[Dynamics of hemogram indicators in children with pathology of the hip joint before and after treatment by the Ilizarov method.]

The pathology of the hip joints in children is the object of increased attention of specialists both in our country and abroad. Despite the wide coverage of this problem, most studies are devoted to analysis of the advantages of various surgical intervention technologies. To determine the significance of differences in hemogram indices in children with different nosological forms of hip joint pathology and indicators of healthy children. Hemogram and leukoformula parameters were determined in 10 healthy children and 47 children with hip joint pathology. The significance of differences in indicators compared with the norm and between different nosological groups of patients was evaluated. The dynamics of hemogram changes was evaluated at a long time after surgery. The largest deviations from normal hemogram values were found in a group of children with hip dysplasia complicated by aseptic necrosis of the femoral head. Two months after surgery, the main hemogram parameters in all groups of patients are normalized. The reactions of lipid peroxidation are changing, as evidenced by a decrease in the number of peroxidation products, primarily diene conjugates. Along with this, the activity of individual antioxidant enzymes changes - the activity of catalase decreases and the activity of superoxide dismutase increases. The most extreme values were noted in the group of children with epiphyseal dysplasia. In children with hip dysplasia complicated by aseptic necrosis of the femoral head, prior to surgical treatment, a statistically significant increase in the number of leukocytes and platelets in the blood serum is observed. In patients with epiphyseal dysplasia, osteochondropathy, both in the early and late stages, changes in the hemogram indices relate to the indicators of red blood cells and hemoglobin. In children with aseptic necrosis of the femoral head, hemogram values did not have statistically significant differences from the norm. In all groups of patients, destabilization of the peroxidation and antioxidant defense systems was noted.

Do the trace elements play a role in the etiopathogenesis of developmental dysplasia of hip?

OBJECTIVE: Alterations in the connective tissue of the hip joint capsule and ligaments might account for the increased laxity seen in patients with developmental dysplasia of the hip. The tensile features of the connective tissue depend on collagen. A number of prior studies have noted the association between the trace elements and collagen biosynthesis. The aim of this research is to determine whether there exists an association between the trace elements and developmental dysplasia of the hip. PATIENTS AND METHODS: This investigation included 27 patients with developmental dysplasia of the hip (18 females and nine males; mean age 24.3 ± 6.3 months, range 18­36 months) and 26 healthy controls (15 females and 11 males; mean age 23.8 ± 5.4 months, range 18-36 months). The levels of the serum trace elements in the groups were statistically compared. RESULTS: The Cu levels of the patients with developmental dysplasia of hip were statistically higher than those of the control group (p<0.05). The Zn, Fe, Mg, and Mn levels of the patients with developmental dysplasia of hip were statistically lower than those of the control group (p<0.05). CONCLUSIONS: We found an association between developmental dysplasia of the hip and the serum trace element levels. We, therefore, believe that the trace element levels may shed light on the etiopathogenesis of developmental dysplasia of the hip. This work should be supported by future studies concerning the causes of the alterations in the serum trace element levels seen in patients with developmental dysplasia of the hip.

Serum prolidase activity and oxidative-antioxidative status in patients with developmental dysplasia of the hip and its relationship with radiographic severity.

BACKGROUND: We aimed to investigate serum prolidase activity and to investigate its association with oxidative-antioxidative status in patients with developmental dysplasia of the hip (DDH). METHODS: Oxidative status parameters, including lipid hydroperoxide (LOOH), total oxidant status (TOS), and the oxidative stress index (OSI), and antioxidative status parameters, free sulfhydryl groups (Total -SH), and total antioxidative capacity (TAC), as well as serum prolidase activity were assessed in patients with DDH (n = 93), and in healthy controls (n = 82). The severity of dysplasia was evaluated according to the Tonnis grading system. RESULTS: Serum prolidase activity and the oxidant parameters (LOOH, TOS, and OSI) were significantly higher and the antioxidant parameters (Total -SH and TAC) were significantly lower in patients with DDH compared to the controls (P < 0.005 for all). Serum prolidase activity was positively correlated with the Tonnis grade of DDH and LOOH, TOS, and OSI levels (P < 0.001 for all), but inversely correlated with total -SH and TAC levels (P < 0.001 for all). CONCLUSION: Increased levels of serum prolidase activity, LOOH, TOS, and OSI, and decreased levels of total -SH and TAC, may be associated with DDH, and these parameters may be useful adjunctive tools to assess the severity of DDH.

