Vitamin D status-associated postoperative complications in patients with hip dysplasia after periacetabular osteotomy: A case-control study.

OBJECTIVES: This study aimed to clarify the relationship between vitamin D status and complications after periacetabular osteotomy. METHODS: A total of 46 hips of 39 patients (3 men and 36 women; mean age at surgery, 41.0 years; mean postoperative follow-up duration, 63 months) were reviewed to obtain the following information: patients' serum 25-hydroxyvitamin D [25(OH)D] status, prevalence of postoperative delayed union of osteotomy sites in the greater trochanter (DUGT) and ischiopubic stress fractures (IPSFs), and risk factors. RESULTS: The mean serum 25(OH)D level was 11.9 ng/ml. DUGT and IPSF were found in four (10.3%) and three (7.7%) patients, respectively. Serum 25(OH)D levels ≤ 11 ng/ml were significantly associated with DUGT in female patients (p = .02). Serum 25(OH)D levels ≤ 9 ng/ml and smoking were significantly associated with IPSF (p = 0.01 and 0.02, respectively). Overall, 21.7% of patients with serum 25(OH)D levels ≤ 11 ng/ml developed at least one complication; no complications occurred when serum 25(OH)D levels were >11 ng/ml. CONCLUSION: Severe vitamin D deficiency was highly prevalent in relatively young patients. Vitamin D deficiency and smoking were independent risk factors for postoperative complications. Proactive supplementation is advisable to reduce postoperative complications, especially in patients with serum 25(OH)D levels ≤ 11 ng/ml.

Impact of scan quality on AI assessment of hip dysplasia ultrasound.

AIMS: Early diagnosis of developmental dysplasia of the hip (DDH) using ultrasound (US) is safe, effective and inexpensive, but requires high-quality scans. The effect of scan quality on diagnostic accuracy is not well understood, especially as artificial intelligence (AI) begins to automate such diagnosis. In this paper, we developed a 10-point scoring system for reporting DDH US scan quality, evaluated its inter-rater agreement and examined its effect on automated assessment by an AI system-MEDO-Hip. METHODS: Scoring was based on iliac wing straightness and angulation; visibility of labrum, os ischium and femoral head; motion; and other artifacts. Four readers from novice to expert separately scored the quality of 107 scans with this 10-point scale and with holistic grading on a scale of 1-5. MEDO-Hip interpreted the same scans, providing a diagnostic category or identifying the scan as uninterpretable. RESULTS: Inter-rater agreement for the 10-point scale was significantly higher than holistic scoring ICC 0.68 vs 0.93, p < 0.05. Inter-rater agreement on the categorisation of individual features, by Cohen's kappa, was highest for os ischium (0.67 ± 0.06), femoral head (0.65 ± 0.07) and iliac wing (0.49 ± 0.12) indices, and lower for the presence of labrum (0.21 ± 0.19). MEDO-Hip interpreted all images of a quality > 7 and flagged 13/107 as uninterpretable. These were low-quality images (3 ± 1.2 vs. 7 ± 1.8 in others, p < 0.05), with poor visualization of the os ischium and noticeable motion. AI accuracy in cases with quality scores < = 7 was 57% vs. 89% on other cases, p < 0.01. CONCLUSION: This study validates that our scoring system reliably characterises scan quality, and identifies cases likely to be misinterpreted by AI. This could lead to more accurate use of AI in DDH diagnosis by flagging low-quality scans likely to provide poor diagnosis up front.

The effect of traditional Chinese medicine fumigation and washing as a complementary and alternative therapy on the recovery of joint function after development dysplasia of the hip in children: A protocol for systematic review and meta-analysis.

