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1.
Medicine (Baltimore) ; 99(14): e19600, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32243382

RESUMO

Slipped capital femoral epiphysis (SCFE) is a very common disorder affecting the adolescent hip. The etiology of SCFE is multifactorial and mechanical force associated with the characteristic morphology of the hip is considered one of the causes of SCFE. We investigated the characteristics of whole pelvic morphology including pelvic incidence (PI) in patients with SCFE and compared it with pelvic morphology in healthy children. We retrospectively assessed the whole pelvic morphology of 17 patients with SCFE and 51 healthy children using their pelvic computed tomography data. We measured superior iliac angle, inferior iliac angle, and ischiopubic angle as the parameters of pelvic rotation. Additionally, we measured acetabular anteversion of the superior acetabulum (AVsup) and of the center of the acetabulum (AVcen), and measured anterior acetabular sector angle (AASA), posterior acetabular sector angle, and the superior acetabular sector angle (SASA) as parameters of acetabular coverage and PI. Each measurement was compared between the 2 groups. AASA and SASA of patients with SCFE were significantly greater than that of controls, and AVsup of patients with SCFE was significantly smaller. There were no significant differences in pelvic rotation, PI, or AVcen between the 2 groups. This is the 1st report to evaluate SCFE patients' whole pelvic morphology including PI and pelvic rotation. Our results showed that patients with SCFE have excessive coverage of the anterior and superior acetabulum, and a more retroverted cranial acetabulum as compared with healthy control subjects. Such characteristic pelvic morphology may be involved in the onset of SCFE. To clarify the mechanical forces involved in SCFE onset, further investigations of pelvic morphology and alignment, including the femur and spine, are needed.


Assuntos
Acetábulo/patologia , Pelve/patologia , Escorregamento das Epífises Proximais do Fêmur/patologia , Tomografia Computadorizada por Raios X , Acetábulo/diagnóstico por imagem , Adolescente , Criança , Feminino , Humanos , Masculino , Pelve/diagnóstico por imagem , Estudos Retrospectivos , Escorregamento das Epífises Proximais do Fêmur/diagnóstico por imagem
2.
Medicine (Baltimore) ; 99(1): e18655, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895830

RESUMO

RATIONALE: Developmental dysplasia of the hip (DDH) has an incidence of 5 per 1000 newborns and its management depends on various factors. We present a rare case of DDH with soft tissue obliteration and a bony prominence in the center of the acetabulum after failed open reduction and acetabuloplasty. PATIENT CONCERNS: A 20-month-old girl presented to our clinic with right hip stiffness after undergoing open reduction and acetabuloplasty at another hospital. DIAGNOSES: The diagnosis of DDH was made using a computed tomography scan that revealed a right hip dislocation with soft tissue obliteration and a bony prominence in the center of the acetabulum. INTERVENTIONS: We used a novel technique for treating the rare presentation of complicated DDH with massive soft tissue obliteration and bony prominence in the center of the acetabulum after failed open reduction and acetabuloplasty. The right hip was surgically explored. The acetabulum was deepened and resurfaced. Bone cement was applied over the acetabulum to prevent future ankylosis. OUTCOMES: At the follow-up 7 years after the last surgery, the patient had regained full range of motion and a properly reduced right hip with optimal acetabular coverage on radiographs. LESSONS: Care must be taken in any patient with DDH who presents with hip redislocation after open reduction. If deepening and resurfacing of the acetabulum are required, bone cement could be used as a temporary spacer for 8 weeks; this was key in treating our patient.


Assuntos
Acetábulo/lesões , Luxação Congênita de Quadril/cirurgia , Acetábulo/diagnóstico por imagem , Cimentos para Ossos , Feminino , Luxação Congênita de Quadril/diagnóstico por imagem , Humanos , Lactente , Recidiva , Tomografia Computadorizada por Raios X
3.
J Pediatr Orthop ; 40(2): 86-92, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31923168

RESUMO

BACKGROUND: Traumatic posterior hip dislocations in children and adolescents requires emergent closed reduction. Postreduction imaging is necessary to assess the concentricity of reduction and structural injuries to the hip. There is no a consensus for which imaging is a modality of choice in such condition. The purposes of this study are to describe magnetic resonance imaging (MRI) findings of traumatic posterior hip dislocations and to compare the effectiveness of MRI with computerized tomography (CT) in detecting structural abnormalities of the hip that impact patient management. METHODS: This study is a retrospective review of imaging in traumatically dislocated hips in patients who were treated at our institution. All CT and MRI imaging were reviewed and specific osseous and soft tissue injuries documented by consensus among 2 musculoskeletal pediatric radiologists who interpreted the MRI and CT scans of each patient in a blinded manner. RESULTS: In total, 27 patients (23 males, 4 females) with mean age of 12.5 years (range, 2 to 19 y) with postreduction MRI were evaluated. MRI findings revealed femoral head injuries in 17 (62.9%), posterior labral entrapments in 6 (22.2%), posterior labral tears in 17 (62.9%), posterior wall fractures in 15 (55.5%), fracture of the posterior unossified part of acetabulum in 4 (14.8%), and ligamentum teres injuries in 8 (29.6%). Of 16 patients who had postreduction CT scans, 6 (37.5%) had femoral head fractures, 9 (56.3%) had posterior wall fractures, and 8 (50%) had intra-articular osseous entrapments. All bony fractures and intra-articular entrapment could be seen on MRI imaging. In 16 patients with both CT and MRI, posterior acetabular injury was detected in 10/16 (62.5%) on MRI and 9/16 (56.3%) on CT. Three patients with entrapment of labrums identified on MRI could not be seen on CT scan. One patient with persistently unstable hip after reduction had an entrapped unossified portion of acetabular fracture which was seen on MRI but not on CT. CONCLUSIONS: MRI is superior to CT scan for detection of structural injuries in children and adolescents with traumatic hip dislocation. The unique structural injuries included entrapment of posterior labrum and posterior unossified acetabular fractures could be seen only at MRI. These findings will impact surgical decision making of these injuries. LEVEL OF EVIDENCE: Level IV.


