A rare soccer-related injury: Traumatic posterior hip fracture-dislocation - Case series and overview of the literature.

BACKGROUND: Soccer is one of the most popular sports with millions of active professional and non-professional players worldwide. Traumatic hip dislocations are rare in soccer but can lead to major sequelae both physically and psychologically. The aim of this review was to obtain insight into the outcomes after surgerically repaired hip fracture-dislocation in soccer players as well as rehabilitation and prevention. METHODS: Two cases of a posterior hip fracture-dislocation that occurred during an amateur soccer match are presented and mechanism of injury, complications and rehabilitation were analysed. Follow-up of both patients was at least one year after surgery. Questionnaires and physical examinations were obtained to quantify and qualify outcome. RESULTS: In both cases the hip-dislocations were reduced within 3 h after injury. Semi-elective open reduction and internal fixation was performed within seven days. In one case, there was a concomitant Pipkin fracture and sciatic nerve neuropathy. There were no postoperative complications. Follow-up showed full of range of motion and normal hip functionality in both cases. However, both patients indicated a reduced quality of life and anxiety related to the accident. CONCLUSION: Traumatic hip fracture-dislocations during soccer practice are extremely rare. Despite uncomplicated fracture healing after surgery and return of hip function, both patients still suffer from psychological problems resulting in a decreased quality of life. Further research is required to enhance psychological outcomes, as well as to facilitate return to pre-injury levels of participation and engagement in sports following traumatic hip fracture-dislocations related to soccer.

Prevention of hip displacement in children with cerebral palsy: a systematic review.

AIM: To conduct a systematic review and evaluate the quality of evidence for interventions to prevent hip displacement in children with cerebral palsy (CP). METHOD: A systematic review was performed using American Academy of Cerebral Palsy and Developmental Medicine (AACPDM) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. Searches were completed in seven electronic databases. Studies were included if participants had CP and the effectiveness of the intervention was reported using a radiological measure. Results of orthopaedic surgical interventions were excluded. RESULTS: Twenty-four studies fulfilled the inclusion criteria (4 botulinum neurotoxin A; 2 botulinum neurotoxin A and bracing; 1 complementary and alternative medicine; 1 intrathecal baclofen; 1 obturator nerve block; 8 positioning; 7 selective dorsal rhizotomy). There was significant variability in treatment dosages, participant characteristics, and duration of follow-up among the studies. Overall, the level of evidence was low. No intervention in this review demonstrated a large treatment effect on hip displacement. INTERPRETATION: The level and quality of evidence for all interventions aimed at slowing or preventing hip displacement is low. There is currently insufficient evidence to support or refute the use of the identified interventions to prevent hip displacement or dislocation in children and young people with CP. WHAT THIS PAPER ADDS: High-quality evidence on prevention of hip displacement is lacking. No recommendations can be made for preventing hip displacement in children with cerebral palsy because of poor-quality evidence. High-quality, prospective, longitudinal studies investigating the impact of interventions on hip displacement are required.

Do alumina matrix composite bearings decrease hip noises and bearing fractures at a minimum of 5 years after THA?

BACKGROUND: Ceramic-on-ceramic bearing couples are theoretically attractive in total hip arthroplasty (THA) because of low wear, but concerns regarding ceramic fracture and squeaking have arisen. Improved material properties of newer alumina matrix composite (AMC) materials, known as Delta ceramics, may reduce these risks. In addition, the use of thinner liners and larger femoral heads may be helpful clinically to lower the rate of dislocation. However, limited short-term clinical results are available and intermediate-term effects are unclear. QUESTIONS/PURPOSES: (1) What is the frequency of bearing-related complications (dissociation, fracture, and noise) with ceramic-on-ceramic AMC bearings in cementless THA? (2) What other complications arose in patients treated with these bearings? (3) What are the Harris hip scores (HHS) and survivorship free from reoperation and revision at a minimum of 5 years after cementless THA performed with AMC bearings? METHODS: Over a 9-month period in 2009, one surgeon performed 125 THAs, of which 100 (80% of the total) were performed with cementless, AMC bearings. During the period in question, the exclusion criteria for this implant were primary THAs with severe acetabular or femoral bone defect and revision THAs. Of these, 94 hips (95%) in 91 patients were available for analysis at a minimum of 5 years (range, 5-6 years), because five patients (six hips) had died. Mean age at the time of arthroplasty was 55 ± 14 years. Prostheses with an identical design and Biolox(®) Delta ceramics were used in all patients. Noise was classified into squeaking, clicking, grinding, and popping. Ceramic fracture, dislocation, and any other complications associated with the use of AMC ceramics were also investigated. Clinical evaluation included the modified HHS preoperatively and at each followup. Survivorship free from reoperation and revision was calculated using the Kaplan-Meier method. RESULTS: Of 91 patients, four developed bearing-related complications, including one with liner dissociation despite initial square seating and three with clicking. No patients had ceramic fractures. A single event of perioperative dislocation occurred in one patient and postoperative periprosthetic fracture occurred in two hips. Mean HHS improved from 56 to 93 points at the final followup (p < 0.001). Survivorship at 5 years free from reoperation and revision was 96.8% and 97.9%, respectively. CONCLUSIONS: Improved material properties combined with the possible use of larger diameter heads make AMC ceramics a promising alternative bearing option with seemingly comparable clinical outcomes reported by others with conventional ceramic bearings. Despite these encouraging results, however, meticulous technical precautions such as square seating and proper impaction in particular should be taken during liner insertion, because we did observe one liner dissociation and several patients with hip noises. LEVEL OF EVIDENCE: Level IV, therapeutic study.