BACKGROUND: Development dysplasia of the hip (DDH) is a common childhood orthopedic disease in clinic. The cause of DDH is not yet clear. If DDH is not treated promptly or correctly, it will seriously affect the life quality of the child. At present, surgery is the main means of treating older DDH, but it is easy to appear development dysplasia of the hip after surgery, and the joint movement is limited after surgery. For modern medicine, it has not many treatments to solve this problem. As one of the commonly used treatment methods, but the effect of routine functional exercise is not ideal. Traditional Chinese medicine fumigation and washing belongs to the category of Chinese medicine external treatment, which can directly act on the focus. It has the functions of relaxing muscles and tendons and removing obstruction from meridians, activating blood to eliminate stagnation. It has achieved good effects in relieving joint disorders, but it is lack of the high-quality evidence support, so there is controversy about the clinical application of traditional Chinese medicine fumigation and washing. This study will conduct a systematic review to compare the application effect and safety of traditional Chinese medicine fumigation and washing as a complementary and alternative therapy and traditional rehabilitation training in the treatment of postoperative joint function recovery after development dysplasia of the hip in children. The research results will provide evidence-based medical evidence to support the choice of treatment for the disease. METHODS: Using computer to retrieve PubMed, ScienceDirect, Web of Science, EMBase, Cochrane Library, WANFANG Database, CNKI, and VIP Database, CBM, and using the method of combining mesh words with item words to retrieve the Chinese and English databases, to retrieve the randomized controlled study on the application of traditional Chinese medicine fumigation and washing on the recovery of joint function after development dysplasia of the hip in children. The retrieval time is from January 1990 to January 2021. Two researchers screen and evaluate the quality of the retrieved literatures according to the inclusion and exclusion criteria. In the event of a disagreement, a third researcher will join the discussion to resolve the disagreement. Using Revman 5.3 software to conduct meta-analysis. RESULTS: This study will compare the application effect and safety of traditional Chinese medicine fumigation and washing as a complementary and alternative therapy and traditional rehabilitation training in the treatment of postoperative joint function recovery after development dysplasia of the hip in children. CONCLUSION: The results of this study will be published in an internationally influential academic journal to provide evidence-based medical evidence for the selection of supplement and alternative therapies on the recovery of joint function after development dysplasia of the hip in children. ETHICS AND DISSEMINATION: This study does not involve specific patients, and all research data comes from publicly available professional literature, so an ethics committee is not required to conduct an ethical review and approval of this study. OSF REGISTRATION: DOI 10.17605/OSF.IO/RUHK5.

Result of cementless total hip arthroplasty in a patient with osteopoikilosis, hip dysplasia and advanced osteoarthritis: a case report.

BACKGROUND: Osteopoikilosis (OPK) is a rare benign sclerosing bone dysplasia and is often incidentally found on plain radiography. OPK generally does not require treatment. Nevertheless, osteonecrosis or degenerative joint disease can occur in the setting of OPK, and little is known with regard to the longevity of arthroplasty prostheses implanted into OPK-bearing bones. CASE PRESENTATION: A 55-year-old male presented with progressive right hip pain in 2012. He was diagnosed with coexisting osteopoikilosis and developmental dysplasia of the right hip with advanced osteoarthritis after a series of imaging studies including radiographs, magnetic resonance imaging (MRI), and bone scan. A cementless total hip arthroplasty was performed to treat his right hip pain. Radiographs at eight-year follow-up showed the prosthetic components were well-fixed. Harris hip score of the patient's right hip was 93. The patient can walk without assistance and work as a construction worker. CONCLUSION: Cementless arthroplasty can be considered in patients with hip arthropathies and co-existing osteopoikilosis. Continued follow-up is required to establish the long-term results.

Effectiveness of Multi-Modal Blood Management in Bernese Periacetabular Osteotomy and Periacetabular Osteotomy with Proximal Femoral Osteotomy.

OBJECTIVE: Bernese periacetabular osteotomy (PAO), an effective treatment for patients with developmental dysplasia of the hip (DDH), is characterized by wide exposure, cancellous bone surgery, and difficult techniques. In addition, the hip joint is deep and of rich muscles and neurovascular supply, which significantly increases bleeding. For patients who had combined proximal femoral osteotomy (PFO), the blood loss may be tremendous. The blood management for PAO is still challenging. We aimed to evaluate the effectiveness of multi-modal blood management for PAO and PAO combined with PFO. PATIENTS AND METHODS: We retrospectively evaluated patients who had PAO with or without combined procedures from June 2010 to December 2018 in our department. The multi-modal blood management protocol included three parts: (i) pre-operation - autologous component blood donation and iron supplement/erythropoietin; (ii) during operation - controlled hypotension anesthesia, intraoperative auto-blood transfusion, tranexamic acid (20 mg/kg, IV / 0.5 g local), and standardized surgical procedure to shorten surgical time; and (iii) post-operation - no drainage used, selective allo-blood transfusion, and ice packing technique. As the lacking of the above standard blood management protocol during PAO or PAO + PFO initially, we divided all the patients into three groups: Group A (PAO) - before protocol started, 74 hips; Group B (PAO) - after protocol finalized, 178 hips; Group C (PAO + PFO) - after protocol finalized, 55 hips. The intraoperative blood loss, surgical time, allo-transfusion rate, pre- and postoperative hemoglobin were compared among groups. RESULTS: Both the general characteristics and preoperative hemoglobin were comparable among the three groups (P < 0.001). The intraoperative blood loss was 797.1 ± 312.2, 381.7 ± 144.0 and 544.1 ± 249.1 mL, respectively. The surgical time was 109.6 ± 18.5, 80.2 ± 20.0 and 154.3 ± 44.7 min, respectively. The allo-transfusion rate was 86.5%, 0%, and 2%, respectively. The mean decreased value of hemoglobin on the first postoperative day of group B and group C was greater than that of group A, which was associated with the higher allo-transfusion rate of group A. However, on the third postoperative day, the mean decreased value of hemoglobin of group B was less than that of group A and group C. CONCLUSION: Perioperative multi-modal blood management for PAO or PAO + PFO can significantly decrease intraoperative blood loss, reduce allo-transfusion rate from over 80% to 0%, and ensure the rapid recovery of postoperative hemoglobin level.