Assuntos
Acetábulo/diagnóstico por imagem , Fraturas do Fêmur/diagnóstico por imagem , Luxação do Quadril/diagnóstico por imagem , Articulação do Quadril/diagnóstico por imagem , Imagem por Ressonância Magnética , Tomografia Computadorizada por Raios X , Acetábulo/lesões , Adolescente , Criança , Pré-Escolar , Feminino , Cabeça do Fêmur/diagnóstico por imagem , Cabeça do Fêmur/lesões , Luxação do Quadril/terapia , Humanos , Fraturas Intra-Articulares/diagnóstico por imagem , Masculino , Estudos Retrospectivos , Ligamentos Redondos/lesões , Lesões dos Tecidos Moles/diagnóstico por imagem , Adulto Jovem
4.
Br J Radiol ; 93(1108): 20190817, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31899657

RESUMO

OBJECTIVE: To determine if MRI findings prior to intra-articular corticosteroid hip infiltration are related to treatment outcomes. METHODS: This prospective outcome study with retrospective MRI evaluation includes 100 consecutive patients with MRI within 6 months before a therapeutic intra-articular hip injection. Labrum, bone marrow, acetabular and femoral cartilage abnormalities were assessed by two radiologists blinded to patient outcomes: the proportion reporting "improvement" on the Patient's Global Impression of Change (PGIC) scale at 1 day, 1 week and 1 month follow-up were compared based on MRI findings using χ2. The t-test was used to compare pain change scores with MRI abnormalities. RESULTS: Patients with a normal labrum in the posterosuperior quadrant were more likely to report PGIC "improvement" at 1 week compared to labral degeneration (p = 0.048). Significant differences in pain change scores were found at all time points for the labral anteroinferior quadrant (p = 0.001, 1 day; p = 0.010, 1 week; p = 0.034, 1 month) with the highest reduction in patients with labral degeneration. Females were 2.80 times more likely to report clinically relevant "improvement" at 1 day (p = .049) and 2.90 times more likely to report clinically relevant "improvement" at 1 month (p = .045). CONCLUSION: Cartilage defects and marrow abnormalities were not associated with outcomes. Patients with a normal labrum in the posterosuperior quadrant had better outcomes at 1 week. Patients with labral degeneration of the anteroinferior quadrant had higher levels of pain reduction at all time points. Females were significantly more likely to report PGIC "improvement". ADVANCES IN KNOWLEDGE: A significant treatment outcome was observed amongst gender, although there were no significant differences in the MRI findings.


Assuntos
Articulação do Quadril/diagnóstico por imagem , Imagem por Ressonância Magnética Intervencionista , Osteoartrite do Quadril/diagnóstico por imagem , Peptídeos/administração & dosagem , Acetábulo/diagnóstico por imagem , Adulto , Idoso , Medula Óssea/diagnóstico por imagem , Cartilagem/diagnóstico por imagem , Distribuição de Qui-Quadrado , Feminino , Articulação do Quadril/efeitos dos fármacos , Humanos , Injeções Intra-Articulares/métodos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/tratamento farmacológico , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
5.
Bone Joint J ; 101-B(12): 1578-1584, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31787002

RESUMO

AIMS: A borderline dysplastic hip can behave as either stable or unstable and this makes surgical decision making challenging. While an unstable hip may be best treated by acetabular reorientation, stable hips can be treated arthroscopically. Several imaging parameters can help to identify the appropriate treatment, including the Femoro-Epiphyseal Acetabular Roof (FEAR) index, measured on plain radiographs. The aim of this study was to assess the reliability and the sensitivity of FEAR index on MRI compared with its radiological measurement. PATIENTS AND METHODS: The technique of measuring the FEAR index on MRI was defined and its reliability validated. A retrospective study assessed three groups of 20 patients: an unstable group of 'borderline dysplastic hips' with lateral centre edge angle (LCEA) less than 25° treated successfully by periacetabular osteotomy; a stable group of 'borderline dysplastic hips' with LCEA less than 25° treated successfully by impingement surgery; and an asymptomatic control group with LCEA between 25° and 35°. The following measurements were performed on both standardized radiographs and on MRI: LCEA, acetabular index, femoral anteversion, and FEAR index. RESULTS: The FEAR index showed excellent intraobserver and interobserver reliability on both MRI and radiographs. The FEAR index was more reliable on radiographs than on MRI. The FEAR index on MRI was lower in the stable borderline group (mean -4.2° (sd 9.1°)) compared with the unstable borderline group (mean 7.9° (sd 6.8°)). With a FEAR index cut-off value of 2°, 90% of patients were correctly identified as stable or unstable using the radiological FEAR index, compared with 82.5% using the FEAR index on MRI. The FEAR index was a better predictor of instability on plain radiographs than on MRI. CONCLUSION: The FEAR index measured on MRI is less reliable and less sensitive than the FEAR index measured on radiographs. The cut-off value of 2° for radiological FEAR index predicted hip stability with 90% probability. Cite this article: Bone Joint J 2019;101-B:1578-1584.


