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Esmaeili S, Ghaseminejad-Raeini A, Ghane G, Soleimani M, Mortazavi SMJ, Shafiei SH. Total Hip Arthroplasty in Patients Who Have Crowe Type IV Developmental Dysplasia of the Hip: A Systematic Review. J Arthroplasty 2024:S0883-5403(24)00478-9. [PMID: 38759817 DOI: 10.1016/j.arth.2024.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Developmental dysplasia of the hip (DDH) is one of the principal causes of secondary hip osteoarthritis, giving rise to considerable pain, impaired mobility, and a reduced quality of life. The optimal approach to managing individuals who have Crowe-type IV DDH remains controversial. This study aimed to review the existing literature on the application of total hip arthroplasty (THA) as a treatment modality for Crowe-type IV DDH, assessing its efficacy in addressing this severe hip deformity. METHODS A comprehensive search across the PubMed, Scopus, and Web of Science databases identified relevant studies. Inclusion criteria encompassed investigations reporting outcomes of THA in Crowe-type IV DDH patients. Data extraction and quality assessment were performed independently by two reviewers. Utilizing R software, the prevalence of THA complications was analyzed through proportion analysis, employing the inverse variance method. RESULTS In this systematic review, a total of 74 studies were included, comprising a collective sample size of 2,829 patients (3,356 hips) diagnosed with Crowe-type IV DDH. The posterior/posterolateral approach was the most commonly utilized surgical approach, followed by the lateral Hardinge and direct lateral approaches. The majority of studies have employed subtrochanteric osteotomies. Notably, post-THA, leg length discrepancy (LLD) decreased, Trendelenburg sign resolved, and back pain reduced. Patient-reported outcome measures like the Harris Hip Score (HHS) improved significantly. The pooled prevalence rates of major postoperative complications were also assessed, including dislocation (7.2%), revision (8.7%), intraoperative fractures (10.5%), loosening (5.7%), nerve paralysis (5.6%), deep vein thrombosis (3.6%), infection (3.8%), heterotopic ossification grade 2 and above (6.1%), and a complicated patient rate of 11.0%. CONCLUSION Synthesizing diverse study data, an overview of THA's performance emerges, demonstrating significant enhancements in function, pain reduction, quality of life, and the correction of substantial LLD. While THA has shown positive outcomes, instances of complications have been reported. The decision to undergo THA should involve a collaborative assessment between the surgeon and the patient, considering potential benefits and complications.
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Affiliation(s)
- Sina Esmaeili
- Orthopedic Surgery Research Center (OSRC), Orthopedic Department, Sina University Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Amirhossein Ghaseminejad-Raeini
- Orthopedic Surgery Research Center (OSRC), Orthopedic Department, Sina University Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Golnar Ghane
- Medical Surgical Department, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Soleimani
- Orthopedic Surgery Research Center (OSRC), Orthopedic Department, Sina University Hospital, Tehran University of Medical Science, Tehran, Iran
| | | | - Seyyed Hossein Shafiei
- Orthopedic Surgery Research Center (OSRC), Orthopedic Department, Sina University Hospital, Tehran University of Medical Science, Tehran, Iran.
