Hip dislocation in children can occur congenitally in isolation or in conjunction with other congenital abnormalities. Traumatic hip dislocations in children are relatively uncommon and anterior dislocation of hip joint is even rarer. We report such a case following unusual mode of injury in a 12-year-old child. The patient underwent successful emergent closed reduction of left hip. The clinical course and follow-up assessment of the patient was otherwise uneventful. At 2 years' follow-up there was no evidence of osteoarthritis, coxa magna, heterotrophic calcification, in congruency of the joints or avascular necrosis of the head of femur.
Child ; Hip Dislocation ; physiopathology ; therapy ; Humans ; Male ; Manipulation, Orthopedic ; methods

Adult ; Female ; Hip Dislocation ; physiopathology ; therapy ; Hip Joint ; physiopathology ; Humans ; Male ; Middle Aged ; Musculoskeletal Manipulations ; Treatment Outcome ; Young Adult

Curved periacetabular osteotomy (CPO) was developed for the treatment of dysplastic hips in 1995. In CPO, the exposure of osteotomy sites and osteotomy of the ischium are made in the same manner as Bernese periacetabular osteotomy, and iliac and pubic osteotomies are performed in the same manner as rotational acetabular osteotomy. We studied the dynamic instabilities of 25 dysplastic hips before and after CPO using triaxial accelerometry. Overall magnitude of acceleration was significantly decreased from 2.30 +/- 0.57 m/sec2 preoperatively to 1.55 +/- 0.31 m/sec2 postoperatively. Pain relief and improvement of acetabular coverage resulting from acetabular reorientation seem to be related with reduction of dynamic instabilities of dysplastic hips. Isokinetic muscle strengths of 24 hips in 22 patients were measured preoperatively and after CPO. At 12 months postoperatively, the mean muscle strength exceeded the preoperative values. These results seem to be obtained due to no dissection of abductor muscles in CPO. The preoperative presence of acetabular cysts did not influence the results of CPO. An adequate rotation of the acetabular fragment induced cyst remodeling. Satisfactory results were obtained clinically and radiographically after CPO in patients aged 50 years or older. CPO alone for the treatment of severe dysplastic hips classified as subluxated hips of Severin group IV-b with preoperative CE angles of up to -20degrees could restore the acetabular coverage, weight-bearing area and medialization of the hip joint. CPO without any other combined procedure, as a treatment for 17 hips in 16 patients with Perthes-like deformities, produced good mid-term clinical and radiographic results. We have been performing CPO in conjunction with osteochondroplasty for the treatment of acatabular dysplasia associated with femoroacetabular impingement since 2006. The combined procedure has been providing effective correction of both acetabular dysplasia and associated femoral head-neck deformities without any increased complication rate. We have encountered an obturator artery injury in one case and two intraoperative comminuted fractures. Although serious complications such as motor nerve palsy, deep infection, necrosis of the femoral head or acetabulum, and delayed union or nonunion of the ilium were reported, such complications have never occurred in our 700 cases so far.
Acetabulum/physiopathology/*surgery ; Hip Dislocation, Congenital/complications/physiopathology/*surgery ; Humans ; Osteoarthritis, Hip/etiology/physiopathology/*surgery ; Osteotomy/adverse effects/*methods ; Recovery of Function

OBJECTIVETo analysis the effects of restoring neck length and femoral calcar of femoral component on the reconstruction of femoral offset and its affection on soft tissue balance in total hip arthroplasty with standard femoral components.

METHODSSixty-eight patients (71 hips, 30 male and 38 female,ranging in age from 17 to 89 years,with an average of 63.5 years)undergone primary total hip arthroplasty were followed up. The postoperative hip scored according to Harris hip score symtem, and femoral offset,femoral calcar restored as well as neck length of femoral component were measured from the postoperative X-ray image, and the adductor muscle force was measured by Cybex-6000 isokinetic muscle strength testing system.

RESULTSFemoral neck length had highly significant and positive correlation with femoral offset (r = 0.64, P < 0.001), and had more effects on femoral offset than restoring femoral calcar (t = 3.07, P < 0.01), but had no significant difference on postoperative Harris score. The postoperative femoral offset of patients operated for the femoral head osteonecrosis was less than those for the hip osteoarthrosis (t = 2.91, P < 0.01) and the femoral neck fracture (t = 3.31, P < 0.01). The adductor muscle force in patients who restored femoral offset were better than those failed to restore femoral offset.

