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  New publications of our resource   August 23, 2025 1926HeyGrovesEH The author proposes fixation of the femoral head by creating a LCF from the joint capsule during reduction of congenital hip dislocation.  1927HeyGrovesEH   The author  describes  fixation of the femoral head by creating a LCF from the joint capsule during reduction of congenital hip dislocation.  1968TrevorD The author discusses E. Hey Groves's operation for reconstruction of the LCF in the reduction of congenital hip dislocation. August 16, 2025 1869BirkettJ The author described the damage of the LCF and its strength when observing a fracture-dislocation of the femo ral head. August 10, 2025 18c.Italian_School  Painting. Drawing depicting the circumstances and mechanism of the LCF injury.  1922MayM  Painting. Draw ing depicting the circumstances and mechanism of the LCF injury.  1930ShagallM Gouache. Drawing depicting the circumstances and mechanism of the LC...
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1968TrevorD

 

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[i] Annotation

Fragments from the book: Trevor D. The place of the Hey Groves-Colonna operation in the treatment of congenital dislocation of the hip (1968). The author discusses E. Hey Groves's operation for reconstruction of the ligamentum capitis femoris (LCF) in the reduction of congenital hip dislocation. The text in Russian is available at the following link: 1968TrevorD.


Quote, pp. 241-243.

THE LATE PROFESSOR HEY GROVES, one-time Professor of Surgery in the University of Bristol, a Surgeon of the Bristol General Hospital, and a Vice-President of the Royal College of Surgeons of England, in his Bradshaw Lecture at the College (1926) stated of all the joints in the body the hip is perhaps the most important, and in regards to its ailments it is certainly the most difficult for treatment'. Further, he mentioned that ' to replace and retain the dislocated hip, to establish correct relations between an ill-formed femoral head and an equally ill-developed acetabulum is a true orthopaedic problem. These statements made in 1926 are still true to-day.

Hey Groves lamented that little had been done for children with congenital dislocation of the hip between the ages of four and 14; below four he considered that the then current practice of manipulative reduction followed by immobilization in a plaster of Paris spica for a sufficient length of time was adequate; subsequent studies have shown that this opinion was unduly optimistic. Above 14 he considered reconstruction of the dislocated hip was not possible, with which there is general agreement. But between four and 14 years of age he maintained that much could and should be done for these children, but only by operative means.

He outlined a surgical programme which was later published in the British Journal of Surgery (1926), and also in the Robert Jones Birthday Volume (1928). He recommended open replacement of the femoral head, and, if stable into a well-formed socket, then plaster of Paris immobilization for several months. If the femoral head could not be contained the acetabulum should be improved by a kind of shelf-operation or deepened sufficiently by reaming to receive the femoral head. Hey Groves found the latter manoeuvre produced stability, but as the femoral head, which had probably some areas of erosion and had poor articular cartilage, was placed in actual contact with the acetabulum, denuded of its articular cartilage with raw bleeding osseous walls, little wonder that complete stiffness occurred. Thereupon, he developed his procedure further by recommending that the acetabulum should be deepened as before, as this was the best method of producing stability, but that there should be some structure placed between the untouched femoral head and the raw surface of the acetabulum, namely the joint capsule which was lined on its inner surface by smooth synovial membrane. Hey Groves had observed a constriction of the capsule in children of this age-range who had been walking, namely the hour-glass; thus he advised that the joint capsule should be dissected from its surroundings right down proximally to the hour-glass, that is between the hour-glass and the acetabulum; there it should be divided and in doing so the ligamentum teres, if present, also inevitably divided. Accordingly, he recommended, in addition, such was his genius, that an artificial ligamentum should be constructed by using stout, strong, kangaroo tendinous filaments, attaching them to the capsule and then threading them through a hole in the floor of the deepened socket and bringing the tendinous fibres out of the pelvis over the brim of the pelvis; the femoral head covered by capsule was then reduced into the deepened socket and the tendinous kangaroo fibres were then securely sutured to the brim of the pelvis or to Poupart's ligament (Fig. la)-a most ingenious operation, but, alas, nothing more was written in the British surgical literature concerning this procedure! We do not know how often Hey Groves performed this operation, nor do we know what the end results were like.

But in 1932 Professor Paul Colonna described a very similar procedure as the result of his experience in 1929 when dealing with a boy of seven years suffering from bilateral congenital dislocation of the hip at Bellevue Hospital, New York. Open replacement of the right hip into a deepened socket was performed without any preliminary traction (Hey Groves insisted on adequate preliminary traction); the replacement was accomplished according to Colonna's words by 'main strength and awkwardness; the result was a completely stiff hip with X-ray evidence of fragmentation and traumatic osteo-arthritis. Whereupon, in the following year, when tackling the left hip, preliminary traction was used, the femoral head was placed in a deepened socket with the intervention of the capsule in exactly the manner, except for the ligamentum-teres reconstruction, as recommended by Hey Groves. Since then, Paul Colonna made several contributions in American surgical literature on the indication, the procedure and the end results of the operation. In other words, it was a British invention developed in America, hence my reason for naming the operation the Hey Groves-Colonna. Having paid due homage to the originators, I think that it is wiser to refer to it as Capsular Arthroplasty; incidentally, the only arthroplasty of the hip at present performed without the intervention of any foreign material.

Quote p. 250.

When dealing with a subluxation the procedure differs a little. To obtain sufficient capsule to cover the femoral head is a problem, and so the operation proceeds anteriorly and posteriorly as described, but from above it is most important to dissect into the acetabulum between it and the compressed, tough and usually smooth, soft tissue against which the femoral head has been articulating; it is taken along with the capsule which is thereby made adequate.

