Purpose: The prognosis of congenital hip displacement basically depends on the time of diagnosis and treatment. Recognising high-risk hips early remains a number one priority. We conducted a prospective study over a 20-year period from 1992 to 2002 to analyse the epidemiology of congenital hip displacement. Material and methods: The series included 1056 children with congenital hip disease (1491 hips). Epidemiological data, ultrasound and x-ray findings were recorded over 20 years. The objective was to identify risk factors and evaluate the impact of prevention measures. Results: The sex ratio showed female predominance, 6:1. The left hip was involved 1.8 times more often, with 41% bilateral involvement. Risk factors were major: family history (31%), breech presentation (25%), postural syndrome (12%); or minor: primiparity (54.4%), birth weight > 4 kg (9.2%). One or more major risk factors were found in 60.5% of the children and 30% had at least one minor risk factor. No risk factor was found in 40%. Screening efficacy improved with a rate of diagnosis before 4 months of 59% in 1983 and 96% in 2002. The number of hips discovered after the age of one year was 15% in 1983 and 6% in 2002. Discussion: The severity of the hip displacement is not influenced by risk factors nor bilateral involvement. Screening has enabled earlier diagnosis with a 37% increase in the rate of identification before the age of four months. This has been made possible by a systematic examination at birth and ultrasonography introduced in 1989. Conclusion: A regional map showing the paediatrician : maternity : general practitioner distributions is an important tool for screening campaigns. Despite adequate screening 40% of these children do not have any risk factor. Repeated examinations, communication and information exchange between healthcare professionals are the keys to success

Objective: The presentation of mid-term results of porous tantalum TMT cup in congenital high hip dislocation. Materials and Methods: Between November 1997 and December 2000, we performed 27 total hip replacements in 22 women patiens suffering from high congenital hip dislocation according Xartofilakidis classification. The acetabular component was implanted at the true acetabular bed with restoration of the centre of hip rotation. Clinical and radiological observation took place in regular intervals for an average time of 10.2 years (8.5–12 years). Results: The average Harris Hip Score improved from 48.3 preoperatively (range 15–65) to 89.5 at the latest follow-up (56–100). Oxford hip score declined from 49.5 preoperatively to 21.2 at the first year and to 15.2 at five years examination. The absolute acetabular component’s migration was evaluated by EBRA method in the first 2 years and was at average 0.85 mm at the first year and 1.05 mm at the second year. An incident of gross initial migration was observed. No acetabular revision was performed and there was no case of mechanical loosening. Conclusion: The acetabular TMT component is highly adhesive and porous with a modulus of elasticity close to subchondral bone. It promotes initial stability, induces bone penetration and integration and offers a more “physiologig” load transfer. It also offers adequate polyethylene thickness, even in the smallest sizes, due to its manufacturing. The recent results from its use in high hip dislocation are excellent and justify the further study of longevity and probably the superiority of this material

Total hip joint replacement (THJR) for high riding congenital hip dislocation (CDH) is often performed in young patients, and presents unique problems with acetabular cup placement and leg length inequality. A database and the NZ Joint Registry were used to identify 76 hips in 57 patients with a diagnosis of CDH who underwent THJR in the Wellington region between 1994 and 2015. Records and radiographs of 46 hips in 36 patients classified pre-operatively as Crowe II, III or IV were reviewed. Surgical technique used a direct lateral approach, the uncemented acetabular component was located in the anatomic hip center and a primary femoral stem was used in all but one hip. Whether a step-cut sub-trochanteric femoral osteotomy was performed depended on degree of correction, tension on the sciatic nerve, and restoration of leg length. For the 36 patients classified as Crowe II or higher, the average age at operation was 44 years (26 – 66), female:male ratio was 4.5:1 and follow-up averaged 10 years (2 – 22.3). Of the 15 hips classified as Crowe IV, 10 required a step-cut sub-trochanteric femoral osteotomy to shorten the femur, but 5 were lengthened without undo tension on the sciatic nerve. Nine Crowe IV hips received a conventional proximally coated tapered primary femoral component. Oxford hip scores for 76% of patients was excellent (> 41/48), and 24% had good scores (34 – 41). All femoral osteotomies healed. Five hips have been revised, one at 2 years for femoral loosening, one at 5 years for dislocation, two at 12 years for liner exchanges, and one at 21 years for femoral loosening. THJR using primary prostheses for CDH can provide durable long-term results