Assuntos
Acetábulo/diagnóstico por imagem , Cabeça do Fêmur/diagnóstico por imagem , Luxação do Quadril/diagnóstico por imagem , Instabilidade Articular/diagnóstico por imagem , Imagem por Ressonância Magnética , Acetábulo/fisiopatologia , Acetábulo/cirurgia , Adolescente , Adulto , Epífises/diagnóstico por imagem , Epífises/fisiopatologia , Epífises/cirurgia , Feminino , Cabeça do Fêmur/fisiopatologia , Cabeça do Fêmur/cirurgia , Seguimentos , Luxação do Quadril/fisiopatologia , Luxação do Quadril/cirurgia , Humanos , Instabilidade Articular/etiologia , Instabilidade Articular/cirurgia , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Radiografia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Adulto Jovem
6.
J Pediatr Orthop ; 39(10): 510-515, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31599860

RESUMO

BACKGROUND: Retroversion of the acetabulum is a cause of pincer impingement. Symptomatic retroversion has traditionally been treated with anteverting periacetabular osteotomy (PAO). However, arthroscopic rim trimming can also treat pincer impingement associated with acetabular retroversion. The purpose of this study was to report the outcomes and radiographic findings in a series of adolescent patients with symptomatic acetabular retroversion treated arthroscopically. METHODS: Data were prospectively gathered at a single institution using an established hip preservation registry. Patients below 18 years with a retroverted acetabulum that underwent primary hip arthroscopy with 2-year follow-up were included. Acetabular retroversion was defined by 3 radiographic criteria: the presence of crossover, ischial spine sign, and posterior wall sign. Radiographic measurements of the lateral center-edge angle, anterior center-edge angle, alpha angle, and crossover percentage were reported preoperatively and postoperatively. Patient-reported outcome (PROs) measures included the modified Harris Hip Score, the non-Arthritic Hip Score, Hip Outcome Score Sports Subscale, visual analog scale, and patient satisfaction, recorded at 3 months, 1 year, and 2 years, postoperatively. In addition, International Hip Outcome Tool scores were gathered at 2 years. RESULTS: Between April 2008 and July 2014, there were 43 patients (48 hips) treated with hip arthroscopy who met the inclusion criteria. The average age was 16.1 years (range, 13.9 to 17.9 y) and there were 38 females and 10 males. The average follow-up was 50.4 months, with a minimum of 2 years. Statistically significant improvements in all PROs were found at 2 years postoperatively. There were 9 hips with lateral center-edge angle ≤25 degrees; the PROs of this group was not different than patients with normal coverage. Three patients underwent arthroscopic revision. No patient subsequently underwent anteverting PAO during the study period. There were no reported complications. CONCLUSIONS: Femoroacetabular impingement caused by acetabular retroversion treated with hip arthroscopy demonstrates good outcomes at 2 years with a low complication rate. Symptomatic adolescents may be safely and successfully treated arthroscopically, potentially avoiding anteverting PAO. STUDY DESIGN: Level of evidence 4-case series.


Assuntos
Acetábulo/cirurgia , Artroscopia/métodos , Impacto Femoroacetabular/cirurgia , Acetábulo/diagnóstico por imagem , Adolescente , Artroscopia/efeitos adversos , Feminino , Impacto Femoroacetabular/diagnóstico por imagem , Impacto Femoroacetabular/etiologia , Seguimentos , Humanos , Masculino , Medidas de Resultados Relatados pelo Paciente , Satisfação do Paciente , Radiografia , Reoperação , Resultado do Tratamento
7.
J Pediatr Orthop ; 39(10): e750-e754, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31599861

RESUMO

BACKGROUND: Osteogenesis imperfecta (OI) is a genetic disorder commonly associated with osteopenia, osteoporosis, bone fractures, bone deformities, and other clinical features. A frequent radiologic finding with OI is acetabular protrusio (AP). We hypothesized that AP develops in patients with OI over time. In addition, we hypothesized that AP also develops in patients with OI without radiographic evidence of AP on initial examination. METHODS: Medical records and radiographs of 55 patients (109 hips) diagnosed with OI evaluated at our institution were retrospectively reviewed. Previously established radiographic criteria using the center-edge (CE) angle of Wiberg, position of the acetabulum relative to the iliopectineal line, crossing of the acetabulum across the ilioischial (Kohler) line, and position of the teardrop figure relative to the ilioischial (Kohler) line were utilized to assess AP severity. In addition, pharmacological treatments and patient factors including body mass index (BMI) were recorded. Radiographs of patients with OI that were taken ≥2 years apart were analyzed utilizing AP radiographic criteria to assess for changes. The changes in AP-related measurements were standardized by distance or degree per year. In addition, patient factors were evaluated for associations with AP development. RESULTS: In this series of 109 hips (55 patients), incidence of AP in earliest radiographs was 45% (49/109). Patients with OI type I and III demonstrated the highest incidence of AP (65%). Among the hips that did not meet the criteria for AP in their early radiographs, 24 (40%) were positive for AP by their latest radiograph. In the hips that initially presented with AP, 42% showed increased CE angles on later radiographs. Twenty-six hips (24%) showed either no observable changes or reduced CE angles. Risk factors that were significantly associated with greater odds of developing AP included (1) an age under 12; (2) a BMI>25; (3) presence of AP of the contralateral hip; and (4) female sex. Bisphosphonates, vitamin D, physical therapy, and other drugs related to treatment of OI reduced the risk of developing AP but did not achieve statistical significance. CONCLUSIONS: AP is a common finding in OI patients (54%). Among hips of OI patients that met criteria for AP in early radiographs, 42% (20/48) demonstrated greater CE angles in their latest radiographs. Similar changes were observed in OI patients who did not initially meet criteria for diagnosis for AP. However, CE angle measurements between the 2 groups did not significantly differ (P=0.71). In terms of Kohler line crossing, patients that met criteria for AP in early radiographs had significantly greater change per year than those that did not have AP criteria (P<0.05). The findings suggest AP may develop over time in patients with OI and may be influenced by patient factors such as age, sex, and BMI. In addition, unilateral AP may have a significant impact on the development of AP of the contralateral hip. LEVEL OF EVIDENCE: Level IV-retrospective case series.


