Minimally Invasive Radiographic Evaluation of the Dysplastic Hip Joint Configuration in Terms of Surgical Treatment with Hip Preservation by PAO.

Introduction: Residual developmental dysplasia of hip (RDDH) is a factor of early osteoarthritis of the hip. The main problems are pain and instability of the hip joint due to inadequate coverage of the femoral head by the acetabulum. The purpose of this study was to radiologically evaluate RDDH after Bernese periacetabular osteotomy (PAO) and to compare RDDH to healthy hips. Materials and Methods: The radiological parameters of RDDH treated by PAO were retrospectively evaluated. Digital AP pelvic radiographs were taken, including parameters of central edge angle and femoral head coverage, medialization, distalization, and ilio-ischial angle. Clinical assessment is based on the VAS scale. The study group consisted of patients with RDDH, and the control group consisted of patients without RDDH. Results: After PAO radiological parameters decreased: medialization by 2.68 mm, distalization by 3.65 mm, and ilio-ischial angle by 2.62°. However, there was an increase in the parameters: CEA by 17.61° and FHC by 16.46%. There was a mean 3 point decrease in pain on the VAS scale. There was also a statistically significant radiological difference in the structure of dysplastic hip joints before surgery and healthy hip joints of the control group. Conclusions: Radiological studies confirmed the effectiveness of the PAO method in the treatment of RDDH. Based on all radiological parameters, differences between healthy and dysplastic hip joints were demonstrated. We believe that a thorough understanding of the values of radiological parameters used to describe dysplastic hip joints will allow us to improve the imaging diagnosis of this condition.

Assessment of the endoprosthesis offset in a dysplastic coxarthrosis.

Incorrectly developed acetabulum and subluxated hip joint may cause many problems for proper implantation of endoprosthesis. The aim of this work is to assess the radiological results of offset restoration and selection of endoprosthesis implant in a dysplastic hip joint. The study group consisted of patients who had a surgery in the period between 2016 and 2018. All of them had a cementless total hip endoprosthesis. The group consisted of 91 patients (96 hip joints), with an average age of 42 years (31-47 years). 55 left and 41 right hip joints. 70 females and 21 males. The control group consisted of patients who were not diagnosed with hip joint dysplasia. The control group consisted of 70 patients (70 hip joints), with an average age of 35 years (19-55 years). 53 females and 17 males. The radiographic assessment included the measuring of medialization and distalization which describe the offset of hip joint. The joint decentration was classified according to Crowe. Based on radiographic measurements we have achieved statistically significant (p<0.05) changes in medialization and distalization parameters. We have not noticed a statistically significant difference for medialization parameter (p=0.8259) after a surgery when compared to the control group. For all patients we have achieved a restoration of correct offset in the horizontal plane. The main idea behind endoprosthesis in a dysplastic coxarthosis is the implantation of endoprosthesis cup in an anatomically correct location. Small screw- in cup and conical stem offer great possibility of restoring correct offset of a dysplastic hip joint.

Epidemiology of femoral shaft fractures in Poland.

INTRODUCTION: Femoral shaft fractures are undoubtedly a common issue in orthopedic practice, which frequently requires surgical treatment. The clinical significance of such fractures is high, but the statistics of their occurrence was not covered in any comprehensive study in Polish medical literature. THE AIM OF THE STUDY: The study aimed to assess the incidence of femoral shaft fractures in the Polish population with particular reference to the mechanism of such events in pediatric patients. MATERIAL AND METHODS: The assessment of the total incidence and the incidence in individual age groups was performed basing on data concerning 2015-2018 obtained from the National Health Fund. Data regarding the mechanism of the event were obtained at the Pediatric Teaching Clinical Hospital, University Clinical Center of the Medical University of Warsaw. RESULTS: We assessed the total incidence at the level of 10.5 cases per 100 000 inhabitants yearly in Poland. A significant difference was noted in the incidence in individual age groups, particularly in the elderly. The incidence of femoral shaft fractures in patients older than 70 was twofold higher than in the general population. The paper also tackles the issue of mortality in patients with femoral shaft fractures, which reaches 16% annually. High-energy trauma was responsible for the majority of femoral shaft fractures in children with the dominant activity being trampoline jumping. At the same time, the incidence was comparable between boys and girls. CONCLUSIONS: The obtained results were discussed against statistics concerning other countries with the outcomes being rather similar. No significant differences were observed as regards the Polish population versus populations of other countries.

