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Cummings JL, Oladeji AK, Rosenfeld S, Johnson M, Goldstein R, Georgopoulos G, Stephenson L, White NW, Hosseinzadeh P. Severity of hip dysplasia as the major factor affecting outcome of closed reduction in children with hip dysplasia. J Pediatr Orthop B 2024; 33:322-327. [PMID: 37669157 DOI: 10.1097/bpb.0000000000001122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
The objective of this study was to analyze a multicenter cohort of children with developmental dysplasia of the hip (DDH) who underwent treatment with closed reduction. We sought to report the effects that severity of hip dysplasia and age have on the development of femoral head avascular necrosis (AVN) and the need for additional procedures. All patients with DDH and minimum 2 years of follow-up who underwent closed reduction were identified. The following variables were recorded: sex, laterality of hip involvement, age, acetabular index (AI), and International Hip Dysplasia Institute (IHDI) grade. The effects of patient age and pre-procedure IHDI grade on the rate of AVN and need for additional procedures after the closed reduction were analyzed using an alpha of 0.05. Seventy-eight total hips were included in the final analysis. The average patient age was 12 months. AVN of the femoral head was reported in 24 hips (30.8%) and 32 hips (41.0%) required additional surgery. Higher pre-op IHDI grade was associated with higher risk of developing Bucholz-Ogden grades II-IV AVN of the femoral head ( P = 0.025) and requiring additional surgery ( P = 0.033) regardless of patient age. There were no statistically significant differences for the effect of age on the measured outcomes ( P > 0.05). These findings suggest that severity of dislocation (IHDI grade) is a significant risk factor for the development of AVN and need for additional procedure.
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Affiliation(s)
- Jason L Cummings
- Department of Orthopedic Surgery, Washington University in St. Louis, Saint Louis, Missouri
| | - Afolayan K Oladeji
- Department of Orthopedic Surgery, Washington University in St. Louis, Saint Louis, Missouri
| | | | - Megan Johnson
- Vanderbilt Children's Hospital, Nashville, Tennessee
| | | | | | | | - Nathan W White
- Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Pooya Hosseinzadeh
- Department of Orthopedic Surgery, Washington University in St. Louis, Saint Louis, Missouri
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McLaughlin D, De Salvo S, Brewerton K, Hui C, Bouchard M. Routine ultrasound screening for hip dysplasia in children with clubfoot is not supported. INTERNATIONAL ORTHOPAEDICS 2024; 48:1793-1797. [PMID: 38602555 DOI: 10.1007/s00264-024-06169-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/27/2024] [Indexed: 04/12/2024]
Abstract
PURPOSE Despite the existence of guidelines for screening for developmental dysplasia of the hip (DDH), there remains controversy regarding the need for routine ultrasound screening for DDH in patients with clubfoot due to an unclear correlation between the two conditions. The purpose of this study is to determine whether ultrasound screening for DDH in this population improved the diagnostic accuracy of DDH over standard assessment for patient risk factors and physical exam. METHODS This is a retrospective cross-sectional review of infants diagnosed with idiopathic clubfoot who underwent hip ultrasounds to assess for DDH as identified by keyword search in an institutional radiological database at a tertiary care paediatric hospital. Patient demographics, risk factors for DDH, physical exam findings, and ultrasound results were recorded. RESULTS Of the 120 patients who met the inclusion criteria between 2003 and 2018, 8 had hip dysplasia confirmed on ultrasound (6.7%). All these patients either had known risk factors for hip dysplasia or had an abnormal physical exam finding suggestive of hip instability or dislocation as performed by an orthopaedic surgeon on their initial consultation. CONCLUSION A detailed history to determine risk factors and a thorough physical exam are adequate to determine the need for hip ultrasound in infants with idiopathic clubfoot. Routine ultrasound screening of all patients with clubfoot is likely unnecessary and may pose a significant burden on the health care system.
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Affiliation(s)
| | - Sara De Salvo
- The Division of Orthopaedics, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Kathryn Brewerton
- The Division of Orthopaedics, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Caitlyn Hui
- The Department of Medicine, University of Toronto, Toronto, ON, Canada
- The Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Maryse Bouchard
- The Division of Orthopaedics, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
- The Division of Orthopaedics, University of Toronto, Toronto, ON, Canada.
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Shimizu T, Takahashi D, Suzuki H, Shimizu H, Ogawa T, Yokota S, Ishizu H, Iwasaki N. Validation of parameters recommended for secondary screening for developmental dysplasia of the hip in Japan. J Orthop Sci 2024; 29:1015-1019. [PMID: 37451975 DOI: 10.1016/j.jos.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 06/19/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Based on the Japanese Pediatric Orthopaedic Association's guidelines, secondary screening and imaging including ultrasonography and radiography, are recommended in infants with limited hip abduction (<70°) or in those with multiple risk factors including the following: asymmetrical skin creases, a family history of developmental dysplasia of the hip, female sex, and pelvic position at delivery. However, there is still little information regarding the usefulness of this guideline. The objective of this study was to investigate the association between the risk factors and developmental dysplasia of the hip diagnosed using ultrasound and radiography. METHODS A total of 356 infants (67 boys and 289 girls) underwent secondary ultrasonographic and radiological screening for developmental dysplasia of the hip in our hospital. Risk factors were documented from their medical records. The recommended item score, which we defined as an integrated value of the recommended item, was calculated for each patient. The limitation of hip abduction alone was a criterion for secondary screening; therefore, we defined the scores as follows: the limitation of hip abduction scored 2 points and other recommended scores were assigned 1 point. If the recommended item score was 2 points or more, we classified the infants as high-risk. RESULTS A total of 280 of 356 infants were included in the high-risk group, which showed a higher ratio of cases with abnormal imaging findings than the low-risk group. According to the multivariate logistic regression analyses among the recommended items, being female, skin asymmetry, and limb limitation were identified as independent risk factors for imaging abnormality and the need for Pavlik harness treatment. CONCLUSIONS The recommended items for secondary screening based on the Japanese Pediatric Orthopaedic Association's guidelines could be useful for screening infants in need of treatment.