CONCLUSIONThere are several factors affecting femoral offset restoration for soft tissue balance in total hip arthroplasty with standard femoral components, among them, the key factor is the neck length of femoral component which is more significant than femoral calar restoration for reconstruction of femoral offset. The role of femoral offset on soft tissue balance in total hip arthroplasty was strengthening the postoperative adductor muscle.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Hip ; Cartilage ; physiopathology ; Female ; Femur ; diagnostic imaging ; physiopathology ; surgery ; Follow-Up Studies ; Hip ; physiopathology ; surgery ; Humans ; Male ; Middle Aged ; Radiography

Snapping hip syndrome is a relatively common problem that can be easily managed with conservative treatment. This syndrome can be divided into external, internal and intra-articular types. Internal snapping hip syndrome is the rarest amongst these and its etiology is not well understood. We report a unique case of osteochondroma arising from the anterior inferior iliac spine (AIIS), which caused the internal snapping hip syndrome with hip pain and restriction of activity. This rare case of snapping hip syndrome from the AIIS was treated surgically and the symptoms completely disappeared after excision of the tumor.
Adult ; *Bone Neoplasms ; Female ; *Hip Joint/diagnostic imaging/physiopathology ; Humans ; *Ilium/diagnostic imaging/physiopathology ; *Joint Diseases/etiology/physiopathology ; *Osteochondroma

OBJECTIVETo analyze the effect of biomechanical reconstruction of the hip in metal-on-metal total hip resurfacing.

METHODSThirty patients undergoing hip resurfacing arthroplasties were enrolled in this study. The clinical outcomes of the patients were assessed according to the Harris Hip Score before and after the surgery, X-ray examinations and biomechanical reconstruction evaluations.

RESULTSAfter the operation, the length of the patients' legs was shortened by a mean of 2.4 mm. and the femoral offset was decreased by a mean of 5.45 mm. No dislocation were be found in these patients. The preoperative Harris Hip Score was 36.69-/+7.16, significantly lower than that postoperative score (89.63-/+3.36, P<0.01).

CONCLUSIONPrecise biomechanical reconstruction of the hip can be achieved in hip resurfacing arthroplasty, and the stability and functional restoration is guaranteed by large diameter prosthesis design.

Adolescent ; Adult ; Arthroplasty, Replacement, Hip ; methods ; Biomechanical Phenomena ; Female ; Hip Joint ; physiopathology ; Hip Prosthesis ; Humans ; Male ; Metals ; chemistry ; Middle Aged ; Prosthesis Design ; Retrospective Studies ; Young Adult

Adult ; Aged ; Female ; Hip ; physiopathology ; Humans ; Knee ; physiopathology ; Lumbosacral Region ; injuries ; physiopathology ; Male ; Middle Aged ; Range of Motion, Articular ; Sprains and Strains ; physiopathology ; therapy ; Young Adult

BACKGROUND: Some dysplastic hips with favorable radiographic parameters fail to develop normally, suggesting that we should consider cartilaginous or soft tissue structures for further information regarding the condition of the hip. The purpose of this study was to provide a clear definition of concentric reduction in developmental dysplasia of the hip (DDH) based on magnetic resonance imaging (MRI), and to determine how radiographic and MR-based parameters could be used together to treat dysplastic hips. METHODS: We studied range of motion (ROM)-MRI of 25 patients with unilateral hip dysplasia (mean age at the time of MR imaging, 44.1 months). Each ROM-MRI consisted of a set of bilateral hip scans in the following positions: neutral; abduction; abduction- internal rotation; abduction-internal rotation-flexion; and adduction. Before MR scanning, the 25 patients received the following primary treatments: closed reduction (n = 15; at a mean age of 14.5 months); and open reduction (n = 10; at a mean age of 10.0 months). The following new parameters appear to be useful in treating DDH: 1) the labral angle, the angle the labrum makes with the acetabulum; 2) the uncorrected labral deformity (ULD), the "residual deformity" (deflection of the labrum) when the affected labrum is freed from pressure in abduction; and 3) the zone of compressive force (ZCF), the region of the acetabulum through which the body weight acts on the femoral head. RESULTS: A concentrically-reduced hip is one in which the labrum points downward in the neutral position, at the same angle as that of the normal side; and in which the ZCF is zone 3, the inner acetabular zone as defined herein. The ULD and the ZCF may be determined precisely as we have done, or the physician may simply observe the changes in the orientation of the labrum and compare the changes qualitatively to the unaffected side, and likewise for the medial joint space. CONCLUSIONS: Detailed analysis of the labrum as permitted by ROM-MRI, together with acetabular index and other parameters measured from radiographs, provides important information for physicians treating childhood hip dysplasia.
Child, Preschool ; Female ; Hip Dislocation, Congenital/*diagnosis/physiopathology/radiography/surgery ; Hip Joint/pathology/physiopathology/radiography ; Humans ; Infant ; *Magnetic Resonance Imaging ; Male ; Range of Motion, Articular