Purpose: Implantation of a prosthesis on a remodelled femur can cause technical difficulties affecting the outcome of the arthroplasty. We performed a tridimensional study of the femoral anatomy before prosthesis implantation for sequelar congenital hip dislocation. Material and method: The series included 312 hips in 262 patients. The same radiography and computed tomography work-up was perfomred in all patients. There were 288 women and 84 men, men age 56 years. Mean weight was 66 kg and mean height was 163 cm. The crowe classification was 195 dysplasia, 123 dislocations (41% class I, 27% class II, 13% class III, 19% class IV). Telemetric measurements were: femoral isthma, the centre of the lesser trochanter, limb length discrepancy, the cephalo-cervico-diaphyseal angle. Computed tomographic measurements were: anterio-posterior and mediolateral dimensions and femur funneling, helitorsion between the bichondylar plane and the upper femur, anteroposterior diameter of the acetabulum. Results: The mean mediolateral and anteroposterior diameters of the femoral canal at the isthma were 9.8 and 13.1 cm respectively in dysplasia and 9.3 and 12.6 cm, 9.4 and 12.7, and 9.7 and 13.6 cm in I, II, and III–IV congenital dislocations respectively. The femoral funneling index varied from 1.9 to 7.6 in dysplasia and from 2.6 to 7.9, 2.1 to 8.4 and 2.1 to 8.7 in I, II, and III–IV congenital dislocations respectively. The mean cephalo-cervico-diaphyseal angle was 129.3°, 131.9°, 136.8°, and 127.4° respectively. Maximal leg length discrepancy was 45, 57, 71, and 82 cm respectively. Mean helitorsion was 22.9° (1°–52°), 36.4° (8°–86°), 43.2° (2°–82°- and 38.4° (6°–68°) respectively. The mean anteroposterior diameter of the acetabulum was 52, 51.2, 53.1; and 49.6 cm respectively. Discussion and conclusion: The dysplastic or dislocated femur is narrower than the normal femur with wide variations in funneling and cephalo-cervico-diphyseal angle. The mean difference in leg length increases gradually with helitorsion but with wide individual variability, irrespective of the grade. These tridimensional anatomic data can be useful for predicting difficulties in prosthetic treatment of these patients

Avascular necrosis is an iatrogenic complication of the treatment of congenital dislocation of the hip. In order to assess the incidence of this and other complications, we have reviewed a consecutive series of 211 children treated at some stage with the modified Denis Browne splint used in Adelaide. In 173 children treated with this splint alone for 238 subluxed or dislocated hips which were stable when reduced, six hips (2.5%) developed radiographic avascular necrosis, though there was progressive growth deformity in only one. There was a much higher incidence among cases treated for unstable reduction by tenotomy, plaster spica and then the splint, 20 of 33 hips (60.6%) showing radiographic signs, though only one led to progressive abnormality. Of seven patients treated by adductor tenotomy and the splint no case of avascular necrosis was encountered. In the whole series the incidence of significant long-term growth disturbance in children treated in this splint was 0.7%. The great majority of our cases of avascular necrosis were attributable to manipulation and plaster, not to the subsequent use of a splint.

Purpose: To analyse middle-term outcomes of treatment of patients with congenital luxation of hip using modified overhead traction.

Material and Methods: During the years 1991–2001, a total of 116 patients (138 hip joints) were treated. The group comprised 99 girls and 17 boys with the average age 4.7 months (ranging from 1.5–11 months). Patients were divided into two subgroups: patients who have been treated at our department from the determination of the diagnosis and those referred to our department from other facilities after unsuccessful conservative therapy. Only those patients were evaluated in whom the traction therapy was completed at least 2 years ago, the mean follow-up period was 4.5 years (2–10). After the initial preparatory horizontal traction, we moved to a 4-week overhead regimen wherein we increased the abduction by 10 degrees every five days. After completing the dystraction, every hip joint was examined using arthrography and where the reposition was possible, the therapy continued with the fixation in plaster spike for 6 weeks. Pavlik harnes were used for the final phase of the treatment.

