Eighty seven dislocations were seen in 1571 consecutive total hip replacements, mostly performed through a posterior approach. Nine occurred immediately after operation and most of the remainder within 5 weeks. In 26 cases further dislocation occurred, and in 11 patients another operation was required. The 87 dislocated hips have been compared with the remaining 1484. Factors predisposing to dislocation included revision operations, the experience of the surgeon and proper reconstruction of the abductor musculature. When the hip was deemed unstable at the end of an operation, dislocation occurred on 18 occasions out of 20 such cases. The position of the components in the dislocated hips was compared with that in 100 stable prostheses chosen by random sampling. A vertical acetabular prosthesis, and retroversion of the acetabular and femoral components all favoured dislocation. In 331 replacements with a 22 mm diameter head 29 dislocations were seen (8.7%), whereas in 168 replacements with 32 mm heads, 5 dislocations occurred (2.9%).
Oral rehabilitation of patients presenting multiple microdontia is a real therapeutic challenge. These alterations in size, often associated with other dental anomalies, have aesthetic and functional repercussions for patients and can lead to significant psycho-social consequences. We report here the case of an 11-year-old patient with bilateral sectorial microdontia and agenesis of teeth numbers 13 and 23. She also presented staturo-ponderal delay and a history of acute coronary syndrome with a lower coronary occlusion of unknown aetiology. At first, additive coronoplasties and an orthodontically retained interim prosthesis answered the aesthetic and functional need during childhood and adolescence. Once she reached adulthood, a multidisciplinary meeting was conducted and a treatment plan was established. The decision was made to rehabilitate the upper arch with a permanent bridge and the lower arch with indirect adhesive restorations. This solution solved the problem of the bilateral lateral infraocclusions and tooth agenesis, restoring both aesthetics and function. This paper presents 15 years of management and treatment of a patient presenting multiple microdontia associated with hypodontia. Both the multidisciplinary approach and coordination between the different medical team members was essential to maintain the existing dentition while preparing, planning, and carrying out a personalized treatment plan once maxillofacial growth was complete.
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