Increasing substance P levels in serum and synovial tissues from patients with developmental dysplasia of the hip (DDH).

BACKGROUND: The tachykininergic neurotransmitters have been proved to be involved in the inflammatory progress and chronic pain in series of disease. The present study was undertaken to evaluate the levels of substance P (SP) and its receptors NK-1 receptor (NK-1R) in both serum and synovial tissues of hip joint from patients with different stages of DDH, and to detect the possible correlation of serum SP levels with pain sensation and dysfunction of the hip joint. METHODS: SP levels in serum and synovial tissues from patients with DDH and DDH combined with osteoarthritis (DDH&OA) group were compared through immunohistochemistry (IHC), ELISA, and 2-step acetic acid extraction method respectively. Expression of NK-1R in synovial tissues was compared through IHC, quantitive Real-Time PCR (QRT-PCR) and Western-Blot. The severities of pain sensation and the functional activities of hip joint were assessed by Visual analogue scale (VAS) and Harris hip score (HHS). Correlations of serum SP levels with VAS, HHS and erythrocyte sedimentation rate (ESR) were evaluated respectively in these groups. RESULTS: Significantly elevated serum SP levels were detected in group of DDH and DDH&OA compared to that in normal group. IHC, QRT-PCR as well as tissue Elisa showed that SP levels in synovial tissue of DDH&OA group is stronger than that in DDH group. Serum SP levels in each group have no gender differences. The enhanced SP levels in synovial tissue mainly came from the segregation of peripheral nerve endings. Serum SP correlated with VAS and HHS in patients with DDH&OA (Male + Female). Serum SP correlated with HHS in patients with DDH (Male). Serum SP levels also correlated with erythrocyte sedimentation rate (ESR) in patients with DDH&OA (Male + Female). Up-regulated expression of NK-1R was also observed in synovial tissue of patients with DDH&OA compared to patients with DDH, through western-blot, IHC, and QRT-PCR. CONCLUSIONS: These findings indicated that the increasing SP levels in serum and synovial tissues, observed from patients with DDH to patients with DDH&OA, might associate with the loss of function and chronic pain sensation in hip joint. SP along with its receptors NK-1R might be involved in the progression of DDH into DDH&OA. In the future, inhibitors of SP as well as NK-1R may represent a novel pharmacotherapy target for pain relieving, inflammation alleviating and joint degeneration delaying for patients with DDH.

The relationship between neonatal developmental dysplasia of the hip and maternal hyperthyroidism.

OBJECTIVE: Development of the hip joint is complete by 11 weeks of gestation. As triiodothyronine and thyroxine are important regulators of early bone and muscle development, we hypothesized that excessive thyroid hormone in the early fetal period was a congenital risk factor of developmental dysplasia of the hip (DDH). Consequently, it was proposed that elevations of maternal thyroxine in the first trimester could alter the incidence of neonatal DDH. METHODS: The patient population comprised a retrospective cohort of all children born in Yukiguni-Yamato General Hospital from 1996 to 2003 (n = 2137). All infants were physically assessed for DDH. Pregnancies were divided into normal, Graves disease (n = 15), and severe hyperemesis gravidarum in the first trimester (n = 39, which is associated with gestational transient hyperthyroidism in up to 73%). RESULTS: From a total 2137 pregnancies, 21 children (18 female) were diagnosed with DDH. Thirteen affected infants were from normal pregnancies (0.63%), 3 from mothers affected with Graves disease (20%, P < 0.0001), and 5 from mothers with hyperemesis gravidarum (12.8%, P < 0.0001). CONCLUSIONS: Developmental dysplasia of the hip is associated with first-trimester maternal hyperthyroidism, and infants of these mothers should be closely checked for hip abnormalities.

