for all patients who underwent isolated acetabular component liner exchange surgery with a HXLPE component in our institute between August 2000 and January 2015. Patients were classified according to the fixation method used (original locking mechanism (n = 36) or cemented (n = 50)). Survival and revision rates were compared. A total of 86 revisions were performed and the mean duration of follow-up was 13 years.


The Bone & Joint Journal
Vol. 105-B, Issue 6 | Pages 649 - 656
1 Jun 2023
Dagneaux L Amundson AW Larson DR Pagnano MW Berry DJ Abdel MP

Aims

Nonagenarians (aged 90 to 99 years) have experienced the fastest percent decile population growth in the USA recently, with a consequent increase in the prevalence of nonagenarians living with joint arthroplasties. As such, the number of revision total hip arthroplasties (THAs) and total knee arthroplasties (TKAs) in nonagenarians is expected to increase. We aimed to determine the mortality rate, implant survivorship, and complications of nonagenarians undergoing aseptic revision THAs and revision TKAs.

Methods

Our institutional total joint registry was used to identify 96 nonagenarians who underwent 97 aseptic revisions (78 hips and 19 knees) between 1997 and 2018. The most common indications were aseptic loosening and periprosthetic fracture for both revision THAs and revision TKAs. Mean age at revision was 92 years (90 to 98), mean BMI was 27 kg/m2 (16 to 47), and 67% (n = 65) were female. Mean time between primary and revision was 18 years (SD 9). Kaplan-Meier survival was used for patient mortality, and compared to age- and sex-matched control populations. Reoperation risk was assessed using cumulative incidence with death as a competing risk. Mean follow-up was five years.


Bone & Joint 360
Vol. 11, Issue 4 | Pages 11 - 14
1 Aug 2022


The Bone & Joint Journal
Vol. 102-B, Issue 6 | Pages 709 - 715
1 Jun 2020
Abdelsamie KR Elhawary I Ali H Ali M EL-Shafie M Dominic Meek RM

Aims

Femoral revision component subsidence has been identified as predicting early failure in revision hip surgery. This comparative cohort study assessed the potential risk factors of subsidence in two commonly used femoral implant designs.

Methods

A comparative cohort study was undertaken, analyzing a consecutive series of patients following revision total hip arthroplasties using either a tapered-modular (TM) fluted titanium or a porous-coated cylindrical modular (PCM) titanium femoral component, between April 2006 and May 2018. Clinical and radiological assessment was compared for both treatment cohorts. Risk factors for subsidence were assessed and compared.


The Bone & Joint Journal
Vol. 101-B, Issue 6_Supple_B | Pages 123 - 126
1 Jun 2019
El-Husseiny M Masri B Duncan C Garbuz DS

Aims

We investigated the long-term performance of the Tripolar Trident acetabular component used for recurrent dislocation in revision total hip arthroplasty. We assessed: 1) rate of re-dislocation; 2) incidence of complications requiring re-operation; and 3) Western Ontario and McMaster Universities osteoarthritis index (WOMAC) pain and functional scores.

Patients and Methods

We retrospectively identified 111 patients who had 113 revision tripolar constrained liners between 1994 and 2008. All patients had undergone revision hip arthroplasty before the constrained liner was used: 13 after the first revision, 17 after the second, 38 after the third, and 45 after more than three revisions. A total of 75 hips (73 patients) were treated with Tripolar liners due to recurrent instability with abductor deficiency, In addition, six patients had associated cerebral palsy, four had poliomyelitis, two had multiple sclerosis, two had spina bifida, two had spondyloepiphyseal dysplasia, one had previous reversal of an arthrodesis, and 21 had proximal femoral replacements. The mean age of patients at time of Tripolar insertions was 72 years (53 to 89); there were 69 female patients (two bilateral) and 42 male patients. All patients were followed up for a mean of 15 years (10 to 24). Overall, 55 patients (57 hips) died between April 2011 and February 2018, at a mean of 167 months (122 to 217) following their tripolar liner implantation. We extracted demographics, implant data, rate of dislocations, and incidence of other complications.


The Bone & Joint Journal
Vol. 101-B, Issue 5 | Pages 522 - 528
1 May 2019
Medellin MR Fujiwara T Clark R Stevenson JD Parry M Jeys L

Aims

The aim of this study was to evaluate the prosthesis characteristics and associated conditions that may modify the survival of total femoral endoprosthetic replacements (TFEPR).