OBJECTIVETo evaluate the clinical results of the total hip replacement in the treatment of severe deformity of the hip joint caused by advanced ankylosing spondylitis.

METHODSForty-five hips with severely deformities in 33 patients suffered from advanced ankylosing spondylitis treated by total hip replacement were followed-up from 1992 to 2005 in our department. The pain index, deformity angle, range of motion of the joint, changes of weight baring capacity of a single leg, and the postoperative complications were compared and analysed in this study.

RESULTSThe pain was complete released in 27 hips after surgery; the average pain index decreased 1 grade. The angle of flexion deformity of hip decreased by 44.17 degrees averagely. The average range of motion of the hip improved 58.4 degrees. Thirty-one operated hips could bare weight itself. Twenty-two hips occurred prosthesis Sinking of the femur head prosthesis occurred in 22 hips. The sciatic nerve was contused in one case because of violent reduction after the installation of prosthesis, and recovered in 8 months.

CONCLUSIONThe midterm clinical results of total hip replacement in the treatment of severe deformity of hip caused by advanced ankylosing spondylitis is satisfactory.

Adolescent ; Adult ; Arthroplasty, Replacement, Hip ; adverse effects ; Female ; Hip ; abnormalities ; physiopathology ; Humans ; Male ; Pain ; Range of Motion, Articular ; Spondylitis, Ankylosing ; pathology ; physiopathology ; surgery ; Weight-Bearing

OBJECTIVETo evaluate the clinical and radiographic effects of total hip arthroplasty (THA) in the treatment of bony ankylosis of hips.

METHODSFrom January 2003 to August 2009, 20 patients (30 hips) with bony ankylosis of hips were treated with THA. There were 12 males and 8 females, with an average age of 36 years old. After operation, the follow-up results were evaluated with clinical and radiographic criteria. The clinical follow-up results were evaluated with Harris score, satisfaction of pain relief, limb length discrepancy, ROM of hip and the strength of hip abductor. The X-ray imaging follow-up results were evaluated with acetabula and periprosthetic osteolysis, prosthesis loosening, radiolucent and heterotopic ossification.

RESULTSThe average following-up was 4 years. The mean preoperative Harris score was (40.75 +/- 6.52) as opposed to postoperative Harris score of (86.40 +/- 5.42). Total pain relief was 65% and partial pain relief was 35% around the affected hips. The recovery of abductors strength was satisfactory in 13 cases, with limp symptoms was relieved obviously, and limb shortening decreased to less than 0.5 cm. The postoperative ROM of hip was significantly improved compared with the preoperative ROM. Radiographic analysis showed that heterotopic ossification in 2 cases, and radiolucent around prosthesis in one case. There were no dislocation and revision cases.

CONCLUSIONThe THA can provide satisfactory clinical results in bony ankylosis of hips, which not only correct the deformity and recover the functions of hip, but also relieve the pain of hip to improve quality of life.

Adult ; Ankylosis ; diagnostic imaging ; physiopathology ; surgery ; Arthroplasty, Replacement, Hip ; methods ; Female ; Hip Joint ; physiopathology ; Humans ; Male ; Middle Aged ; Radiography ; Range of Motion, Articular