RESUMEN
BACKGROUND: Patients with osteonecrosis of the femoral head secondary to DDH frequently require total hip arthroplasty (THA), but it is not well understood which factors necessitate this requirement. We determined the incidence of THA in patients who have osteonecrosis secondary to DDH and factors associated with need for THA. METHODS: We included patients who received closed or open reductions between 1995 and 2005 with subsequent development of osteonecrosis. We determined osteonecrosis according to Bucholz and Ogden; osteoarthritis severity (Kellgren-Lawrence), subluxation (Shenton's line); neck-shaft angle; and acetabular dysplasia (centre-edge and Sharp angles). We also recorded the number of operations of the hip in childhood and reviewed case notes of patients who received THA to describe clinical findings prior to THA. We assessed the association between radiographic variables and the need for THA using univariate logistic regression. RESULTS: Of 140 patients (169 hips), 22 patients received 24 THA (14%) at a mean age of 21.3 ± 3.7 years. Associated with the need for THA were grade III osteonecrosis (OR 4.25; 95% CI 1.70-10.77; p = 0.0019), grade IV osteoarthritis (21.8; 7.55-68.11; p < 0.0001) and subluxation (8.22; 2.91-29.53; p = 0.0003). All patients who required THA reported at least 2 of: severe pain including at night, stiffness, and reduced mobility. Acetabular dysplasia and number of previous operations were not associated with the need for THA. CONCLUSIONS: We identified a 14% incidence of THA by age 34 years in patients with osteonecrosis secondary to DDH. Grade III osteonecrosis (global involvement femoral head and neck) was strongly associated with THA, emphasising the importance to avoid osteonecrosis when treating DDH.
Asunto(s)
Artroplastia de Reemplazo de Cadera , Displasia del Desarrollo de la Cadera , Necrosis de la Cabeza Femoral , Humanos , Artroplastia de Reemplazo de Cadera/efectos adversos , Femenino , Masculino , Necrosis de la Cabeza Femoral/etiología , Necrosis de la Cabeza Femoral/epidemiología , Necrosis de la Cabeza Femoral/diagnóstico por imagen , Displasia del Desarrollo de la Cadera/cirugía , Displasia del Desarrollo de la Cadera/diagnóstico por imagen , Displasia del Desarrollo de la Cadera/epidemiología , Adulto , Adulto Joven , Adolescente , Estudios Retrospectivos , Radiografía , Incidencia , Luxación Congénita de la Cadera/cirugía , Luxación Congénita de la Cadera/diagnóstico por imagen , Luxación Congénita de la Cadera/complicaciones , Osteoartritis de la Cadera/cirugía , Osteoartritis de la Cadera/diagnóstico por imagen , Osteoartritis de la Cadera/epidemiología , Osteoartritis de la Cadera/etiologíaRESUMEN
Aims: The objective of this study was to present the outcomes of rotational acetabular osteotomy (RAO) over a 30-year period for osteoarthritis (OA) secondary to dysplasia of the hip in pre- or early-stage OA. Methods: Between September 1987 and December 1994, we provided treatment to 47 patients (55 hips) with RAO for the management of pre- or early-stage OA due to developmental hip dysplasia. Of those, eight patients (11 hips) with pre-OA (follow-up rate 79%) and 27 patients (32 hips) with early-stage OA (follow-up rate 78%), totalling 35 patients (43 hips) (follow-up rate 78%), were available at a minimum of 28 years after surgery. Results: In the pre-OA group, the mean Merle d'Aubigné score improved significantly from 14.5 points (SD 0.7) preoperatively to 17.4 points at final follow-up (SD 1.2; p = 0.004) and in the early-stage group, the mean score did not improve significantly from 14.0 (SD 0.3) to 14.6 (SD 2.4; p = 0.280). Radiologically, the centre-edge angle, acetabular roof angle, and head lateralization index were significantly improved postoperatively in both groups. Radiological progression of OA was observed in two patients (two hips) in the pre-OA group and 17 patients (18 hips) in the early-stage group. Kaplan-Meier survival analysis, with radiological progression of OA as the primary outcome, projected a 30-year survival rate of 81.8% (95% confidence interval (CI) 0.59 to 1.00) for the pre-OA group and 42.2% (95% CI 0.244 to 0.600) for the early-stage group. In all cases, the overall survival rate stood at 51.5% (95% CI 0.365 to 0.674) over a 30-year period, and when the endpoint was conversion to total hip arthroplasty, the survival rate was 74.0% (95% CI 0.608 to 0.873). Conclusion: For younger patients with pre-OA, joint preservation of over 30 years can be expected after RAO.