Assuntos
Acetábulo/anormalidades , Acetábulo/diagnóstico por imagem , Osteogênese Imperfeita/complicações , Osteogênese Imperfeita/diagnóstico por imagem , Adolescente , Adulto , Fatores Etários , Índice de Massa Corporal , Criança , Pré-Escolar , Progressão da Doença , Feminino , Articulação do Quadril/anormalidades , Articulação do Quadril/diagnóstico por imagem , Humanos , Masculino , Radiografia , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais
8.
Eur J Radiol ; 120: 108694, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31593844

RESUMO

PURPOSE: To evaluate the clinical, radiological and periprocedural features associated with the occurrence or worsening of acetabular fracture (OWAF) following percutaneous cementoplasty of the acetabulum (PCA) in cancer patients. METHOD: All patients who underwent PCA in our comprehensive cancer center for an acetabular metastasis between January 2008 and December 2015 were included. Clinical features, characteristics of the metastasis on computed tomography (CT-scan) (location [roof, quadrilateral surface, anterior and posterior columns], number of locations, matrix, extra/intra-articular fractures, extra-osseous or subchondral extensions) and of the procedure (extra- or intra-articular cement leakage (IACL), percentage of filling of each location, complications) were reported as well as prior, concomitant or post-PCA treatments. The endpoint was OWAF on CT-scan during post-PCA follow-up. Log-rank tests and Cox models were used to identify prognostic factors. RESULTS: 140 PCA were identified in 129 patients (11 bilateral procedures, median age: 66.6). Eighteen (18/140, 12.9%) had an initial articular fracture. IACL was seen in 12/140 (8.6%) PCA. The only feature associated with IACL was a pre-existing articular fracture (p = 0.009). Of the 111 patients with imaging follow-ups, 18 (16.2%) showed OWAF. In multivariate analysis, the presence of cement filling (even partial) of all acetabular metastatic locations was the only feature predictive of OWAF-free survival (hazard ratio = 3.8, p = 0.031). CONCLUSIONS: Injecting cement in all areas affected by acetabular metastases could prevent OWAF. Because survival following PCA is not negligible, completing an insufficient first PCA could help preserve patients' quality of life.


Assuntos
Acetábulo/lesões , Neoplasias Ósseas/complicações , Neoplasias Ósseas/terapia , Cementoplastia/efeitos adversos , Fraturas Ósseas/etiologia , Fraturas Ósseas/terapia , Acetábulo/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Ósseas/diagnóstico por imagem , Cementoplastia/métodos , Feminino , Fraturas Ósseas/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Tomografia Computadorizada por Raios X , Resultado do Tratamento
9.
J Bone Joint Surg Am ; 101(17): 1554-1562, 2019 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-31483398

RESUMO

BACKGROUND: Despite the fact that many surgeons perform partial capsular detachment from the anterosuperior aspect of the acetabulum to correct acetabular deformities during hip arthroscopy, few studies have focused on whether these detachments influence hip joint stability. The aim of this study was to investigate the capsular attachment on the anterosuperior aspect of the acetabulum. We hypothesized that the attachment on the inferior aspect of the anterior inferior iliac spine (AIIS) is wide and fibrocartilaginous and might have a substantial role in hip joint stability. METHODS: Fifteen hips from 9 cadavers of Japanese donors were analyzed. Eleven hips were analyzed macroscopically, and the other 4 were analyzed histologically. In all specimens, the 3-dimensional morphology of the acetabulum and AIIS was examined using micro-computed tomography (micro-CT). RESULTS: Macroscopic analysis showed that the widths of the capsular attachments varied according to the location, and the attachment width on the inferior edge of the AIIS was significantly larger than that on the anterosuperior aspect of the acetabulum. Moreover, the capsular attachment on the inferior edge of the AIIS corresponded with the impression, which was identified by micro-CT. Histological analysis revealed that the hip joint capsule on the inferior edge of the AIIS attached to the acetabulum adjacent to the proximal margin of the labrum. In addition, the hip joint capsule attached to the inferior edge of the AIIS via the fibrocartilage. CONCLUSIONS: The capsular attachment on the inferior edge of the AIIS was characterized by an osseous impression, large attachment width, and distributed fibrocartilage. CLINICAL RELEVANCE: It appeared that the capsular attachment on the inferior edge of the AIIS was highly adaptive to mechanical stress, on the basis of its osseous impression, attachment width, and histological features. Anatomical knowledge of the capsular attachment on the inferior edge of the AIIS provides a better understanding of the pathological condition of hip joint instability.


