Traumatic anterior dislocation of the hip is rare. Bilateral traumatic anterior dislocation is an even rarer injury; indeed, only 5 cases have been reported in the English literature. We describe a case of a bilateral traumatic anterior dislocation of the hip and a concomitant unstable lumbar burst fracture following a mechanism of injury distinctly different from other reports.
*Accidents, Occupational ; Acetabulum/injuries ; Buttocks/*injuries ; Fractures, Bone/complications/etiology/radiography ; Hip Dislocation/etiology/*radiography ; Humans ; Lumbar Vertebrae/*injuries ; Lumbosacral Region/*injuries ; Male ; Middle Aged ; Spinal Fractures/etiology/*radiography

OBJECTIVETo study the occurrence and radiograph features of the acetabular retroversion in hip dysplasia, and to evaluate the effects on the retroversion by the traditional maneuvers in the periacetabular osteotomy.

METHODSBernese periacetabular osteotomy was performed to 45 continuous dysplastic hips (43 patients) from December 2001 to November 2003. There were 37 female (39 hips) and 6 male (6 hips), average age was 28.9 (range, 15-45). The diagnosis of acetabular retroversion was based on the "cross-over" and "posterior wall" signs on the standard radiographs of the patients pre- or postoperatively.

RESULTSAmong total 45 hips, the "cross-over" sign was positive in 8 hips, whereas including the "posterior wall" sign positive in 5 hips. The occurrence of retroversion was 17.8%. And the cross-over points were located within the superior 1/3 of the acetabulums in all cases. After the osteotomy, all the cross-over points moved to the inferior 1/3 of the acetabulums, and the "posterior wall" sign was seen in all 8 cases.

CONCLUSIONSApproximately one sixth of the patients with acetabular dysplasia have retroversion in which the superior 1/3 of the acetabulum faces posterolaterally. The retroversion can be identified with the standard AP pelvic radiographs. With the traditional maneuvers in periacetabular osteotomy, the retroversion will be aggravated in these patients.

Acetabulum ; abnormalities ; diagnostic imaging ; Adolescent ; Adult ; Female ; Follow-Up Studies ; Hip Dislocation, Congenital ; surgery ; Humans ; Male ; Osteotomy ; adverse effects ; methods ; Postoperative Complications ; diagnostic imaging ; etiology ; Radiography

OBJECTIVETo explore the correct localization of the acetabular component, surgical technique and the outcome in total hip arthroplasty (THA) for acetabular dysplasia with secondary osteoarthritis.

METHODSA retrospective review was undertaken of 39 hips (33 patients) that had been performed a total hip arthroplasty for acetabular dysplasia with secondary osteoanthritis from September 1989 to January 2003. These patients were divided into two groups, 16 patients (20 hips) who were performed by regular THA of Harris method were defined as group A and the other 17 patients (19 hips) by acetabular centralization technique as group B. The hip function was evaluated using Harris hip score before and after operation. The horizontal location of the center of the hip (the distance along the intertear drop line extending lateral or medial from the inferior point of the teardrop to the perpendicular line dropped from the center of the femoral head), abduction angle of the cup, and femoral offset was measured.

RESULTSAt the most recent follow-up, the mean Harris hip score was 88.9 +/- 5.8, and 82.3 +/- 8.4 for the anatomical position reconstruction and the lateral displacement hips, respectively (P < 0.05). The horizontal distance between the teardrop and the hip center was significantly shorter in B group [(37.3 +/- 3.4) mm] than in A group [(46.1 +/- 5.3) mm] (P < 0.05). Two patients had bone resorption of autograft and malposition of the acetabular component during follow-up, while others had no revision, loosening, or migration of the acetabular component.

CONCLUSIONAccurately confirmed acetabular position, stable acetabular component, and appropriate techniques are important to guarantee the clinical efficacy of THA.