Asunto(s)
Acetábulo , Osteoartritis de la Cadera , Osteotomía , Humanos , Osteotomía/métodos , Osteoartritis de la Cadera/cirugía , Osteoartritis de la Cadera/etiología , Femenino , Estudios de Seguimiento , Acetábulo/cirugía , Acetábulo/diagnóstico por imagen , Masculino , Adulto , Resultado del Tratamiento , Persona de Mediana Edad , Radiografía , Luxación Congénita de la Cadera/cirugía , Luxación Congénita de la Cadera/complicaciones , Luxación Congénita de la Cadera/diagnóstico por imagen , Adulto Joven , AdolescenteRESUMEN
BACKGROUND: Congenital dislocation of the knee is characterised by excessive knee extension or dislocation and anterior subluxation of the proximal tibia, and this disease can occur independently or coexist with different systemic syndromes. Nevertheless, significant controversy surrounds treating this disease when combined with hip dislocation. This paper presents a case of a 4-month-old patient diagnosed with bilateral hip dislocation combined with this disease. The study discusses the pathophysiology, diagnosis, and treatment methods and reviews relevant literature. CASE PRESENTATION: We reported a case of a 4-month-old female infant with congenital dislocation of the right knee joint, which presented as flexion deformity since birth. Due to limitations in local medical conditions, she did not receive proper and effective diagnosis and treatment. Although the flexion deformity of her right knee joint partially improved without treatment, it did not fully recover to normal. When she was 4 months old, she came to our hospital for consultation, and we found that she also had congenital dislocation of both hip joints and atrial septal defect. We performed staged treatment for her, with the first stage involving surgical intervention and plaster orthosis for her congenital dislocation of the right knee joint, and the second stage involving closed reduction and plaster fixation orthosis for her congenital hip joint dislocation. Currently, the overall treatment outcome is satisfactory, and she is still under follow-up observation. CONCLUSIONS: Early initiation of treatment is generally advised, as nonsurgical methods prove satisfactory for mild cases. However, surgical intervention should be considered in cases with severe stiffness, unresponsive outcomes to conservative treatment, persistent deformities, or diagnoses and treatments occurring beyond the first month after birth.
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Luxación Congénita de la Cadera , Luxación de la Rodilla , Humanos , Femenino , Luxación de la Rodilla/complicaciones , Luxación de la Rodilla/congénito , Luxación de la Rodilla/terapia , Luxación de la Rodilla/diagnóstico por imagen , Luxación de la Rodilla/cirugía , Luxación de la Rodilla/diagnóstico , Luxación Congénita de la Cadera/complicaciones , Luxación Congénita de la Cadera/terapia , Luxación Congénita de la Cadera/diagnóstico , Lactante , Resultado del Tratamiento , Articulación de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/fisiopatología , Moldes QuirúrgicosRESUMEN
PURPOSE: Despite the existence of guidelines for screening for developmental dysplasia of the hip (DDH), there remains controversy regarding the need for routine ultrasound screening for DDH in patients with clubfoot due to an unclear correlation between the two conditions. The purpose of this study is to determine whether ultrasound screening for DDH in this population improved the diagnostic accuracy of DDH over standard assessment for patient risk factors and physical exam. METHODS: This is a retrospective cross-sectional review of infants diagnosed with idiopathic clubfoot who underwent hip ultrasounds to assess for DDH as identified by keyword search in an institutional radiological database at a tertiary care paediatric hospital. Patient demographics, risk factors for DDH, physical exam findings, and ultrasound results were recorded. RESULTS: Of the 120 patients who met the inclusion criteria between 2003 and 2018, 8 had hip dysplasia confirmed on ultrasound (6.7%). All these patients either had known risk factors for hip dysplasia or had an abnormal physical exam finding suggestive of hip instability or dislocation as performed by an orthopaedic surgeon on their initial consultation. CONCLUSION: A detailed history to determine risk factors and a thorough physical exam are adequate to determine the need for hip ultrasound in infants with idiopathic clubfoot. Routine ultrasound screening of all patients with clubfoot is likely unnecessary and may pose a significant burden on the health care system.
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Pie Equinovaro , Ultrasonografía , Humanos , Pie Equinovaro/diagnóstico por imagen , Estudios Retrospectivos , Masculino , Femenino , Estudios Transversales , Ultrasonografía/métodos , Lactante , Factores de Riesgo , Luxación Congénita de la Cadera/diagnóstico por imagen , Luxación Congénita de la Cadera/complicaciones , Luxación Congénita de la Cadera/diagnóstico , Recién Nacido , Examen Físico/métodos , Displasia del Desarrollo de la Cadera/diagnóstico por imagen , Tamizaje Masivo/métodosRESUMEN
CASE: We present a case of an 8-year-old boy with classical bladder exstrophy and a neglected right hip dislocation, exemplifying the risk of missed developmental dysplasia of the hip (DDH) in patients with exstrophy requiring careful orthopaedic oversight. CONCLUSIONS: When treating patients with bladder exstrophy, physicians and surgeons should be vigilant not to miss associated DDH. If this condition requires surgical treatment, preoperative planning with computed tomography scans is vital to uncovering the complexities arising from abnormal pelvic and acetabular anatomy and ensuring successful treatment outcomes.
