Environmental and Genetic Risk Factors in Developmental Dysplasia of the Hip for Early Detection of the Affected Population.

Diagnosis of developmental dysplasia of the hip (DDH) mostly relies on physical examination and ultrasound, and both methods are operator-dependent. Late detection can lead to complications in young adults. Current evidence supports the involvement of environmental and genetic factors, such as single nucleotide variants (SNVs). Incorporating genetic factors into diagnostic methods would be useful for implementing early detection and management of affected individuals. Our aim was to analyze environmental factors and SNVs in DDH patients. We included 287 DDH cases and 284 controls. Logistic regression demonstrated an association for sex (OR 9.85, 95% CI 5.55-17.46, p = 0.0001), family history (OR 2.4, 95% CI 1.2-4.5, p = 0.006), fetal presentation (OR 3.19, 95% CI 1.55-6.54, p = 0.002), and oligohydramnios (OR 2.74, 95%CI 1.12-6.70, p = 0.026). A model predicting the risk of DDH including these variables showed sensitivity, specificity, PPV, and NPV of 0.91, 0.53, 0.74, and 0.80 respectively. The SNV rs1800470 in TGFB1 showed an association when adjusted for covariables, OR 0.49 (95% CI 0.27-0.90), p = 0.02. When rs1800470 was included in the equation, sensitivity, specificity, PPV and NPV were 0.90, 0.61, 0.84, and 0.73, respectively. Incorporating no-operator dependent variables and SNVs in detection methods could be useful for establishing uniform clinical guidelines and optimizing health resources.

Volumetric measurement of the acetabular cavity in patients with unilateral neglected developmental dysplasia of the dislocated hip operated in a single time.

BACKGROUND: Plain radiography is the most often imaging method used for postoperative assessment of inveterate developmental dysplasia of the hip. This technique does not permit to achieve an accurate diagnose of intra-articular changes, specifically articular congruity. OBJECTIVE: analyze the morphological changes of the acetabular volume by computed tomography, in patients operated by medium adductor myotomy, psoas tenotomy, open hip reduction, diaphysectomy, varus osteotomy and derotating and Dega-type acetabuloplasty. METHOD: A pilot clinical trial was conducted including six patients with unilateral inveterate dysplasia admitted to the Rehabilitation National Institute. Computed tomography were analyzed using an engineering design software. RESULTS: It was found that in all cases analyzed, operated acetabular volume was greater than the contralateral (8 to 48%), however, no significant difference between the volumes was found (p = 2.46). Significant difference between the volume and the age of patients, in multifactorial ANOVA tests (p = 0.006), Cochran's (p = 0.00019) and Kruskal-Wallis (p = 2.925 × 10-8) was found. CONCLUSION: It is clear that the proposed measurement technique is able to identify differences between volumes (operated and contralateral). The clinical monitoring of these patients can validate the results obtained by this measurement technique, and it will serve to estimate the effectiveness of the surgical technique applied in patients.

ANTECEDENTES: El método más utilizado para la evaluación posquirúrgica de la displasia del desarrollo de la cadera inveterada es la radiografía convencional, lo que impide medir con precisión cambios intraarticulares. OBJETIVO: Analizar los cambios morfológicos del volumen acetabular mediante tomografía computarizada en pacientes operados con miotomía de aductor mediano, tenotomía de psoas, reducción abierta de cadera, diafisectomía, osteotomía varizante y desrotadora, y acetabuloplastia tipo Dega. MÉTODO: Se realizó un estudio piloto en el que se analizaron tomografías de seis pacientes del Instituto Nacional de Rehabilitación con displasia inveterada unilateral, por medio de software de diseño para determinar el volumen acetabular. RESULTADOS: Se encontró que el volumen acetabular operado fue mayor que el contralateral (8 vs. 48%), pero no se halló diferencia significativa entre los volúmenes (p = 2.46). Se encontraron diferencias significativas entre los volúmenes y la edad de los pacientes, evaluadas mediante ANOVA multifactorial (p = 0.006), Cochran (p = 2.925 × 10−8) y Kruskal-Wallis (p = 0.00019). CONCLUSIÓN: Es claro que la técnica de medición propuesta permite identificar diferencias entre volúmenes (operado y contralateral). El seguimiento clínico de estos pacientes podrá validar los resultados obtenidos por este método y servirá para poder estimar la eficacia de la técnica quirúrgica aplicada en los pacientes.

Arthroscopic retrieval of a broken guidewire fragment from the hip joint after cannulated screw fixation of slipped capital femoral epiphysis.

The use of cannulated screws for internal fixation of slipped capital femoral epiphysis (SCFE) is recognized as the standard method of treatment and has fewer complications compared with previous methods such as pins or tri-flanged nails. Some complications related to guidewires have been reported in the treatment SCFE. The most dangerous complication is inadvertent advance of the guidewire into the pelvic cavity. Guidewire breakage is frequent and maybe under-reported. Articular migration of a guidewire fragment has potentially devastating effects and implies a second surgical procedure. Open arthrotomy is the traditional method for fragment removal from the hip joint. We report the case of a 12-year-old-girl with bilateral SCFE. Both hips were fixed with cannulated screws. A guidewire broke inside her right hip, leaving an articular fragment located at the inferior-posterior acetabular notch. Hip arthroscopy was performed 6 weeks after the index procedure; the fragment was located and removed from the joint. No evidence of cartilage damage other than the perforation created by the guidewire was found. Hip arthroscopy is an attractive option for articular foreign body removal; it has the potential for less morbidity and is adequate for evaluating and treating articular cartilage lesions.