: Changes in arthroscopic findings before and after acetabular labrum resection for osteoarthritis of the hip were studied.Acetabular labrum resection for osteoarthritis of the hip was performed on 27 hips in this study. Before acetabular labrum resection, detachment of the acetabular labrum was observed in 26 hips and inversion was observed in 1 hip. These labrums were always interposed between the femoral head and the acetabulum.Marked damage of the articular cartilage in 19 hips was seen in the area corresponding to the acetabular labrum. A second arthroscope (1-1.5 years later), demonstrated improvement of the articular cartilage in 11 hips, but, the degree of fibrillation and irregularity on the articular cartilage was increased in 6 hips. We conclude that the interposed acetabular labrum may be the cause of the cartilage damage and that acetabular labrum resection should be carried out in such cases.
Using arthroscopy, we studied the status of reduction in developmental dysplasia of the hip. Hips were examined in 2 boys and 15 girls, aged 5 months to 3 years (average, 1 year 4 months). All joints were irreducible and treated with Pavlik harness or overhead traction. We performed hip arthroscopy using a medial approach with a 2.7-mm arthroscope under general anesthesia and observed the status of reduction during manipulation. We classified the status of reduction into four types: type 1, the femoral head remained outside the acetabular labrum and was irreducible (7 joints) ; type 2, the femoral head was moved on the labrum but was incompletely reducible (4 joints) ; type 3, the top of the femoral head was moved over the labrum but was incongruent and arthroscopically visible (2 joints); and type 4, the femoral head was completely reducible and arthroscopically invisible (4 joints). Type 1 joints were treated with open reduction, and type 2 joints were treated with either open reduction or closed reduction. Joints of types 3 and 4 were treated with closed reduction. Hip arthroscopy is useful for selective screening of irreducible developmental dysplasia of the hip.
In treating congenital dislocation of the hip , the importance of early screening should be emphasized. We summarized the results of orthopaedic examination for neonates who were born from Oct. 1977 to Dec . 1994. During this time 11370 babies were born in the maternity ward of Showa University Fujigaoka Hospital. A total of 8886 babies (78 .2%) were examined, including 4506 male babies and 4380 female babies. Regarding the click sign , in which the instability of the hip joint can be felt by allowing the femoral head to slip in and out of the joint cavity, Ortolan's click sign was positive in 6 cases (6 joints) and Barlow's click sign was positive in 8 cases (10 joints). Of the cases tested by Barlow's click sign, 0.1 % were positive. In these cases one was affected with Larsen's syndrome. Three cases that tested negative using the click sign were found to be dislocated at the follow-up time during infancy . In the click sign-positive cases, plaster cast fixation was performed in two patients , the remaining five patients were treated by a Pavlik harness and one patient was treated by abducted diaper. From follow-up examinations at an average age of 5.4 years satisfactory results were obtained in seven cases; only one case treated by plaster cast fixation showed bilateral slight aseptic necrosis of the femoral head. Although click sign-positive cases have been decreased due to primary prophylaxis from birth, the neonatal examination is essential for detecting the dislocation of the hip in early life.
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