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Extrofia de la Vejiga , Displasia del Desarrollo de la Cadera , Luxación Congénita de la Cadera , Masculino , Humanos , Niño , Extrofia de la Vejiga/complicaciones , Extrofia de la Vejiga/diagnóstico por imagen , Extrofia de la Vejiga/cirugía , Acetábulo , Luxación Congénita de la Cadera/complicaciones , Luxación Congénita de la Cadera/diagnóstico por imagen , Luxación Congénita de la Cadera/cirugía , PelvisRESUMEN
The aim of this study was to present the mid-term results of ultra-short cementless stem total hip arthroplasty (THA) in patients with Crowe type II developmental dysplasia of the hip. The study consists of 68 patients (75 THAs) with a Proxima stem implanted between 2006 and 2015. The clinical results include Harris Hip Scores. Radiological follow-up reports on stem migration, bony trabecular development and radiolucent lines. Kaplan-Meier survival analysis was performed. The mean age of patients was 48.4 years, with a mean follow-up 114 months. The average Harris Hip Score improved significantly from 45.1 preoperatively to 97.6 at the final evaluation (p < 0.001). Stem migration was observed in five hips (in all of them up to the 6th postoperative month, without any further progression of migration or radiological loosening). Bony trabecular development was detected in modified Gruen zones (1, 2, 4, 6, 7 for Proxima stem): in zone 1 (0%), 2 (49.3.0%), 4 (38.7%), 6 (82.7%), 7 (0%). Radiolucent lines were observed around one cup (DeLee and Charnley zone I) and three stems (none was loose, all three with fibrous stable fixation). Complications were found in three hips (4.0%): intraoperative periprosthetic femoral fracture (threated with cerclage wire) in two hips and squeezing hip in one patient (with perioperative ceramic inlay breakage and exchange). No hip was revised. The implant survival was 100.0% both clinically and radiologically. Observations in the mean follow-up of 114 months show that the results (clinical and radiological) of the Proxima stem in patients with Crowe type II DDH are promising.
Asunto(s)
Artroplastia de Reemplazo de Cadera , Displasia del Desarrollo de la Cadera , Luxación Congénita de la Cadera , Prótesis de Cadera , Fracturas Periprotésicas , Humanos , Persona de Mediana Edad , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Cadera/métodos , Prótesis de Cadera/efectos adversos , Displasia del Desarrollo de la Cadera/cirugía , Estudios de Seguimiento , Luxación Congénita de la Cadera/complicaciones , Luxación Congénita de la Cadera/cirugía , Resultado del Tratamiento , Estudios Retrospectivos , Fracturas Periprotésicas/cirugíaRESUMEN
In the management of true hip dysplasia, the bony deformity is nearly always accompanied by, and often causal of, intra-articular pathology. It is strongly recommended to conduct a comprehensive preoperative evaluation as well as arthroscopic evaluation and treatment of coexisting hip joint conditions prior to performing an open Bernese periacetabular osteotomy. The osteotomy improves coverage of the femoral head and corrects the abnormal joint mechanics and loading patterns, which result in cartilage damage and subsequent osteoarthritis. Arthroscopy allows treatment of the intra-articular pathology. Combining the hip arthroscopy and periacetabular osteotomy procedures into a single surgical intervention, performed by either a single surgeon or a collaborative surgical team, allows us to address both the cause and the effects of dysplasia. This once-controversial combined technique has become a standard practice in the field with widespread adoption.
Asunto(s)
Luxación Congénita de la Cadera , Luxación de la Cadera , Osteoartritis de la Cadera , Humanos , Acetábulo/cirugía , Acetábulo/patología , Luxación de la Cadera/cirugía , Luxación de la Cadera/complicaciones , Artroscopía/métodos , Luxación Congénita de la Cadera/complicaciones , Articulación de la Cadera/cirugía , Articulación de la Cadera/patología , Osteoartritis de la Cadera/cirugía , Osteotomía/métodos , Resultado del Tratamiento , Estudios RetrospectivosRESUMEN
Background: Periacetabular Osteotomy (PAO) is a well-established surgical intervention for the treatment of hip dysplasia. Purpose: Our primary objective was to assess whether a group of young flexibility athletes who underwent PAO for hip dysplasia recovered their pre-operative hip range of motion (ROM) within 1 year of surgery. Our secondary objective was to compare hip ROM recovery between a group of young flexibility athletes and a group of non-flexibility athletes who underwent PAO for hip dysplasia. Results: In our study, 100% of flexibility athletes regained preoperative hip external rotation at 1-year post-operation. This was also the first plane of motion to return to preoperative motion in flexibility athletes. A significantly higher percentage of non-flexibility athletes regained their preoperative hip internal rotation compared to flexibility athletes (100% compared to 54%; P = .02), but not flexion or external rotation at 1-year post-operation. Conclusion: Our findings may help providers to set expectations regarding the recovery of hip ROM in flexibility athletes who undergo PAO for hip dysplasia.Level of Evidence: Level IV.
