Congenital hip dislocation in adults

　　The etiology of congenital hip dislocation in adults is still not fully clear. The disease has a high incidence rate and shows a significant gender bias, related to genetic factors, joint ligament laxity, and abnormal fetal position, etc.

　　When treating congenital hip dislocation in adults, attention should be paid to avascular necrosis of the femoral head and recurrent dislocation after surgery.

　　1. Avascular necrosis of the femoral head

　　Avascular necrosis of the femoral head is a iatrogenic complication, mainly caused by mechanical pressure leading to arterial ischemia.

　　2. Recurrent dislocation after surgery

　　Although the incidence rate of recurrent dislocation after surgery is not high, once it occurs, the prognosis is poor, and complications such as avascular necrosis of the femoral head and joint stiffness may occur. Every effort should be made to prevent it. The main causes are poor joint capsule tension, which is the most common cause; secondly, excessive anterior tilt angle without correction; and there are also reasons such as head and acetabulum asymmetry and improper treatment. Prevention should be strengthened, and early surgical treatment should be sought if it occurs.

　　3. Hip joint movement limitation or stiffness

　　This complication is relatively common, and the incidence rate increases with age. The higher the position of the dislocated femoral head, the more severe the periarthritic contracture, and if correction is not performed, it is easy to develop hip joint movement limitation or stiffness. This is especially true for patients who have used hip orthopedic casting after surgery. Early joint function exercise after surgery should be strengthened, and hip abduction casting brace fixation should be adopted. After one week, sitting exercises should be practiced. Casting fixation can also be avoided, and continuous passive motion (CPM) can be used for joint function exercise after surgery.

　　Most symptoms of developmental dysplasia of the acetabulum in patients with congenital hip dislocation appear between the ages of 25 and 40. Early symptoms include hip fatigue, acidity, dull pain, which can occur at the root of the thigh, the front of the thigh, or the buttocks. As the disease progresses, joint pain intensifies, and symptoms such as limping and pain at rest appear. This is due to the upward and outward displacement of the femoral head, making the affected limb shorter. With the progression of osteoarthritis, the range of joint movement is also gradually affected.

　　Congenital hip dislocation in adults is caused by traumatic factors. Paying attention to safety in production and life and avoiding injury is the key to preventing this disease. Once it occurs, active prevention of complications should be taken.

　　1. Hip dislocation should be treated promptly. Some dislocations may be accompanied by acetabular fractures, and X-ray films must be taken for diagnosis. Early reduction is easy and the effect is good. For old cases, most require surgical reduction, and the effect is relatively poor. In addition, improper treatment may cause avascular necrosis of the femoral head, seriously affecting joint function.

　　2. Hip dislocation, especially complications after treatment for congenital hip dislocation, are mostly caused by rough manipulation, insufficient traction, not grasping the indications for surgery, not understanding the factors hindering reduction, and improper fixation, among other reasons. Most of these can be avoided.

　　The examination methods for congenital hip dislocation in adults include physical and imaging examinations.

　　1. Physical Examination

　　1. Hip Abduction Test: When both hip and knee joints are屈曲90°, the hip joints of normal newborns and infants can abduct about 80°. Abduction limitation within 70° should raise suspicion of hip dislocation. If a sound is heard after the examination and the hip can be abduced to 90°, it indicates that the dislocation has been reduced.

　　2. Galeazzi sign: Both hips are flexed to 90°, the legs are together, both sides of the medial malleolus are aligned, and the level of the patient's knee joint is lower than the shoulder side.

　　3. Ortolani and Barlow tests (‘Pop-in’ and ‘Pop-out’ tests).

　　4. The adductor muscle of the affected side is tense and contracted.

　　Secondly, Imaging Examination

　　1. Ultrasound examination: It is a useful and non-invasive method, which is the most convenient and effective method for general surveys.

　　2. X-ray examination: X-ray films can show acetabular dysplasia, plate semi-dislocation, or dislocation in patients suspected of congenital hip dislocation. When taking X-ray films, a protective plate for the gonads should be added.

　　After surgery for adult congenital hip dislocation, patients should enhance nutrition, eat more protein-rich foods such as fish, eggs, and soy products, and appropriately increase calcium. Maintain smooth defecation, drink more water, eat more vegetables and fruits such as green vegetables, celery, and bananas. If constipation, use laxatives such as glycerin suppositories. Avoid spicy foods such as chili and mustard. Smoking and drinking should be戒除.

　　The treatment principle for early hip dysplasia in adults with congenital hip dislocation is to reduce the load on the joint, avoid physical labor and strenuous exercise to prevent hip dislocation. For early and middle-stage patients, surgical treatment can be adopted to increase acetabular coverage, prevent joint subluxation, and delay the onset of osteoarthritis. There are many surgical methods, such as acetabular osteotomy, peripheral osteotomy, medullary osteotomy, acetabular roof osteotomy, and so on.

　　Patients with late-stage acetabular dysplasia often have severe osteoarthritis, with most of the articular cartilage destroyed, bone hyperplasia of the acetabulum and femoral head, and narrowing or even disappearance of the joint space. At this time, the joint pain is severe, and the patient finds it difficult to take a step. The aim of treatment is to relieve pain and restore joint function, and the first choice of surgery is artificial total hip joint replacement.