Displasia epifisaria de Meyer. Presentación de un caso / Meyer epiphyseal dysplasia. Case presentation

RESUMEN Se presentó el caso de una niña con el diagnóstico de displasia de Meyer. Consiste en una alteración en el desarrollo de la cadera en el niño dado por irregularidad y retraso en la osificación del núcleo de la epífisis femoral, aunque muchos ortopedistas la consideran como una variante fisiológica normal. Radiológicamente se manifiesta como un patrón granular múltiple de osificación y clínicamente si bien puede ser sintomática en algunos casos, lo más frecuente es que sea asintomática. Se enfatizó en la importancia de considerar a la displasia de Meyer como posibilidad diagnóstica ante alteraciones en la osificación de la epífisis femoral. Se señaló a la displasia congénita de la cadera y la enfermedad de Perthes como principales entidades a tener en cuenta al hacer el diagnóstico diferencial. Se analizó la evolución clínico-radiológica de la paciente a partir de los datos recogidos en la historia clínica. Se concluyó enfatizando que la displasia de Meyer debe tenerse presente como posibilidad diagnóstica ante casos similares, realizar una cuidadosa valoración de cada paciente y tener en cuenta a la displasia congénita de la cadera y la enfermedad de Perthes como diagnóstico diferencial atendiendo a la edad del paciente (AU).

ABSTRACT The authors present the case of a female child diagnosed with Meyers dysplasia. It is an alteration of the hip development in children, given the ossification irregularity and retardation of the femoral epiphysis nucleus, although several orthopedists consider it a normal physiological variant. Radiologically, it shows like a multiple granular pattern of ossification, and clinically it could be symptomatic in several cases, but more frequently it is asymptomatic. It was emphasized the importance of considering Meyer dysplasia as a diagnostic possibility in the presence of alterations in the femoral epiphysis ossification. The authors indicated hip congenital dysplasia and Perthes disease as main entities to take into account when making the differential diagnosis. They also analyzed clinic-radiological evolution of the patient on the basis of the data collected in the clinical record. They concluded emphasizing that Meyer dysplasia must be taken into consideration as a diagnostic possibility in similar cases, each patient should be carefully assessed and that hip congenital dysplasia and Perthes disease have to be considered as differential diagnosis given the age of the patient (AU).

Treatment of Osteoarthritis Secondary to Developmental Dysplasia of the Hip with Prolotherapy Injection versus a Supervised Progressive Exercise Control.

BACKGROUND Osteoarthritis secondary to developmental dysplasia of the hip (DDH) is one of the major causes of hip pain and disability. The aim of the study was to compare the effectiveness of prolotherapy (PrT) injections versus exercise protocol for the treatment of DDH. MATERIAL AND METHODS There were 46 hips of 41 patients who had osteoarthritis secondary to DDH included in this study. Patients were divided into 2 groups: treated with PrT (PrT group; n=20) and exercise (control group; n=21). Clinical outcomes were evaluated with visual analog scale for pain (VAS) and Harris hip score (HHS) at baseline, 3 weeks, 3 months, 6 months, and a minimum of 1-year follow-up. In PrT group clinical results were also compared in Crowe type I-IV hips. RESULTS Between group analysis revealed no significant between group differences at baseline. Dextrose injection recipients out performed exercise controls for VAS pain change score at 6 months (-4.6±2.6 versus -2.8±2.5; P=0.016), and 12 months (-4.5±2.4 versus -2.9±2.5; P=0.017) and for HHS at 6 months (24.2±14.0 versus 14.8±12.4; P=0.007) and 12 months (24.3±13.4 versus 16.5±11.3; P=0.018). CONCLUSIONS To our best knowledge, this study is the first regarding the effects of an injection method in the treatment of osteoarthritis secondary to DDH. According to our study, PrT is superior to exercises. PrT could provide significant improvement for clinical outcomes in DDH and might delay surgery.