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Baile , Luxación Congénita de la Cadera , Luxación de la Cadera , Humanos , Acetábulo/cirugía , Luxación de la Cadera/cirugía , Luxación de la Cadera/complicaciones , Estudios Retrospectivos , Luxación Congénita de la Cadera/complicaciones , Luxación Congénita de la Cadera/cirugía , Osteotomía , Rango del Movimiento Articular , Atletas , Resultado del Tratamiento , Articulación de la Cadera/cirugíaRESUMEN
PURPOSE: To follow-up the non-operated hips of patients who underwent unilateral rotational acetabular osteotomy (RAO) for bilateral developmental dysplasia of the hip (DDH) for a minimum of 20 years to clarify (1) the timing of onset of hip osteoarthritis (OA) in DDH, and (2) factors associated with the development of OA. METHODS: This study included 92 non-operated hips of patients who underwent unilateral RAO for bilateral DDH. We examined the timing of OA onset and total hip arthroplasty (THA) and the joint survival rate in the studied hips. Furthermore, the patients were divided into those with OA onset (progression group) and those without OA onset and compared in terms of lateral center-edge angle (LCEA), sharp angle, acetabular head index (AHI), acetabular roof obliquity (ARO), joint congruity, and the presence or absence of OA progression on the RAO side. RESULTS: The progression group experienced OA onset 12 years after RAO and underwent THA 6 years after OA onset. The 20-year joint survival rate was 73% with the endpoint of OA onset and 81% with the endpoint of THA. The progression group had significantly smaller LCEA and AHI and larger ARO. The risk of developing OA was 8.2 times greater in patients with LCEA ≤ 7° than in those with LCEA > 7°. CONCLUSION: The patients with OA progression group experienced OA onset at an average age of 55 years. A small LCEA (≤ 7°) was identified as a risk factor for the development of OA.
Asunto(s)
Displasia del Desarrollo de la Cadera , Luxación Congénita de la Cadera , Luxación de la Cadera , Humanos , Persona de Mediana Edad , Estudios de Seguimiento , Displasia del Desarrollo de la Cadera/cirugía , Displasia del Desarrollo de la Cadera/complicaciones , Luxación de la Cadera/cirugía , Luxación de la Cadera/complicaciones , Estudios Retrospectivos , Acetábulo/cirugía , Osteotomía , Articulación de la Cadera/cirugía , Resultado del Tratamiento , Luxación Congénita de la Cadera/cirugía , Luxación Congénita de la Cadera/complicacionesRESUMEN
PURPOSE: This systematic review and meta-analysis aimed to compare the outcomes of total hip arthroplasty (THA) in patients with developmental dysplasia of the hip (DDH) and those with osteoarthritis (OA). METHODS: Four databases were searched from inception till February 2023 for original studies that compared the outcomes of THA in DDH and OA. The primary outcome was the revision rate; the secondary outcomes were dislocation and failure modes (i.e. aseptic loosening, PJI, instability, and periprosthetic fractures), hospital stay and costs. This review was conducted as per PRISMA guidelines, and the risk of bias was assessed using the Newcastle-Ottawa scale. RESULTS: A total of 9 observational studies with 575,255 THA (469,224 hips) were included, with a mean age of 50.6 years and 62.1 years for DDH and OA groups, respectively. There was a statistically significant difference in revision rate between DDH and OA patients in favour of OA (OR, 1.66; 95% CI 1.11-2.48; p-value, 0.0251). However, dislocation rate (OR, 1.78, 95% CI 0.58-5.51; p-value, 0.200), aseptic loosening (OR, 1.69; 95% CI 0.26-10.84; p-value, 0.346) and PJI (OR, 0.76; 95% CI 0.56-1.03; p-value, 0.063) were comparable across both groups. CONCLUSION: A higher revision rate following total hip arthroplasty was associated with DDH compared with osteoarthritis. However, both groups had similar dislocation rates, aseptic loosening and PJI. Consideration of confounding factors, such as patient age and activity level, is crucial when interpreting these findings. LEVEL OF EVIDENCE : III. TRIAL REGISTRATION: PROSPERO registration: CRD42023396192.