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Hu Y, Sun Z, Zhang J, Yan M, Mao Y, Li H, Yu D, Zhai Z. A New Method to Predict Postoperative Stem Anteversion in Total Hip Arthroplasty for Developmental Dysplasia of the Hip. Orthop Surg 2024; 16:1101-1108. [PMID: 38509013 PMCID: PMC11062849 DOI: 10.1111/os.14037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 02/12/2024] [Accepted: 02/25/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Preoperative evaluation of femoral anteversion to predict postoperative stem anteversion aids the selection of an appropriate prosthesis and optimizes the combined anteversion in total hip arthroplasty (THA) for developmental dysplasia of the hip (DDH). The conventional prediction methods are based on the femoral anteversion measurement at the location of the femoral head and/or neck. However, varied differences between femoral anteversion and postoperative stem anteversion were demonstrated. This study investigated the predictive role of a new method based on the principle of sagittal three-point fixation. METHODS From January 2017 to December 2018, a total of 133 DDH hips that underwent THA were retrospectively analyzed. There were 76 Crowe type I, 27 type II, and 30 type III hips. The single-wedge stem was used in 49 hips, and the double-wedge stem was used in 84 hips. Preoperative native femoral anteversion at the femoral head-neck junction, anterior cortex anteversion at 2 levels of the lesser trochanter, posterior cortex anteversion at 5 levels of the femoral neck, and postoperative stem anteversion were measured using two-dimensional computed tomography. Predictive anteversion by the new method was calculated as the average anteversion formed by the anterior cortex at the lesser trochanter and the posterior cortex at the femoral neck. RESULTS For hips with different neck heights, different Crowe types, different stem types, or different femoral anteversions, native femoral anteversion showed widely varied differences and correlations with stem anteversion, with differences ranging from -1.27 ± 8.33° to -13.67 ± 9.47° and correlations ranging from 0.122 (p = 0.705, no correlation) to 0.813. Predictive anteversion formed by the anterior cortex at the lesser trochanter proximal base and posterior cortex 10 mm above the lesser trochanter proximal base showed no significant difference with stem anteversion, with less varied differences (0.92 ± 7.52°) and good to excellent correlations (r = 0.826). CONCLUSION Adopting our new method, predictive anteversion, measured as the average anteversion of the anterior cortex at the lesser trochanter proximal base and posterior cortex 10 mm above the lesser trochanter proximal base, predicted postoperative stem anteversion more reliably than native femoral anteversion.
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Affiliation(s)
- Yuehao Hu
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic SurgeryShanghai Ninth People's Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Ziyang Sun
- Department of OrthopedicsShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Jingwei Zhang
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic SurgeryShanghai Ninth People's Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Mengning Yan
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic SurgeryShanghai Ninth People's Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yuanqing Mao
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic SurgeryShanghai Ninth People's Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Huiwu Li
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic SurgeryShanghai Ninth People's Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Degang Yu
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic SurgeryShanghai Ninth People's Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Zanjing Zhai
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic SurgeryShanghai Ninth People's Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
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Shahbazi P, Jalilvand AH, Ghaseminejad-Raeini A, Ghaderi A, Sheikhvatan M, Fallah Y, Shafiei SH. Risk Factors for Dislocation following Total Hip Arthroplasty in Developmental Dysplasia of the Hip: A Systematic Review and Meta-Analysis. Int Orthop 2023; 47:3063-3075. [PMID: 37688602 DOI: 10.1007/s00264-023-05949-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/16/2023] [Indexed: 09/11/2023]
Abstract
PURPOSE This systematic review and meta-analysis aimed to identify risk factors of dislocation after total hip arthroplasty (THA) in patients with developmental dysplasia of the hip (DDH). METHODS A systematic literature review was performed on 18th August 2022 using Medline, Embase, Scopus, Web of Science electronic databases, and a manual search. The study was conducted according to the PRISMA guidelines and registered with PROSPERO. Statistical analysis includes assessment of heterogeneity and data synthesis using RevMan 5.4. RESULTS Review of five studies including 2865 patients and 116 dislocated hips found that lower body mass index (BMI) (SMD = 0.22, p = 0.04, I2 = 0%), Crowe classification type IV versus I, II, and III (OR = 2.70, p = 0.004, I2 = 51%), higher cup inclination (SMD = 0.39 p = 0.0007, I2 = 0%), femoral head size < 28 mm (OR = 5.07, p = 0.003, I2 = 71%), lateral surgical approach (OR = 1.96, p = 0.02, I2 = 0%), and postoperative infection (OR = 6.26, p < 0.0001, I2 = 0%) were significant risk factors. However, age, gender, cup anteversion, femoral osteotomy, vertical (V-COR) centre of rotation, intraoperative fracture, preoperative and postoperative leg length discrepancy (LLD) and previous hip surgery were not found to be significant risk factors. CONCLUSION This study underscores importance of these risk factors in THA planning for DDH patients to reduce dislocation risk. Further research needed to understand mechanisms.