Assuntos
Acetábulo/anatomia & histologia , Articulação do Quadril/anatomia & histologia , Acetábulo/diagnóstico por imagem , Idoso de 80 Anos ou mais , Cadáver , Feminino , Impacto Femoroacetabular/patologia , Fibrocartilagem/anatomia & histologia , Articulação do Quadril/diagnóstico por imagem , Humanos , Instabilidade Articular/patologia , Masculino , Microtomografia por Raio-X
10.
J Pediatr Orthop ; 39(9): 449-452, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31503229

RESUMO

BACKGROUND: Developmental dysplasia of the hip (DDH) is one of the most common congenital defects in the newborn. When its severe form is not corrected, it is associated with long-term morbidity. Closed reduction with casting is the standard primary treatment and reduction is confirmed by magnetic resonance imaging (MRI). We reported our experience on the reliability of MRI in postreduction assessment of DDH. METHODS: All children who underwent closed reduction for Graf type IV DDH at our institution between September 2010 and June 2016 were retrospectively reviewed. Since 2010 we assessed postreduction position of the femoral head by performing a MRI. RESULTS: Twenty-five (5 male, 20 female) patients presented with 29 (15 left sided, 6 right sided, 4 bilateral) Graf type IV DDH and underwent closed reduction at a mean age of 3.4 months. In all patients MRI studies performed within 24 hours were diagnostic, showing a concentric reduction of the femoral head within the acetabulum in 24/25 patients. In the patient with persistent hip instability, a subsequent open reduction was performed. In all the cases, there was no need of any contention or sedation during MRI. CONCLUSIONS: On the basis of our experience, MRI is an excellent, safe and, reliable modality to confirm maintenance of adequate femoral head position and to evaluate soft tissue interposition. We agree that MRI is the gold standard to early depict dislocation after closed reduction of DDH.


Assuntos
Acetábulo/diagnóstico por imagem , Cabeça do Fêmur/diagnóstico por imagem , Luxação Congênita de Quadril/diagnóstico por imagem , Luxação Congênita de Quadril/terapia , Imagem por Ressonância Magnética , Feminino , Humanos , Lactente , Masculino , Reprodutibilidade dos Testes , Estudos Retrospectivos
11.
J Dance Med Sci ; 23(3): 126-132, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31500694

RESUMO

Due to frequent movements involving extreme hip amplitudes, ballet dancers often present with hip pain and chondrolabral lesions as seen in femoroacetabular impingement. The lesions appear even with normal anatomy. Diagnosis is often delayed, and treatment is challenging, especially in skeletally immature patients. This study reports the case of an adolescent ballet dancer suffering from a large symptomatic labral tear. The literature has also been reviewed for context regarding the pathophysiology and current therapeutic management of these injuries.


Assuntos
Acetábulo/lesões , Cartilagem Articular/lesões , Dança/lesões , Acetábulo/diagnóstico por imagem , Adolescente , Cartilagem Articular/diagnóstico por imagem , Lesões do Quadril/diagnóstico por imagem , Articulação do Quadril , Humanos
12.
J Med Case Rep ; 13(1): 293, 2019 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-31522686

RESUMO

BACKGROUND: A hip joint ganglion is a rare cause of lower-extremity swelling. CASE PRESENTATION: We report a case of a Japanese patient with ganglion of the hip with compression of the external iliac/femoral vein that produced signs and symptoms mimicking those of deep vein thrombosis. CONCLUSIONS: Needle aspiration of the ganglion was performed, and swelling of the lower extremity promptly decreased. At 7.5 years after aspiration, there was no recurrence of swelling of the leg. Although the recurrence rate for ganglions after needle aspiration is high, it is worthwhile trying aspiration first.


Assuntos
Acetábulo/diagnóstico por imagem , Constrição Patológica/fisiopatologia , Edema/fisiopatologia , Veia Femoral/fisiopatologia , Cistos Glanglionares/fisiopatologia , Veia Ilíaca/fisiopatologia , Idoso de 80 Anos ou mais , Constrição Patológica/diagnóstico por imagem , Feminino , Veia Femoral/diagnóstico por imagem , Cistos Glanglionares/diagnóstico por imagem , Humanos , Veia Ilíaca/diagnóstico por imagem , Extremidade Inferior/fisiopatologia , Imagem por Ressonância Magnética , Tomografia Computadorizada por Raios X
13.
Bone Joint J ; 101-B(9): 1042-1049, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31474147

RESUMO

AIMS: Several radiological methods of measuring anteversion of the acetabular component after total hip arthroplasty (THA) have been described. These are limited by low reproducibility, are less accurate than CT 3D reconstruction, and are cumbersome to use. These methods also partly rely on the identification of obscured radiological borders of the component. We propose two novel methods, the Area and Orthogonal methods, which have been designed to maximize use of readily identifiable points while maintaining the same trigonometric principles. PATIENTS AND METHODS: A retrospective study of plain radiographs was conducted on 160 hips of 141 patients who had undergone primary THA. We compared the reliability and accuracy of the Area and Orthogonal methods with two of the current leading methods: those of Widmer and Lewinnek, respectively. RESULTS: The 160 anteroposterior pelvis films revealed that the proposed Area method was statistically different from those described by Widmer and Lewinnek (p < 0.001 and p = 0.004, respectively). They gave the highest inter- and intraobserver reliability (0.992 and 0.998, respectively), and took less time (27.50 seconds (sd 3.19); p < 0.001) to complete. In addition, 21 available CT 3D reconstructions revealed the Area method achieved the highest Pearson's correlation coefficient (r = 0.956; p < 0.001) and least statistical difference (p = 0.704) from CT with a mean within 1° of CT-3D reconstruction between ranges of 1° to 30° of measured radiological anteversion. CONCLUSION: Our results support the proposed Area method to be the most reliable, accurate, and speedy. They did not support any statistical superiority of the proposed Orthogonal method to that of the Widmer or Lewinnek method. Cite this article: Bone Joint J 2019;101-B:1042-1049.