Asunto(s)
Artroplastia de Reemplazo de Cadera , Luxación Congénita de la Cadera , Prótesis de Cadera , Luxaciones Articulares , Osteoartritis de la Cadera , Humanos , Persona de Mediana Edad , Artroplastia de Reemplazo de Cadera/efectos adversos , Luxación Congénita de la Cadera/complicaciones , Luxación Congénita de la Cadera/cirugía , Estudios Retrospectivos , Osteoartritis de la Cadera/cirugía , Osteoartritis de la Cadera/etiología , Luxaciones Articulares/cirugía , Prótesis de Cadera/efectos adversos , ReoperaciónRESUMEN
BACKGROUND: Coxa valga, measured as the neck-shaft angle (NSA) or head-shaft angle (HSA), is regarded as a potential risk factor for hip dislocation in patients with cerebral palsy. We investigated the effects of a novel hip brace on coxa valga. METHODS: A prospective, multicenter, assessor-blinded, randomized controlled trial was conducted from July 2019 to November 2021. Children with cerebral palsy aged 1 to 10 years with Gross Motor Function Classification System levels IV and V were recruited. The study group wore a hip brace for at least 12 hour a day. A lower strap of the hip brace was designed to prevent coxa valga biomechanically. The effectiveness of the hip brace on coxa valga was assessed by measurement of the NSA and head-shaft angle at enrollment and 6 and 12 months after enrollment. RESULTS: Sixty-six participants were enrolled, and 33 patients were assigned to each group. Changes in the mean NSA of both sides and the NSA of left side showed significant differences between the 2 groups over 12 months (mean NSA of both sides, -1.12 ± 3.64 in the study group and 1.43 ± 3.75 in the control group, P = .023; NSA of the left side, -1.72 ± 5.38 in the study group and 2.01 ± 5.22 in the control group, P = .008). CONCLUSIONS: The hip brace was effective in preventing the progression of coxa valga and hip displacement, suggesting that the prevention of coxa valga using hip brace is a contributing factor in prevention of hip displacement.
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Parálisis Cerebral , Coxa Valga , Luxación Congénita de la Cadera , Luxación de la Cadera , Humanos , Niño , Luxación de la Cadera/prevención & control , Luxación de la Cadera/complicaciones , Parálisis Cerebral/complicaciones , Estudios Prospectivos , Luxación Congénita de la Cadera/complicacionesRESUMEN
Developmental dysplasia of the hip (DDH), characterized by acetabular deformity that manifests from loose ligaments to complete dislocation of the hip, can cause notable pain and dysfunction and lead to hip dislocation, secondary fractures, scoliosis, and osteoarthritis of hip. Variants in FLNA may produce a spectrum of malformations in multiple organs, especially the skeleton. This study aimed to identify the genetic etiologies of DDH patients and provide genetic testing information for further diagnosis and treatment of DDH. We recruited a Chinese woman with DDH and her family members. Whole-exome sequencing was used to identify the patient's genetic etiologies. Protein models were used to analyze the pathogenic mechanism of the identified variants. A novel variant (c.3493T>G, p.C1165G) of FLNA was detected. The structural models of the mutant FLNA protein indicated that the variant would lose its sulfhydryl side chain and destroy the attraction between benzene rings and sulfhydryl. We reported a novel variant (c.3493T>G, p.C1165G) of FLNA in a Chinese woman with DDH. Our research outcome enriches the gene pool for hip dysplasia and emphasizes the pathogenicity of sulfhydryl side chain disruption in FLNA.
