Congenital Displacement Of The Hip Joint

If I have seen further, it is by standing on ye shoulders of giants. Sir Isaac Newton (1675) Although congenital displacement of the hip has always been recognised as the commonest pre-natal deformity of the musculoskeletal system found in otherwise normal children, it is surprising to find that much of our present-day understanding concerning its origin and nature has been discovered only in the past 150 years and its successful management eventu ally emerged during the last 60 years, almost within the professional life time of our more senior colleagues. Whereas Hippocrates (460-370 B. C. ) appeared to recognise patients that had experienced dislocation of their hips in utero and identified them from acquired forms of displacement, according to Severin (1941) it was another 2000 years before Palleta (1820) first recorded a careful description of the deformity based on his observations at an autopsy performed on an II-day-old boy with bilateral dislocations; he concluded that the findings were not caused by injury at birth, but dated from a pre-natal stage. Soon after, Baron Dupuytren (1847) gave an accurate description of congenital dislocation in his contribution entitled "Memoire sur un deplacement original ou congenital de la tete des femurs". He noted the absence of abscesses and fistulae as seen in painful and cruel pathological dislocations, which led him to believe that these congenital displacements were not likely to be the result of foetal disease as the affected babies appeared quite healthy at birth.

For more than 100 years, congenital dislocation of the hip has been an area of concern in orthopedics. This publications on the subject are al most too numerous to count. Yet our knowledge of the basic principles of congenital hip dislocation and its management is constantly being expanded by new research. In Germanspeaking countries, Kaiser pub lished the last comprehensive textbook on congenital hip dislocation in 1958, and Schlegel followed with a comprehensive handbook in 1961. In the Angloamerican world, Coleman's monograph was pub lished in 1978, Somerville's in 1982, and Wilkinson's in 1985. In 1982 Tachdjian compiled a volume on congenital hip dislocation that con tained contributions from 44 authorities. The purpose of the present book is to provide an overview of our pre sent state of knowledge of congenital hip dislocation, covering basic principles, diagnosis, methods of closed and open treatment, and indi cations. In the process, an attempt is made to trace progress in the field from its beginnings to the present time. Many authors describe the diagnosis and treatment of congenital hip dysplasia and dislocation in terms of specific age groups. We believe it is more prudent to take an individualized approach based on arthro graphic findings and the degree of severity of pathologic changes. Less emphasis is placed here on the management of patients by age group.

This book is concerned with the effect that displacement, whether minimal or severe, may have on the hip joint. Although it is concerned with the changes which take place in childhood and during growth, when they are most common and most severe, it is also to a lesser extent concerned with the way they will continue or even start long after growth has ceased. It is based on a series of about 450 cases of congenital displacement of the hip treated when the deformity was established, together with unstable hips drawn from 82000 children whose hips were examined at the time of birth. This study was carried out at the Nuffield Orthopaedic Centre in Oxford. It was started in early 1949 by the author with Mr. J. C. Scott and continued until mid-1977, since when it has continued in the capable hands of Mr. J. W. Goodfellow and Mr. M. K. Benson. The study was started at a time when the generally accepted view was still that the displacement was part of the primary failure of development of the acetabulum, which could not adequately contain the femoral head. Conservative treatment with manipulative reduc tion followed by a prolonged period of plaster immobilisation was the method of choice. Few attempts had been made with surgery as a primary procedure and these had not met with continuing success.

Congenital hip disease (CHD) is the main cause of secondary osteoarthritis (OA) of the hip in young adults, which accounts for almost 40% of all cases of hip OA. Total hip replacement (THR) performed using optimal techniques can achieve a radical improvement in the quality of life of adult patients. This book offers in-depth coverage of all aspects of CHD in adults and its treatment. Relevant information is first provided on the basic anatomy of the hip and OA of the hip and on the classification, epidemiology, and natural history of CHD. The now limited role of femoral and pelvic osteotomies is carefully evaluated, and the use of THR is then considered in detail. Indications and preoperative planning are discussed, and the available operative techniques, analyzed. Clear guidance is provided on overcoming major technical difficulties, and the benefits of particular approaches and techniques are highlighted. More than 180 images and numerous case studies complement this reader-friendly text. The book will be an invaluable tool for orthopedic surgeons, rheumatologists and radiologists. ​