Acetabulum ; surgery ; Adult ; Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Hip ; methods ; Female ; Follow-Up Studies ; Hip Dislocation, Congenital ; complications ; diagnostic imaging ; surgery ; Humans ; Male ; Middle Aged ; Osteoarthritis, Hip ; diagnostic imaging ; etiology ; surgery ; Radiography ; Retrospective Studies

BACKGROUND: We evaluated the clinical and radiological results of one-stage correction for cerebral palsy patients. METHODS: We reviewed clinical outcomes and radiologic indices of 32 dysplastic hips in 23 children with cerebral palsy (13 males, 10 females; mean age, 8.6 years). Ten hips had dislocation, while 22 had subluxation. Preoperative Gross Motor Function Classification System (GMFCS) scores of the patients were as follows; level V (13 patients), level IV (9), and level III (1). Acetabular deficiency was anterior in 5 hips, superolateral in 7, posterior in 11 and mixed in 9, according to 3 dimensional computed tomography. The combined surgery included open reduction of the femoral head, release of contracted muscles, femoral shortening varus derotation osteotomy and the modified Dega osteotomy. Hip range of motion, GMFCS level, acetabular index, center-edge angle and migration percentage were measured before and after surgery. The mean follow-up period was 28.1 months. RESULTS: Hip abduction (median, 40degrees), sitting comfort and GMFCS level were improved after surgery, and pain was decreased. There were two cases of femoral head avascular necrosis, but no infection, nonunion, resubluxation or redislocation. All radiologic indices showed improvement after surgery. CONCLUSIONS: A single event multilevel surgery including soft tissue, pelvic and femoral side correction is effective in treating spastic dislocation of the hip in cerebral palsy.
Adolescent ; Arthroplasty/*methods ; Cerebral Palsy/*complications ; Child ; Child, Preschool ; Female ; Hip Dislocation/*etiology/*surgery ; Hip Joint/pathology/radiography/*surgery ; Humans ; Male ; Osteotomy ; Pain/etiology ; Range of Motion, Articular ; Tomography, X-Ray Computed

OBJECTIVETo observe the leg length discrepancy and accompanied knee varus/valgus deformity in matured patients with unilateral dislocation of the hip.

METHODSFrom March 2011 to December 2012, 28 patients who had unilateral dislocation of hip (Hartofilakidis classification II 17 cases and III 11 cases) were involved in this study.There were 6 male patients and 22 female patients, the age of the patients were 13.4-66.2 years, with mean age of 29.8 years. The standing anteroposterior full leg length X-ray films were obtained. Leg length discrepancy, the length of the femur, the length of the tibia and identified the varus/valgus knee deformities were measured. Statistical analysis was performed. A student's t test for paired samples was done for comparison of the parameters in the same patient between dislocated and undislocated leg, and the χ(2) test were used to assess valgus and varus knees, leg length discrepancy in high dislocation and low dislocation groups.

RESULTSSeventeen (60.7%) cases had longer femur length on the dislocated side than that on the undislocated side (t = 1.328, P = 0.197), with the maximum lengthening of 32.7 mm and a mean lengthening of 9.5 mm. Twenty-one (75.0%) cases had longer tibia length on the dislocated side (t = 3.039, P = 0.006), with a maximum lengthening of 10.9 mm and a mean lengthening of 4.5 mm. Twenty (71.4%) cases had longer relative leg length on the dislocated side (t = 2.451, P = 0.022), with a maximum lengthening of 25.0 mm and a mean lengthening of 9.4 mm. On the dislocated side of the leg, the degree of valgus angle was 3° ± 4°,while on the undislocated side, that was -3° ± 4°(t = 5.642, P = 0.000). On the dislocated side, 12 cases (42.9%) were of valgus deformities and 1 case was of varus deformity. On the contralateral side, 15 cases of varus deformities (53.6%) and 1 case of valgus deformity were observed(χ(2) = 18.139,P = 0.000).

CONCLUSIONSMost dislocated legs are longer in length than the contralateral side, both femur and tibia have also lengthened accordingly. Many knees on the dislocated side present valgus deformity, half of the knees on the contralateral side present varus deformity.

Adolescent ; Adult ; Aged ; Female ; Femur ; abnormalities ; diagnostic imaging ; Hip Dislocation, Congenital ; complications ; radiotherapy ; Humans ; Knee Joint ; abnormalities ; diagnostic imaging ; Leg Length Inequality ; diagnostic imaging ; etiology ; Male ; Middle Aged ; Radiography ; Tibia ; abnormalities ; diagnostic imaging ; Young Adult