Growth and remodelling of the dysplastic hip after conservative reduction in congenital dislocation.

This study presents the development and remodelling of 78 dysplastic hips treated conservatively. The hip joints were observed from the end of conservative treatment, during growth until maturity, up to the age of 18 years and beyond. We used 9 radiological parameters of hip structure. The parameters described the status of the acetabulum, proximal end of the femur and the joint congruity. The values of these parameters were compared with the norms established for healthy hips. The material was divided into groups with regard to the parameter values. It was found that hip congruity at the age from 2 to 5 years or from 2 to 7 years is the most important factor that determines the development of both the acetabulum and the whole joint. Based on the values of three radiological parameters, describing hip congruity at this period of life, it was found that the remodelling of a dysplastic hip follows one of three definable models. If we attribute the development of a given hip to a given model, then the status of this hip at maturity is predictable. What makes the prediction of the final condition of the hip feasible is the observation of the hip remodelling process from age 2 to 5 or 7 years. This also permits a decision regarding surgery to eliminate any dysplastic elements from the hip during the childs optimal age for operative treatment. (Hip International 2002; 12: 320-33).

[MR imaging of the subcapital growth plate of the proximal femur]. / Obraz podglowowej chrzastki nasadowej blizszego konca kosci udowej w badaniu MR.

The possibilities of MR imaging of the subcapital growth plate of the proximal femur were evaluated in 36 children with 58 normal hips. The most common presentation of the area of subcapital growth plate on MR images was that of a hypointense band on T1-weighted images and a hyperintense band on sequences using fat saturation. Thinning of the growth plate with age was observed and in the older subjects in this group the growth plate was no longer visible.

[Clinical, radiological and personal condition of patients over 18 year of age with congenital hip dislocation treated conservatively]. / Stan kliniczny, radiologiczny i osobisty osób w wieku powyzej 18 lat, leczonych w dziecinstwie zachowawczo bez powiklan z powodu wrodzonego zwichniecia stawu biodrowego.

The paper presents the clinical, radiological and personal condition of 121 patients (162 hip joints) age 18 to 32 years (mean age 24 years) treated during childhood because of congenital hip dislocation. In 34% of the cases slight and moderate pain was reported, but no other symptoms were found during follow-up. Radiological condition was assessed as very good in 34% of the cases, good in 48%, satisfactory in 6% and unsatisfactory in 5%. Structural changes in spongy bone, which may be early signs of degenerative disease were found in 3 hips. These changes were visible on X-ray films as a sign of increased density in the upper rim of the acetabulum. The assessed patients lead a normal life, work, often doing a job that is inappropriate for people who should take special care of their hip joints.

[An analysis of the selected parameters of the normal hip joint during growth in magnetic resonance imaging]. / Analiza niektórych parametrów budowy prawidlowego stawu biodrowego w przebiegu jego wzrostu w obrazie rezonansu magnetycznego.

Dynamics of the selected parameters of the normal hip joint during growth has been presented. Fifty-three normal hips in 40 individuals aged 3-17 years were assessed with Magneton Impact MRI. The angles and indices were found on T1 coronal images in Spin Echo or Turbo Spin Echo sequence. Acetabular roof angle of Hilgenreiner, acetabular inclination angle of Sharp, Wiberg angle and Heyman-Herndon index were calculated with both bony and cartilaginous elements regarded. Parameters based on cartilaginous parts of the joint did not change during normal growth, but they do change if calculated with the use of bony landmarks reaching Acartilaginous values by the age of 14-15. The results suggest, that during growth gradual ossification of cartilaginous elements takes place but the proportions remain unchanged. The investigation determines the age of enhanced ossification and the age of its termination.

[Development of the normal infantile hip joints assessed by MRI]. / Badania nad rozwojem dzieciecego prawidlowego stawu biodrowego w obrazie rezonansu magnetycznego.

The paper provides an overview of the time of appearance of the secondary ossification centers and closure of the growth plates of the acetabulum and proximal epiphysis of the femur: the triradiate cartilage, the acetabular roof growth cartilage, the subcapital growth cartilage, the growth cartilage of the major trochanter, the growth cartilage of the minor trochanter. The study is based upon 62 MRI scans of healthy hips in 45 patients aged 3-21. The examined hips showed no pathologic traits--neither in the MRI scan nor in X-ray investigation. In Spin Echo and Turbo Spin Echo sequential imaging all obtained slices were used, on GRADIENT ECHO: FISP 3D, FLASH 2D, and FLASH 3D FAT SAT only chosen slices were included in the study. This way the following results were obtained: the ossification center of the major trochanter appears at the age of 3 in girls and at the age of 6 in boys, while the ossification center of the minor trochanter appears at the age of 6 in both sexes. The times of complete ossification of following growth cartilages were observed: for the triradiate cartilage ossification was observed at age 12-15 in girls and 15-16 in boys; for the cartilage of the acetabular roof ossification was noted at age 12-15 in girls and 15-18 in boys; ossification in the subcapital growth cartilage occurred at age 15-17 in girls and 16-18 in boys; the major trochanter growth cartilage ossifies at age 15-16 in girls and 16-18 in boys; for the minor trochanter ossification of the growth cartilage occurs at age 14-16 in girls and at age 16-18 in boys. The secondary ossification center of the pubic bone appears at age 9-11 in girls and 13-16 in boys and the secondary ossification center of the acetabular roof appears at age 13-17 in girls and boys. This study expand our knowledge on the development of the hip joint and facilitate the assessment of hip pathology.

