1. A scheme was started in 1960 with the object of ensuring that the hips of all babies born in the North-Eastern Region of Scotland were examined shortly after birth.

2. 1,671 children with suspected abnormalities have been seen during the ensuing ten years, and the findings are discussed.

3. Clinical examination is essential. Radiographic examination of the newborn is not necessary and may be misleading, but it does prove that some hips with limited abduction but no instability are in fact dislocated.

4. Treatment is not started when the diagnosis is made shortly after birth. The children are re-examined at three weeks, when spontaneous recovery has occurred in about half. The others, whether they show instability or only limitation of abduction of the hips, are treated in a simple splint until they are three months old. Any residual stiffness is an indication for further splintage.

5. The first radiographs are taken when the children are three months old, and no child is discharged until the radiographs show that the upper femoral epiphyses have appeared and are in normal position.

6. We appreciate that we are treating some children who would have recovered spontaneously, but we do not know how to distinguish them. There is no evidence that splintage harms a hip.

7. Eighty-six children (5 per cent of the total) needed operation usually because the diagnosis was missed at birth.

8. Children with familial joint laxity or genu recurvatum should be examined especially carefully for associated hip abnormality.

9. The incidence of abnormality of the hips at birth is about one in fifty live births.

1. Out of 11,868 children born in one maternity department and examined neonatally three cases (possibly four) of typical dislocation were missed at the first examination but diagnosed and treated with good results within the following few months.

2. One single neonatal examination of the hip is not sufficient. Repeated examinations during the first weeks and months are essential.

3. Treatment with a Frejka pillow is unsatisfactory. The von Rosen splint is preferable.

4. Following the campaign for neonatal diagnosis and early treatment no case of established dislocation has been encountered after the age of six months.

5. Atypical cases present special problems.

We analysed one surgeon’s attempt to reconstruct the hip in 66 patients (84 hips) with chronic dislocation and to restore the height of the centre of rotation above the transverse teardrop line, the bodyweight lever arm, the abductor lever arm, and the abductor angle to normal. The outcome was assessed using a patient profile at 0, 10 and 20 years, a clinical assessment of pain, mobility and the range of active movement. We measured the work done by active movement against gravity, radiological signs of loosening, migration and subsidence, and the need for revision. We used survival at ten years and revision as the endpoint.

The incidence of complications was higher than in arthroplasty for primary osteoarthritis of the hip, but the outcome was considered satisfactory. The advantages of a flanged cemented socket were demonstrated. A custom-made, laterally reduced, Charnley extra small CDH femoral prosthesis was used in certain cases.

A study of structures which obstruct reduction of hip dislocation was performed on 15 hips by magnetic resonance imaging (MRI). Before treatment started, MRI studies were performed on 10 patients, six of whom were treated conservatively, after which further MRI studies helped to establish a concentric reduction. In the other four conservative treatment failed and they were operated on; in them the MRI studies were compared with arthrographic and surgical findings. In all but one of these 10 patients, MRI enabled us to differentiate between an everted and an inverted limbus. In five other patients with unsatisfactory development of the hip following closed reduction, MRI was compared with earlier arthrographic studies. MRI provided accurate anatomical information which would not have been obtained by arthrography. It clearly has great potential in assisting the surgeon to select the appropriate form of treatment.

1. It is suggested that the obstruction causing delayed reduction of the congenitally dislocated hip is the infolded limbus.

2. An operation is described by which the infolding limbus may be easily and safely removed.

3. The early results of the operation are reported.

4. The evidence for the original assumption is discussed.

The femoral head receives blood supply mainly from the deep branch of the medial femoral circumflex artery (MFCA). In previous studies we have performed anatomical dissections of 16 specimens and subsequently visualised the arteries supplying the femoral head in 55 healthy individuals. In this further radiological study we compared the arterial supply of the femoral head in 35 patients (34 men and one woman, mean age 37.1 years (16 to 64)) with a fracture/dislocation of the hip with a historical control group of 55 hips. Using CT angiography, we identified the three main arteries supplying the femoral head: the deep branch and the postero-inferior nutrient artery both arising from the MFCA, and the piriformis branch of the inferior gluteal artery. It was possible to visualise changes in blood flow after fracture/dislocation.

Our results suggest that blood flow is present after reduction of the dislocated hip. The deep branch of the MFCA was patent and contrast-enhanced in 32 patients, and the diameter of this branch was significantly larger in the fracture/dislocation group than in the control group (p = 0.022). In a subgroup of ten patients with avascular necrosis (AVN) of the femoral head, we found a contrast-enhanced deep branch of the MFCA in eight hips. Two patients with no blood flow in any of the three main arteries supplying the femoral head developed AVN.

Cite this article: Bone Joint J 2013;95-B:1453–7.

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.

Aims

The aim of this systematic review was to report the rate of dislocation following the use of dual mobility (DM) acetabular components in primary and revision total hip arthroplasty (THA).