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Affiliation(s)
- Parmida Shahbazi
- Orthopedic Department, Orthopedic Surgery Research Center (OSRC), Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Hossein Jalilvand
- Orthopedic Department, Orthopedic Surgery Research Center (OSRC), Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Ghaseminejad-Raeini
- Orthopedic Department, Orthopedic Surgery Research Center (OSRC), Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Ghaderi
- Orthopedic Department, Orthopedic Surgery Research Center (OSRC), Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrdad Sheikhvatan
- Orthopedic Department, Orthopedic Surgery Research Center (OSRC), Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Heidelberg Medical Hospital, Heidelberg, Germany
| | - Yousef Fallah
- Orthopedic Department, Orthopedic Surgery Research Center (OSRC), Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyyed Hossein Shafiei
- Orthopedic Department, Orthopedic Surgery Research Center (OSRC), Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Yang F, Zhou Z, Zhang X, Huang H, Ju X, Wang J. Arthroscopy Confers Favorable Clinical Outcomes in Asian Patients with Borderline Developmental Dysplasia of the Hip. Orthop Surg 2023; 15:2393-2399. [PMID: 37519268 PMCID: PMC10475655 DOI: 10.1111/os.13839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/26/2023] [Accepted: 06/30/2023] [Indexed: 08/01/2023] Open
Abstract
OBJECTIVE Hip arthroscopy has recently appeared as a successful therapy in treating borderline developmental dysplasia of the hip (BDDH). This study aimed to describe the minimal 2-year follow-up after hip arthroscopy for patients with BDDH in the Asian population and use the combination of lateral center edge angle (LCEA) and alpha angles to detect the appearance of impingement in the BDDH population. METHODS This retrospective investigation was conducted utilizing information from arthroscopically treated BDDH patients in 2018 and 2019. The following patient-reported outcomes were reported: modified Harris Hip Score, Hip Outcome Score-Activities of Daily Living, International Hip Outcome Tool 12-component form, and Visual Analog Scale. We also considered the clinical data regarding radiological measurements, intraoperative findings, interventions, complications, and subsequent surgical revisions, in the analysis of combination angles in detecting the occurrence of impingement. Patients with asymptomatic contralateral hips from traumatic hip injury (pelvic fracture) served as the control group. A 2:1 propensity score matching was based on age, sex, and BMI. A receiver operating characteristic curve (ROC) was used to identify the thresholds of combination angles and their accuracies. RESULTS A total of 77 hips met the inclusion and exclusion requirements. After the follow-up period, most patients showed a considerable improvement in patient-reported outcomes compared to their preoperative values (P < 0.001 for all). The overall rate of complications was 5.2%, whereas the rate of revisions was 3.9%. Increasing preoperative alpha angle age was significantly positively correlated with improving patient-reported outcomes. The combined angle cut-off was determined to be 80.5° (AUC, 0.858; 95% CI: 0.757-0.938; sensitivity (SE), 98.1%; specificity (SP), 74.1%; P < 0.001) for the occurrence of impingement in BDDH population. CONCLUSION Good patient-reported outcomes and low revision rates can be expected in the BDDH population with careful selection of patients in Asian populations. A combination angle >80.5° could be a reliable predictive factor of impingement in BDDH populations.
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Affiliation(s)
- Fan Yang
- Department of Sports MedicinePeking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports InjuriesBeijingChina
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of EducationBeijingChina
| | - Zheng Zhou
- Department of Sports MedicinePeking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports InjuriesBeijingChina
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of EducationBeijingChina
| | - Xin Zhang
- Department of Sports MedicinePeking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports InjuriesBeijingChina
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of EducationBeijingChina
| | - Hongjie Huang
- Department of Sports MedicinePeking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports InjuriesBeijingChina
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of EducationBeijingChina
| | - Xiaodong Ju
- Department of Sports MedicinePeking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports InjuriesBeijingChina
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of EducationBeijingChina
| | - Jianquan Wang
- Department of Sports MedicinePeking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports InjuriesBeijingChina
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of EducationBeijingChina
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Ghaznavi A, Mohammadpour M, Noori A, Rajei M. Geographical Distribution of Developmental Dysplasia of the Hip: A Brief Epidemiological Study of Iran. Med J Islam Repub Iran 2023; 37:13. [PMID: 37123328 PMCID: PMC10134083 DOI: 10.47176/mjiri.37.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Indexed: 05/02/2023] Open
Abstract
Background Local epidemiological data are necessary to identify the disease hot spots and running screening programs. In this study, we evaluated the demographic characteristics of developmental dysplasia of the hip (DDH) in a tertiary referral hospital in Iran. Methods In a retrospective study, the medical profiles of 137 DDH children, who were referred to our university hospital between 2014 and 2020, were reviewed for characteristics such as gender, place of birth, age at the diagnosis, gestational age (term or preterm), twin or single birth, mother's age, pregnancy number, breech presentation, associated deformity, family history of DDH, et cetera. Results The study population included 24 (17.5%) boys and 113 (82.5%) girls with a mean age of 2.3 ± 2 years. In the majority of cases (54.2%), it was the firstborn. Twin delivery was seen in only 5 (4.1%) cases. The associated deformity was noticed in 17 (12.4%) patients. Clubfoot was the most commonly associated deformity that was seen in 6 of 17 (35.3%) patients. A family history of DDH was recorded in 12 (8.8%) patients. The breech presentation was recorded in 19 (13.9%) patients. The mean age of the mother at the delivery was 27.2 ± 6.1 years. Tehran, Lorestan, Kurdistan, and Khuzestan provinces had the most referrals. Conclusion DDH is associated with the female sex, positive family history, breech presentation at delivery, clubfoot deformity, and geographic district. These associations could be used for identifying the disease hot spots and running screening programs for earlier detection and better management of DDH.