[Images of growth zones of the femoral head, neck and greater trochanter in MR examination]. / Obraz stref wzrostowych glowy i szyjki kosci udowej oraz kretarza wiekszego w badaniu MR.

The possibilities of MR imaging were evaluated in 36 children with 58 normal hips. The analysed children were divided into 3 groups, basing on age at the time of investigation i.e. children less than 5 years old, age ranging from 5 to 12 years, and over 12 years of age. MRI allowed visualisation of all growth zones of the proximal femur. On T-1 weighted images the growth cartilage of the femoral head, neck, and greater trochanter were of intermediate signal intensity. On sequences using fat saturation and on gradient echo images the cartilage was of high signal intensity. The growth zone of the subtrochanteric cartilage was of low signal intensity on T-1 weighted images and high signal intensity on sequences using fat saturation and on gradient echo images. T-1 weighted images together with FLASH 3D FAT SAT seem to be sufficient for the analysis of the growth zones of the proximal femur.

[Possibility of stereometric evaluation of child's hip structures by MRI]. / Mozliwosci oceny przestrzennej struktur dzieciecego stawu biodrowego za pomoca rezonansu magnetycznego (MR).

A series of magnetic resonance imaging (MRI) examinations of 188 pathologic and normal hip joints has been reviewed to evaluate usefulness of this method for 3-D imaging of this joint. The age of patients ranged from 3 years to 22 years. MRI was done for diagnosis, pre-operative planning or post-operative assessment. Fifty-four hips were normal. Normal hip, dysplastic and the one after septic arthritis have been delineated. All MRI examinations were done with Magnetic Impact. Spin Echo, Turbo Spin Echo and FLASH 3D FAT SAT techniques were employed, all three planes included. All hip joint elements were separately described, the difference between the immature and adult hip were presented. Objective parameters were introduced. MRI proved extremely useful for diagnostics, surgery planning and follow-up of immature hip joint.

[Normal values of some parameters determining congruency of the hip in the radiographic image]. / Normy niektórych parametów okreslajacych kongruencje stawu biodrowego w obrazie radiologicznym.

Normal values of 11 radiographic parameters determining hip congruency in radiographic picture are presented. These angles and indices are given for 1-7 years age group and subsequently 8-12, 13-16 and 17-22 years of age.

[Normal values of some parameters of the acetabulum and proximal femur in radiographic images]. / Normy niektórych parametrów budowy panewki stawu biodrowego i blizszego konca kosci udowej w obrazie radiologicznym.

Normal values of 9 angles and indices describing acetabulum and proximal femur are presented. Analysis of 260 normal hip joints in individuals from 1 to 22 years of age served to establish these values.

[Anatomy and development of the hip joint during growth. II. Anatomy and development of the proximal femur]. / Budowa i rozwój stawu biodrowego w przebiegu wzrostu. Czesc II: Budowa i rozwój blizszego konca kosci udowej.

Anatomy and development of proximal femur during growth is discussed on the basis of vast literature. The issue of proximal femur growth zones and factors determining normal growth, that is static and kinetic forces within loaded joint and kinetic forces within loaded joint and muscle function are presented.

[Modifications of certain morphologic parameters in radiology of the hip joint]. / Modyfikacje niektórych parametrów budowy radiologicznej stawu biodrowego.

The modification of some angles and indices used in radiographic hip measurements have been presented. Idelberger and Frank angles, "hip value", roof-head index, decentration index were discussed. Advantages coming from the use of those modifications have been exposed.

[Centering angles of the femoral head and neck in the dysplastic hip]. / Katy centrowania glowy i szyjki kosci udowej w dysplastycznym stawie biodrowym.

Centering angle of the femoral head determining relation of the head and acetabulum depending on the epiphyseal plane and acetabular roof coverage of the head is described. Centering angles of the neck indicating cranial or lateral dislocation of the proximal femur in relation to apparent shaft-neck angle and anteversion angle are also described. The parameters proved useful in grading of the dysplastic hip.

