(iii) Adolescent hip dysplasia

Assessment of the endoprosthesis offset in a dysplastic coxarthrosis

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

Hip dysplasia in adolescence: osteotomy in childhood improves the results of periacetabular osteotomy in adolescents and young adults : a prospective study

AIMS

Developmental dysplasia of the hip (DDH) describes a pathological relationship between the femoral head and acetabulum. Periacetabular osteotomy (PAO) may be used to treat this condition. The aim of this study was to evaluate the results of PAO in adolescents and adults with persistent DDH.

METHODS

Patients were divided into four groups: A, adolescents who had not undergone surgery for DDH in childhood (25 hips); B, adolescents who had undergone surgery for DDH in childhood (20 hips); C, adults with DDH who had not undergone previous surgery (80 hips); and D, a control group of patients with healthy hips (70 hips). The radiological evaluation of digital anteroposterior views of hips included the Wiberg angle (centre-edge angle (CEA)), femoral head cover (FHC), medialization, distalization, and the ilioischial angle. Clinical assessment involved the Harris Hip Score (HHS) and gluteal muscle performance assessment.

RESULTS

Significant improvements in radiological parameters were achieved in all measurements in all groups (p < 0.05). The greatest improvement was in CEA (mean of 19° (17.2° to 22.3°) in Group B), medialization (mean of 3 mm (0.9 to 5.2) in Group C), distalization (mean of 6 mm (3.5 to 8.2) in Group B), FHC (mean of 17% (12.7% to 21.2%) in Group B), and ilioischial angle (mean of 5° (2.3° to 8.1°) in Group B). There were significant improvements in the mean HHS and gluteal muscle performance scores postoperatively in all three groups.

CONCLUSION

The greatest correction of radiological parameters and clinical outcomes was found in patients who had undergone hip surgery in childhood. Although the surgical treatment of DDH in childhood makes subsequent hip surgery more difficult due to scarring, adhesions, and altered anatomy, it requires less correction of the deformity and has a beneficial effect on the outcome of PAO in adolescence and early adulthood. Cite this article: Bone Joint J 2022;104-B(7):775-780.

An exploratory study of young women adjusting to developmental dysplasia of the hip and deciding on treatment choices

OBJECTIVE

To explore the experiences of young women adjusting to living with developmental dysplasia of the hip (DDH) and deciding on treatment choices.

METHODS

Exploratory study of a set of online postings from one message board aimed at women with DDH. Postings of five, purposively selected users were explored from first posting to the time of their peri-acetabular osteotomy surgery. Data analysis was performed through the approach of interpretive phenomenological analysis.

RESULTS

Two major concepts were prominent across participants' accounts; first, 'challenging the life course and identity as a young woman' and second, 'saving my joints'. Central was the women's description of how the diagnosis of DDH challenged the way they viewed themselves as young women. Once the women began to understand the long-term implications of having DDH they all began a quest to save their 'native joint', delaying the need for an artificial joint for as long as possible.

CONCLUSION

The findings demonstrate the personal nature and diversity of the journeys the women followed. DDH potentially provides a critical case for exploration of the process of adjustment, as its treatment pathway and rehabilitation are lengthy and both physically and emotionally demanding.