Pediatric Orthopaedic Consults From Chiropractic Care.

Alternative medicine in pediatrics is expanding, with chiropractic now a common choice for families seeking alternative medical care. Currently, there is sparse information in the literature exploring the role of chiropractic in orthopaedic pathology. The objective of this case series is to present pediatric patients who received treatment from chiropractors and orthopaedic physicians as well as to review the respective existing research. Data collected included chiropractic diagnosis, orthopaedic diagnosis, imaging studies, treatments, and complications. Twenty-three patients were studied. Scoliosis, Legg-Calvé-Perthes disease, developmental dysplasia of the hip, cerebral palsy, skeletal dysplasia, and slipped capital femoral epiphysis were diagnoses included. Children had multiple sessions of chiropractic for management of these conditions. The parents' perception for chiropractic was positive in every case. Delayed referral, misdiagnosis, adverse events from manipulative therapy, and ineffective treatments were observed in the present study. More research is indicated to validate chiropractic in children with orthopaedic pathology. (Journal of Surgical Orthopaedic Advances 27(1):58-63, 2018).

Alumina Delta-on-Highly Crosslinked-Remelted Polyethylene Bearing in Cementless Total Hip Arthroplasty in Patients Younger than 50 Years.

BACKGROUND: The purpose of this retrospective study was to determine the clinical and radiographic results, prevalence of polyethylene wear and osteolysis, and fracture of alumina delta ceramic femoral head or highly crosslinked, remelted polyethylene (HXLPE) liner associated with the use of alumina delta ceramic femoral head-on-HXLPE bearing in cementless total hip arthroplasty in patients younger than 50 years. METHODS: We reviewed the cases of 119 patients (130 hips) who underwent a cementless total hip arthroplasty using alumina delta ceramic-on-HXLPE bearing when they were 50 years or younger at the time of surgery. The most common diagnoses were osteonecrosis (51%) and osteoarthritis secondary to developmental dysplastic hip (39%). Osteolysis and polyethylene wear rates were evaluated with use of radiography and computed tomography. In addition, prevalence of fracture of alumina delta ceramic head and polyethylene line was documented. The mean follow-up was 8.3 years (range, 7-9 years). RESULTS: The mean Harris hip score, Western Ontario and McMaster Universities Osteoarthritis Index score, University of California, Los Angeles activity score were 94 points, 14 points, and 8.1 points, respectively, at the final follow-up. No patient had thigh pain. All acetabular components and all but one femoral components were well fixed. The mean annual penetration rate of femoral head was 0.022 ± 0.003 mm/year. No hip had osteolysis or ceramic head or HXLPE liner fracture. CONCLUSION: Our average 8.3-year results with the use of alumina delta ceramic-on-HXLPE bearing in the patients younger than 50 years suggest that cementless acetabular and femoral components provide a high survival rate without evidence of osteolysis or ceramic head or AXLPE liner fracture.

Characterization of Hip Morphology in Children With Mucopolysaccharidosis Types I and II.

BACKGROUND: The purpose of this study is to describe the natural history of hip morphology in patients with mucopolysaccharidoses (MPS) I and MPS II. METHODOLOGY: This is a retrospective radiographic analysis of 88 hips in 44 children with MPS I and II. Radiographs were examined to determine hip migration, femoral head sphericity, and acetabular dysplasia at different ages throughout childhood. In individual hips, change in morphology and rate of change were analyzed. RESULTS: There was a high rate of hip migration and femoral head dysplasia in both MPS I and MPS II. Progressive migration was seen in three quarters of hips and progressive femoral head deformity in over half of hips. Acetabular dysplasia was variable, ranging from normal to severely dysplastic, but did not change with time. Overall, hips were more dysplastic in MPS I than MPS II. CONCLUSIONS: Hip morphology is variable in MPS I and MPS II ranging from almost normal to severely dysplastic. Some hips do not deteriorate with time and thus surgical intervention may not be necessary in all cases. Deterioration is slow allowing time to plan a holistic approach to treatment. LEVEL OF EVIDENCE: Level IV-case series.