When the hour-glass is reached it is divided across, the ligamentum teres if present being divided at the sometime. The femurs now free from any acetabular attachments; the capsule is incised for a short distance extending from the hour-glass opening to allow inspection of the femoral head, notice being paid to the state of the articular cartilage, particularly as regards pitting or erosion and attention as to its size, shape and any deformity; and the presence of any adhesions between the capsule and the femoral head most likely to be encountered where previous hip operations have been performed. On occasion the capsule is exceedingly thick on its superior aspect, 1 centimeter or more in thickness, generally due to the response of stresses of weight bearing; it has to be pared down to about 3 millimeters, otherwise it becomes impossible to make a socket large enough to accommodate the femoral head with such a thick capsule. On the other hand the capsule may be scanty, and to cover the articular surface of the femoral head adequately flaps may have to be raised from the thickest part of such a capsule and sutured in rotation fashion. Before closure of the capsule it is possible to estimate within a wide margin the amount of anteversion of the femoral neck. The incision in the capsule is closed by interrupted sutures of chromic catgut, and this closure must be really secure and the femoral articular surface completely covered by capsule, which is lined on its inner surface by synovial membrane.

 


Fig. 1. (a) Diagram of operation proposed by the late Professor Hey Groves. (A) Raw bleeding surface of deepened socket at site of natural acetabulum. (B) Capsule covering femoral head. (C) Synovial membrane. (D) Reconstructed artificial ligamentum teres. (b) Method of applying skeletal traction. Kirschner wires are crossed to eliminate any side-slipping of the wires and stirrup-this method was suggested by Cyril Monty, M.D., F.R.C.S. Side-slipping can also be prevented by encasing the wires and stirrup in plaster of Paris. Note that the opposite hip has been immobilized in a plaster of Paris spica to stabilize the pelvis.


 


Trevor D. The place of the Hey Groves-Colonna operation in the treatment of congenital dislocation of the hip. Annals of The Royal College of Surgeons of England. 1968;43(5)241-58.  pmc.ncbi.nlm.nih.gov


Ernest William Hey Grove first described the operation of reconstruction of the LCF for congenital hip dislocation in 1926 in The Lancet. The following year, the author published a more detailed article in the British Journal of Surgery.

The work is cited in the following publications: 


David Trevor, MSc, FRCS. Consultant Orthopaedic Surgeon, Charing Cross Hospital; Consultant Surgeon, Royal National Orthopaedic Hospital.


ligamentum capitis femoris, ligamentum teres, ligament of head of femur, plastic surgery, reconstruction, congenital dislocation, pathology



NB! Fair practice / use: copied for the purposes of criticism, review, comment, research and private study in accordance with Copyright Laws of the US: 17 U.S.C. §107; Copyright Law of the EU: Dir. 2001/29/EC, art.5/3a,d; Copyright Law of the RU: ГК РФ ст.1274/1.1-2,7

                                                                   

1927HeyGrovesE

  Content [i]   Annotation [ii]   Original text [iii]   Illustrations [iv]   Source  &  links [v]   Notes [vi]   Authors & Affiliations [vii]   Keywords [i]   Annotation Fragment from the article: Groves EH. Some contribution to the reconstruction surgery of the hip (1927). The author  describes  fixation of the femoral head by creating a ligamentum capitis femoris (LCF) from the joint capsule during reduction of congenital hip dislocation. The text in Russian is available at the following link:  1927HeyGrovesEH . [ii]   Original text Quote,  pp. 5 11-513.   In the one method stability is secured by gouging out a deep acetabulum, but with a great sacrifice of the mobility of the joint; in the other free movement is retained in a loose joint, the stability of which is uncertain by constructing a new acetabular shelf. I still believe that by further improvement in the technique we shall be able...

1926HeyGrovesEH

  Content [i]   Annotation [ii]   Original text [iii]   Illustrations [iv]   Source  &  links [v]   Notes [vi]   Authors & Affiliations [vii]   Keywords [i]   Annotation Fragment from the article: Groves EH. Some contribution to the reconstruction surgery of the hip (1926). The author proposes fixation of the femoral head by creating a ligamentum capitis femoris (LCF) from the joint capsule during reduction of congenital hip dislocation. The text in Russian is available at the following link: 1926HeyGrovesEH . [ii]   Original text Quote,  pp. 10 5 6-1057 .   Congenital Dislocation of the Hip. It is now generally recognized that early cases of congenital dislocation of the hip can be efficiently treated and cured by manipulation. But it is not realised that in older children when manipulative reduction is impossible, a great deal can still be done by open operation to get firm and useful hip-joints. It is w...

1869BirkettJ

  Content [i]   Annotation [ii]   Original text [iii]   Illustrations [iv]   Source  &  links [v]   Notes [vi]   Authors & Affiliations [vii]   Keywords [i]   Annotation The article: Birkett J. Description of a Dislocation of the Head of the Femur, complicated with its Fracture; with Remarks (1869). The author described the damage to the ligamentum capitis femoris (LCF) and its strength when observing a fracture-dislocation of the femoral head. The text in Russian is available at the following link: 1869BirkettJ . [ii]   Original text DESCRIPTION OF A  DISLOCATION OF THE HEAD OF THE FEMUR, COMPLICATED WITH ITS FRACTURE; WITH REMARKS. BY JOHN BIRKETT, F.R.C.S.,  SURGEON TO GUY'S HOSPITAL. Received Jan. 12th. - Read Feb. 23rd, 1869.   A WOMAN, et. 35, of rather short stature, was brought into Guy's Hospital on account of the following injuries, the infliction of which she survived a few minutes only...