Results: In the group of primarily treated patients, reposition was successful in 78 out of 91 hip joints (85.7%). In another 4 hip joints (4.4%), reluxation occurred after an average period of 3.5 weeks after the removal of the spike. Nine hip joints (9.9%), 7 of type IV and 2 of type IIIB, were non-repositionable. Much worse results were achieved in the group of patients who received previous treatment. Only 12 hip joints (25.5%) were maintained permanently repositionable but neither of them was of type IV. Reluxation within two weeks after the removal of the fixation occurred in another 5 hip joints (10.6%). A total of 30 hip joints (63.9%) could not be reposed due to arthrographic findings of reposition obstacles. All these patients were admitted for treatment after the 6th month of age. We have observed no case of avascular head necrosis in the group of 90 patients who received conservative treatment.

Conclusion: Traction therapy is a safe and mild method of treatment for congenital luxation of the hip joint. The rate of success of the therapy depends on the sonographic findings and age of patients at the beginning of therapy. Considerably worse results are achieved in the group of patients who have already received unsuccessful inadequate treatment.

We report on a radiographic screening programme at four months of age for infants who were clinically normal at neonatal examination but were considered to be 'at risk' for congenital dislocation of the hip because of their family history, breech presentation, or a persistent click. From a total population of 13,662 live births over a two-year period, 357 (2.6%) infants at risk were identified. Of these 46 had abnormal radiographs (six subluxations, 40 acetabular dysplasia). In 12 infants treatment resulted in a normal hip; 34 required no treatment but were followed up until their radiographs were normal and walking had begun. Of the 311 infants with normal radiographs, 256 (82%) were examined after 15 months of age; none had any detectable abnormality. We suggest that radiography of the hip at four months is a valuable adjunct to neonatal screening for infants at increased risk of congenital dislocation of the hip.

Between November 1997 and December 2000 we performed 27 total hip replacements in 22 patients with high congenital dislocation of the hip using porous tantalum monoblock acetabular components implanted in the true acetabular bed. Clinical and radiological evaluation was performed at regular intervals for a mean of 10.2 years (8.5 to 12). The mean Harris Hip Score improved from 48.3 (15 to 65) pre-operatively to 89.5 (56 to 100) at the final follow-up. The mean Oxford Hip Score was 49.5 (35 to 59) pre-operatively and decreased to 21.2 (12 to 48) at one year and 15.2 (10 to 28) at final follow-up. Migration of the acetabular component was assessed with the EBRA software system. There was a mean migration of 0.68 mm (0.49 to 0.8) in the first year and a mean 0.89 mm (0.6 to 0.98) in the second year, after excluding one initial excessive migration. No revision was necessary for any reason, no acetabular component became loose, and no radiolucent lines were observed at the final follow-up.

The porous tantalum monoblock acetabular component is an implant offering adequate initial stability in conjunction with a modulus of elasticity and porosity close to that of cancellous bone. It favours bone ingrowth, leading to good mid-term results.

Purpose of the study: The natural history of congenital hip dysplasia with weight-bearing usually progresses towards degenerative joint disease. The anatomic type of the dislocation, whether treated or not, was well classified by Crowe who described four types.

Material and methods: Since 1989, we have used an ABG hydroxyapatite (HA) coated prosthesis for the treatment of congenital hip dysplasia. The hemispheric acetabular implant is coated with hydroxyapatite and the femoral implant, which is inserted in an anatomic position with anteversion, antetorsion and anteflexion, has a HA-coated stem. Forty-three Crowe type 3 or 4 hips (high position) were treated with this technique:

implantation of the cup in the paleoacetabulum;

Results: Cup implantation in the paleoacetabulum was achieved in all patients except two. A screwed autograft was inserted in 75% and remained stable over time for the larger grafts but tended to resorb for smaller grafts. For femoral anteverions, an ABG implant was used in 34 cases: 21 ABG1 stems, 11 ABF2 stems, and one ABG revision stem. The ABG stem enabled satisfactory anatomic restoration in 20 hips but with postoperative stiffness. For 14 hips, due to the important femoral anteversion related to the dysplasia, a reversed ABG-HA implant was used: eight left implants for right hips and six right implants for left hips. This «reversed» curvature gained 24° in the femoral anteversion plane. The outcome was excellent in these 14 cases, particularly with a clear improvement in postoperative external rotation. At close to 15 years follow-up we have had no case of femoral loosening, nor of femoral shaft osetolysis, with this type of implant.