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Affiliation(s)
- Tomohiro Shimizu
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nish-7, Kita-ku, Sapporo 060-8638, Japan.
| | - Daisuke Takahashi
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nish-7, Kita-ku, Sapporo 060-8638, Japan
| | - Hisataka Suzuki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nish-7, Kita-ku, Sapporo 060-8638, Japan
| | - Hirokazu Shimizu
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nish-7, Kita-ku, Sapporo 060-8638, Japan
| | - Takuya Ogawa
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nish-7, Kita-ku, Sapporo 060-8638, Japan
| | - Shunichi Yokota
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nish-7, Kita-ku, Sapporo 060-8638, Japan
| | - Hotaka Ishizu
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nish-7, Kita-ku, Sapporo 060-8638, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nish-7, Kita-ku, Sapporo 060-8638, Japan
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Huang X, Cheng X, Gao S, Liu Y, Su Y, Feng C. Prediction of the Labrum Shape in Patients With Developmental Dysplasia of the Hip Based on Pelvic Radiography. J Pediatr Orthop 2024; 44:e490-e495. [PMID: 38533533 DOI: 10.1097/bpo.0000000000002676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
BACKGROUND The shape of the labrum is strongly correlated with outcomes of developmental dysplasia of the hip (DDH). Magnetic resonance imaging (MRI) is the generally preferred imaging technique for observing the labrum. PURPOSE We aimed to find a correlation between the labrum shape and anterior-posterior (AP) pelvic measurements in children with DDH. METHODS Preoperative AP pelvic x-ray radiographs and MRI of patients with DDH from January 2019 to December 2021 were retrospectively collected and divided into three groups by labrum shape on MRI: everted, partly inverted, and inverted. The acetabular length ratio (RAL) in patients with unilateral DDH and the ratio of acetabular length to interpedicular distance (RALI) in all patients were calculated. T-tests were used to analyze differences between the groups. Receiver operating characteristic curve (ROC) analysis was performed between the everted group and the partly inverted and inverted groups. RESULTS We found significant differences in RAL between the everted and partly inverted groups, everted and inverted groups, and everted and combined groups. The ROC analysis showed that the best cutoff value for RAL was 0.945 between the everted and combined groups, with an area under the curve (AUC) of 88.4%. The sensitivity at the best RAL value was 0.783, and the specificity was 0.887. Moreover, we observed a significant difference in RALI between the everted, partly inverted, and inverted groups, as well as between the everted and combined groups. The optimal cutoff value for RALI between the everted and combined groups was 0.575, with an AUC of 74.5%. The sensitivity at the best RALI value was 0.765, and the specificity was 0.674. CONCLUSION The RAL or RALI values on pelvic AP radiographs can be used to predict the shape of the labrum. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Xinyan Huang
- Department of Radiology, Children's Hospital of Chongqing Medical University; Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders
| | - Xiang Cheng
- Department of Radiology, Children's Hospital of Chongqing Medical University; Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders
| | - Sijie Gao
- Department of Radiology, Children's Hospital of Chongqing Medical University
| | - Yinxin Liu
- Department of Radiology, Children's Hospital of Chongqing Medical University
| | - Yuxi Su
- Department of Orthopedics, Children's Hospital of Chongqing Medical University; Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Jiangxi Hospital Affiliated Children's Hospital of Chongqing Medical University
| | - Chuan Feng
- Department of Radiology, Children's Hospital of Chongqing Medical University, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders
- China International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing, China
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Sato T, Yamate S, Utsunomiya T, Inaba Y, Ike H, Kinoshita K, Doi K, Kawano T, Shiomoto K, Hara T, Sonoda K, Kaneuji A, Takahashi E, Shimizu T, Takahashi D, Kohno Y, Kabata T, Inoue D, Matsuda S, Goto K, Mawatari T, Baba S, Takagi M, Ito J, Nakashima Y. Life Course Epidemiology of Hip Osteoarthritis in Japan: A Multicenter, Cross-Sectional Study. J Bone Joint Surg Am 2024; 106:966-975. [PMID: 38626018 DOI: 10.2106/jbjs.23.01044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/18/2024]
Abstract
BACKGROUND The incidence of developmental dysplasia of the hip (DDH) in Japanese newborns has reduced drastically following a primary prevention campaign initiated around 1972 to 1973; this perinatal education campaign promoted maintaining the hips of newborns in the naturally flexed-leg position. The purpose of the present study was to describe the life course epidemiology of hip osteoarthritis (OA) in adolescent and adult patients and to assess its association with exposure to the primary prevention campaign for DDH. METHODS We included new patients with hip OA diagnosed from January 1, 2022, to December 31, 2022, at 12 core hospitals (8 special-function hospitals and 4 regional medical care support hospitals). The trend in the percentage of hips with a history of DDH treatment in childhood was estimated with use of a centered moving average using the birth year of the patient. We compared the prevalence of severe subluxation (Crowe type II, III, or IV) between patients with secondary hip OA due to hip dysplasia who were born in or before 1972 and those who were born in or after 1973. RESULTS Overall, 1,095 patients (1,381 hips) were included. The mean age at the time of the survey was 63.5 years (range, 15 to 95 years). A total of 795 patients (1,019 hips; 73.8% of hips) were diagnosed with secondary OA due to hip dysplasia. Approximately 13% to 15% of hips among patients born from 1963 to 1972 had a history of DDH treatment in childhood; however, the percentage decreased among patients born in or after 1973. The prevalence of severe subluxation (Crowe type II, III, or IV) among patients born in or after 1973 was 2.4%, which was significantly less than that among patients born in or before 1972 (11.1%; odds ratio, 0.20; p < 0.001). CONCLUSIONS As of 2022, secondary hip OA due to hip dysplasia is still responsible for most new cases of adolescent and adult hip OA seen in core hospitals in Japan. However, the perinatal education campaign initiated 50 years ago, which utilized a population approach and advocated for maintaining the hips of newborns in the naturally flexed-leg position, may have improved the environmental factors of DDH, as indicated by the apparently reduced need for treatment of DDH in childhood and the associated severe subluxation. This may result in a reduced need for challenging hip surgery later in life. LEVEL OF EVIDENCE Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Taishi Sato