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Displasia del Desarrollo de la Cadera , Luxación Congénita de la Cadera , Femenino , Humanos , Benceno , Displasia del Desarrollo de la Cadera/complicaciones , Displasia del Desarrollo de la Cadera/genética , Filaminas/genética , Pruebas Genéticas , Luxación Congénita de la Cadera/genética , Luxación Congénita de la Cadera/complicaciones , Luxación Congénita de la Cadera/diagnóstico , Estudios RetrospectivosAsunto(s)
Artroplastia de Reemplazo de Cadera , Displasia del Desarrollo de la Cadera , Luxación Congénita de la Cadera , Humanos , Artroplastia de Reemplazo de Cadera/efectos adversos , Pérdida de Sangre Quirúrgica/prevención & control , Jordania/epidemiología , Displasia del Desarrollo de la Cadera/cirugía , Luxación Congénita de la Cadera/complicaciones , Luxación Congénita de la Cadera/cirugía , HemoglobinasRESUMEN
PURPOSE: This systematic review and meta-analysis aimed to identify risk factors of dislocation after total hip arthroplasty (THA) in patients with developmental dysplasia of the hip (DDH). METHODS: A systematic literature review was performed on 18th August 2022 using Medline, Embase, Scopus, Web of Science electronic databases, and a manual search. The study was conducted according to the PRISMA guidelines and registered with PROSPERO. Statistical analysis includes assessment of heterogeneity and data synthesis using RevMan 5.4. RESULTS: Review of five studies including 2865 patients and 116 dislocated hips found that lower body mass index (BMI) (SMD = 0.22, p = 0.04, I2 = 0%), Crowe classification type IV versus I, II, and III (OR = 2.70, p = 0.004, I2 = 51%), higher cup inclination (SMD = 0.39 p = 0.0007, I2 = 0%), femoral head size < 28 mm (OR = 5.07, p = 0.003, I2 = 71%), lateral surgical approach (OR = 1.96, p = 0.02, I2 = 0%), and postoperative infection (OR = 6.26, p < 0.0001, I2 = 0%) were significant risk factors. However, age, gender, cup anteversion, femoral osteotomy, vertical (V-COR) centre of rotation, intraoperative fracture, preoperative and postoperative leg length discrepancy (LLD) and previous hip surgery were not found to be significant risk factors. CONCLUSION: This study underscores importance of these risk factors in THA planning for DDH patients to reduce dislocation risk. Further research needed to understand mechanisms.
Asunto(s)
Artroplastia de Reemplazo de Cadera , Displasia del Desarrollo de la Cadera , Luxación Congénita de la Cadera , Luxaciones Articulares , Humanos , Artroplastia de Reemplazo de Cadera/efectos adversos , Displasia del Desarrollo de la Cadera/complicaciones , Displasia del Desarrollo de la Cadera/cirugía , Luxación Congénita de la Cadera/cirugía , Luxación Congénita de la Cadera/complicaciones , Luxaciones Articulares/cirugía , Factores de Riesgo , Estudios RetrospectivosRESUMEN
INTRODUCTION: Adolescent idiopathic scoliosis radiographic screening will often include the hips. The purpose of this study is to evaluate the prevalence of hip dysplasia by lateral center edge angle (LCEA) on scoliosis radiographs in patients presenting with severe range (>45 deg) idiopathic curves. METHODS: We reviewed 200 consecutive patients (400 hips) with idiopathic scoliosis with major coronal curves ≥45 degrees between October 2009 and October 2022. The presenting scoliosis radiograph PA were reviewed for the following variables: major coronal curve direction, coronal balance, and lateral center edge angles. An LCEA value ≤18 was considered dysplastic. To assess potential measurement variability related to parallax of the scoliosis radiographs, the intermodality intraclass correlation coefficient (ICC) was measured from a subset of 20 hip LCEA values from patients with both scoliosis and pelvis radiographs. RESULTS: A total of 200 patients [mean age: 13.6 (1.8) years; Female: 79%] were reviewed. The mean major curve (SD) was 58.6 degrees (11.4 deg). Overall 19% (37/200) patients or 11% (43/400) of hips had hip dysplasia. Of the dysplastic hips, 16% (6/43, P <0.001) were bilateral and 57% (21/43, P =0.04) were right sided. There was no association between dysplastic hip laterality and ipsilateral or contralateral coronal balance ( P =0.26) or curve direction ( P =0.49). The interobserver ICC for assessment of LCEA on scoliosis radiographs was 0.85, and the intermodality ICC between pelvic and scoliosis radiographs was 0.78. CONCLUSION: Hip dysplasia was present in 19% of patients presenting with large major curves, and many of these patients had right sided hip dysplasia. There was no association between hip dysplasia laterality and the patient's major curve direction or coronal balance. There was good intermodality reliability (ICC=0.78) between LCEA values in patients who had both scoliosis and pelvis radiographs, and good inter-rater reliability between raters. Radiographic interpretation of adolescent idiopathic scoliosis should focus not only on the description of the curve and ruling out underlying segmentation anomalies but should also include critical assessment of the hips to exclude co-existing hip dysplasia. LEVEL OF EVIDENCE: Therapeutic study-level IV.