Patients and Methods

In all, 81 patients treated with TFEPR from 1976 to 2017 were retrospectively evaluated and failures were categorized according to the Henderson classification. There were 38 female patients (47%) and 43 male patients (53%) with a mean age at diagnosis of 43 years (12 to 86). The mean follow-up time was 10.3 years (0 to 31.7). A survival analysis was performed followed by univariate and multivariate Cox regression to identify independent implant survival factors.


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_8 | Pages 87 - 87
1 May 2019
Sculco T
Full Access

Although the incidence of total hip dislocation has decreased, it still remains a major problem particularly if recurrent. The actual incidence is around 1–2% but it has been documented as the leading cause for hip revision in the United States. In patients with recurrent hip dislocation, technical issues of leg length inequality, incorrect offset, and poor implant position should be addressed surgically and the abnormality corrected. In patients with recurrent hip dislocation, the articulation is preferably converted to a more stable articulation, with constrained sockets and dual mobility being the choices. In my experience, dual mobility articulations remain an excellent option for recurrent hip dislocation and its use is increasing significantly. It provides improved hip stability and data have demonstrated good success with recurrent hip dislocation. However, with use of the modular variety of dual mobility which is needed for acetabular cup fixation with screw augmentation, dissimilar metals are placed in contact (titanium socket and cobalt chrome liner insert) which potentially can pose a fretting or corrosion problem in longer term outcomes. Constrained sockets of the tripolar configuration provide another option which is useful in those patients with severe abductor dysfunction or insufficiency. Constrained sockets can also be cemented into the existing shell in cases where there is a well-fixed cup and cup removal may lead to significant bone loss and a need for complex acetabular reconstruction. It is important to remember that there are two types of constrained sockets, tripolar and focal constraint. Results with the tripolar constrained socket have been significantly better than the focal constraint variety which adds a polyethylene rim piece to the liner. In a mid-term follow up (2–9 years) of 116 constrained tripolar sockets, recurrent dislocation was only 3.3%. In papers reporting on focal constrained sockets, recurrent dislocation was in the 9–29% range. There continues to be a role for constrained sockets and selection of implant type has made a difference in ultimate outcome


The Bone & Joint Journal
Vol. 100-B, Issue 7 | Pages 898 - 902
1 Jul 2018
Lachiewicz PF O’Dell JA

Aims

To report our experience with trunnion corrosion following metal-on-polyethylene total hip arthroplasty, in particular to report the spectrum of presentation and determine the mean time to presentation.

Patients and Methods

We report the presenting symptoms and signs, intraoperative findings, and early results and complications of operative treatment in nine patients with a mean age of 74 years (60 to 86). The onset of symptoms was at a mean of seven years (3 to 18) after index surgery.


Orthopaedic Proceedings
Vol. 100-B, Issue SUPP_10 | Pages 26 - 26
1 Jun 2018
Sculco T
Full Access

Although the incidence of total hip dislocation has decreased, it still remains a major problem particularly if recurrent. The actual incidence is around 1–2% but it has been documented as the leading cause for hip revision in the United States. In patients with recurrent hip dislocation, technical issues of leg length inequality, incorrect offset, and poor implant position should be addressed surgically and the abnormality corrected. In patients with recurrent hip dislocation, the articulation is preferably converted to a more stable articulation, with constrained sockets and dual mobility being the choices. In my experience, dual mobility articulations remain an excellent option for recurrent hip dislocation and its use is increasing significantly. It provides improved hip stability and data have demonstrated good success with recurrent hip dislocation. However, with use of the modular variety of dual mobility which is needed for acetabular cup fixation with screw augmentation, dissimilar metals are placed in contact (titanium socket and cobalt chrome liner insert) which potentially can pose a fretting or corrosion problem in longer term outcomes. Constrained sockets of the tripolar configuration provide another option which is useful in those patients with severe abductor dysfunction or insufficiency. Constrained sockets can also be cemented into the existing shell in cases where there is a well-fixed cup and cup removal may lead to significant bone loss and need for complex acetabular reconstruction. It is important to remember that there are two types of constrained sockets, tripolar and focal constraint. Results with the tripolar constrained socket have been significantly better than the focal constraint variety which adds a polyethylene rim piece to the liner. In a mid-term follow up (2–9 years) of 116 constrained tripolar sockets, recurrent dislocation was only 3.3%. In papers reporting on focal constrained sockets, recurrent dislocation was in the 9–29% range. There continues to be a role for constrained sockets and selection of implant type has made a difference in ultimate outcome