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Affiliation(s)
- Alireza Ghaznavi
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Mohammadpour
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Arash Noori
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Maziar Rajei
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Corresponding author:Maziar Rajei,
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Vasyl S, Viktor F. MODIFIED SALTER PELVIC OSTEOTOMY FOR THE DDH TREATMENT. Acta Ortop Bras 2023; 31:e259040. [PMID: 37082156 PMCID: PMC10112343 DOI: 10.1590/1413-785220233101e259040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 05/04/2022] [Indexed: 04/22/2023]
Abstract
Objectives Three pelvic osteotomies (Salter, Dega, Pemberton) are widely used in walking patients under seven years old for DDH treatment. We've proposed a modified Salter Pelvic Osteotomy (SPO), which has the advantages of the abovementioned osteotomies. Methods Short- and mid-term results were assessed in 19 patients after the modified SPO application. Patients were examined before and after the surgery, at 6 months postoperatively, and at follow-up. Results Acetabular Index (AI) before the surgery was 39.5 ± 7 °; after the surgery - 24.4 ± 5.5 °, at 6 months - 20.4 ± 5 ° (9-28), at follow-up - 14.5 ± 4 °; AI correction - 14.9 ± 5.5 °. Lateral Centre-Edge Angle at follow-up - 22.7 ± 4.7 °. Clinical results at follow-up were I / II McKay grade in 18 patients (94.7%); radiological results were I / II Severin class in 18 patients (94.7%). Conclusion Modified SPO improves the FH coverage in any direction; results after modified SPO are excellent and good in most patients. Level of Evidence IV; Case Series .
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Affiliation(s)
- Suvorov Vasyl
- SI -The Institute of Traumatology and Orthopedics by NAMS of Ukraine, Department of Reconstructive Orthopedics and Traumatology in Children and Adolescents, Kyiv, Ukraine
| | - Filipchuk Viktor
- SI -The Institute of Traumatology and Orthopedics by NAMS of Ukraine, Department of Reconstructive Orthopedics and Traumatology in Children and Adolescents, Kyiv, Ukraine
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Guan J, Wang Z, Zhang Z, Wang Z, Wu M, Zhang H, Chen X, Zhou J. 3D PRINTING APPLICATION IN BONE DEFECT AREA MEASUREMENT ON PATIENTS WITH DEVELOPMENTAL DYSPLASIA OF THE HIP. Acta Ortop Bras 2022; 30:e233064. [PMID: 36506861 PMCID: PMC9721433 DOI: 10.1590/1413-785220223002e233064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 03/16/2021] [Indexed: 12/05/2022]
Abstract
Objectives Evaluate the application value of 3D printing technology in measuring acetabular bone defect area in adult patients diagnosed with developmental dysplasia of the hip (DDH). Methods 23 cases of DDH requiring total hip replacement surgery were enrolled in this study. Preoperative examination confirmed the standard pelvic plain films Crowe, including 3 cases of Crowe I, 7 Crowe II, and 13 Crowe III. The 3D printing technology was used to print the hip model before the operation. Based on the pre-printed model, pre-operative planning and surgical procedures were established. The area of the acetabular bone defects was measured, the selected size prosthesis was recorded, and the surgery was performed (group A). The actual acetabular bone defect area and the prosthesis size were also recorded (group B). Results The comparative results indicated that the actual acetabular defect area measured intraoperatively and the area measured using the 3D printing technology did not significantly differ for all participants (all P>0.05). Conclusion Preoperative model can accurately measure the acetabular bone defect area for DDH. It is significant to develop individualized implants for DDH patients treated with the 3D printing technique. Level of Evidence IV: Case series .