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoshi Yamate
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takeshi Utsunomiya
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yutaka Inaba
- Department of Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Hiroyuki Ike
- Department of Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Koichi Kinoshita
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Kenichiro Doi
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Tsutomu Kawano
- Department of Orthopaedic Surgery, Kyushu Rosai Hospital, Kitakyushu, Japan
| | - Kyohei Shiomoto
- Department of Orthopaedic Surgery, Kyushu Rosai Hospital, Kitakyushu, Japan
| | - Toshihiko Hara
- Department of Orthopaedic Surgery, Aso Iizuka Hospital, Iizuka, Japan
| | - Kazuhiko Sonoda
- Department of Orthopaedic Surgery, Aso Iizuka Hospital, Iizuka, Japan
| | - Ayumi Kaneuji
- Department of Orthopaedic Surgery, Kanazawa Medical University, Kahoku, Japan
| | - Eiji Takahashi
- Department of Orthopaedic Surgery, Kanazawa Medical University, Kahoku, Japan
| | - Tomohiro Shimizu
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Daisuke Takahashi
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yusuke Kohno
- Department of Orthopaedic Surgery, Japan Community Healthcare Organization (JCHO) Kyushu Hospital, Kitakyushu, Japan
| | - Tamon Kabata
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Daisuke Inoue
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Koji Goto
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Taro Mawatari
- Department of Orthopaedic Surgery, Hamanomachi Hospital, Fukuoka, Japan
| | - Shoji Baba
- Department of Orthopaedic Surgery, Hamanomachi Hospital, Fukuoka, Japan
| | - Michiaki Takagi
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Juji Ito
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Sasaki Y, Suzuki D, Tokita R, Takashima H, Matsumura H, Nagoya S. Specific pelvic shape in patients with developmental dysplasia of the hip on 3D morphometric homologous model analysis. PLoS One 2024; 19:e0300938. [PMID: 38829863 PMCID: PMC11146717 DOI: 10.1371/journal.pone.0300938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 05/18/2024] [Indexed: 06/05/2024] Open
Abstract
PURPOSE To clarify the morphological factors of the pelvis in patients with developmental dysplasia of the hip (DDH), three-dimensional (3D) pelvic morphology was analyzed using a template-fitting technique. METHODS Three-dimensional pelvic data of 50 patients with DDH (DDH group) and 3D pelvic data of 50 patients without obvious pelvic deformity (Normal group) were used. All patients were female. A template model was created by averaging the normal pelvises into a symmetrical and isotropic mesh. Next, 100 homologous models were generated by fitting the pelvic data of each group of patients to the template model. Principal component analysis was performed on the coordinates of each vertex (15,235 vertices) of the pelvic homologous model. In addition, a receiver-operating characteristic (ROC) curve was calculated from the sensitivity of DDH positivity for each principal component, and principal components for which the area under the curve was significantly large were extracted (p<0.05). Finally, which components of the pelvic morphology frequently seen in DDH patients are related to these extracted principal components was evaluated. RESULTS The first, third, and sixth principal components showed significantly larger areas under the ROC curves. The morphology indicated by the first principal component was associated with a decrease in coxal inclination in both the coronal and horizontal planes. The third principal component was related to the sacral inclination in the sagittal plane. The sixth principal component was associated with narrowing of the superior part of the pelvis. CONCLUSION The most important factor in the difference between normal and DDH pelvises was the change in the coxal angle in both the coronal and horizontal planes. That is, in the anterior and superior views, the normal pelvis is a triangle, whereas in DDH, it was more like a quadrilateral.
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Affiliation(s)
- Yui Sasaki
- Division of Rehabilitation, Hitsujigaoka Hospital, Sapporo, Japan
| | - Daisuke Suzuki
- Department of Health Sciences, Hokkaido Chitose Collage of Rehabilitation, Chitose, Japan
| | - Ryo Tokita
- Department of Rehabilitation, Sapporo Medical University Hospital, Sapporo, Japan
| | - Hiroyuki Takashima
- Division of Biomedical Science and Engineering, Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Hirofumi Matsumura
- Department of Physical Anthropology, School of Health Science, Sapporo Medical University, Sapporo, Japan
| | - Satoshi Nagoya
- Division of Orthopaedic Surgery, Sapporo Kojinkai Memorial Hospital, Sapporo, Japan
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Tan SHS, Lim JXY, Lim AKS, Hui JHP. Risk factors for a false negative Ortolani and Barlow examination in developmental dysplasia of the hip. Orthop Traumatol Surg Res 2024; 110:103796. [PMID: 38081355 DOI: 10.1016/j.otsr.2023.103796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 02/01/2023] [Accepted: 02/10/2023] [Indexed: 12/18/2023]
Abstract
INTRODUCTION Although universal screening by neonatal clinical examination with Ortolani and Barlow manoeuvres is widely adopted, its role as a sole screening tool is controversial due to its poor sensitivity and failure in identifying hip joints that eventually require surgical intervention. HYPOTHESIS This study aims to identify risk factors for a false negative Ortolani and Barlow examination in neonatal screening for DDH. The hypothesis is that risk factors for developmental dysplasia of the hips could similarly be risk factors for a false negative Ortolani and Barlow examination. MATERIAL AND METHODS In the 14-year retrospective cohort study, all newborn infants born in a single institution from 1st January 1999 to 31st December 2013 were screened clinically with the Ortolani/Barlow manoeuvre by a neonatologist. Infants with positive risk factors, despite a normal clinical examination, were then scheduled for bilateral hip ultrasound in the first three months of life and evaluated according to the Graf's method, Harcke's method of dynamic ultrasound screening and Terjesen's method of evaluation for femoral head coverage. RESULTS A total of 164 infants with normal Ortolani and Barlow examinations were scheduled for bilateral hip ultrasound due to the presence of risk factors. Amongst these, 32 (19.5%) infants were evaluated to have an abnormal hip on ultrasound. Breech position was the only statistically significant risk factor for a false negative Ortolani/Barlow examination (14/34, 41.2% vs. 18/112, 13.8%; p<0.001). DISCUSSION Sonographic hip examinations are recommended for all infants with breech presentation even if they have a normal Ortolani and Barlow examination. LEVEL OF EVIDENCE III; case-control study.