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Luxación Congénita de la Cadera , Luxación de la Cadera , Escoliosis , Adolescente , Femenino , Humanos , Acetábulo , Luxación de la Cadera/diagnóstico por imagen , Luxación de la Cadera/etiología , Luxación Congénita de la Cadera/complicaciones , Luxación Congénita de la Cadera/diagnóstico por imagen , Luxación Congénita de la Cadera/epidemiología , Articulación de la Cadera , Osteotomía , Reproducibilidad de los Resultados , Estudios Retrospectivos , Escoliosis/diagnóstico por imagen , MasculinoRESUMEN
BACKGROUND: When performing total hip arthroplasty in patients with severe developmental dysplasia, shortening the femur facilitates reduction while also preventing sciatic or crural nerve injury and excessive length of the operated limb. No consensus exists about the optimal type of implant and best internal fixation procedure, two parameters that directly govern the risk of the most common intraoperative and postoperative complications (diaphyseal fractures, dislocation, non-union). To minimise these risks, we developed a technique combining a transverse subtrochanteric shortening osteotomy, a long ovoid-profiled, cementless stem anchored in the metaphysis, and double tension-band wiring for internal fixation. The primary objective of this study was to evaluate the outcomes of this technique with emphasis on (i) complications and femoral implant survival, (ii) clinical outcomes (functional scores and lower-limb length inequality [LLLI]), and time to healing. HYPOTHESIS: Our technique is associated with low rates of intraoperative and postoperative complications. MATERIAL AND METHODS: This single-centre retrospective cohort study included patients who underwent THA with a transverse subtrochanteric shortening osteotomy and fixation using double tension-band wiring to treat severe (Crowe III or IV) developmental hip dysplasia. The femoral implant was a long, ovoid, cementless stem fully coated with hydroxyapatite. We collected the intraoperative and postoperative complications, survival, LLLI, functional scores (Harris Hip Score [HHS] and Forgotten Joint Score [FJS]), patient satisfaction, and radiographic outcomes. RESULTS: The study included 31 hips in 25 patients. Two patients (2/31 hips, 6.5%) were lost to follow-up, leaving 29 hips for the analysis of postoperative outcomes. Mean follow-up was 13.7±4.2 years (range, 5.8-18.3 years). The four intraoperative complications (4/31, 12.9%) consisted fracture of the diaphysis (2/31, 6.5%), fracture of the greater trochanter (1/31, 3.2%), and sciatic nerve injury followed by a full recovery (1/29, 3.4%). The 8 (8/29, 27.5%) postoperative complications consisted of dislocation (2/29, 6.9%), stem subsidence (2/29, 6.9%), and non-union (4/29, 13.8%). Femoral implant survival at last follow-up was 87.1% (95% CI, 76.1-99.7). The mean HHS increased from 39.6±12.0 (range, 14-61) before surgery to 81.7±13.2 (range, 48-100) at last follow-up (p<0.01). The FJS at last follow-up indicated that the joint was forgotten in 14/29 (48.2%) cases and caused only acceptable symptoms in 9/29 (31.0%) of cases. Clinically significant (≥ 1cm) LLLI was present in 8/29 (27.6%) patients postoperatively compared to 19/29 (65.5%) preoperatively. The mean LLLI decreased from 20.8±19.7mm (range, 0-60mm) to 5.0±7.3mm (range, 0-30mm). Mean time to healing was 4.3±2.4 months (range, 2-11 months). CONCLUSION: Regarding these complex procedures, this technique was associated with low rates of intraoperative fractures and early postoperative complications. However, femoral stem survival was shorter than in earlier studies and the non-union rate was high, despite satisfactory functional and clinical outcomes.
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Artroplastia de Reemplazo de Cadera , Luxación Congénita de la Cadera , Luxaciones Articulares , Humanos , Artroplastia de Reemplazo de Cadera/métodos , Luxación Congénita de la Cadera/diagnóstico por imagen , Luxación Congénita de la Cadera/cirugía , Luxación Congénita de la Cadera/complicaciones , Estudios Retrospectivos , Fémur/cirugía , Complicaciones Posoperatorias/cirugía , Luxaciones Articulares/cirugía , Osteotomía/métodos , Extremidad Inferior/cirugía , Complicaciones Intraoperatorias , Estudios de SeguimientoAsunto(s)
Artroplastia de Reemplazo de Cadera , Displasia del Desarrollo de la Cadera , Luxación Congénita de la Cadera , Humanos , Artroplastia de Reemplazo de Cadera/efectos adversos , Pérdida de Sangre Quirúrgica/prevención & control , Jordania/epidemiología , Displasia del Desarrollo de la Cadera/cirugía , Luxación Congénita de la Cadera/complicaciones , Luxación Congénita de la Cadera/cirugía , HemoglobinasRESUMEN
OBJECTIVE: This study aimed to identify the relevance of hospitalizations for congenital hip deformities in Bahia. METHODS: This is a retrospective epidemiological study in public databases. Descriptors in health sciences: "congenital hip dysplasia", "congenital hip dislocation", and "congenital dislocation hip". This is qualitative-quantitative research with the analysis of secondary data and cross-sectional typologies in the databases of the Ministry of Health - Health Information (TABNET), made available by the Department of Informatics of the Unified Health System (DATASUS). RESULTS: Bahia was the third Brazilian state with the highest number of hospitalizations, registering 1481 cases. The municipalities in Bahia with the highest prevalence were Itanhém, Salvador, and Barreiras, with 912, 445, and 20 cases, respectively. CONCLUSIONS: The elevated number of congenital hip deformities reflects a public health problem, requiring investments in public policies.