Discussion: Certain authors propose using a custom-made implant for sequelar congenital hip dysplasia, but we prefer the proposed technique which provides very satisfactory results and limits the need for custom-made material.

The incidence of clinically significant avascular necrosis (AVN) following medial open reduction of the dislocated hip in children with developmental dysplasia of the hip (DDH) remains unknown. We performed a systematic review of the literature to identify all clinical studies reporting the results of medial open reduction surgery. A total of 14 papers reporting 734 hips met the inclusion criteria. The mean follow-up was 10.9 years (2 to 28). The rate of clinically significant AVN (types 2 to 4) was 20% (149/734). From these papers 221 hips in 174 children had sufficient information to permit more detailed analysis. The rate of AVN increased with the length of follow-up to 24% at skeletal maturity, with type 2 AVN predominating in hips after five years’ follow-up. The presence of AVN resulted in a higher incidence of an unsatisfactory outcome at skeletal maturity (55% vs 20% in hips with no AVN; p < 0.001). A higher rate of AVN was identified when surgery was performed in children aged < 12 months, and when hips were immobilised in ≥ 60°of abduction post-operatively. Multivariate analysis showed that younger age at operation, need for further surgery and post-operative hip abduction of ≥ 60° increased the risk of the development of clinically significant AVN.

Cite this article: Bone Joint J 2014;96-B:279–86.

Aim. Aim of this monocentric, prospective study was to evaluate the safety, efficacy, clinical and radiographical results at 24-month follow-up (N = 6 patients) undergoing hip revision surgery with severe acetabular bone defects (Paprosky 2C-3A-3B) using a combination of a novel phase-pure betatricalciumphosphate - collagen 3D matrix with allograft bone chips. Method. Prospective follow-up of 6 consecutive patients, who underwent revision surgery of the acetabular component in presence of massive bone defects between April 2018 and July 2019. Indications for revision included mechanical loosening in 4 cases and history of hip infection in 2 cases. Acetabular deficiencies were evaluated radiographically and CT and classified according to the Paprosky classification. Initial diagnosis of the patients included osteoarthritis (N = 4), a traumatic fracture and a congenital hip dislocation. 5 patients underwent first revision surgery, 1 patient underwent a second revision surgery. Results. All patients were followed-up radiographically with a mean of 25,8 months. No complications were observed direct postoperatively. HHS improved significantly from 23.9 preoperatively to 81.5 at the last follow-up. 5 patients achieved a defined good result, and one patient achieved a fair result. No periprosthetic joint infection, no dislocations, no deep vein thrombosis, no vessel damage, and no complaint about limbs length discrepancy could be observed. Postoperative dysmetria was found to be + 0.2cm (0cm/+1.0cm) compared to the preoperative dysmetria of − 2.4 cm (+0.3cm/−5.7cm). Conclusions. Although used in severe acetabular bone defects, the novel phase-pure betatricalciumphosphate - collagen 3D matrixshowed complete resorption and replacement by newly formed bone, leading to a full implant integration at 24 months follow-up and thus represents a promising method with excellent bone regeneration capacities for complex cases, where synthetic bone grafting material is used in addition to autografts

Introduction. Orthopaedic rehabilitation of adolescences and young adults with high dislocation of the femur is rather challenging. The role of palliative salvage procedures is controversial enough in the cohort of patients. Materials and Methods. Treatment outcomes of 10 patients with congenital hip dislocation were analyzed. Mean age at intervention was 17,8 years (15–22). The grade of dislocation were assessed according to Eftekhar: type C − 2, type D − 8. The mean baseline shortening was 4.7±0.36 cm. All subjects underwent PSO with the Ilizarov method. Another osteotomy for lengthening and realignment was produced at the boundary of the upper and middle third of the femur. The mean time in the Ilizarov frame was 5.3 months. Results. The mean follow-up was 2.6±.1 years (range, 15 to 32 years). Limb shortening of 1 cm to 1. 1. /. 2. cm was observed in four cases. Functional outcomes according to d'Aubigne-Postel were: Pain 4,4±0,15 points. ROM − 4,1±0,3 points. Walking ability − 4,5±0,2 points. Two cases had good results (15–17 points), and seven patients had fair outcomes (12–14 points). A poor result (7 points) was recorded in one female patient 28 years after PSO followed by THA. Conclusions. Hip reconstruction with the Ilizarov method can be used in specific clinical situations as an alternative salvage procedure to delay THR in young patients with high dislocation of the femur