Assuntos
Acetábulo/diagnóstico por imagem , Artroplastia de Quadril/efeitos adversos , Anteversão Óssea/diagnóstico por imagem , Cabeça do Fêmur/diagnóstico por imagem , Prótese de Quadril/efeitos adversos , Acetábulo/cirurgia , Anteversão Óssea/etiologia , Diagnóstico por Computador , Cabeça do Fêmur/cirurgia , Humanos , Radiografia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
14.
Med Sci Monit ; 25: 5953-5960, 2019 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-31399554

RESUMO

BACKGROUND Screw penetration into the hip joint is a severe complication during acetabular fracture surgery. The standard fluoroscopic views of the pelvis cannot provide adequate safety during screw insertion. The aim of this research was to determine and evaluate the accuracy of the acetabular lateral view for screw placement. MATERIAL AND METHODS Twenty screws were randomly chosen and intentionally penetrated into the articular surface (1-2 mm), and the remaining 20 screws were extra-articular ones positioned in close proximity to the articular surface. Three surgeons, each evaluating 40 screws, provided a total of 120 rated observations for each screw position. We compared the traditional view or combined with lateral acetabular view with the criterion standard based on unaided visual assessment. A blinded and independent review of each pelvic intraoperative fluoroscopy was made by 3 independent observers. Specificity, sensitivity, positive predictive value, negative predictive value, correct interpretation, intra-class correlation coefficients (ICC), and Youden index were calculated. RESULTS There were significant differences in sensitivity, NPV, correct interpretation, and Youden index between the 2 groups (P<0.05). The ICC was 0.531 when the antero-posterior, iliac, and obturator oblique views were used. The ICC was remarkably increased when using a combination of the ''lateral'' view and the standard views for screw perforation of the joint. CONCLUSIONS Use of the lateral view of the acetabulum can be a complementary method to identify malpositioned screws, and it helps increase the accuracy rate of inserting screws in the treatment of posterior wall fracture.


Assuntos
Acetábulo/diagnóstico por imagem , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Acetábulo/lesões , Acetábulo/cirurgia , Adulto , Idoso , Parafusos Ósseos , Cadáver , Fluoroscopia/métodos , Fraturas do Quadril , Humanos , Masculino , Pessoa de Meia-Idade , Pelve/cirurgia , Cirurgia Assistida por Computador/métodos
15.
Acta Orthop Traumatol Turc ; 53(5): 346-350, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31400967

RESUMO

OBJECTIVE: The aim of this study was to investigate whether being the parents of children with developmental hip dysplasia (DDH) is a risk factor for asymptomatic dysplasia. METHODS: Asymptomatic parents of children who were diagnosed with DDH were assessed for presence of dysplasia by examining their anteroposterior pelvis radiographs at the neutral position. Eighty-six hips of 43 participants were included in the study group and 98 hips of 49 participants were included in the control group. Presence of hip dysplasia over the anteroposterior pelvis radiographs was analyzed for Wiberg's angle, acetabular index of the weight-bearing zone (the Tönnis angle), acetabular depth/width index, femoral head coverage ratio (FHCR) and femoral neck/shaft angle. RESULTS: The mean acetabular depth/width ratio was 44.3% in the study group and 53.5% in the control group. And, the mean FHCR was 80% in the study group and 82% in the control group. There was a statistically significant difference between the two groups in terms of mean acetabular depth/width ratio (p < 0.05) and FHCR (p < 0.05). In addition, 21 participants in the study group and 2 in the control group had a pathological acetabular depth/width ratio. And, the number of participants with a pathological FHCR was 22 in the study group and 13 in the control group. A statistically significant difference was found between the two groups regarding the number of pathological measurements of acetabular depth/width ratio (p < 0.05) and FHCR (p < 0.05). CONCLUSION: Having a parent with DDH is a definitive risk factor for the development of hip dysplasia in childhood. In addition, being a parent of a child with DDH is a risk factor for asymptomatic dysplasia. These parents should be screened by roentgenogram. LEVEL OF EVIDENCE: Level III, Diagnostic Study.