Hip osteonecroses treated with calcium sulfate-calcium phosphate bone graft substitute have different results according to the cause of osteonecrosis: alcohol abuse or corticosteroid-induced.

INTRODUCTION: The aim of the study was to assess the factors influencing the final results of treatment of the femoral head osteonecrosis (ONFH) with core decompression and bone substitute grafting. The special interest was focused on comparison between alcohol- and steroid-induced ONFHs. MATERIAL AND METHODS: In this prospective study, a total of 53 patients (58 hips) in the mean age of 35.5 years were included: 29 had a history of alcohol use (32 hips) and 24 of steroid use (26 hips). The mean follow-up was 4.2 years (minimum 3 years). RESULTS: At last follow-up, significant improvements were noted in the Harris Hip Score (HHS) (mean 44.0 vs 55.9 points, p < 0.00002) and VAS scores (mean 7.0 vs 5.8 points, p < 0.0002) for the whole ONFH cohort, comparing to pre-operative status. The degree of improvement did not differ between Ficat and Arlet grade II and grade III (mean 14.9 vs 6.2 points, respectively, p = 0.1). No change was found between the final and initial results in this group in the steroid group (HHS mean 42.2 vs 45.5 points, p = 0.5 and VAS mean 6.8 vs 6.5 points, p = 0.5), but the improvement was noted in the alcohol group (HHS mean 45.5 vs 64.4 points, p < 0.0001; VAS mean 7.1 vs 5.2 points, p < 0.0001) comparing to pre-operative status. CONCLUSIONS: Presented treatment of ONFH significantly improves hip function, offers pain reduction, and gives similar functional improvement for hips scoring grade II and III on the Ficat and Arlet scale. A good response to operative treatment is seen in patients with alcohol-induced ONFH, but not in those with steroid-induced ONFH.

Osteochondroplasty as a treatment of femoroacetabular impingement.

BACKGROUND: Femoroacetabular impingement (FAI) is a condition characterized by repetitive abnormal contact of the femoral acetabulum with the femoral head-neck region, which leads to the development of early-stage coxarthrosis. Early diagnosis and appropriate treatment of FAI can halt the development of coxarthrosis. MATERIAL AND METHODS: We present the early results of surgical treatment of 13 patients with FAI by osteochondroplasty of the head-neck region. An anterior approach to the hip joint was employed without surgical dislocation of the femoral head. The follow-up period ranged from 1.5 to 4 years. Clinical assessment was conducted according to the Harris classification. The FAI index was measured during radiographic evaluation. RESULTS: Clinical assessment revealed an improvement in 12 patients. Radiographically, the value of FAI index was normal in all the patients who underwent the surgery. CONCLUSIONS: Osteochondroplasty of the head-neck region appears to be an effective treatment of FAI in early-stage coxarthrosis.

New concepts in the aetiology of primary osteoarthritis of the hip caused by femoroacetabular impingement.

The paper presents modern concepts in the aetiology and development of osteoarthritis of the hip. Femoroacetabular impingement (FAI) is a condition characterized by a repetitive abnormal contact of the acetabular rim with the femoral head-neck region, which leads to the development of early osteoarthritis of the hip. There are three types of FAI: cam type, pincer type, and mixed type. FAI is diagnosed on the basis of history, clinical assessment and imaging evidence from radiographs, magnetic resonance imaging, ultrasound scans and computed tomography. Early diagnosis and appropriate treatment of FAI make it possible to halt the development of osteoarthritis of the hip.

Evaluation of risk factors in developmental dysplasia of the hip in children from multiple pregnancies: results of hip ultrasonography using Graf's method.