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Affiliation(s)
- Jianzhong Guan
- Affiliated Hospital of Bengbu Medical College, Department of Orthopedics, Bengbu Anhui, China
| | - Zhaodong Wang
- Affiliated Hospital of Bengbu Medical College, Department of Orthopedics, Bengbu Anhui, China
| | - Zheng Zhang
- Affiliated Hospital of Bengbu Medical College, Department of Orthopedics, Bengbu Anhui, China
| | - Zhiyan Wang
- Affiliated Hospital of Bengbu Medical College, Department of Orthopedics, Bengbu Anhui, China
| | - Min Wu
- Affiliated Hospital of Bengbu Medical College, Department of Orthopedics, Bengbu Anhui, China
| | - Heng Zhang
- Affiliated Hospital of Bengbu Medical College, Department of Orthopedics, Bengbu Anhui, China
| | - Xiaotian Chen
- Affiliated Hospital of Bengbu Medical College, Department of Orthopedics, Bengbu Anhui, China
| | - Jiansheng Zhou
- Affiliated Hospital of Bengbu Medical College, Department of Orthopedics, Bengbu Anhui, China
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Shen J, Sun J, Ma H, Du Y, Li T, Zhou Y. High Hip Center Technique in Total Hip Arthroplasty for Crowe Type II-III Developmental Dysplasia: Results of Midterm Follow-up. Orthop Surg 2020; 12:1245-1252. [PMID: 32776482 PMCID: PMC7454156 DOI: 10.1111/os.12756] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 06/13/2020] [Accepted: 06/21/2020] [Indexed: 12/19/2022] Open
Abstract
Objectives We aimed to show the utility of high hip center technique used in patients with Crowe II–III developmental dysplasia of the hip at the midterm follow‐up and evaluated the clinical and radiographic results between different heights of hip center. Methods From December 2003 to November 2013, we retrospectively evaluated 69 patients (85 hips) with Crowe II–III dysplasia who underwent a high hip center cementless total hip arthroplasty. The patients were divided into two groups according to the height of hip center, respectively group A (≥ 22 mm and < 28 mm) and group B (≥28 mm). The survivorship outcomes and radiographic and clinical results, including the vertical and horizontal distances of hip center, femoral offset, abductor lever arm, cup inclination, leg length discrepancy, Trendelenburg sign, and limp were evaluated. Results The mean follow‐up time was 8.9 ± 1.8 years. The mean location of the hip center from the inter‐teardrop was 25.1 ± 1.6 mm vertically and 30.0 ± 3.8 mm horizontally in group A, and 33.1 ± 4.8 mm vertically and 31.4 ± 6.1 mm horizontally in group B. Eleven hips of group B showed a lateralization over 10 mm, and the same was shown in one hip in group A (P = 0.012). There were no statistically significant differences between two groups in postoperative femoral offset, abductor lever arm, leg length discrepancy and cup inclination. At the final follow up, the mean WOMAC and Harris hip score were significantly improved in both groups. Of the 85 hips, four hips in group A and three hips in group B showed a positive Trendelenburg sign. Additionally, four patients in group A and two patients in group B presented with a limp. No significant differences were shown regarding the Harris hip score, WOMAC score, Trendelenburg sign, and limp between two groups. One hip of group A was revised by reason of dislocation at 8.3 years after surgery. One hip of group B was diagnosed with osteolysis and underwent a revision at 8.1 years after surgery. The Kaplan–Meier implants survivorship rates at the final follow‐up for all‐causes revisions in group A and group B were similar (96.7% [95% confidence interval, 90.5%–100%] and 96.2% [95% confidence interval, 89.0%–100%], respectively). Conclusions The high hip center technique is a valuable alternative to achieve excellent midterm results for Crowe II–III developmental dysplasia of the hip. Further, between the groups with differing degrees of HHC, there were no significant differences in outcomes or survivorship in our study.