Purpose of the study: the Pavlik harness has been used for the treatment of congenital hip dislocation since it was designed by Arnold Pavlik in 1950. There remains however a certain debate concerning the best moment to start treatment and its duration. We advocate early use of the Pavlic harness for a short period. Material and methods: Forty-five hips (34 infants) were treated. The diagnosis of dislocation was clinical. The Barlow and Ortolani maneuvers were used to search for clinical instability classed as «positive dislocation test» or «negative test but presence of piston movement». Different classifications of positive tests were used to search for an association with increasing severity of hip instability. Static and dynamic ultrasound was then used to confirm the diagnosis of hip dislocation. A Pavlik harness was installed immediately after diagnosis of congenital hip dislocation, on the day of birth if possible, according to the precepts proposed by the inventor. Results: Among the 43 hips analyzed I the present series, reduction and stabilization was successfully achieved with the Pavlic harness in 40 used as early as possible for a short a period as possible. This 95.6% success rate (2 failures, 0 complications) was achieved within 3 o 8 weeks. Discussion: Our results are comparable with other series reporting early use of the Mubarak method. The duration of treatment was shorter with our therapeutic method. We did not attempt to treat the dysplasia, spontaneous regression was monitored radiographically. Conclusion: We consider congenital hip displasia to be a therapeutic emergency. Treatment should be undertaken as soon as the dislocating intrauterine constraints cease. Early use of the Pavlik harness on easily dislocated or dislocated reducible hips has given excellent results. The shorter treatment duration does not lead to any recurrence as long as clinical stability with formal radiographic confirmation at treatment end

The management of a personal series of over 500 patients with congenital hip dislocations has been reviewed with special reference to the mistakes that have been made and the safeguards which have now been adopted

A clinical and radiographic study was conducted on 97 total hip arthroplasties (79 patients) performed for congenital hip dislocation using three-dimensional custom cementless stem. The mean age was 48 years (17 to 72). The mean follow up was 123 months (83 to 182). According to Crowe, there were 37 class 1, 28 class 2, 13 class 3 and 19 class 4. The average lengthening was 25 mm (5 to 58 mm), the mean femoral anteversion 38.6° (2° to 86°) and the correction in the prosthetic neck −23.6° (71° to 13°). The average Harris hip score improved from 58 to 93 points. Six hips (6.2%) required a revision. The survival rate was 97.7% ± 0.3% at 13 years. Custom cementless stem allows anatomical reconstruction and good functional results in a young and active population with disturbed anatomy, while avoiding a femoral osteotomy

We reviewed the cases of 38 children with 45 congenitally dislocated hips who presented for primary treatment after the age of three years. Of these, 34 hips were managed by the 'direct approach' of Somerville and Scott (1957); 14 of these required secondary operations for subluxation, often with a poor outcome. Eleven hips were treated by combined pelvic and femoral osteotomy which, in general, gave good results. At a mean follow-up of 16.7 years, 80% of the whole series had a good or excellent clinical result and 51% were good or excellent radiologically. Simultaneous correction both above and below the hip is considered to be the best treatment for the older child with congenital hip dislocation

A clinical and radiological study was conducted on 97 total hip replacements performed for congenital hip dislocation in 79 patients between 1989 and 1998 using a three-dimensional custom-made cementless stem. The mean age at operation was 48 years (17 to 72) and the mean follow-up was for 123 months (83 to 182). According to the Crowe classification, there were 37 class I, 28 class II, 13 class III and 19 class IV hips. The mean leg lengthening was 25 mm (5 to 58), the mean pre-operative femoral anteversion was 38.6° (2° to 86°) and the mean correction in the prosthetic neck was −23.6° (−71° to 13°). The mean Harris hip score improved from 58 (15 to 84) to 93 (40 to 100) points. A revision was required in six hips (6.2%). The overall survival rate was 89.5% (95% confidence interval 89.2 to 89.8) at 13 years when two hips were at risk. This custom-made cementless femoral component, which can be accommodated in the abnormal proximal femur and will correct the anteversion and frontal offset, provided good results without recourse to proximal femoral corrective osteotomy