Dega transiliac pelvic osteotomy for developmental hip dysplasia: a systematic review.

A systematic review of studies reporting outcomes after Dega transiliac pelvic osteotomy (DO) in developmental dysplasia of the hip (DDH) was carried out with a meta-analysis of the pre- and postoperative acetabular index (AI) values. The MEDLINE, ClinicalKey, PubMed, and Cochrane Library databases were searched for articles published up to April 2020 (keywords: Dega, Dega osteotomy, Dega acetabuloplasty, Dega transiliac, and Dega acetabular). The reference lists of reviewed articles were manually searched. Three hundred and seventy-two articles were identified; 23 met the inclusion criteria. The difference between pre- and postoperative AI values were reported in 19 studies (636 hips); the average postoperative AI value was ≤20° in 16/19. Ten studies were included in the meta-analysis. The overall difference between the mean pre- and postoperative AI was 22.5° (95% confidence interval 20.2-24.8°). The average postoperative center-edge angle was reported in 14/23 studies (480 hips) and was normative (≥20°). Hips were assessed using the Severin classification in 11/23 studies; 81.7% of 410 hips were Severin class I-II. The clinical outcome quantified following McKay/Berkeley or other criteria in nine studies (512 hips) was good or very good in 84.8% of hips at follow-up. The incidence of avascular necrosis (AVN) of the femoral head was 18.9% (19 studies, 856 hips). The cumulative rate of reoperation of 5.8% was reported in 14 studies. DO ensures adequate correction of radiological parameters in DDH, and facilitates a good clinical outcome with low incidences of AVN and reoperation risk. Level of evidence: IV.

Open reduction, Dega osteotomy and proximal femoral osteotomy in delayed diagnosis of developmental hip dislocation: outcome at 40-year follow-up.

PURPOSE: Late-diagnosed dislocated hips underwent open reduction, Dega osteotomy, and proximal femoral osteotomy between 1968 and 1988. The objectives of this study are to assess the survival of hips into adulthood, clinical and radiological outcome, patients' life perspectives and the risk factors of failure. METHODS: An assessment of 67 hips treated when younger than five years (

Dega Transiliac Pelvic Osteotomy: the History of Surgical Technique Development.

BACKGROUND: Wiktor Dega originally described the surgical technique of transiliac osteotomy in 1969 in the Polish Orthopaedics and Trauma Surgery Journal. Its worldwide popularity spread just after it was presented in English by Grudziak and Ward in 2001 [1]. This paper aims to describe the development of the technique by Wiktor Dega's team. MATERIAL AND METHODS: An analysis of original papers published by Dega between 1929-1974 was performed to clarify the chronology of development of the technique. RESULTS: Dega's interest in developmental dysplasia of the hip (DDH) had begun as early as 1929, when he presented in Vilnius a paper about the aetiology and pathogenesis of the disease. The concept of transiliac osteotomy had been initially based on König's idea of shelf procedure. Dega called this procedure plastic surgery of the acetabular roof and performed it between 1927 and 1930. In 1964, Dega published a paper that described the basic concept of DDH treatment with a pelvic osteotomy termed supraacetabular semi-circular osteotomy. This procedure differed from transiliac osteotomy because it did not involve cutting the inner cortex of the ilium. In 1968 the first 'technically proper' transiliac osteotomy was performed and then described in 1969. In 1974, Dega emphasized that both the outer and inner iliac walls should be osteotomized in the transiliac osteotomy. CONCLUSION: The political situation of the 1950s and the 1960s made it difficult to freely exchange views and clinical experiences between the Western and Eastern political camps. Despite this, Wiktor Dega became a precursor of effective surgical treatment in DDH worldwide.

Does hemipelvis structure and position influence acetabulum orientation?