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Affiliation(s)
- Junmin Shen
- Medical School of Chinese People's Liberation Army, Beijing, China.,Department of Orthopedics, The First Medical Centre, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Jingyang Sun
- Medical School of Chinese People's Liberation Army, Beijing, China.,Department of Orthopedics, The First Medical Centre, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Haiyang Ma
- Medical School of Chinese People's Liberation Army, Beijing, China.,Department of Orthopedics, The First Medical Centre, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yinqiao Du
- Medical School of Chinese People's Liberation Army, Beijing, China.,Department of Orthopedics, The First Medical Centre, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Tiejian Li
- Medical School of Chinese People's Liberation Army, Beijing, China.,Department of Orthopedics, The First Medical Centre, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yonggang Zhou
- Medical School of Chinese People's Liberation Army, Beijing, China.,Department of Orthopedics, The First Medical Centre, Chinese People's Liberation Army General Hospital, Beijing, China
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Abstract
BACKGROUND This paper presents a parametric investigation into the effect of femoroacetabular impingement (FAI) and developmental dysplasia of the hip (DDH) on the sphericity of the femoral supra-equatorial region and acetabulum. METHODS Radiographic parameters from x-rays, sphericity calculations and visualisation and joint contact area and pressure from FE models of 10 DDH, FAI and normal hips were analysed and compared both within and between hip groups. RESULTS The sphericity of the acetabulum and femoral head of both the DDH and FAI groups was found to be less than that for normal hips but the variation in sphericity was greater (range 2.4% for normal hips, compared to 3.3% and 3.1% for the FAI and DDH groups respectively). For the DDH group, femoral head sphericity was found to correlate strongly with 2 of the radiographic parameters used to diagnose the condition, CE angle and Sharp angle. For FAI and DDH hips peak contact pressure primarily occurred in Ilizaliturri Zone 2 (anterior-superior region) in the acetabulum and femoral head which corresponded with increased aspherity in this region compared to the normal hip group. These findings correlate with loading and damage patterns reported in the literature. Additionally, our analysis identified a protrusion of bone in Ilizaliturri Zones 1 and 6 (anterior-inferior region) of the acetabulum of a subgroup of FAI hips, whose existence was confirmed using a full-scale hip model fabricated using a 3D printer, which we believe could result in cartilage damage. CONCLUSION We postulate that such protrusions could potentially explain residual symptoms and unaddressed structural deformity in patients who have undergone FAI surgery.
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Affiliation(s)
- Reynol A Diaz-Lopez
- School of Engineering and Materials Science, Queen Mary University of London, London, UK
| | | | | | - Colin G Bailey
- School of Engineering and Materials Science, Queen Mary University of London, London, UK
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Gambling T, Long AF. Development and validation of a patient-centered outcome measure for young adults with pediatric hip conditions: the "Quality of Life, Concerns and Impact Measure". Patient Relat Outcome Meas 2019; 10:187-204. [PMID: 31388318 PMCID: PMC6606942 DOI: 10.2147/prom.s192672] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 04/17/2019] [Indexed: 12/26/2022]
Abstract
Purpose: To develop and validate a patient-centered, evaluative outcome measure to assess patient-significant and identified impacts of the three pediatric hip conditions (the “Quality of Life, Concerns and Impact Measure” (QoLC&I)), for use by patients and clinicians in discussions over treatment options and the evaluation of treatment and post-operative rehabilitation. Patients and methods: The measure was developed through a qualitative study, via two web-based forums (patient narratives, n=84) and one specialist orthopedic adult hip clinic (conducting interviews, n=38). The draft (1) measure was piloted in an asynchronous web-based discussion group forum; following revision, it was piloted with a group of clinicians and patients to assess its patient and clinical utility, face and content validity. The final, refined prototype measure (QoLC&I, draft 3) was subjected to psychometric evaluation. Results: A total of 230 patients provided useable data for the psychometric analysis: 70% (160) had a confirmed diagnosis of Developmental Dysplasia of the Hip, 15% (35) Perthes, 11% (26) Slipped Upper Femoral Epiphyses; 4% (9) PHC not stated. The scale showed good acceptability (few missing items, good spread, low floor/ceiling effects), relevance (76% stating they would find the measure useful in their discussions with clinicians), and good internal consistency (Cronbach’s α=0.98; average ICC=0.98). Hypotheses on convergent validity (with the General Health Questionnaire, to measure depression, and the International Hip Outcome Tool Short Form, to measure quality of life) and divergent validity (with the General Self-Efficacy Scale, to measure coping) were confirmed. Conclusion: The 64-item QoL&CI measure is a practical and valid measure addressing areas of clinical and patient significance and has potential value to assist patients and clinicians in discussions about treatment choices and treatment progress. Future research will address further psychometric testing (test–retest validity and responsiveness to change), in additional sites, and embedding the measure into clinical practice.