Hip dislocation increases roughness of oxidized zirconium femoral heads in total hip arthroplasty: an analysis of 59 retrievals.

The aims of this study were to assess damage on the surface of retrieved oxidized zirconium (OxZr) metal femoral heads, to measure surface roughness of scratches, and to evaluate the extent of surface effacement using scanning electron microscopy (SEM). Ceramic zirconia-toughened alumina heads were analyzed for comparison. OxZr femoral heads explanted for recurrent dislocation had the most severe damage (P<0.001). The median surface roughness of damaged OxZr femoral heads was 1.49µm, compared to 0.084µm for damaged ceramic heads and 0.052µm for undamaged OxZr (P<0.001). This may be of clinical concern because increased surface roughness has the potential to increase the wear of polyethylene liners articulating against these OxZr heads in THA.

The impact of complementary and alternative medicine on hip development in children with cerebral palsy.

AIM: This study aimed to evaluate the effect of complementary and alternative medicine (CAM) approaches on long-term surgical requirements, and clinical and radiographic outcomes for children with cerebral palsy and hip displacement. METHOD: Twenty-three children with cerebral palsy and early hip displacement who were offered preventive hip surgery and whose parents declined in favour of CAM approaches were followed (13 males, 10 females; mean age 13 y 9 mo [SD 3 y 1 mo]; mean length of follow-up 10 y 2 mo [SD 2 y 11 mo]; 17 with spastic quadriplegia, two with spastic triplegia, and four with spastic diplegia; three with gross motor function classified at Gross Motor Function Classification System [GMFCS] level II, four at level III, six at level IV, and 10 at level V). Principal outcome measures were progression of hip displacement (measured by migration percentage: the percentage of the femoral head sitting outside of the acetabulum), eventual need for reconstructive or salvage surgery, and long-term hip morphology (classified by the Melbourne Cerebral Palsy Hip Classification Scale). The results were compared with a previously reported cohort of 46 children who had surgery when recommended (31 males, 15 females; mean age 13 y 11 mo [SD 1 y 6 mo]; mean length of follow-up 10 y 10 mo; 10 with diplegia and 36 with quadriplegia; three at GMFCS level II, 11 at level III, 20 at level IV, and 12 at level V). RESULTS: Outcomes for 23 children who had pursued CAM were analysed (mean length of follow-up 10 y 2 mo). Hip displacement progressed in one or both hips in all non-ambulant children (GMFCS level IV or V). Of the 20 children with documented progressive hip displacement, eight developed pain and deformity requiring salvage surgery. An additional 11 children with progressive hip displacement had late reconstructive surgery when symptoms first started. There was strong evidence of a relationship between GMFCS and both progressive hip displacement (χ(2) =17.78; p=0.001) and final Melbourne Cerebral Palsy Hip Classification Scale grade (odds ratio 12.5; p=0.012; 95% confidence interval 1.7-90.4). There was also evidence of those children who pursued CAM requiring more complex surgery than the group who had surgery when recommended (odds ratio 2.5; p=0.002; 95% confidence interval 1.4-4.5). INTERPRETATION: CAM therapy did not appear to influence the progression of hip displacement in children with cerebral palsy. Most children required major reconstructive surgery or salvage surgery despite pursuing CAM.

Traumatic hip dislocation in children.