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Affiliation(s)
- Si Heng Sharon Tan
- Department of Orthopaedic Surgery, National University Health System (NUHS) Tower Block Level 11, 1E Kent Ridge Road, Singapore 119074, Singapore.
| | - Joel Xue Yi Lim
- Department of Orthopaedic Surgery, National University Health System (NUHS) Tower Block Level 11, 1E Kent Ridge Road, Singapore 119074, Singapore
| | - Andrew Kean Seng Lim
- Department of Orthopaedic Surgery, National University Health System (NUHS) Tower Block Level 11, 1E Kent Ridge Road, Singapore 119074, Singapore
| | - James Hoi Po Hui
- Department of Orthopaedic Surgery, National University Health System (NUHS) Tower Block Level 11, 1E Kent Ridge Road, Singapore 119074, Singapore
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Giorgi V, Apostolo G, Bertelè L. Treatment of developmental hip dysplasia with manual therapy following Pavlik harness failure: a case report with long-term follow-up. J Man Manip Ther 2024; 32:352-361. [PMID: 38706305 PMCID: PMC11216241 DOI: 10.1080/10669817.2024.2349334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 04/24/2024] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND Developmental dysplasia of the hip (DDH) is a common musculoskeletal disorder in newborns, ranging from mild dysplasia to complete dislocation. Early detection and intervention are crucial for managing DDH. However, in some cases, standard orthopedic treatments such as the Pavlik harness fail, and alternative approaches are needed. Our study explores the possibility that manual therapy, specifically the Mézières-Bertelè Method (MBM), could be beneficial in cases of DDH that are resistant to conventional treatments. CASE DESCRIPTION We present a case of a 20-month-old female who had been suffering from persistent DDH (Graf's type IIIC on the left), pain and limping, despite previous conventional treatments, including the Pavlik harness. The patient received daily MBM sessions for six months, followed by maintenance sessions every two months. OUTCOMES After undergoing the MBM treatment, the patient showed clinical improvements, such as normal neuromotor development and restored hip joint parameters. We observed normal walking and running abilities, and X-ray parameters returned to normal levels. The patient sustained positive outcomes during long-term follow-up until the age of 7. CONCLUSION The MBM manual therapy was used to treat a challenging case of DDH resistant to conventional treatment. This case report suggests a possible correlation between manual therapy and improved outcomes in resistant DDH and highlights the potential relevance of addressing the inherent musculoskeletal components of the condition.
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Affiliation(s)
- Valeria Giorgi
- Rehabilitation Center, Apostolo Foundation, Lecco, Italy
| | | | - Laura Bertelè
- Rehabilitation Center, Apostolo Foundation, Lecco, Italy
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9
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Shon SW, Park SJ, Bae MH, Park KH. The usefulness of universal ultrasound before hospital discharge for early diagnosing hip dysplasia in Korean neonates with breech presentation in a single center: A retrospective study. Medicine (Baltimore) 2024; 103:e38316. [PMID: 38787997 PMCID: PMC11124717 DOI: 10.1097/md.0000000000038316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 04/30/2024] [Indexed: 05/26/2024] Open
Abstract
Developmental dysplasia of the hip (DDH) is a broad-spectrum disorder. Early diagnosis and treatment are important for improved prognosis and a lower risk of long-term complications. Selecting high-risk infants is important for the early diagnosis of DDH using ultrasonography; however, there are no standard international guidelines. This study aimed to identify the usefulness of universal ultrasound before hospital discharge in breech-born neonates and proposes selective ultrasound for high-risk patients. A retrospective chart review was conducted to identify breech-born neonates who underwent hip ultrasonography before discharge for the detection of DDH between 2019 and 2023. Patients were categorized into DDH and non-DDH groups according to the ultrasound results. We compared sex, gestational age, birth weight, first-born status, twin pregnancy, associated anomalies, presence of symptoms, physical examination results, and timing of the first hip ultrasound. The medical records of the mothers were reviewed to identify the amount of amniotic fluid and duration of breech presentation. This study included 102 patients, of whom 62 and 40 were assigned to the non-DDH and DDH groups, respectively. Congenital anomalies, positive symptoms, and positive physical examination results were significant risk factors. However, female sex, first-born status, and oligohydramnios were not statistically significant. The duration of breech presentation during pregnancy was not significant. Additionally, the risk of Pavlik harnesses was higher in patients who underwent a positive physical examination. Universal ultrasonography before discharge is not recommended for the early diagnosis of DDH in all breech-born neonates because of the high rate of overdiagnosis. We recommend that ultrasonography be performed in patients with congenital anomalies, except for foot problems, or in those with a positive physical examination conducted by trained specialists.