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Affiliation(s)
- Tina Gambling
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Andrew F Long
- School of Healthcare, University of Leeds, Leeds, UK
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D'Alessandro M, Dow K. Investigating the need for routine ultrasound screening to detect developmental dysplasia of the hip in infants born with breech presentation. Paediatr Child Health 2018; 24:e88-e93. [PMID: 30996612 DOI: 10.1093/pch/pxy081] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Objectives Breech presentation is a recognized risk factor for developmental dysplasia of the hip (DDH). Within North America, there is a lack of consensus on screening guidelines for DDH in infants with a negative physical examination of the hips. This study evaluates the need for ultrasound screening in all breech born infants to detect DDH and whether this is influenced by gender, gestational age and mode of delivery. Methods A retrospective chart review was conducted to identify breech born infants who underwent routine hip ultrasound to detect DDH between 2010 and 2015. Patients were grouped by physical exam and ultrasound findings and compared based on gender, gestational age and mode of delivery. Results Three hundred and eighteen patients were identified (191 female, 127 male; 26 preterm, 57 late preterm, 235 term; 263 caesarean section delivery, 55 vaginal delivery). Three hundred and eight patients had a negative physical exam of which 27 were diagnosed with DDH based on screening ultrasound with females predominant (P<0.05). 12.50% of females with a negative physical exam had DDH compared to 3.23% of males (P<0.05). There was no difference in the rate of DDH detected by screening ultrasound based on gestational age (P=0.94) or mode of delivery (P=0.59). Conclusions The diagnosis of DDH in breech born infants by screening ultrasound in those with a negative physical exam of the hips is more predominant in females, with no apparent association with gestational age or mode of delivery. Future analyses with larger sample sizes are needed before conclusions can be made on screening protocols.
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Affiliation(s)
| | - Kimberly Dow
- Department of Pediatrics, Queen's University, Kingston, Ontario
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Sonohata M, Kitajima M, Kawano S, Mawatari M. Nerve Palsy after Total Hip Arthroplasty without Subtrochanteric Femoral Shortening Osteotomy for a Completely Dislocated Hip Joint. Open Orthop J 2016; 10:785-792. [PMID: 28217204 PMCID: PMC5299549 DOI: 10.2174/1874325001610010785] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 10/29/2016] [Accepted: 11/03/2016] [Indexed: 11/25/2022] Open
Abstract
Background: Neurological injuries are a rare but devastating complication after total hip arthroplasty (THA). The purpose of this study was to retrospectively determine the frequency of nerve palsy after THA without subtrochanteric femoral shortening osteotomy in patients with a completely dislocated hip joint without pseudo-articulation between the femoral head and iliac bone. Methods: Between October 1999 and September 2001, nine primary THAs were performed for patients with a completely dislocated hip joint. The limb lengths, neurological abnormalities, and the extent of their neurological recovery were evaluated. Three THAs were combined with subtrochanteric femoral shortening osteotomy, and six THAs were combined without subtrochanteric femoral shortening osteotomy. Results: The mean length of the operation was 4.8 cm (range, 3.0-6.5 cm). Sciatic nerve palsy developed in four of the nine patients after THA. None of the cases with sciatic nerve palsy were combined with subtrochanteric femoral shortening osteotomy. Three of four patients did not completely recover from sciatic nerve palsy. Conclusions: THA for patients with a completely dislocated hip was associated with a high risk of nerve palsy due to excessive limb lengthening; the potential for recovery from nerve palsy was observed to be poor. Subtrochanteric femoral shortening osteotomy should be used in combination with THA in patients with a completely dislocated hip.
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Affiliation(s)
- Motoki Sonohata
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga 849-8501, Saga, Japan
| | - Masaru Kitajima
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga 849-8501, Saga, Japan
| | - Shunsuke Kawano
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga 849-8501, Saga, Japan
| | - Masaaki Mawatari
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga 849-8501, Saga, Japan
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