A Study about Significance of the Arthrography in Treatment of Congenital Dislocation of the Hip

Lee, S H; Chang, J S; Lee, I H; Cha, E N

Abstract

Although conventional tool it is, hip arthrography remains affirmative method for appraisal of quality of reduction and for visualization of the intrinsic obstructive factors impeding closed reduction in treatment of congenital dislocation of the hip(CDH). The authors have analyzed clinical and arthrographic materials of 37 CDHs from 35 patients which have been followed up for more than 1 year postoperatively. The results are as follows; l. Among 35 patients, laterality was right in 10 cases, left in 23 cases and bilateral in 2 cases. Age distribution ranged from 1 month to 4 years 2 months, whose mean was 1 year and 1 month. 2. Prereduction arthrography showed following observation: subluxation in 7 cases(19.4% ), dislocation in 29(80.6%), deformed limbus in 28 cases(77.8%), hourglass capsular configuration in 13 cases(36.1%), shortened transverse acetabular ligament in 11 cases(30.6%), ligamentum teres hypertrophy in 8 cases(22.2%). Reduction arthrography showed following observations: adequate reduction in 22 cases(61.1%), inadequate reduction in 14 cases(38.9%) with medial dye pooling more than 2mm. 3. Adequate reduction was obtained in 22 cases(61.1%) and were treated by closed reduction. Deformed limbus with medial dye pooling more than 2mm was considered as inadequate reduction and there were 14 cases(38.9%) of this kind reduction. They were treated with open reduction in 3 cases, open reduction with innominate osteotomy in 8 cases, open reduction with femoral shortening in 1 case, open reduction with Klisic operation in 2 cases. 4. Clinical results were classified as Excellent in 28 cases(77.8%), Good in 15 cases(19.4%) according to Gibson and Benson. Radiological results were classifed as Excellent in 9 cases(25.0%). Good in 10 cases(27.8%), Fair in 15 cases(41.7%), Poor in 2 cases(5.5%) according to Severin. 5. We conclude from this study that arthrographic investigations can play a useful role in the diagnosis of the cause of the obstruction in CDH and thus help to determine proper management.