Asunto(s)
Luxación Congénita de la Cadera , Humanos , Estudios Transversales , Estudios Retrospectivos , Radiografía , Luxación Congénita de la Cadera/epidemiología , Luxación Congénita de la Cadera/complicaciones , Luxación Congénita de la Cadera/diagnóstico por imagen , Salud PúblicaRESUMEN
PURPOSE: Early osteoarthritis (OA) due to developmental dysplasia of the hip (DDH) is a known indication for total hip arthroplasty (THA). Though screening tools and joint-preserving procedures have been established successfully, there still is a relevant number of patients suffering DDH. Due to the lack of long-term outcome studies, we like to close this gap and present the results of a highly specialized center. METHODS: The study included 126 patients, who were treated in our institution with primary THA for DDH between January 1997 and December 2000. At the time of final follow-up, at a mean of 23 years postoperatively, 110 patients (121 hips) were clinically evaluated using the Harris-Hip Score. In addition, complication and surgical revision rates were assessed. We collected surgery-related data like implant choice and special surgical features such as autologous acetabular reconstruction or femoral osteotomies. Additionally, the severity of preoperative DDH was measured radiographically according to Crowe classification. RESULTS: There were 91 female (83%) and 19 male (17%) patients with an average age of 51 ± 9.5 years (range 21-65) included. Mean follow-up was 23 ± 1.3 years (21-25), with a minimum of 21 years being necessary for inclusion. Using revision for any indication as primary endpoint, the Kaplan-Meier survivorship was 98.3% at 10 years and 81.8% at final follow-up. The overall revision rate was 18% (22 cases), which were split up as follows: 20 (17%) implant failures (loosened or broken components), one (1%) periprosthetic infection and one (1%) periprosthetic fracture. Regarding complications, we observed nine (7%) dislocations and one case (1%) with severe heterotopic ossification that required surgical excision. The mean Harris-Hip score at latest follow-up was 78 ± 14 points (32-95). CONCLUSIONS: Though implants and surgical techniques have improved over time, our results suggest THA in patients suffering DDH to be seriously challenging with relatively high overall complications in long-term observation and fair clinical outcome after 21 years postoperatively. There is evidence that prior osteotomy might be associated with a higher revision rate.
Asunto(s)
Artroplastia de Reemplazo de Cadera , Displasia del Desarrollo de la Cadera , Luxación Congénita de la Cadera , Humanos , Masculino , Femenino , Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Artroplastia de Reemplazo de Cadera/efectos adversos , Luxación Congénita de la Cadera/cirugía , Luxación Congénita de la Cadera/complicaciones , Estudios de Seguimiento , Displasia del Desarrollo de la Cadera/cirugía , Displasia del Desarrollo de la Cadera/complicaciones , Resultado del Tratamiento , Estudios RetrospectivosRESUMEN
Aims: To clarify the mid-term results of transposition osteotomy of the acetabulum (TOA), a type of spherical periacetabular osteotomy, combined with structural allograft bone grafting for severe hip dysplasia. Methods: We reviewed patients with severe hip dysplasia, defined as Severin IVb or V (lateral centre-edge angle (LCEA) < 0°), who underwent TOA with a structural bone allograft between 1998 and 2019. A medical chart review was conducted to extract demographic data, complications related to the osteotomy, and modified Harris Hip Score (mHHS). Radiological parameters of hip dysplasia were measured on pre- and postoperative radiographs. The cumulative probability of TOA failure (progression to Tönnis grade 3 or conversion to total hip arthroplasty) was estimated using the Kaplan-Meier product-limited method, and a multivariate Cox proportional hazard model was used to identify predictors for failure. Results: A total of 64 patients (76 hips) were included in this study. The median follow-up period was ten years (interquartile range (IQR) five to 14). The median mHHS improved from 67 (IQR 56 to 80) preoperatively to 96 (IQR 85 to 97) at the latest follow-up (p < 0.001). The radiological parameters improved postoperatively (p < 0.001), with the resulting parameters falling within the normal range in 42% to 95% of hips. The survival rate was 95% at ten years and 80% at 15 years. Preoperative Tönnis grade 2 was an independent risk factor for TOA failure. Conclusion: Our findings suggest that TOA with structural bone allografting is a viable surgical option for correcting severely dysplastic acetabulum in adolescents and young adults without advanced osteoarthritis, with favourable mid-term outcomes.