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Affiliation(s)
- Seung Woo Shon
- Department of Emergency Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Su Jeong Park
- Department of Pediatrics, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Mi Hye Bae
- Department of Pediatrics, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Kyung Hee Park
- Department of Pediatrics, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
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Caruso G, Gambuti E, Spadoni E, Filipponi S, Saracco A, Artioli F, Galla A, Massari L. Incidence of risk factors in developmental dysplasia of the hip: a retrospective study on 18,954 cases. Hip Int 2024:11207000241248416. [PMID: 38767233 DOI: 10.1177/11207000241248416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
BACKGROUND DDH is 1 of the most important causes of childhood disability. A diagnosis of instability can be made in the neonatal period via the Ortolani and Barlow manoeuvres. However, clinical examination, although highly specific, has poor sensitivity as compared to ultrasound. There is controversy between the necessity of universal screening for dysplasia of all newborns or selective screening reserved for those with clinical signs of instability or known risk factors of DDH. AIM To analyse the risk factors of congenital hip dysplasia in a consecutive case series of children referred for diagnosis and treatment of DDH. MATERIALS AND METHODS This was a cross-sectional study on infants consecutively examined between January 2000 and December 2019 at the Marino Ortolani Centre in Ferrara, Italy. The first 3 types on Graf's classification were considered physiological (1A, 1B, 2A+), while the last 6 pathological (2A-, 2B, 2C, 2D, 3, 4). RESULTS 18,954 infants met the inclusion criteria and were therefore considered eligible for the study. Of these 18,954 infants, 56% (n = 10,629) were females and 44% (n = 8325) were males. According to Graf classification, 34.9% (n = 6621) were 1A, 52.7% (n = 9999) were 1B, 4.0% (n = 753) were 2A+, 2.5% (n = 478) were 2A-, 1.5% (n = 284) were 2B, 1% (n = 196) were 2C, 1.3% (n = 243) were 2D, 1% (n = 193) were 3 and 1.0% (n = 187) were 4. The most significant risk factor was the female gender (OR 5.36; 95% CI, 4.63-6.20) followed by a family history (OR 2.35; 95% CI, 2.08-2.65), then skeletal pathologies (OR 2.04; 95% CI, 1.21-3.42), oligohydramnios (OR 1.75; 95% CI, 1.44-2.13), and finally breech presentation (OR 1.42: 95% CI, 1.27-1.60). CONCLUSIONS Based on our data, family history, musculoskeletal disease, oligohydramnios and breech presentation are the main risk factors for DDH development, as is the female sex.
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Affiliation(s)
- Gaetano Caruso
- Department of Neurosciences and Rehabilitation, University of Ferrara, Ferrara, Italy
- Orthopaedics and Traumatology Unit, S. Anna University Hospital of Ferrara, Ferrara, Italy
| | - Edoardo Gambuti
- Department of Neurosciences and Rehabilitation, University of Ferrara, Ferrara, Italy
- Orthopaedics and Traumatology Unit, S. Anna University Hospital of Ferrara, Ferrara, Italy
| | - Elisa Spadoni
- Department of Neurosciences and Rehabilitation, University of Ferrara, Ferrara, Italy
- Orthopaedics and Traumatology Unit, S. Anna University Hospital of Ferrara, Ferrara, Italy
| | - Sara Filipponi
- Department of Neurosciences and Rehabilitation, University of Ferrara, Ferrara, Italy
- Orthopaedics and Traumatology Unit, S. Anna University Hospital of Ferrara, Ferrara, Italy
| | - Achille Saracco
- Department of Neurosciences and Rehabilitation, University of Ferrara, Ferrara, Italy
- Orthopaedics and Traumatology Unit, S. Anna University Hospital of Ferrara, Ferrara, Italy
| | - Francesca Artioli
- Orthopaedics and Traumatology Unit, S. Anna University Hospital of Ferrara, Ferrara, Italy
- Marino Ortolani Centre for diagnosis and treatment of developmental dysplasia of the hip, Ferrara, Italy
| | - Ambra Galla
- Department of Neurosciences and Rehabilitation, University of Ferrara, Ferrara, Italy
- Orthopaedics and Traumatology Unit, S. Anna University Hospital of Ferrara, Ferrara, Italy
| | - Leo Massari
- Department of Neurosciences and Rehabilitation, University of Ferrara, Ferrara, Italy
- Orthopaedics and Traumatology Unit, S. Anna University Hospital of Ferrara, Ferrara, Italy
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11
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Lee S, Choi YH, Cheon JE, Lee SB, Cho YJ. [Pediatric Hip Disorders]. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2024; 85:531-548. [PMID: 38873372 PMCID: PMC11166597 DOI: 10.3348/jksr.2024.0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/19/2024] [Accepted: 03/14/2024] [Indexed: 06/15/2024]
Abstract
Developmental dysplasia of the hip is a condition characterized by hip joint instability due to acetabular dysplasia in infancy, necessitating precise ultrasound examination. Legg-Calvé-Perthes disease is caused by a temporary disruption in blood flow to the femoral head during childhood, progressing through avascular, fragmentation, re-ossification, and residual stages. Slipped capital femoral epiphysis is a condition where the femoral head shifts medially along the epiphyseal line during adolescence due to stress, such as weight-bearing. Differentiating between transient hip synovitis and septic arthritis may require joint fluid aspiration. Osteomyelitis can be associated with soft tissue edema and osteolysis. When multiple lesions are present, it is essential to distinguish between Langerhans cell histiocytosis and metastatic neuroblastoma. This review will introduce imaging techniques and typical findings for these conditions.