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_22 | Pages 45 - 45
1 Dec 2016
Lachiewicz P
Full Access

Dual mobility components for total hip arthroplasty provide for an additional articular surface, with the goals of improving range of motion, jump distance, and overall stability of the prosthetic hip joint. A large polyethylene head articulates with a polished metal acetabular component, and an additional smaller metal head is snap-fit into the large polyethylene. The first such device was introduced for primary total hip arthroplasty by Bousquet in the 1970s, thus, the “French connection”. Dual mobility components have been released for use in North America over the past five years. In some European centers, these components are routinely used for primary total hip arthroplasty. However, their greatest utility may be to manage recurrent dislocation in the setting of revision total hip arthroplasty. Several retrospective series and the Swedish hip registry have shown satisfactory results for this indication at short- to medium-term follow-up times. However, there are important concerns with polyethylene wear, late intraprosthetic dislocation, and the lack of long-term follow-up data. These components are an important option in the treatment of recurrent dislocation in younger patients, revision of failed metal-metal resurfacing, and salvage of failed constrained liners. There are more recent concerns of possible iliopsoas tendinitis, elevated metal levels with one design, and acute early intraprosthetic dislocation following attempted closed reduction. However, a dual mobility component may now be the preferred solution in revision surgery for recurrent hip dislocation


The Bone & Joint Journal
Vol. 98-B, Issue 6 | Pages 767 - 771
1 Jun 2016
Konan S Duncan CP Masri BA Garbuz DS

Aims

Reconstruction of the acetabulum after failed total hip arthroplasty (THA) can be a surgical challenge in the presence of severe bone loss. We report the long-term survival of a porous tantalum revision acetabular component, its radiological appearance and quality of life outcomes.

Patients and Methods

We reviewed the results of 46 patients who had undergone revision of a failed acetabular component with a Paprosky II or III bone defect and reconstruction with a hemispherical, tantalum acetabular component, supplementary screws and a cemented polyethylene liner.


The Bone & Joint Journal
Vol. 97-B, Issue 10 | Pages 1435 - 1440
1 Oct 2015
Heidt C Hollander K Wawrzuta J Molesworth C Willoughby K Thomason P Khot A Graham HK

Pelvic obliquity is a common finding in adolescents with cerebral palsy, however, there is little agreement on its measurement or relationship with hip development at different gross motor function classification system (GMFCS) levels.

The purpose of this investigation was to study these issues in a large, population-based cohort of adolescents with cerebral palsy at transition into adult services.

The cohort were a subset of a three year birth cohort (n = 98, 65M: 33F, with a mean age of 18.8 years (14.8 to 23.63) at their last radiological review) with the common features of a migration percentage greater than 30% and a history of adductor release surgery.

Different radiological methods of measuring pelvic obliquity were investigated in 40 patients and the angle between the acetabular tear drops (ITDL) and the horizontal reference frame of the radiograph was found to be reliable, with good face validity. This was selected for further study in all 98 patients.

The median pelvic obliquity was 4° (interquartile range 2° to 8°). There was a strong correlation between hip morphology and the presence of pelvic obliquity (effect of ITDL on Sharpe’s angle in the higher hip; rho 7.20 (5% confidence interval 5.59 to 8.81, p < 0.001). This was particularly true in non-ambulant adolescents (GMFCS IV and V) with severe pelvic obliquity, but was also easily detectable and clinically relevant in ambulant adolescents with mild pelvic obliquity.

The identification of pelvic obliquity and its management deserves closer scrutiny in children and adolescents with cerebral palsy.

