The results of excision of the hip have as yet been very discouraging, the mortality of the whole series of published cases being, according to Dr. Hodge's careful table, very little under 1 in every 2 cases, viz., 1 in 2-5/53. Later statistics are however more favourable.
Like all other excisions, the mortality increases very much with the patient's age.
Thus of 103 completed cases in which the age is given, 53 recovered and 50 died, but dividing the cases at the end of the sixteenth year, we find that of the children below this age 43 recovered and 29 died, a mortality of 40.2 per cent.; of the adults, 10 recovered, and 21 died, or a mortality of 67.6 per cent.
If we remember the marvellous power of recovery from joint diseases we find in childhood, under the influence of good diet, cod-liver oil, and fresh air, we cannot shut our eyes to the fact that such results and such a mortality are by no means encouraging.
From an extensive experience in a special hospital for hip-disease, where fresh air, abundant nourishment, and very excellent nursing are provided, the author is learning more and more to trust to the power of nature in the cure of even very advanced cases of hip-disease in children, and he believes that operation is rarely necessary, or even warrantable, except for the removal of sequestra.
Mr. Holmes's[62] statistics are interesting. He has operated on no fewer than nineteen cases. Of these seven died, one after secondary amputation at the hip. Another required amputation and recovered. Two others died of other diseases without having used their limb. Of the remaining nine, three were perfectly successful, four were promising cases, and two unpromising.
Professor Spence in 19 cases had 6 deaths, or a mortality of 31.6 per cent.
Culbertson's collection gives out of 426 cases, 192 deaths, or 45 per cent.
Mr. Croft, whose skill and success as an operator are well known, has recorded 45 cases of excision of hip in his own practice; of these 16 died, 11 were under treatment, 18 had recovered, of which 16 had moveable joints and useful limb; the other two are "potentially cured."[63]
Various other incisions have been devised for gaining access to the joint. The most noticeable are those in which a flap is made instead of a linear incision. Sedillot makes a semilunar or ovoid flap, the base of which is just below the great trochanter, and which includes it, the convexity being upwards and the flap being turned down. Gross's modification of this is preferable, being turned the opposite way, the convexity being downwards ([Plate III.] fig. e.), and the flap thus being turned up.