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12
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Moon KR, Byon SS, Kim SH, Lee BD. Automated assessment of pelvic radiographs using deep learning: A reliable diagnostic tool for pelvic malalignment. Heliyon 2024; 10:e29677. [PMID: 38660256 PMCID: PMC11040132 DOI: 10.1016/j.heliyon.2024.e29677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 04/12/2024] [Accepted: 04/12/2024] [Indexed: 04/26/2024] Open
Abstract
Pelvic malalignment leads to general imbalance and adversely affects leg length. Timely and accurate diagnosis of pelvic alignment in patients is crucial to prevent additional complications arising from delayed treatment. Currently, doctors typically assess pelvic alignment either manually or through radiography. This study aimed to develop and assess the validity of a deep learning-based system for automatically measuring 10 radiographic parameters necessary for diagnosing pelvic displacement using standing anteroposterior pelvic X-rays. Between March 2016 and June 2021, pelvic radiographs from 1215 patients were collected. After applying specific selection criteria, 550 pelvic radiographs were chosen for analysis. These data were utilized to develop a deep learning-based system capable of automatically measuring radiographic parameters relevant to pelvic displacement diagnosis. The system's diagnostic accuracy was evaluated by comparing automatically measured values with those assessed by a clinician using 200 radiographs selected from the initial 550. The results indicated that the system exhibited high reliability, accuracy, and reproducibility, with a Pearson correlation coefficient of ≥0.9, an intra-class correlation coefficient of ≥0.9, a mean absolute error of ≤1 cm, mean square error of ≤1 cm, and root mean square error of ≤1 cm. Moreover, the system's measurement time for a single radiograph was found to be 18 to 20 times faster than that required by a clinician for manual inspection. In conclusion, our proposed deep learning-based system effectively utilizes standing anteroposterior pelvic radiographs to precisely and consistently measure radiographic parameters essential for diagnosing pelvic displacement.
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Affiliation(s)
- Ki-Ryum Moon
- Department of Computer Science, Kyonggi University, Suwon-si, Gyeonggi-do, 16227, Republic of Korea
| | - Shi Sub Byon
- AI Lab., HealthHub, Co. Ltd., Seoul, Republic of Korea
| | - Sung Hyun Kim
- Human Medical Imaging and Intervention Center, Seoul, Republic of Korea
| | - Byoung-Dai Lee
- Department of Computer Science, Kyonggi University, Suwon-si, Gyeonggi-do, 16227, Republic of Korea
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13
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Wang Y, Jiang Q, Xie D, Li X, Wang H, Zeng C, Lei G, Yang T. In-hospital complications and readmission patterns in 13,937 patients with developmental dysplasia of the hip undergoing total hip arthroplasty: Evidence from the Chinese national database. Surgeon 2024; 22:99-106. [PMID: 37872053 DOI: 10.1016/j.surge.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/15/2023] [Accepted: 10/10/2023] [Indexed: 10/25/2023]
Abstract
PURPOSE Clarifying the prognosis and readmission patterns of patients with developmental dysplasia of the hip (DDH) following total hip arthroplasty (THA) would provide important references for clinical management for this population. Using the Chinese national inpatient database (i.e., Hospital Quality Monitoring System [HQMS]), we aimed to compare in-hospital complications and readmission patterns following THA in patients with DDH and primary osteoarthritis (OA). METHODS Patients undergoing THA for DDH and OA between 2013 and 2019 were identified using the HQMS. Demographics and clinical characteristics were compared between the two groups. After propensity score matching, in-hospital complications and readmission patterns were compared using a logistic regression model. RESULTS According to the analysis of 13,937 propensity-score matched pairs, there were no significant differences in the incidence of in-hospital death (0.01 % vs 0.04 %, P = 0.142), transfusion (8.09 % vs 7.89 %, P = 0.536), wound infection (0.31 % vs 0.25 %, P = 0.364), deep venous thrombosis (0.45 % vs 0.43 %, P = 0.786), pulmonary embolism (0.03 % vs 0.05 %, P = 0.372) or all-cause readmission (2.87 % vs 3.12 %, P = 0.219) between two groups. However, DDH patients had higher surgical readmission rates than OA patients (1.43 % vs 1.14 %, P = 0.033). When analyzing causes of surgical readmission, DDH patients had increased risk of dislocation (0.37 % vs 0.21 %, P = 0.011) and aseptic loosening (0.17 % vs 0.07 %, P = 0.024) than OA patients. CONCLUSION DDH patients had an increased risk of surgical readmission following THA, mainly driven by dislocation and aseptic loosening, which should be recognized and appropriately prevented.
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Affiliation(s)
- Yuqing Wang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qiao Jiang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Dongxing Xie
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiaoxiao Li
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China
| | - Haibo Wang
- China Standard Medical Information Research Center, Shenzhen, Guangdong, China; Clinical Trial Unit, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Chao Zeng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China; Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China; Hunan Engineering Research Center for Osteoarthritis, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Guanghua Lei
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China; Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China; Hunan Engineering Research Center for Osteoarthritis, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Tuo Yang
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China; Health Management Center, Xiangya Hospital, Central South University, Changsha, Hunan, China.
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14
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Chen YP, Fan TY, Chu CC, Lin JJ, Ji CY, Kuo CF, Kao HK. Automatic and human level Graf's type identification for detecting developmental dysplasia of the hip. Biomed J 2024; 47:100614. [PMID: 37308078 PMCID: PMC10955653 DOI: 10.1016/j.bj.2023.100614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/11/2023] [Accepted: 06/07/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Developmental dysplasia of the hip (DDH) is a common congenital disorder that may lead to hip dislocation and requires surgical intervention if left untreated. Ultrasonography is the preferred method for DDH screening; however, the lack of experienced operators impedes its application in universal neonatal screening. METHODS We developed a deep neural network tool to automatically register the five keypoints that mark important anatomical structures of the hip and provide a reference for measuring alpha and beta angles following Graf's guidelines, which is an ultrasound classification system for DDH in infants. Two-dimensional (2D) ultrasonography images were obtained from 986 neonates aged 0-6 months. A total of 2406 images from 921 patients were labeled with ground truth keypoints by senior orthopedists. RESULTS Our model demonstrated precise keypoint localization. The mean absolute error was approximately 1 mm, and the derived alpha angle measurement had a correlation coefficient of R = 0.89 between the model and ground truth. The model achieved an area under the receiver operating characteristic curve of 0.937 and 0.974 for classifying alpha <60° (abnormal hip) and <50° (dysplastic hip), respectively. On average, the experts agreed with 96% of the inferenced images, and the model could generalize its prediction on newly collected images with a correlation coefficient higher than 0.85. CONCLUSIONS Precise localization and highly correlated performance metrics suggest that the model can be an efficient tool for assisting DDH diagnosis in clinical settings.