BACKGROUND: Although acetabulum orientation is well established anatomically and radiographically, its relation to the innominate bone has rarely been addressed. If explored, it could open the discussion on patomechanisms of such complex disorders as femoroacetabular impingement (FAI). We therefore evaluated the influence of pelvic bone position and structure on acetabular spatial orientation. We describe this relation and its clinical implications. METHODS: This retrospective study was based on computed tomography scanning of three-dimensional models of 31 consecutive male pelvises (62 acetabulums). All measurements were based on CT spatial reconstruction with the use of highly specialized software (Rhinoceros). Relations between acetabular orientation (inclination, tilt, anteversion angles) and pelvic structure were evaluated. The following parameters were evaluated to assess the pelvic structure: iliac opening angle, iliac tilt angle, interspinous distance (ISD), intertuberous distance (ITD), height of the pelvis (HP), and the ISD/ITD/HP ratio. The linear and nonlinear dependence of the acetabular angles and hemipelvic measurements were examined with Pearson's product - moment correlation and Spearman's rank correlation coefficient. Correlations different from 0 with p < 0.05 were considered statistically significant. RESULTS: Comparison of the axis position with pelvis structure with orientation in the horizontal plane revealed a significant positive correlation between the acetabular anteversion angle and the iliac opening angle (p = 0.041 and 0.008, respectively). In the frontal plane, there was a positive correlation between the acetabular inclination angle and the iliac tilt angle (p = 0.025 and 0.014, respectively) and the acetabular inclination angle and the ISD/ITD/HP ratio (both p = 0.048). CONCLUSIONS: There is a significant correlation of the hemipelvic structure and acetabular orientation under anatomic conditions, especially in the frontal and horizontal planes. In the anteroposterior view, the more tilted-down innominate bone causes a more caudally oriented acetabulum axis, whereas in the horizontal view this relation is reversed. This study may serve as a basis for the discussion on the role of the pelvis in common disorders of the hip.

Evolution of the term and definition of dysplasia of the hip - a review of the literature.

There is no consensus on the definition of dysplasia of the hip (DH). Past and present concepts used to describe DH do not form a complete view of the pathology. Moreover, some authors still present the disease as congenital, not developmental. This prompted authors to analyze the evolution of the definition of DH. Based on the biomedical databases 500 articles and books in the field of hip dysplasia were found and analyzed. Fifteen definitions of hip dysplasia met inclusion criteria, subsequently were analyzed and presented in chronological order. The analysis revealed that currently there is no single, universal definition of hip dysplasia in the aspect of morphological, clinical, and radiological studies. Despite the widely-used term of DH, it is described imprecisely and in different ways. Therefore, it is necessary to develop a multidisciplinary definition of this pathology covering all aspects of hip disorders considered valid in modern orthopaedics.

An accurate method of radiological assessment of acetabular volume and orientation in computed tomography spatial reconstruction.

BACKGROUND: Two-dimensional (2D) measurements of acetabular morphology and orientation are well known; there is less information on these acetabular characteristics in three dimensions. One important reason is the lack of standardized reference planes for the pelvis, especially in relation to the spinopelvic unit; another is that no method precisely assesses the acetabulum in three-dimensional (3D) orientation based on its axis rather than on the directions of the edges of the acetabular rim. We present an objective, highly reliable and accurate, axis-based approach to acetabular anthropometry in the measurement of acetabular volume and spatial orientation in both normal and pathologic hips. This was done using reference planes based on the sacral base (SB) and true acetabular axis in 3D computed tomography (CT) pelvic reconstruction. METHODS: Radiological examinations of 30 physiologic pelves (60 acetabula) were included in the study. Reliability and accuracy of the method were verified by comparing acetabular angles in 2D pelvic scans with 3D reconstructions. We also applied the method to two pathologic acetabula. RESULTS: Comparison of axis position in the horizontal plane revealed significant positive correlations between 2D angle measurements (acetabular anteversion angle [AAA] and anterior acetabular index [AAI]) and 3D measurement of anteversion angle (p < 0.001 and p = 0.012, respectively). In the frontal plane, there was no difference between abduction angle, measured on topogram, and inclination angle, obtained from a 3D model (p = 0.517). In the sagittal plane, there was a significant negative correlation between AAA and acetabular tilt (p < 0.001). Inter- and intra-observer reproducibility was excellent for determination of the sacral-base plane and assessment of volume, with Fleiss κ coefficients of 0.850 and 0.783, respectively, and intraclass correlation coefficients of 0.900 and 0.950, respectively. Inter-observer reproducibility for evaluation of acetabular axis ranged from 0.783 to 0.883, and intra-rater reliability ranged from 0.850 to 0.900 for all 3D angles. CONCLUSIONS: Our method is a new, reliable diagnostic tool for assessing the acetabula in both normal and pathologic hip joints. The sacral-base plane can be used as a stable reference that takes the relationship of the acetabulum to the spinopelvic unit into consideration.