Assuntos
Acetábulo , Doenças Assintomáticas/epidemiologia , Luxação Congênita de Quadril , Articulação do Quadril , Pais , Acetábulo/diagnóstico por imagem , Acetábulo/patologia , Adulto , Criança , Correlação de Dados , Feminino , Luxação Congênita de Quadril/diagnóstico , Luxação Congênita de Quadril/epidemiologia , Articulação do Quadril/anormalidades , Articulação do Quadril/diagnóstico por imagem , Humanos , Masculino , Radiografia/métodos , Estudos Retrospectivos , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , Fatores de Risco
16.
J Bone Joint Surg Am ; 101(16): 1495-1504, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31436658

RESUMO

BACKGROUND: The aims of this study were to describe a novel minimally invasive, interlocking periacetabular osteotomy (PAO) for the treatment of hip dysplasia that was developed at our institution and to report on its safety, complications, and early clinical outcomes. METHODS: This was a prospective longitudinal study of the first 200 consecutive hips that underwent the CU (University of Colorado) PAO, an interlocking osteotomy combining the benefits of the Birmingham interlocking pelvic osteotomy (BIPO) and the Ganz PAO. The technique provides direct visualization of the sciatic nerve during the ischial osteotomy and allows for immediate weight-bearing postoperatively. Demographic characteristics, intraoperative and perioperative parameters, and functional outcomes were documented. All patients underwent hip arthroscopy 3 to 10 days prior to the PAO to address concomitant intra-articular pathology. Mechanical deep venous thrombosis (DVT) prophylaxis was used for 2 weeks postoperatively. Results were stratified to compare the first 100 and the second 100 cases. RESULTS: A total of 161 patients (200 hips) underwent primary PAO; mean follow-up was 20 months (range, 3 to 33 months). The mean patient age at the time of surgery was 29.4 years (range, 13 to 55 years). Females accounted for 89% of the patients included in this study. The average length of stay was 4 days. A concomitant proximal femoral derotational osteotomy was performed in 19 hips. The lateral center-edge angle (LCEA) improved from a mean of 18.8° preoperatively to 31.5° postoperatively (p < 0.001). The mean Non-Arthritic Hip Score (NAHS) improved from 56.0 preoperatively to 89.4 at the 24-month follow-up (p < 0.0001). Paresthesias in the distribution of the lateral femoral cutaneous nerve were common (65% at 2 weeks postoperatively) but resolved in 85% of the patients within the first 6 months. There were no sciatic nerve-related complications, deep infections, or DVTs. CONCLUSIONS: The CU PAO enables corrective realignment of symptomatic acetabular dysplasia with direct visualization of the sciatic nerve, early weight-bearing, cosmetic incisions, and good short-term outcomes. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Acetábulo/cirurgia , Luxação do Quadril/diagnóstico por imagem , Luxação do Quadril/cirurgia , Osteotomia/métodos , Amplitude de Movimento Articular/fisiologia , Acetábulo/diagnóstico por imagem , Adolescente , Adulto , Fatores Etários , Colorado , Feminino , Hospitais Universitários , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Osteotomia/efeitos adversos , Medição da Dor , Segurança do Paciente/estatística & dados numéricos , Cuidados Pós-Operatórios/métodos , Cuidados Pré-Operatórios/métodos , Estudos Prospectivos , Radiografia/métodos , Recuperação de Função Fisiológica , Índice de Gravidade de Doença , Fatores Sexuais , Resultado do Tratamento , Adulto Jovem
17.
J Pediatr Orthop ; 39(8): 416-421, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31393302

RESUMO

BACKGROUND: Derotational osteotomy of the proximal femur has proved to be effective in the treatment of residual acetabular dysplasia. However, the reason why this osteotomy is effective remains debatable. The purpose of this study is to investigate if an alteration of femoral head orientation affects acetabular growth. METHODS: A proximal femoral osteotomy was performed in 21 lambs aged 3 months: 5 varus osteotomies (110 degrees), 4 valgus osteotomies (150 degrees), and 12 derotation osteotomies. Results were compared with a control group (5 animals). Osteotomy was fixed with a screw-plate device. Version was controlled intraoperatively with K-wires. Animals were killed 3 months after surgical procedure. A morphometric study of both proximal femur and acetabulum was performed, including deepness, volume and diameters of the acetabulum, neck-shaft angle and femoral version. RESULTS: The average neck-shaft angle for the normal, anteversion, and retroversion groups was 129 degrees, whereas it was 110 degrees for the varus group and 149 degrees for the valgus group. The average femoral version for the normal, valgus, and varus groups was 21 degrees of anteversion, whereas it was 38 degrees of anteversion for the so-called anteversion group and 17 degrees of retroversion for the retroversion group. Nor the neck-shaft angle, nor the femoral version correlated with the acetabular anteroposterior diameter (P=0.698, 0.6, respectively), the acetabular inferosuperior diameter (P=0.083, 0.451, respectively) or the acetabular deepness (P=0.14, 0.371, respectively). The neck-shaft angle correlated significantly with acetabular volume (P=0.023), so that the lower the neck-shaft angle, the higher the acetabular volume (r=-0.453). The femoral version did not correlated with acetabular volume (P=0.381). CONCLUSIONS: Decreasing the neck-shaft angle provokes an increase in acetabular volume, whereas changes in femoral version do not affect the acetabular growth. Extra-articular osteotomies that alter femoral orientation affect intra-articular gross morphology. LEVEL OF EVIDENCE: Level II-therapeutic study.