Increasing expression of substance P and calcitonin gene-related peptide in synovial tissue and fluid contribute to the progress of arthritis in developmental dysplasia of the hip.

INTRODUCTION: Developmental dysplasia of the hip (DDH) is a common musculoskeletal disorder that has pain and loss of joint function as major pathological features. In the present study, we explored the mechanisms of possible involvement and regulation of substance P (SP) and calcitonin gene-related peptide (CGRP) in the pathological and inflammatory processes of arthritis in DDH. METHODS: Blood, synovial tissue and fluid samples were collected from patients diagnosed with different severities of DDH and from patients with femoral neck fracture. Levels of SP, CGRP and inflammatory cytokines in synovium and synovial fluid (SF) in the different groups were evaluated by immunohistochemistry, real-time PCR and enzyme-linked immunosorbent assay (ELISA). Correlations between neuropeptides and inflammatory cytokines in SF were evaluated by partial correlation analysis. The proinflammatory effects of SP and CGRP on synoviocytes obtained from patients with moderate DDH were investigated in vitro by real-time PCR and ELISA. The mechanisms of those effects were evaluated by Western blot analysis and nuclear factor κ-light-chain-enhancer of activated B cells (NF-κB) DNA binding assay. RESULTS: Significantly increased levels of neuropeptides and inflammatory cytokines were observed in synovium and SF from patients in the severe DDH group compared with the moderate DDH and control groups. In moderate DDH samples, SP in SF correlated with tumor necrosis factor (TNF)-α, and CGRP in SF correlated with TNF-α and interleukin (IL)-10. In the severe DDH group, SP in SF correlated with interleukin (IL)-1ß, TNF-α and IL-10. CGRP in SF correlated with TNF-α. Additionally, SP might have had obvious proinflammatory effects on synoviocytes through the activation of NF-κB. CONCLUSIONS: The upregulation of SP and CGRP in synovium and SF might participate in the inflammatory process of arthritis in DDH. The activation of the NF-κB pathway seems indispensable in the proinflammatory effect of SP on synoviocytes. This original discovery may indicate a potential clinical drug target and the development of innovative therapies for DDH.

Early predictors of acetabular growth after closed reduction in late detected developmental dysplasia of the hip.

This study evaluates improvement of the acetabular index (AI) in patients with developmental dysplasia of the hip at 4 years after closed reduction, and determines the association between the final AI and a set of factors. Sixty-two patients (74 hips) treated with closed reduction were categorized into three groups according to age: group A (0-12 months, 18 hips), group B (13-18 months, 24 hips), and group C (>18 months, 32 hips). There was no difference in AI among the three groups before reduction (P=0.293). In groups A and C, the AI decreased significantly over time until 3 years after reduction and no differences were observed between the time points of 3 and 4 years. At 4 years after reduction, the AI of group C was significantly higher than that of groups A (P<0.001) and B (P=0.012). The overall AI improvement rate was 28.63%. The AI improvement rate of group A was significantly higher than that of group C (P=0.005). Pearson correlation analysis indicated no correlation between center-head distance discrepancy and the final AI (P=0.811). Linear regression suggested that age and initial AI correlated significantly with the final AI (R=0.617, F=15.031, P<0.001). Other factors, such as sex, center-edge angle of Wiberg, bilaterally involved, and avascular necrosis of the femoral head, showed no correlations with the final AI (P>0.05). According to the coefficients, initial AI (ß1=0.432, P<0.001) had greater effect than age (ß2=0.197, P=0.023) on the final AI. In conclusion, the AI decreases in all patients after reduction and stabilizes at 3 years after reduction. The AI improvement rate is correlated negatively with age. Age and initial AI are early predictors of the progress of AI after closed reduction in developmental dysplasia of the hip patients.

[Congenital dysplasia and dislocation of the hip: proven and new procedures in diagnostics and therapy]. / Angeborene Hüftdysplasie und -luxation : Bewährte und neue Verfahren in Diagnostik und Therapie.

