1/25. Finding patients after 40 years: a very long term follow-up study of the Colonna arthroplasty.Between 1952 and 1965, surgeons at the los angeles Shriners Hospital managed 23 hips with the Colonna two-stage capsular arthroplasty, a procedure originally described in 1936 with very stringent indications for the treatment of childhood hip dysplasia. By using chart review, credit traces, telephone listings software, and the internet, we found 17 (90%) of 19 patients known to be alive 40 years after surgery. Only four of 16 patients questioned have not undergone total hip arthroplasty, and these patients were no better candidates for the Colonna arthroplasty than were the 12 patients who have required hip-replacement surgery. We do not support revival of this now obscure procedure. However, we do attest that the average clinical investigator currently has access to tools that allow reliable location of patients for very long term follow-up. This technology will improve the accuracy and statistical power of outcomes research.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
2/25. Traumatic posterior dislocation of hip in children.Traumatic posterior dislocation of the hip joint in children is an uncommon injury. It constitutes a true orthopedic emergency. It makes up over 80% of pediatric hip dislocations. In children, it can occur as a result of minimal trauma, which is attributed to a soft pliable acetabulum and ligamentous laxity. In skeletally mature adolescents, a greater force is required to dislocate the hip joint. Delay in reduction is associated with long-term complications such as avascular necrosis and degenerative arthritis. Avascular necrosis is related to the duration of dislocation. A poorer prognosis is associated with delay in reduction beyond 6 hours, advanced skeletal maturity, or multiple traumas. Prompt reduction minimizes complications. We report two cases of traumatic posterior dislocation of hip in children aged 3 and 14 years. Both were reduced within 6 hours of dislocation, and review at 6 months revealed normal examination and no evidence of any post-traumatic changes. Post-reduction treatment remains without a consensus. This review highlights the clinical presentation, management, and time-sensitive complications of the injury.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
3/25. Dealing with post-traumatic arthrosis of the hip.The conversion of the arthritic post-traumatic hip may be more similar to revision surgery than routine primary hip replacement. Careful preoperative planning and templating is essential. Soft-tissue balance to produce stability is challenging, and patients may need bracing with a THR orthosis postoperatively to assure soft-tissue healing and stability. Acetabular bone stock may be significantly compromised, and the preoperative identification of bone stock deficiencies may not always be possible. The surgeon should be prepared with adequate allograft, acetabular reconstruction rings, and alternative procedures such as fusion or resection arthroplasty in these challenging cases.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
4/25. Recurrent dislocation of the hip in a child with down syndrome: a 20-year follow-up.This is a report of recurrent dislocation of the hip in a child with down syndrome. The child was treated with a soft tissue repair that prevented further dislocations. However, 20 years later, the hip had subluxed and secondary degenerative arthritis had developed. This case emphasizes the necessity of life-long follow-up and prompt treatment of hip disease in patients with down syndrome.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
5/25. A test model of hip brace for prevention of dislocation after total hip arthroplasty (Zetton Band).Hip dislocations remain an intractable problem in patients with soft tissue impairment, particularly in those with muscle weakness around the hip, such as those who have undergone revision total hip arthroplasty (THA). At the authors' hospital, postoperative dislocations were observed in 10 of 154 hips between January 1985 and June 1988. Five hips required re-replacement. Conventional measures to prevent or treat post-THA dislocations have been anti-dislocation pants for soft fixation and a cast or abduction-forcing braces for firm fixation. However, the anti-dislocation pants for soft fixation were not as effective as indicated by the above 10 postoperative dislocations. The firm fixation techniques are considered to cause a reduction in muscle strength, causing psychological stress and poor activity of daily living (ADL). The authors devised a soft brace for easy application and prepared its test model to prevent muscle weakening, allow stability of the hip during rotation and avoid restrictions in ADL. This brace was applied to a patient who had 3 dislocations in a short period after being discharged who sustained a postoperative dislocation and achieved good results.- - - - - - - - - - ranking = 4keywords = soft (Clic here for more details about this article) |