BACKGROUND: The risk factors for developmental dysplasia of the hip (DDH) in infants from unifetal pregnancies are commonly known. Many of these factors also apply to multiple pregnancies. The aim of this paper was to evaluate the influence of selected, widely recognized DDH risk factors in unifetal pregnancy on the development of hip joints in infants from multiple pregnancies. The following risk factors were examined: family history of DDH, breech presentation, duration of pregnancy, birth weight and sex. MATERIAL AND METHODS: The study included 200 newborns (400 hip joints) from multiple pregnancies. Ultrasound screening was performed using the Graf method during the first five postnatal days. RESULTS: No cases of hip joint dysplasia requiring treatment were reported in the study group. The analysis of correlations between hip joint type according to Graf and the evaluated risk factors revealed the following results: type IIa hips were reported in 26 (6.91%) infants with a family history of DDH, one infant (1.22%) who demonstrated a breech presentation, 23 prematurely born infants (8.93%) and 28 infants with a mean birth weight of 2402 g. The correlations were not statistically significant. Type IIa hips were reported in 21 female infants (10.82%), which constituted a statistically significant correlation (p < or = 0.05). CONCLUSIONS: Among the examined risk factors only the sex of the infant turned out to be significant for the development of hip joints in babies from multiple pregnancies. Type IIa hip joints were more common in female infants.No statistically significant correlations were found between Graf hip types and family history of DDH, breech presentation of the fetus, pregnancy duration under 38 weeks or the infant's birth weight.

Surgical outcome for children in the early phase of Perthes' disease.

Background. This article presents long-term outcomes in the surgical treatment of children in the early phase of Perthes' disease, i.e. Reinberg phases I and II. Material and methods. From among 650 children operated during the period 1976-1998, 128 patients reported for follow-up, including 102 boys and 26 girls, who had been operated by transverse inter- and sub-trochanteric osteotomy according to the authors' own concept. These children ranged in age at surgery from 3 to 13 years (average 7 years); the observation period ranged from 5 to 25 years (average 11 years). The radiological picture of the femoral head in long-term follow-up after surgery was assessed according to the Stulberg and Mose classification schemes. Results. There were 72% good outcomes, 23% satisfactory, and 5% poor. Retrospectively, 105 hips (81%) of the total 128 were classified radiologically to Herring group A or B. This large percentage of A and B results indicates that the disease process was just beginning, and had not yet involved the entire femoral head. Of all the operated patients, 77 (60%) did not go through the fragmentation period or only just entered the initial phases of stage III. Conclusions. Our observations would indicate that in the course of surgery the progress of the disease is halted, as though the femoral osteotomy released an unknown factor limiting the development of the disease and halting its progress at the phase at which the surgery is performed.

The surgical treatment of children with Perthes' disease: 26 years of experience.

Background. The purpose of this article is to present the history of the authors' own technique for the surgical treatment of children with Perthes' disease by means of inter- and subtrochanteric osteotomy, and to describe the outcomes achieved. Material and methods. We analyzed 208 hip joints treated during the period 1976-1998 (162 boys and 46 girls, m/f ratio 78/22). The average age at surgery was 7.8 years, and at final check-up, 13 years; the average observation period was 11 years (range 5-25). After surgery the children were immobilized in a plaster cast for 8 weeks, and then for 8 more weeks in an exercise cast. Results. We analyzed the results, assessed according to the Stulberg and Mose systems, in 3 age groups with differing outcome. In the 3-5 years age bracket there were 81% good outcomes, 22% satisfactory, and 5% poor. In the 6-8 age bracket, there were 77% good outcomes, 18% satisfactory, and 5% poor. In the 9-14 age bracket we found 50% good outcomes, 40% satisfactory, and 10% poor. Conclusions. In 60% of the children operated in the early phase of the disease we observed cessation of the disease process and accelerated healing of the necrosis in the femoral head. These joints either did not pass through a fragmentation phase or only entered it. The outcomes we achieved and the short period of immobilization in plaster cast are good reasons to recommend this type of treatment.

[Results of surgical treatment of congenital clubfeet with the Sotirow method]. / Ocena wyników operacyjnego leczenia wrodzonej stopy konsko-szpotawej metoda Sotirowa.

Clinical and radiological results of surgical treatment of congenital clubfeet by an antero-lateral approach first introduced by Sotirow in 1976 are presented. The aim of this paper was to assess long-term results of this procedure on children (aged 5-18 months at the time of surgery). A series of 65 feet in 42 cases diagnosed with congenital talipes equinovarus was evaluated. Forty-two cases were treated conservatively with casts--changed on a weekly basis for 2-3 months and then every 2 weeks. Magone's score criteria were used to assess the method. Average follow-up was 7 years. Clinically 72% of the results were rated as excellent or good. We found the biggest problem during the Sotirow procedure was placing the trochlea of the talus bone into his anatomical into its' anatomical position in the talo-crural joint. The method introduced by Sotirow seems to be highly effective and worth applying. It enables a real elimination of soft-tissue contractures, which retains the deformity of the foot through an antero-lateral approach.