[Anatomy and development of the hip joint during growth. I. anatomy and development of the acetabulum]. / Budowa i rozwój stawu biodrowego w przebiegu wzrostu. Czesc I: budowa stawu i rozwój panewki.

Anatomy and development of the hip joint during growth is discussed on the basis of vast literature. The issue of acetabular growth zones and factors determining normal growth are presented.

[Usefulness of magnetic resonance imaging in diagnosis of selected diseases of the hip joint in children and adolescents]. / Przydatnosc tomografii rezonansu magnetycznego w diagnostyce wybranych chorób stawu biodrowego u dzieci i mlodziezy.

The possibilities of MRI use for diagnostics of various conditions of the hip in children and adolescents are presented. The method proved to be highly valuable.

[Treatment for congenital dislocation of the hip at the orthopedic department of the Institute of Orthopedics and Rehabilitation in Poznan from 1946 to 1991]. / Leczenie wrodzonego zwichniecia stawów biodrowych w Poznanskiej Klinice Ortopedycznej w latach 1946-1991.

During forty-five years (1946-1991) over 6000 children were treated conservatively and over 6000 surgical procedures for congenital dislocation of the hip were carried out at Orthopedic Department of Institute of Orthopedics and Rehabilitation in Poznan. Modalities of treatment, types and numbers of operations are presented.

[What determines treatment results of the Frejka pillow treatment for congenital hip dislocation?]. / Od czego zalezy wynik leczenia poduszka Frejki wrodzonej dysplazji stawu biodrowego z przemieszczeniem?

The results of treatment of 1008 hips in 779 children were analyzed and their dependence on objective factors established. The major influence is attributed to the initial displacement of the femoral head; the greater it is the worse is the result. The age at the onset of treatment influences results only indirectly with displacement increasing in time. No other factor as sex, side involved (left, right or both), or family history seems to play a role.

[Remarks concerning diagnostic principles and early treatment of congenital hip dislocation]. / Uwagi w sprawie zasad rozpoznawania i wczesnego leczenia wrodzonego zwichniecia stawu biodrowego.

Principles of early diagnosis and treatment of congenital dislocation of the hip are presented. The clinical course, complications and results of treatment by Frejka pillow are reported. Indications for surgical treatment in cases of failure by conservative management, as well as in cases of deficient rebuilding of the hip are discussed.

[Avascular necrosis of the hip in radiologic images during treatment using the Freyka pillow for congenital hip dislocation]. / Zaburzenia odzywcze stawu biodrowego w obrazie radiologicznym w przebiegu leczenia przy pomocy poduszki Frejki wrodzonej dysplazji z przemieszczeniem.

Radiological picture of 823 hips in 636 children treated with the use of Freyka pillow between 1972 and 1976 was assessed. Avascular necrosis of the proximal end of the femur was found in 113 cases. The older the child was at the beginning of treatment the highest were the chances for developing avascular necrosis, but more serious changes were found in younger children. In the hips with greater initial dislocation changes were more frequent. A comparison between hips treated with Freyka pillow and those treated with different methods as to frequency of avascular necrosis was difficult due to the lack of uniformity in criteria for both diagnosis and assessment of the results.

[Late assessment of the hip joint treated with the Freyka pillow without complications for congenital dysplasia and dislocation]. / Pózna ocena stawów biodrowych leczonych bez powiklan poduszka Frejki z powodu wrodzonej dysplazji z przemieszczeniem.

Clinical and radiological assessment of 504 hips in 389 patients of 10 to 21 years of age (13 years 10 month on average) has been carried out. The patients were treated by Freyka pillow in the childhood. Those with no reduction achieved primarily and operated on because of residual dysplasia as well as patients with severe avascular necrosis were excluded from this study. In 99% of the hips no clinical abnormality was found except for the change of rotation range--decreased external rotation. Radiographic assessment revealed 60% excellent results and 35% good ones with dominant residual feature of increased anteversion of the femoral neck. Remaining 5% were rated as fair--these were the cases that should have been operated on at a suitable time.

[Late results of surgical treatment of infantile idiopathic scoliosis by Harrington's method]. / Odlegle wyniki leczenia operacyjnego skolioz idiopatycznych wczesnodzieciecych metoda Harringtona.

The late results of surgical treatment of infantile scoliosis by the Harrington method have been presented in 43 patients. The patients age at surgical treatment ranged from 11 to 21 years (14.1 years in the average). The patients age at final follow up examination ranged from 18 to 34 years (25.4 years on the average). The curvature angle at operation was 102.1 degrees according to Cobb on the average. 43.7 per cent of curvature was corrected. Although an improvement of posture was present in all the patients, only 51 per cent of the patients, had good posture. After the treatment 81 per cent of the patients worked.