My Orthopedic Surgery

Web site of a support group for this joint condition

ISCHEMIC NECROSIS AS A COMPLICATION IN DELVELOPMENTAL DYSPLASIA
This is an 11 months old white male patient who had congenital dislocation of right hip. This was first detected 6 weeks of age. The patient was a breech child delivered by C-section. He is the first child for this 38 year old mother. At 6 weeks of age, he was placed in a Pavlik harness but this treatment was unsuccessful. Closed reduction was performed, but the hip redislocated. He was kept in an Ilfield brace for a short time and then had open reduction followed by 3 months in a spica cast. Following removal of the cast he redislocated again, and at that time the patient was referred to this Institute.

SUGIOKA OSTEOTOMY
K.B.. 12-year-old boy. B.W. 63 kg(139 Ib.) . Perthes disease. He had right hip pain and limping for seven weeks. When he was first seen at University Hospital of Niigata, the right femoral head was deformed already and collapsed slightly on X-ray. The lateral part of the femoral head showed an impingement lesion. Because good sphericity of the posterior part of the femoral head was still preserved, Sugioka's rotational osteotomy was advised.

DEVELOPMENTAL COXA VARA
* also known as cervical or infantile coxa vara * represents coxa vara not present at birth but rather developing in early childhood * coxa vara is defined as any decrease in the femoral neck-shaft angle less than 120 - 135 degrees

BILATERAL SLIPPED CAPITAL FEMORAL EPIPHYSIS

Avascular Necrosis of the Hip in Sickle Cell Disease

Links to notes on
DDH
Effusion - diff. dx
Perthes Disease
Sickle Cell Anemia
Slipped Capital Femoral Epiphysis
Wheeless' Textbook of Orthopaedics

- decreased neck shaft angle from defect in ossification of femoral neck;
- it is bilateral in 1/3 to 1/2 of cases;
- it can be congenital (noted at birth & differenitated from CDH by MRI), developmental (AD-progressive), or acquired (trauma, LCP, SCFE)
Wheeless' Textbook of Orthopaedics

DDH involves displacement of the femoral head from the acetabulum (during the perinatal period) which disrupts the normal development of the hip joint;
- DDH is estimated to occur in 1 - 1.5 cases per 1000 live births;
- when an agressive screening system is in place (including routine use of ultrasound), it is not uncommon to have a prevalence of 5 / 1000 cases;
- in certain sub-populations, such as North American Indians, incidence can be as high as 35/1000.
Wheeless' Textbook of Orthopaedics

femoral version is defined as the angular difference between axis of femoral neck and the transcondylar axis of the knee;
- excessive femoral anteversion (medial femoral torsion) is most common cause of in-toeing that first presents in early childhood;
Wheeless' Textbook of Orthopaedics

SCREENING PROTOCOL FOR DETECTION OF ISCHAEMIC DISEASE OF THE GROWING HIP AND PREVENTION OF LEGG-CALVÉ-PERTHES DISEASE. Nuno Craveiro Lopes, M.D., Almada-PORTUGAL LCPD is perhaps a multifactorial disease, but what is sure today is that you need two or more ischaemic episodes, occurring within some months to provoke the illness. Those episodes are symptomatic: There is pain and signs one can detect if one is aware of. We call that stage before the onset of LCPD, Ischaemic Disease of the Growing Hip (IDGH).

Wheeless' Textbook of Orthopaedics
- slip of the captial femoral epiphysis occurs with in a narrow window of physiologic maturity of the growing child; - arises from mechanical and constitutional factors; - pts may have underlying endocrine dz (such as hypothyroidism) delayed puberty & bone age; - position of growth plate of proximal femur normally changes from horizontal to to obliqueduring preadolescence and adolescence; - wt increase that occurs during adolescent growth spurt puts extra strain on the growth plate; - remember that bilateral involvement is occurs in over 25% of patients - often within 6 months of the other side;

Developmental Dysplasia of the Hip (DDH)

Common Causes of Hip Pain in Children

Limping of Painful Lower Extremity