The effect of a hippotherapy session on spatiotemporal parameters of gait in children with cerebral palsy - pilot study.

BACKGROUND: Hippotherapy has been shown to produce beneficial effects by improving the most difficult motor functions, such as sitting, running, jumping, coordination, as well as balance and muscle strength in children with motor developmental delays. The aim of this study was to analyze the effect of hippotherapy on spatiotemporal parameters of gait in cerebrally palsied children. MATERIAL AND METHODS: 16 ambulatory cerebrally palsied children (GMFCS Level I-III; Female: 10, Male: 6; Age: 5.7-17.5 years old) qualified for hippotherapy were investigated. Basic spatiotemporal parameters of gait, including walking speed, cadence, step length, stride length and the left-right symmetry, were collected using a three-dimensional accelerometer device (DynaPort MiniMod) before and immediately after a hippotherapy session. The Wilcoxon test was used to verify the differences between pre- and post-session results. RESULTS: Changes of walking speed were statistically significant. With the exception of step length, all spatiotemporal parameters improved, i.e. were closer to the respective reference ranges after the session. However, these changes were not statistically significant. CONCLUSION: One session of hippotherapy may have a significant effect on the spatiotemporal parameters of gait in cerebrally palsied children.

[Idiopathic toe walking (ITW)--normal or pathological?]. / Idiopatyczne chodzenie na palcach--norma czy patologia?

UNLABELLED: Idiopathic toe walking ITW appears to be a clinical problem in otherwise healthy children after 3 years of age. The definitions includes patients walking on toes permanently and temporally. Goal. definition of kinematical and kinetic determinants of ITW and the use of gait analysis determinants of ITW according to Alvarez. Material and methods. 8 patients, mean age 7 (4-11), were assessed in Motion Analysis Laboratory with clinical examination use of Vicon 460 (Vicon U.K.) and force plates AMTI (Newton USA). Presence of 1st rocker, early 3rd rocker, and predominance of first ankle dorsal flexion moment was assessed. RESULTS: 1st rocker was observed in 2 patients--group I, early 3rd rocker in 2 patients group II, and predominance of ankle flexion moment in 3 patients--group III, 1 patient was not classified due to presence of 1st rocker combined with predominance of dorsal flexion moment. CONCLUSION: thanks to motion analysis we have a tool to differentiate between behavioral and fixed deformities and adjust treatment--physiotherapy, BTX, serial casting or surgical orthopaedic treatment.

[Talectomy for the clubfeet treatment in children with myelomeningocoele]. / Resekcja kosci skokowej w leczeniu stopy konsko-szpotawej u dzieci z przepuklina oponowo-rdzeniowa.