6/25. Acetabular labrum entrapment following traumatic posterior dislocation of the hip.In traumatic dislocation of the hip with or without a fracture of the acetabular rim, complete anatomical reduction might be prevented by a bone fragment or infrequently by a soft tissue block, such as a torn acetabular labrum, ruptured capsule, or round ligament. We report a rare case of a tear in the acetabular labrum that prevented complete reduction of the dislocated hip. A 26-year-old man suffered posterior dislocation of the right hip, which was reduced under general anesthesia. The postreduction radiograph showed that the reduction was not complete, and a thin bony fragment was observed in the joint space in the weight-bearing area. Open reduction was performed 11 days later. We found a free bone fragment in the joint space, which was removed. The postoperative radiograph still did not show complete reduction of the hip. A large defect in the contrast medium was shown in the widened joint space by arthrography, which revealed the existence of the soft tissue interposition. We then performed a second operation and learned that the acetabular labrum was widely detached from the anterior to the posterior acetabular rim and was lying deep within the acetabulum. This detached portion of the labrum was excised, and the hip was reduced. The radiograph obtained during surgery then showed complete, concentric reduction. We missed the diagnosis clinically and radiologically at the first operation, proving how important it is to obtain an accurate radiological diagnosis in the operating room.- - - - - - - - - - ranking = 2keywords = soft (Clic here for more details about this article) |
7/25. Recurrent dislocation of the hip in adult paraplegics.Recurrent dislocation of the hip is rare and has not previously been reported in adult paraplegics. This paper describes 3 cases. In one patient it was spontaneous, occurring 16 years after the original injury and was associated with a flexion-adduction contracture of the hip and a shallow acetabulum. One case occurred after minor trauma in a patient who experienced flexion-adduction spasms of the hip. In the third patient the condition was secondary to posterior acetabular deficiency following a conservatively treated fracture dislocation. All 3 patients experienced symptoms of disabling autonomic dysreflexia during the episodes of dislocation. The importance of recognising and adequately treating hip injuries in patients presenting with paraplegia secondary to spinal cord injury is stressed. In patients with spastic paraplegia presenting with recurrent dislocation of the hip, operative treatment combining a soft tissue repair and a bone block to augment the acetabulum is recommended.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
8/25. Entrapment of the acetabular labrum following reduction of traumatic hip dislocation in a child.In traumatic hip dislocation, concentric reduction can be prevented by various causes. Soft-tissue interposition, such as entrapment of the acetabular labrum, is a rare but important cause of failed reduction of a hip. early diagnosis of incomplete reduction due to interposition of soft tissue is important, because delayed treatment is associated with a greater incidence of avascular necrosis of the femoral head and early onset of osteoarthritis. This report describes a case of acetabular labral entrapment following reduction of traumatic hip dislocation in a child. The importance of CT and MRI in arriving at an early diagnosis is emphasized.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
9/25. Reduction of high dislocation of the hip using a distraction nail before arthroplasty.We report the case of a 22-year-old woman who underwent plate and screw fixation for a traumatic left acetabular fracture and fixation with cancellous screws for an associated femoral neck fracture. Two months later, the internal fixation became infected and was removed. This resulted in a painful high dislocation of the hip. We solved the problem with continuous soft-tissue distraction using a fully implantable motorised distraction nail in order to reduce the proximal femur prior to total hip arthroplasty. To our knowledge, this is the first time that reduction of a high dislocation of the hip has been performed using such a system.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
10/25. Iliofemoral distraction and hip reconstruction for the sequelae of a septic dislocated hip with chronic femoral osteomyelitis.We describe a technique of 'cross-hip distraction' to reduce a dislocated hip with subsequent reconstruction of the joint for septic arthritis with extensive femoral osteomyelitis. A 27-year-old woman presented with a dislocated, collapsed femoral head and chronic osteomyelitis of the femur. Examination revealed a leg-length discrepancy of 7 cm and an irritable hip. A staged technique was used with primary clearance of osteomyelitis and secondary reconstruction of the hip. A cross-hip monolateral external fixator was used to establish normal anatomy followed by an arthroplasty. A good functional outcome was achieved. The use of cross-hip distraction avoids soft-tissue and nerve damage and achieved improved abductor function before arthroplasty.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
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