Cite this article: Bone Joint J 2015;97-B:1435–40.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_34 | Pages 420 - 420
1 Dec 2013
McPherson E Burgett M Halim T Donaldson T Clarke I
Full Access

Controversy has existed for decades over the role of fretting-corrosion in modular CoCr heads used with stems of CoCr vs Ti6Al4V. Since retrieval data on taper performance remains scant, we report here an18-year survivorship of a Ti6Al4V: CoCr combination (APR design; Intermedics Inc). Unique to this study were the threaded profiles present on both stem and head tapers (Fig. 1). This female patient was revised for pain, osteolysis and recurrent hip dislocation at 17 years, 10 months. A prior MPE hip replacement performed for her severely dysplastic right hip had lasted 11 years. At this 2nd revision, the 28 mm CoCr head was found dislocated posteriorly and superiorly. Metallosis was evident in the tissues. The polyethylene liner showed extensive rim damage on both anterior and posterior aspects. The neck of her APR Revision stem (Intermedics Inc) had worn through the polyethylene rim and impinged on the metal cage. The cage was found loose, the liner had disassociated, and the peri-trochanteric areas were compromised by massive osteolysis. The femoral stem and head were removed together without disassembly. The femoral stem and acetabular construct were replaced by an ARCOS revision system using 36 mm head with a Freedom cup (cemented to Max-Ti cage; Biomet Inc.). The complete femoral neck and head were bi-valved assembled in horizontal plane for direct imaging by interferometry and SEM (Fig. 1a). After sectioning the head separated from the stem. Quantitative imaging used 1 to 5 regions with 6-replicate measurements per region and differentiation into contact and non-contact zones (Fig. 1b). Visual corrosion mapping (3) was recorded digitally in 4 anatomical views (Figs 1b–f). The thread profile on contact zone inside the head (Fig. 2a) had a pitch of approximately 40 μm and a peak-to-valley depth of 4 μm overall (Fig. 2b profile section of thread: PV = 2 μm). The thread profile on stem trunnion (Fig. 3a) had a pitch of approximately 125 μm and a peak-to-valley depth of 3.5 μm overall (Fig. 2b profile section of thread: PV = 1 μm). Thus the stem trunnion thread was much coarser than the head. Overall corrosion grading was judged very mild. Overall we were satisfied that this Ti6Al4V: CoCr combination taper junction with threaded interfaces had performed very well for 18 years. Nevertheless, our visual grading was subject to opinion and thus unrewarding. The continuing project will quantify the contacting and non-contacting regions of head and stem (Fig. 1b)


The Bone & Joint Journal
Vol. 95-B, Issue 11_Supple_A | Pages 67 - 69
1 Nov 2013
Brooks PJ

Dislocation is one of the most common causes of patient and surgeon dissatisfaction following hip replacement and to treat it, the causes must first be understood. Patient factors include age greater than 70 years, medical comorbidities, female gender, ligamentous laxity, revision surgery, issues with the abductors, and patient education. Surgeon factors include the annual quantity of procedures and experience, the surgical approach, adequate restoration of femoral offset and leg length, component position, and soft-tissue or bony impingement. Implant factors include the design of the head and neck region, and so-called skirts on longer neck lengths. There should be offset choices available in order to restore soft-tissue tension. Lipped liners aid in gaining stability, yet if improperly placed may result in impingement and dislocation. Late dislocation may result from polyethylene wear, soft-tissue destruction, trochanteric or abductor disruption and weakness, or infection. Understanding the causes of hip dislocation facilitates prevention in a majority of instances. Proper pre-operative planning includes the identification of patients with a high offset in whom inadequate restoration of offset will reduce soft-tissue tension and abductor efficiency. Component position must be accurate to achieve stability without impingement. Finally, patient education cannot be over-emphasised, as most dislocations occur early, and are preventable with proper instructions.

Cite this article: Bone Joint J 2013;95-B, Supple A:67–9.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXV | Pages 71 - 71
1 Jun 2012
Ghosh S Shah B Bhansali H
Full Access

Introduction. Revision surgery is generally recommended for recurrent dislocation following Total hip arthroplasty (THA). However, dislocation following revision THA continues to remain a problem with further dislocation rates upto 28% quoted in literature. We present early results of one of the largest series in U.K. using dual mobility cemented acetabular cup for recurrent hip dislocation. Methods. We retrospectively evaluated 40 patients where revision of hip replacement was performed using cemented dual mobility acetabular prosthesis for recurrent dislocations from March 2006 till August 2009 at our district general hospital by a single surgeon (senior author). The series comprised of 13 men and 27 females with average age of 73.4 years (49-92). The mean follow-up period was 23 months. (36 months –6 months). All the hips that were revised had 3 or more dislocations, some them more than 10 times. The cause of dislocation was multifactorial in majority of cases including acetabular component malpositioning mainly due to loosening and wear. A cemented dual mobility cup was used in all cases. In six cases the femoral stem was also revised. Results. At mean follow up of 26 months none of the revised THA had dislocated nor did they have any features of instability. No patients were lost for follow up. Clinically and radiologically there were no features of loosening of the acetabular component. Discussion. The dual mobility cup appears to be a reliable method in treatment for recurrent total hip dislocations. Although our early results are encouraging with no loosening of acetabular components a further evaluation at longer follow- up is recommended