UNLABELLED: Talectomy, despite its palliative character, seems to be a treatment of choice in many cases of severe neurogenic clubfeet. The aim of our study was to determine the value of talectomy in the treatment of equinovarus deformity in children with myelomeningocoele. MATERIAL AND METHOD: The material consists of 12 children with myelomeningocele (21 neurogenic clubfeet), treated by talectomy. The results of two post-operative follow-up examinations were included--first after 15 months (follow-up I, second after 30 months (follow-up II). The material was divided into two groups: I--consist of feet after talectomy combined with wedge resection of calcaneo-cuboid joint, and II--the feet which underwent "only" talectomy. The calcaneo-cuboid wedge osteotomy was performed to improve the forefoot position for the correction of the more severe deformity. The clinical and X-ray records concerning preoperative period were reviewed. At the follow-up the clinical, radiological and functional evaluation were performed with the special affiliation on modified Magone scale. RESULTS: Satisfactory clinical results were achieved in all feet except one which required reoperation. Walking ability in orthopaedic fit was present in 5 cases before surgery, and increased to 9 at follow-up. There were no radiological signs of the tibio-calcaneal fusion at the time of observation. During follow-up, on the basis of radiograms made in lateral position, gradual limitation of ROM in so called "tibio-calcaneal" joint was observed. At follow-up I according to modified Magone scale good clinical result was observed in 3 feet, satisfactory in 10, and unsatisfactory in the remaining 3 feet. At follow-up II 3 were defined as good, 4 were defined as satisfactory and the remaining 8 as pour results (only patients who underwent two postoperative examinations). The clinical deterioration does not correlate with the lost of feet shape correction--but mainly with the lost of the ROM in the new "tibio-calcaneal" joint. There were no statistically significant differences between the clinical outcome of feet from group I and II. The authors concluded that the additional wedge resection of calcaneo-cuboid joint improved the forefoot position and, by this way, makes the surgery correction easier.

[Appearance of spastic hip pain in cerebral palsy children]. / Wystepowanie dolegliwosci bólowych stawów biodrowych u chorych z mózgowym porazeniem dzieciecym.

UNLABELLED: Pain is a serious complication in the development of spastic dislocation of the hip joint, sometimes determining future of the patient, limiting the degree of his independence and comfort of his life. OBJECTIVES: Determination of 1. the frequency of appearance of lower limbs' pain among patients with subluxation and dislocation of the hip joint in the course of spastic form of cerebral palsy; 2. the influence of the surgical treatment on pain development. MATERIALS: We analysed 82 patients (126 spastic hips) treated between 1970 to 1995 with spastic form of cerebral palsy. Patients were divided into 3 groups according to the degree of hip instability and the performed method of treatment. Group 1-41 patients (77 spastic hips) without neurogenic instability of hip (mean value of migration percentage (MP) - 25%), group II - 14 patients (19 hips) with untreated dislocation of hip (MP - 100%), group III- 25 patients (30 hips) with dislocation and subluxation of hips treated by open reduction combined with Dega's pelvic osteotomy and intertrochanteric varus osteotomy of femur. METHODS: Each patient underwent clinical and radiological evaluation of hips. We assessed the value of migration percentage according to Reimers. We adopted the scale of intensity of pain according to Barie: 1) no pain, 2) sporadic pains, 3) frequent pains retreating after administration of routine analgesic drugs, 4) frequent pains persisting after administration of typical analgesics. The evaluation of pains also comprised their localisation within the hip joint and the knee joint of the same limb (projected pains). RESULTS: Group I in 11.7% of hips occurred mild pain, in 20.8% light pain and in 67.5% pain didn't occur, there was no severe pain. In group II in 73.7% appeared severe and mild pain, in 10.5% light pain and in 15.8% pain didn't appear. In group III severe and mild pain occurred in 37%, light in 33% and no pain in 30%. In all groups appearance and severity of pain depends of the degree of hip dislocation (p < 0.01 to 0.001). Appearance and aggravation of hips' pain depends on the degree of decentration of the femur's head from the acetabulum, estimated by the migration percentage (MP). Treatment and prevention demands "aggressive" operative procedure to avoid expansion of the hip's pain. Surgery decreases the frequency and intensity of pain but doesn't make patient totally free from the risk of its appearance.

[Intrathecal baclofen for treatment of spasticity in patient with cerebral palsy--a preliminary report]. / Podpajeczynówkowe podawanie baklofenu w leczeniu spastycznosci u chorych z mózgowym porazeniem dzieciecym--doniesienie wstepne.

Spasticity is a common symptom of upper neuron damage which requires continuous research for new treatment strategies. The aim of this paper is to present the result of intrathecal baclofen infusion in treatment of spasticity in patients with cerebral palsy. Three patients (aged 16 to 21 years) in whom baclofen pumps were implanted underwent clinical and neurophysiological assessment both before and after pump implantation. Early results of spasticity treatment in cerebral palsy with intrathecal baclofen infusions are very promising.