Does ion release differ between hip resurfacing and metal-on-metal THA?

UNLABELLED: Modern metal-on-metal hip resurfacing was introduced as a bone-preserving method of joint reconstruction for young and active patients; however, the large diameter of the bearing surfaces is of concern for potential increased metal ion release. We hypothesized there were no differences in serum concentrations of chromium, cobalt, and molybdenum between patients who had metal-on-metal hip resurfacing (Group A; average head diameter, 48 mm; median followup, 24 months) and patients who had 28-mm metal-on-metal THA (Group B; median followup, 25 months). Serum concentrations also were compared with concentrations in healthy subjects. We identified no differences in ion levels between Groups A and B. A distinction was made according to gender. Women showed a higher chromium release in Group A whereas men had a higher cobalt release in Group B. Values obtained from Group A were higher than those of the control subjects. Our data suggest metal-on-metal bearings for THA should not be rejected because of concern regarding potential increased metal ion release; however, patients with elevated ion levels, even without loosening or toxicity, could be at higher risk and should be followed up periodically. LEVEL OF EVIDENCE: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Genetic variability in the group of patients with congenital hip dislocation.

Our study of genetic homozygosity degree includes an analysis of the presence, distribution and individual combination of 20 selected genetically controlled morpho-physiological traits in the group of patients (N = 93) with congenital hip dislocation (CDH) and in control sample consisting of school children from Belgrade (N = 200). Assuming that CDH is genetically controlled disease, we made a hypothesis that an increased homozygosity level, as well as the changed variability among the patients, could be population-genetic parameter for the prediction of the illness. Taking into consideration our experience, as well as the experience of numerous scientists who studied the nature of the inheritance of mono- and oligo-genically controlled qualitative traits, we applied a methodology to estimate the proportion of such homozygously recessive characters (HRC-TEST). This population-genetic study did not only show statistically significant difference of the middle values of genetic homozygosity (CDH-7.1+/-0.2; control - 5.2+/-0.1), but of the differences in the type of distribution too, as well as the differences in the presence of certain individual combinations of such traits. The described methodology can be used in further analyses, with hope that it can be applied as an early prognosis for decreased resistance to different diseases. The frequencies of ABO blood types in the sample of CDH patients were similar to the average value of Serbian population, while the percentage of blood group A is slightly increased. Comparing frequencies of Rh blood groups, there is no difference between tested samples.

Serum 17 beta-estradiol in newborn and neonatal hip instability.

This study evaluates the association between the level of 17 beta-estradiol in the umbilical cord blood and neonatal hip instability (NHI) in a population-based prospective case-control study comprising 2,185 consecutively newborns. beta-Estradiol levels were measured with a standard fluoroimmunoassay kit. Neonatal hip instability was determined by the anterior dynamic ultrasound method. An increased risk of NHI was found after breech malposition and in girls. Levels of beta-estradiol were higher in boys without NHI than in girls. A negative association between beta-estradiol level and parity was found. A significant association between beta-estradiol level and NHI was shown in boys with low serum concentrations. High levels of beta-estradiol tended to be associated with an increased risk of NHI in girls. An association was found between gender, parity, and beta-estradiol level in cord blood. No firm conclusion on the association between NHI and beta-estradiol level can be made; the possible association may be gender-dependent.

Serum relaxin in the newborn is not a marker of neonatal hip instability.

It has been suggested that intrauterine exposure to high levels of relaxin causes hip instability in newborns. The aim of this work was to evaluate whether the serum relaxin concentration in umbilical vein blood is associated with hip instability in the newborn. Blood was collected by cordocentesis from 2,185 newborns, and serum relaxin levels were obtained by using a standard sandwich enzyme-linked immunosorbent assay (ELISA). Movement of the femoral head in the hip joint was determined for all 2,185 children by the anterior-dynamic ultrasound method. Hereby their status on neonatal hip instability was determined. Fifteen cases (12 girls, three boys) were found, and 106 controls were selected. Only six newborns had unstable hips to a degree requiring treatment. Ten newborns had Ortolani-positive hips. Only three specimens of the 121 samples measured had serum relaxin concentrations above the detection limit of 10 pg/ml. None of these were cases. This study does not show an association of serum relaxin with neonatal hip instability. It is suggested that detectable serum relaxin levels are found in samples from the umbilical cord only when these are contaminated with maternal blood.