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_I | Pages 45 - 45
1 Mar 2010
Hanratty B Stevenson C McAlinden M
Full Access

Introduction: Revision Hip Surgery presents an increasing Orthopaedic Burden. Indications for revision include recurrent hip dislocation, infection, peri-prosthetic fracture, failure of implants, including aseptic loosening, osteolysis, wear or mechanical failure of components. Within the region of Northern Ireland, we have investigated the indications for revision hip procedures, carried out from April 2006 to March 2007. We wanted to establish if the indications of revision surgery are comparable to other national registers. Methods: An audit of all hospitals, which carry out hip revision surgery, was carried out, to identify patients who have undergone revision total hip surgery. The indications for revision procedures were identified, from hospital databases, patient records and examination of pre-operative X-rays. Revision procedures included replacement of one or both components, application of Posterior Lip Augmentation Devices and cable plating or component revision for peri-prosthetic fractures. Results: 180 patients, who had undergone revision, were identified in six hospitals. 56 were female and 124 were male. Revisions were performed for a peri-prosthetic fracture in 38 (21%), infection in 12 (7%), recurrent dislocation in 23(13%) and failure of implants in 105 (58%). In 2 patients (1%) revision was performed after the development of avascular necrosis following resurfacing hip replacement. Discussion: The largest body of information on revision hip surgery is the Swedish registry. Their incidence for revision hip surgery is 7%. Their indications were: aseptic loosening 71%, Infection 7.5%, Fracture as 5.6% and dislocation as 4.8%. Our data indicate a greater prevalence of revision for recurrent dislocation and peri-prosthetic fractures than the Swedish data. Further work should aim to identify any remediable surgical factors which account for these differences


Orthopaedic Proceedings
Vol. 88-B, Issue SUPP_I | Pages 27 - 28
1 Mar 2006
Wojciechowski P Kusz D Cielinsk L Drozhevsky A
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Early reports on revision total hip arthroplasty (RTHA) suggested that outcomes of this procedure are as good as those of primary total hip arthroplasty (THA). However, RTHA is associated with longer surgery time, greater blood loss and increased risk of complications (thromboembolism, nerve injury, periprosthetic fractures, recurrent hip dislocations and infections). Aseptic loosening after RTHA was reported in 36% of patients aged over 55 years within 4 years after revision. Infections were reported in 32% and complications during surgery in 23% of patients respectively. Unsatisfactory results of RTHA stimulate the search for alternative procedures. Girdlestone excision arthroplasty (GA) seems to be a good solution for older patients with high risk of complications related to a poor general condition. Material and method Between 2000 and 2003 we operated 39 patients, 10 for septic (26%) and 29 aseptic (74%) loosening of their THA. All patients complained of painful limb aggravated by weight bearing and the severity of pain was the main indication for the surgery. Average survival time of previous THA was 9 year (range: 1 to 20). We assessed pain, walking distance and the need to use walking aids. The outcomes were measured according to the Harris Hip Scale. The patients had the GA performed. The procedure involved removing implant and bone cement and placing the major trochanter into bone acetabulum. If an infection was present, an antibiotic irrigation system was introduced. No cast or braces were used and walking was started 2–7 days after surgery, depending on patients general condition. Results Good pain control was reported by 33 (85%) patients. The average Harris Hip Score changed from 25 points preoperatively to 53 at latest follow-up. Average limb shortening was 4 centimetres (range: 2 to 8). Walking aids (one or two crutches) were required by all patients. Eighteen (46%) patients walked more than 500 m, 12 (31%) patients walked 200–500 m and 9 (23%) patients walked less than 200 m, of whom one patient was wheelchair bound. Infection ceased in 9 cases, 1 patient died because of complications related to chronic infection. Discussion GA yields satisfactory results in patients who have to have their prostheses removed. It provides a mobile, painless joint. The disadvantages of GA are: limb shortening and unstable gait which requires the use of crutches. This procedure should be indicated for patients with high risk of complications due to poor general health, infection and/or massive loss of bone stock which render more invasive procedures impossible. GA is also advisable in patients with weak hip abductor muscles, when RTHA is associated with a high risk of recurrent hip dislocation. The Girdlestone arthroplasty is a satisfactory salvage procedure in most cases of failed THA, when the choice of reimplantation exposes the patient to a high risk of further failure