BACKGROUND: As developmental dysplasia of the hip (DDH) is the most common congenital muskuloskeletal anomaly, it seems necessary to give an update on the normal growth, pathoanatomy, diagnostic and therapeutic procedures. OBJECTIVES: Which investigations or procedures have withstood the test of time? What are new therapeutic strategies and considerations? What are the problems? METHODS: Review of the current literature on DDH supplemented by several years experience in the treatment of this condition by the authors. RESULTS: We have still a long way to achieve the goal of agreement on universal standardization of assessment and treatment methods based on age and staging regarding DDH, as in the Ponseti treatment procedure for clubfoot. CONCLUSION: Our experiences, as well as the literature suggest the use of Graf's nomenclature for classification of DDH in the first year of life. If dynamic ultrasound (US) shows at least a partial relocation of a decentered hip in the first 6 weeks of life, splinting in human position is advocated. The treatment of a Graf type IV hip joint is very difficult and often need surgery. The established surgical procedures in the literature are still up to date. Radiological follow-up of the affected as well as the unaffected side until the end of the growth phase is mandatory due to the risk of residual dysplasia.

Examination of the newborn: the key skills. Part 3: the hips.

Midwives are increasingly performing the examination of the newborn. his article considers the importance of the examination of the hips in the screening process. The significance of history taking, knowledge of risk factors and the hip examination will be explored. The necessity for early detection and treatment of hip abnormalities, along with referral pathways that the National Screening Committee quires will be highlighted. The impact of late detection of developmental dysplasia of the hip (DDH) on the lives of families and children will also be considered.

Clasificación radiográfica de la cadera con desarrollo displásico / Radiographic classification of developmental dysplasia of the hip

Por más de una década, la férula en abducción de cadera ha sido el método de tratamiento del desarrollo displásico de caderas, en el Hospital Pediátrico Universitario Paquito González Cueto de Cienfuegos. El objetivo de este trabajo es exponer la clasificación dinámica para las caderas con desarrollo displásico, desde el punto de vista radiográfico. Para ilustrar la clasificación se utilizaron esquemas representativos y radiografías de pacientes portadores de diferentes grados de la afección. El comportamiento dinámico de los parámetros radiográficos utilizados en la clasificación, permite realizar agrupaciones diagnósticas antes, durante y después del tratamiento, en función de evaluar los resultados finales de este(AU)

For over a decade, abduction splinting has been the method of treatment for developmental dysplasia of the hip in the Paquito González Cueto University Pediatric Hospital. This paper is aimed at presenting the dynamic classification for this condition from a radiographic point of view. Representative schemes and radiographies of patients with various stages of developmental hip dysplasia were used for illustrating this classification. The dynamic behavior of the radiographic parameters used in the classification allows gathering diagnostic groups before, during and after treatment in order to assess its final results(AU)

Straight tapered titanium stem with alumina bearing in cementless primary total hip arthroplasty: a minimum 5-year follow-up.

The aim of this study was to assess the midterm results of primary cementless total hip arthroplasty using a tapered stem and alumina bearing couple in active patients. After a minimum of 5 years of follow-up, 78 arthroplasties in 72 patients were reviewed retrospectively. The mean Harris hip score was 94 points, and 2 hips had thigh pain. All components radiographically demonstrated stable fixation by bone ingrowth and mild stress shielding of the proximal femur were noted in 14% of hips. There was no significant osteolysis or aseptic loosening. There was a ceramic head fracture in 1 hip and audible sounds in 2 hips. The results of total hip arthroplasty with a straight, tapered, proximally porous-coated stem and alumina-on-alumina bearing were encouraging for active patients.

Diseño de férula en abducción para el tratamiento del desarrollo displásico de la cadera / Design of abduction splint for dysplasia development treatment in the hip

La férula en abducción para el tratamiento del desarrollo displásico de la cadera es un aparato ortopédicocorrector utilizado en la especialidad de ortopedia, la cual tiene como objetivo corregir las alteraciones anatómicas y funcionales que están presentes en losniños que padecen de desarrollo displásico de la cadera. El presente trabajo muestra las características deldiseño, funcionamiento, modo de utilización y aplicación de dicho aparato ortopédico en niños portadores de laafección. Fue diseñado por el Servicio de Ortopedia y Traumatología del Hospital Pediátrico Universitario Paquito González Cueto de Cienfuegos. Es el método de tratamiento conservador que se utiliza en este centrohospitalario y provincia, desde el año 1996, en niños con diagnóstico de la mencionada afectación. Está aprobado para su utilización por el centro de control estatal de equipos médicos y sus autores cuentan con el certificado de autor de invención otorgado por la oficina cubana de la propiedad industrial(AU)