Pathogenetic relevance of the pregnancy hormone relaxin to inborn hip instability.

The etiology of inborn hip dysplasia is unknown. In general, a multifactorial genesis is assumed. The influence of hormones on the development of the fetal hip joint and its stability is discussed as well as mechanical influences. This study was carried out with the intention to examine the correlation between the concentration of the pregnancy hormone relaxin and the stability of the hip joint in newborns. Both hips of 90 newborn children were examined clinically and sonographically. In 25 hips (13.9%), pathological sonograms according to the classification of Graf were found. The relaxin concentration was measured in cord blood using a heterologous radioimmunoassay. Statistical evaluation revealed an insignificant decrease of relaxin concentration with increasing sonographic hip instability. The results indicate that hip instability frequently occurs with decreasing relaxin concentration. These facts contradict the earlier assumption that hip instability coincides with increased relaxin concentrations in newborns. We assume that there is a worse preparation of the pelvis and the birth canal during pregnancy due to the lower relaxin concentration and thus that there could be a higher pressure on the fetus in the perinatal phase. A decreased relaxin concentration seems to have no direct effect on the hip joint tissue, but indirectly there is consequent rigidity of the tissue in mother and child, which can further promote the development of hip instability.

The distribution of blood groups and HLA types in 59 cases of congenital dislocation of the hip.

One-hundred-and-eight patients with congenital dislocation of the hip (CDH) were ABO and Rh(D) typed. Fifty-nine of these patients were also HLA-A, -B, and -DR typed whenever technically possible and in addition the Rhesus, MNSs, Lutheran, Kell, Duffy, and Kidd groups were determined as part of a wider study into hereditary factors in CDH. No association was found between CDH and any of these red cell groups and HLA types. A slight trend towards a decrease of the HLA antigens B7 and DR2 was noted, and a slight increase of B27 and DR7. The increase in frequency of group B present in Italian children was not found in this British study, nor did we find an increase of HLA-A1 as previously reported in Greek children with CDH.

[A study on postoperative management and pre-and postoperative changes of blood volume in orthopedic surgery (author's transl)].

In order to apply adequate postoperative management of patients in the orthopedic surgery, the in vivo effects of the operations were investigated in the present study, from various viewpoints such as circulatory functions, metabolism of proteins, and hepatic and renal functions. In addition, the circulating blood volumes were determined in order to know the variations in the amount of blood loss from the operated regions during and after operations so as to improve the operative and postoperative management. On the basis of the results, the countermeasures against the adverse variations in blood volume were also investigated. Pediatric patients were found to be prone to develop more appreciable systemic postoperative reactions than those in adult ages, especially so in those of circulatory system, peripheral blood, hepatic functions, and protein metabolism, and also prone to be more affected by operative procedures. Senile patients were found to be prone to have less reserve capacity in circulation, peripheral blood, renal functions, and protein metabolism, and also prone to show delayed postoperative reactions and slower recoveries. The results of measurement of circulating blood volume in pre- and postoperations revealed that the loss of circulating blood in most patients was greater than the bleeding weight during the operation measured by gause count, and that, on the day following the operation, the blood volume was reduced by about 10-15% than those immediately after the operation. It was concluded that, as a whole, no changes causing serious deviation from the normal physiological ranges occur except in pediatric and senile patients. On the basis of the above findings, most appreciable systemic postoperative reactions of the operative procedures in orthopedic surgery would be attributed to by loss of blood volume during operations and that the postoperative hemorrhage from bone structure (which is usually difficult to control) or the postoperative hemorrhage after removal of air tourniquet would be almost negligible.