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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
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