Abduction splint is an orthopaedic corrective device. Its objective is to correct functional and anatomic anomalies present in children suffering from hip dysplasia. This work contains the characteristics, working details, way of use and purpose of this device. It was design by the Orthopaedics and Traumatology Department of the Paediatric Hospital Paquito González Cueto in Cienfuegos. This is the treatment used in this centre since 1996 in children suffering from the above mentioned disease. This device has been approved by the State Centre for Medical Equipment Control and its authors have the Innovationios Author Certificate, granted by the Cuban Department for Industrial Property(AU)

[Total hip replacement for the treatment of Crowe IV congenital hip dislocation using small acetabular components combined with medial protrusio technique].

OBJECTIVE: To summarize the surgical technique and the clinical results of small acetabular components combined with medial protrusio technique in primary total hip arthroplasty (THA) for the treatment of Crowe type IV congenital hip dislocation (CHD). METHODS: From January 2000 to December 2005, total 14 patients (16 hips) of Crowe type IV CHD underwent cementless THA (12 unilateral, 2 bilateral) with this new technique. There were 2 males and 12 females with an average age of 49 years (range, 38 to 75 years). The indications for surgery was severe hip pain and leg length discrepancy with difficulty in walking and activating. Cup design: Duraloc (Depuy, Warsaw, USA) in 10 hips, Pressfit S II (LINK, Germany) in 6 hips. The outside diameter of the cup was 42 to 44 mm; and the thickness of the polyethylene liner was 6 to 7 mm. Total hip replacement were performed with the medial protrusion technique to stabilize the fit of a hemispherical metal cup in the acetabulum. The hip functions were evaluated by Harris hip score. The muscle strength of the gluteus medius and gait were respectively evaluated in accordance with the standards of five and four classes. RESULTS: The X-ray showed that the average superolateral bone coverage in these 16 hips (none of which had bone graft) was more than 98 percent. The cup was an average of (5.8 +/- 1.2) mm medial and (6.2 +/- 1.7) mm superior to the Ranawat triangle. The follow-up period ranged from 3 to 9 years. The Harris hip score improved from 25 to 32 preoperatively to 90 to 98 1 year postoperatively. X-ray showed that perforated area of the medial acetabulum were repaired with healed bone mud 4 to 8 months after operation. The rate of linear wear of the polyethylene liner averaged (0.10 +/- 0.03) mm each year. Until now, no aseptic loosening or osteolysis was identified around the acetabulum components, no acetabular components were revised for loosening or other reasons. CONCLUSION: Small acetabular components combined with medial protrusio technique is a simple, reliable and flexible surgical technique. Early and mid-term result in total hip arthroplasty with this technique for the treatment of Crowe type IV CHD is satisfactory.

Alumina-on-alumina total hip arthroplasty in young patients: diagnosis is more important than age.

Total hip arthroplasty (THA) in young patients has a high loosening rate, due in part to acetabular deformities that may compromise bone fixation and polyethylene wear. We therefore asked whether wear or osteolysis and loosening differ in patients under 40 years of age with alumina-on-alumina THA compared to those who are older. We prospectively followed 56 patients (63 hips) younger than 40 years (Group 1) and 247 patients (274 hips) older than 40 (Group 2) who had an alumina-on-alumina THA. The minimum followup was 4 years (mean, 5.6 years; range, 4-9 years). The two groups differed in various features: there were no patients with primary osteoarthritis in Group 1 and they had worse preoperative function and range of mobility, while weight, activity level, and implant size were greater in Group 2. The survival rate for cup loosening at 80 months postsurgery was 90.8% (95% confidence interval, 82.9-98.6%) for Group 1 and 96.5% (95% confidence interval, 94.2-98.7%) for Group 2. Cup loosening was less frequent with primary osteoarthritis than with severe developmental dysplasia of the hip. Although an alumina-on-alumina THA provided similar midterm survival and radiographic loosening in both age groups, the preoperative diagnosis seems more important than age for outcome. Continued followup will be required to determine if the alumina-on-alumina bearings in young patients result less risk of osteolysis and loosening.