Assuntos
Acetábulo , Cabeça do Fêmur , Luxação Congênita de Quadril , Osteotomia , Acetábulo/diagnóstico por imagem , Acetábulo/crescimento & desenvolvimento , Acetábulo/patologia , Animais , Cabeça do Fêmur/diagnóstico por imagem , Cabeça do Fêmur/patologia , Luxação Congênita de Quadril/diagnóstico , Luxação Congênita de Quadril/cirurgia , Tamanho do Órgão , Osteotomia/efeitos adversos , Osteotomia/métodos , Ovinos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
18.
J Orthop Surg Res ; 14(1): 279, 2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31462276

RESUMO

INTRODUCTION: In this study, we described a positioner which allows a combination of preoperative plan and intraoperative insertion of the cup to improve the reconstruction of the rotation center of the hip. MATERIALS AND METHODS: A retrospective study was conducted on 32 consecutive patients (group A) using this positioner and 40 consecutive patients (group B) using conventional method; radiological parameters and clinical measurements before operation and at last follow-up were collected and evaluated. RESULTS: Group A had a reconstructed center of rotation (COR) that was 0.19 mm closer to the anatomic COR in height (P < 0.005), compared with group B with 3.45 mm vertical dislocation. There were no statistically significant differences in the horizontal displacement between the two groups. The accuracy of cup inclination was 42.14 ± 3.57 in the group A and 38.73 ± 7.65 in the group B (P = 0.015). The accuracy of cup anteversion was 14.82 ± 1.44 in the group A and 13.08 ± 5.95 in the group B (P = 0.082). All cups in the group A were radiologically stable, while one cup in the group B was radiologically unstable and was successfully treated with second-stage revision. Both of the groups obtained a higher mean postoperative Harris Hip Score. CONCLUSIONS: Utilizing this positioner helps to restore the COR position more precisely and provides satisfactory radiological and clinical outcomes in the short term, and more studies are required before its widespread adoption for complicated cases.


Assuntos
Acetábulo/diagnóstico por imagem , Acetábulo/cirurgia , Artroplastia de Quadril/instrumentação , Artroplastia de Quadril/normas , Prótese de Quadril/normas , Desenho de Prótese/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
19.
Cir Cir ; 87(5): 490-495, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31448800

RESUMO

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.


Assuntos
Acetábulo/patologia , Luxação Congênita de Quadril/patologia , Processamento de Imagem Assistida por Computador/métodos , Tomografia Computadorizada Multidetectores , Acetábulo/diagnóstico por imagem , Antropometria , Pré-Escolar , Feminino , Luxação Congênita de Quadril/cirurgia , Humanos , Lactente , Masculino , Tamanho do Órgão , Procedimentos Ortopédicos , Projetos Piloto , Estudos Retrospectivos
20.
Acta Orthop Traumatol Turc ; 53(5): 351-355, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31358402

RESUMO

OBJECTIVE: The aim of this study was to measure the cartilaginous coverage of the acetabulum using magnetic resonance imaging (MRI) and to analyze its effect on the timing and necessity of secondary operations in residual acetabular dysplasia (RAD). METHODS: The MRI results of 33 children (30 girls and 3 boys) aged between 5 and 9 years who were operated on unilaterally via a posteromedial limited approach were compared with the radiographical findings of acetabular dysplasia at follow-up. The acetabular index (AI) and the center-edge (CE) angles were measured. MRI was used to measure the osseous acetabular index (OAI), cartilage acetabular index (CAI), and cartilaginous center-edge angles (CCE). The Children's Hospital's Oakland Hip Evaluation Score (CHOHES) was used for the assessment of clinical and functional results. The Severin scoring system was used to evaluate the radiographic results. The Mann-Whitney U test and Spearman correlation tests were used for statistical analysis. RESULTS: In all, 30 (90.9%) girls and 3 (9.1%) boys with an average age of 7.4 years (range: 5-9 years) and a mean follow-up period of 6.1 years (range: 4-8 years) were included. While there was a significant difference between non-dislocated hips and operated hips in 3 measurements (AI, Wiberg CE, and Ogata CE) using X-rays (p < 0.05), no significant difference was found in the MRI measurements (OAI, CAI, and CCE) (p > 0.05). The CAI values were lower than the AI measured on X-ray (p = 0.035). The mean CCE was higher than the mean CE (p = 0.022). The mean CHOHES score was 83.1 (range: 52-100) and the score of 62% patients was above 90. There was no significant difference in terms of CHOHES score according to age at the time of operation (p = 0.43). Three (9.1%) patients were Severin class I, 8 (24.3%) patients were class II, 12 (36.3%) patients were class III and 10 (30.3%) patients were class IV. There was no correlation between preoperative hip dislocation and Severin score (p = 0.056). No significant difference was found between the ambulatory and non-ambulatory groups in terms of Severin classification (p = 0.063). CONCLUSION: Cartilaginous acetabulum should be taken into account in RAD measurements. MRI may be a more appropriate option for the evaluation of acetabular cartilaginous coverage in the evaluation of RAD and the decision to perform surgery, though X-rays are currently the most used method. The results revealed no effect on functional or radiological scores as a result of being of walking age. LEVEL OF STUDY: Level III, Diagnostic Study.


Assuntos
Acetábulo , Cartilagem , Luxação Congênita de Quadril , Imagem por Ressonância Magnética/métodos , Complicações Pós-Operatórias , Radiografia/métodos , Reoperação , Acetábulo/diagnóstico por imagem , Acetábulo/patologia , Fatores Etários , Cartilagem/diagnóstico por imagem , Cartilagem/patologia , Criança , Feminino , Seguimentos , Luxação Congênita de Quadril/diagnóstico , Luxação Congênita de Quadril/fisiopatologia , Luxação Congênita de Quadril/cirurgia , Humanos , Masculino , Seleção de Pacientes , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Reoperação/métodos , Reoperação/normas , Estudos Retrospectivos , Tempo para o Tratamento
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