Hip Joint Instability After the Neonatal Period:Diagnosis and Treatment of 20 Consecutive Cases

Abstract

A consecutive series of 20 children (21 hips) with idiopathic hip joint instability, diagnosed after the neonatal period, is presented. The diagnosis was confirmed by hip joint arthrography. In all the children, 1.5-21 months old at the time of diagnosis, closed reduction could be achieved. They were treated in plaster directly or after treatment of contractures in the adductor muscles of the hip joint. Stability was rapidly attained during plaster treatment. The results of the treatment in plaster were checked by a second arthrography in two thirds of the cases, and all cases have been clinically and radiologically evaluated 1-4.5 years after diagnosis. All of the children developed clinically stable hips and they walk normally. In two hips signs of avascular necrosis of the femoral head were found and in three hips (two children) the skeletal development was markedly delayed. In 81 per cent (17/21 hips) the prognosis was considered good; it is uncertain in the remaining four hips. The appropriate period of fixation in plaster related to the age of the child is discussed.

Arthrography of the Hip in Children

“…Twenty consecutive cases diagnosed after the neonatal period, including children with such lesion, have been reported in detail elsewhere (ALMBY & LONNERHOLM 1978). A detailed report has also been made on 9 other chil dren from the present series in whom treatment initiated in the neonatal period was unsuccessful (ALMBY et coll.…”

“…In cases diagnosed neonatally usually no radio graphic examination is needed at the initial stage of treatment but routine conventional radiography at the age of a few months is generally applied (ALMBY & REHNBERG 1977). That conventional radiography has not always been a satisfactory diagnostic tool for the treatment is evident from the necessity for arthrography is some of these children (Fig.…”