The aim of this study was to evaluate the outcomes of reduction in the treatment of traumatic posterior hip dislocation in children. Data of 22 pediatric patients (22 hips) with traumatic hip dislocation from January 1995 to December 2007 were analyzed. The clinical evaluation focused on symptoms, physical findings, and range of motion. Radiographs identified the type of hip dislocation. The hip dislocation classification was based on Thompson and Epstein. The reduction procedure was performed according to three variants: variant 1, closed reduction; variant 2, release of the adductor longus, lengthening of the psoas tendon, and insertion of a Kirschner wire through the femoral head into the acetabulum; and variant 3, removal of the soft-tissue interposition of the hip. After reduction, radiography was used to determine whether the hip is concentric and to check whether any other injuries might have been caused after manipulation. There were six females (27.3%) and 16 males (72.7%) in this study. All had type I posterior dislocation of the hip. The ages of the patients at diagnosis ranged from 3 years, 2 months to 9 years, 10 months. The reduction procedure was performed according to variant 1 in 16, variant 2 in five, and variant 3 in one. We attained excellent results in eight hips (36.4%), good results in seven hips (31.8%), fair results in four hips (18.2%), and poor results in three hips (13.6%). There was avascular necrosis in three hips (13.6%), coxa magna in two hips (9.1%), deficient limb of 2 cm in two hips (9.1%), and a limp in two hips (9.1%). The hip scores were 82.4 points on average (range 62-100). Children with traumatic hip dislocation should undergo reduction as soon as possible. If the interval from injury to reduction exceeds 3 weeks, we suggest that the surgeon release the adductor longus, lengthen the psoas tendon, and insert a Kirschner wire. This simple and safe surgical procedure results in marked improvement in hip function and prevents complications later.

Alumina-on-alumina THA in patients with juvenile idiopathic arthritis: a 5-year followup study.

BACKGROUND: THA is a concern in juvenile idiopathic arthritis (JIA) owing to patients' youth, poor bone stock, and small physical size. QUESTIONS/PURPOSES: We asked whether (1) uncemented alumina-on-alumina THAs have good clinical and radiographic results at midterm followup in young patients with inflammatory arthritis and end-stage hip disease secondary to JIA, and (2) the anatomic center of rotation of the hip could be reconstructed in patients with acetabular protrusion. We also assessed the rate of surgical complications. PATIENTS AND METHODS: We retrospectively reviewed 31 alumina-on-alumina THAs in 21 patients with a mean age of 30.9 years (range, 14-48 years). Minimum followup until the time of revision of any component or the latest evaluation was 16 months. For nonrevised cases, the minimum followup was 60 months (range, 60-108 months). Acetabular protrusion was mild in 17 hips (Group 1) and moderate-severe in 14 (Group 2). Bone autograft was used to reconstruct the acetabulum in Group 2. Acetabular reconstruction was evaluated according to Ranawat et al. RESULTS: One cup was revised owing to aseptic loosening at 16 months; the remaining hips showed good clinical and radiographic results. The mean postoperative horizontal distance and the distance between the center of the head of the prosthesis and the true center of the femoral head improved in Group 2. There were no complications related to alumina. CONCLUSIONS: Although THA is a technically demanding procedure in patients with JIA, uncemented alumina-on-alumina THA provides pain relief and improves quality of life. In patients with acetabular protrusion, bone grafts enable anatomic cup positioning. Continued followup will be required to determine whether the alumina-on-alumina bearings in patients with JIA result in less osteolysis and loosening. LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

[Etiology of hip dislocation in children with cerebral movement disorders and possibilities of conservative treatment using rotating and spreading plates and electrostimulation]. / Atiologie der Hüftverrenkung bei Kindern mit zerebraler Bewegungsstörung und Möglichkeiten konservativer Behandlung mit Dreh-, Spreizschalen und Elektrostimulation.

Dislocations of the hip associated with spastic paralysis are almost always found in severely disabled children. The onset is in infancy. Two methods, electrostimulation of the minor gluteal muscles and treatment with simple leg casts to correct the malposition, are described. Follow-up examinations showed that the treatment had had a positive effect on the hip condition in 33 of the 42 children treated with casts and 26 of the 32 children treated by electrotherapy. Electrotherapy is an innovation, since in the past it was considered contraindicated in these patients. However, it is based on the fact that the gluteal muscles do not normally show any spasticity. Irrespective of this, the treatment is long-term, and has to be continued for many years, a fact which makes greater demands on the cooperativeness of the family.