Orthopaedic Proceedings
Vol. 86-B, Issue SUPP_IV | Pages 451 - 451
1 Apr 2004
Fresard P
Full Access

Uncemented double-mobility acetabular cups, first used in the late 1970s as a solution to recurrent hip dislocations, have proved efficient in reducing dislocation rates while preserving an important range of motion. The low wear-rate and low mechanical stress on the bone to cup interface enhances survival. New instrumentation has permitted design changes that improve the dislocation coverage of the cup (upper part of the cup) and reduce the risk of impingement with the femoral stem (lower part of the cup). Indications for the use of double-mobility cups have increased. They include primary total hip arthroplasty in relatively unstable hips, in which cases we use the Avantage® press-fit or 3P cup with an AURA II anatomical uncemented or cemented stem, dysplasia (in congenital high dislocations we use the press-fit or 3P or revision cup with an AURA revision stem, and in dysplasia we use small AURA II or Vectra or CMK dysplastic stems), muscular deficiency, in which Avantage® cups can be used with AURA II or revision stems, resection prosthesis or ARMEL calcar prosthesis, etc.)


Orthopaedic Proceedings
Vol. 86-B, Issue SUPP_III | Pages 260 - 260
1 Mar 2004
Boldt J Drobny T Munzinger U
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Aims: This study evaluated the outcome of bilateral hip and knee arthroplasty in the same patient with special regards to schedule planning, postoperative complications and follow-up. Methods: Since 1985 more than 6000 THA and 5500 TKA were implanted in one large center, of which 8% were rheumatoid patients. Quadruple THA and TKA were performed in a total of 58 (0.1%) of which 88% were RA. Mean follow-up of knees was 8.5 years (1–17), of hips 9.5 years (1–18). On average 67% of implants were uncemented. In 21% of the cases all four prostheses were implanted within one year and over 50% within five years. Results: Taking revision of components as failure there were three infections (CLS hip, GSB and LCS knee), two aseptic loosenings (Endler cup, GSB knee), two recurrent hip dislocations, three knee bearing exchanges (LCS, INNEX), and four patella component removal (GSB, PCA). Discussion and Conclusion: Quadruple arthroplasty in the lower extremity did not show an increased failure rate compared with single arthroplasty in this center. The results of this study support the indication for quadruple procedure with early postoperative rehabilitation and full weight bearing. Data suggest a procedure with hips before knees and at least three weeks between any arthroplasty operations


Orthopaedic Proceedings
Vol. 86-B, Issue SUPP_III | Pages 222 - 222
1 Mar 2004
Poul J
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Juvenile hip instability is associated with many conditions. Most of them belong to the group of neuromuscular diseases. Generally following categories can be enumerated: 1. Cerebral palsy, 2. Myelomeningocele, 3. Spinal cord injury, 4. Paraplegia following spine surgery, 5. Poliomyelitis, 6. Inflammatory hip disease, 7. Idiopathic instability, 8. Recurrent post-traumatic hip instability. In the groups 1–5 a chronic muscle imbalance is the reason of the displacement of the femoral head. Inflammatory joint disease produces displacement through cartilage and bone destruction and increased intra-articular pressure. Very rare idiopathic instability is usually associated with generalised hypermobility. For the early diagnosis a careful clinical examination is necessary involving range of motion, testing of the hip stability by the Palmén’s test in the same way like in new-borns. Routine x-ray screening at least once per year is mandatory. For the groups 1–5 a muscle imbalance has to be corrected first. Elimination of muscles contractures or muscles transfers respectively, showed a high efficiency if these surgical corrections were performed early. Femoral osteotomy alone does not provide reliable results. Any form of pelvic osteotomy is necessary to correct acetabular insufficiency. For the inflammatory hip disease early active surgical treatment is best prevention of displacement. Idiopathic hip instability has to be differentiated from common snapping hip. No treatment is necesary. Recurrent hip dislocation can be cured by a posterior capsulorrhaphy