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Affiliation(s)
- Yueh-Peng Chen
- Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Master of Science Degree Program in Innovation for Smart Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tzuo-Yau Fan
- Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Department of Artificial Intelligence Research and Development, Chang Gung Medical Technology Co., Ltd., Linkou, Taiwan
| | - Cheng-Cj Chu
- Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Jainn-Jim Lin
- Division of Pediatric Critical Care Medicine and Pediatric Neurocritical Care Center, Chang Gung Children's Hospital and Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chin-Yi Ji
- Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Department of Artificial Intelligence Research and Development, Chang Gung Medical Technology Co., Ltd., Linkou, Taiwan
| | - Chang-Fu Kuo
- Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
| | - Hsuan-Kai Kao
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Bone and Joint Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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15
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Laborie LB, Rasmussen H, Jacobsen KK, Gundersen T, Rosendahl K. Neonatal Ultrasound and Radiographic Markers of Hip Dysplasia in Young Adults. Pediatrics 2024; 153:e2023064564. [PMID: 38501191 DOI: 10.1542/peds.2023-064564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/11/2024] [Indexed: 03/20/2024] Open
Abstract
OBJECTIVES To examine radiologic outcomes at skeletal maturity of sonographically normal, immature, mildly, and severely dysplastic newborn hips. METHODS During 1988 to 1990, 11 925 newborns were enrolled in a randomized controlled trial examining screening strategies for developmental hip dysplasia. In total, 4469 were invited to clinical and radiologic follow-up 18 years later, of which 1735 had received neonatal ultrasound. Radiographic markers for dysplasia in left adult hips included the center-edge (CE) angle. RESULTS At follow-up, 984 of 1735 (56.7%) with newborn ultrasound met, of which 966 (614 females) had valid radiographs and were thus included. For females, 34 (10.2%) and 1 (0.3%) of the 332 sonographically normal left neonatal hips were judged borderline (20°≤ CE <25°) or dysplastic (CE <20°) at skeletal maturity respectively. Corresponding numbers were 36 (19.7%) and 3 (1.6%) of the 183 immature, 12 (15.6%) and 2 (2.6%) of the 77 mildly dysplastic, and 3 (13.6%) and 3 (13.6%) of the 22 severely dysplastic neonatal left hips (P ≤ .001). In males, no associations were found. In females, adult joint hypermobility was associated with sonographic neonatal hip instability (P = .046), as well as with adult acetabular dysplasia (P = .024). CONCLUSIONS Significant associations between neonatal hip phenotypes and adult dysplasia were revealed in females. This indicates the possibility of different mechanisms affecting the course of developmental dysplasia of the hip for females and males, prompting consideration of prolonged clinical and radiologic follow-up for females with dysplastic neonatal hips. Results in males are limited by low numbers of dysplastic hips. The significance of joint hypermobility warrants further investigation.
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Affiliation(s)
- Lene B Laborie
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Section for Pediatric Radiology, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Hanne Rasmussen
- Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
- Orthopedic Surgery, Aleris Health Hospital, Tromsø, Norway
| | - Kaya K Jacobsen
- Department of Orthopedic Surgery, Førde Central Hospital, Førde, Norway
| | - Trude Gundersen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Karen Rosendahl
- Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
- Section of Paediatric Radiology, University Hospital of North Norway, Tromsø, Norway
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16
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Kolovos S, Sioutis S, Polyzou M, Papakonstantinou ME, Karampikas V, Altsitzioglou P, Serenidis D, Koulalis D, Papagelopoulos PJ, Mavrogenis AF. The risk of DDH between breech and cephalic-delivered neonates using Graf ultrasonography. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1103-1109. [PMID: 37947897 DOI: 10.1007/s00590-023-03770-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 10/23/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE Developmental dysplasia of the hip (DDH) is one of the most common musculoskeletal disorder in infants. The most significant risk factors include female gender, breech presentation, left hip and family history. In this study, we utilized the Graf method at different time intervals to evaluate both breech-delivered and cephalic-born newborns. The objectives were to compare the incidence of DDH in cephalic and breech-delivered neonates and investigate whether the hip joints of neonates delivered in the breech position exhibit a distinct maturation pattern. MATERIAL AND METHODS We studied prospectively 618 hip joints (309 newborns). Each hip joint was examined with the Graf method in four time periods as follows: Phase #1 (0-1 weeks), Phase #2 (1-4 weeks), Phase #3 (4-7 weeks), and Phase #4 (7-10 weeks). The α and β angles for each hip joint were measured, and the hips were classified according to Graf classification. With our statistical analysis within the different phases, we were able to investigate potential variations in the maturation patterns between newborns delivered in the breech and cephalic delivery positions. RESULTS A significant difference (at the 5% level) was observed in Phase 1 between breech and cephalic-delivered neonates (35.6-8.6%). This difference tended to decrease in next phases (13.6-1% in Phase 2, 2.5-0% in Phase 3 and 1.7-0% in Phase 4). A significant difference (at the 5% level) for cephalic-delivered neonates was also observed between Phase 1 and Phase 4 (8.5-0%), but the percentages were low. Additionally, the breech-delivered had extreme difference in incidence of DDH from Phase 1 to Phase 4 (35.6-11.9%, 2.5%, and 1.7%, respectively). CONCLUSION It appears that there is an actual difference in the incidence of DDH between breech-delivered and cephalic-delivered neonates, although the difference may be less significant than previously considered. The majority of the breech-delivered neonates that were initially considered as pathological (Phase 1) are, in fact, healthy. This is ascertained in subsequent ultrasound examinations conducted in later phases (Phases 2-4), when the incidence of pathological cases decreases. This could be attributed to potential different maturation pattern between these groups.
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Affiliation(s)
- Stylianos Kolovos
- Department of Orthopaedics, General Hospital of Larisa, Larisa, Greece
| | - Spyridon Sioutis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Maria Polyzou
- Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Herne, Germany
| | - Maria-Eleni Papakonstantinou
- Third Department of Paediatrics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Vasileios Karampikas
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Pavlos Altsitzioglou
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Dimitrios Serenidis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Dimitrios Koulalis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Panayiotis J Papagelopoulos
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
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17
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Krysta W, Dudek P, Pulik Ł, Łęgosz P. Screening of Developmental Dysplasia of the Hip in Europe: A Systematic Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:97. [PMID: 38255410 PMCID: PMC10814691 DOI: 10.3390/children11010097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/07/2024] [Accepted: 01/09/2024] [Indexed: 01/24/2024]
Abstract
BACKGROUND Developmental dysplasia of the hip (DDH) is a prevalent orthopaedic disorder in children, and screening methods vary across regions due to local health policies. The purpose of this review is to systematise the different ultrasound screening strategies for detecting DDH in newborns in Europe. METHODS Eligible studies from the PubMed, Embase, and Scopus databases, published between 1 January 2018 and 18 March 2023, were included. The inclusion criteria specified a European origin, a focus on newborn human patients, and information on ultrasound for DDH detection. RESULTS In total, 45 studies were included, covering 18 countries. Among them, six nations (Austria, Bosnia and Herzegovina, Poland, Slovenia, the Czech Republic, and Germany) perform universal ultrasound screening. The timing of the first ultrasound varies, with Austria and the Czech Republic within the 1st week, Bosnia and Herzegovina on the day of birth, Poland between 1 and 12 weeks, and Germany before the 6th week. The Graf method is the most popular ultrasound technique used. CONCLUSIONS There is no consensus on the optimal DDH detection approach in Europe. Varied screening methods stem from epidemiological, cultural, and economic differences among countries.
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Affiliation(s)
- Wojciech Krysta
- Student Scientific Association of Reconstructive and Oncology Orthopaedics, Department of Orthopaedics and Traumatology, Medical University of Warsaw, 02-005 Warsaw, Poland; (W.K.); (P.D.)
| | - Patryk Dudek
- Student Scientific Association of Reconstructive and Oncology Orthopaedics, Department of Orthopaedics and Traumatology, Medical University of Warsaw, 02-005 Warsaw, Poland; (W.K.); (P.D.)
| | - Łukasz Pulik
- Department of Orthopaedics and Traumatology, Medical University of Warsaw, 02-005 Warsaw, Poland;
| | - Paweł Łęgosz
- Department of Orthopaedics and Traumatology, Medical University of Warsaw, 02-005 Warsaw, Poland;
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18
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Håberg Ø, Foss OA, Gundersen T, Bjerkestrand Lian Ø, Slettvåg Hoel M, Holen KJ. The incidence of late-detected developmental dysplasia of the hip and its functional outcomes: a 17-year cohort study using selective ultrasound screening. Acta Orthop 2023; 94:588-593. [PMID: 38084932 PMCID: PMC10714967 DOI: 10.2340/17453674.2023.24578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/11/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND AND PURPOSE We aimed to establish the incidence of late-detected developmental dysplasia of the hip (DDH) with a selective ultrasound (US) examination over 17 years using the femoral head coverage (FHC) as a US measurement. The secondary aim was to establish the everyday function using patient-reported outcome measures (PROMs). PATIENTS AND METHODS The incidence of late-detected DDH was based on 60,844 children. Patients diagnosed for the first time after 3 months and before the age of 8 years were included. In the second part of the study, consent to participate was mandatory. PROMIS-25 Pediatric, PROMIS-25 Parent, and EQ-5D-5L were used according to the patient's age to assess everyday function. RESULTS The incidence of late-detected DDH was 0.48/1,000. The median age at diagnosis was 8 months (range 4-41 months), with a tendency to require repeated treatment with open surgery if DDH was diagnosed later. Most children reported no or minor health problems with a mean of 18 years' follow-up. CONCLUSION We found that selective US examination of the hips by measuring the FHC is a reliable method to examine newborns for DDH resulting in a low incidence of late-detected DDH amounting to 0.48/1,000 newborn children.
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Affiliation(s)
- Øyvind Håberg
- Department of Orthopedic Surgery, Kristiansund Hospital; Institute of Neuro Medicine and Movement Science, NTNU, Trondheim.
| | - Olav Andreas Foss
- Department of Orthopedic Surgery, Trondheim University Hospital; Institute of Neuro Medicine and Movement Science, NTNU, Trondheim
| | - Trude Gundersen
- Department of Orthopedic Surgery, Haukeland University Hospital, Norway
| | - Øystein Bjerkestrand Lian
- Department of Orthopedic Surgery, Kristiansund Hospital; Institute of Neuro Medicine and Movement Science, NTNU, Trondheim
| | | | - Ketil J Holen
- Department of Orthopedic Surgery, Trondheim University Hospital; Institute of Neuro Medicine and Movement Science, NTNU, Trondheim
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Yasin MS, Al Karmi J, Suleiman DO, Raja YM, Alshrouf MA, Abu Halaweh A, Hamdan M, Samarah O. Acetabular index as an indicator of Pavlik harness success in grade I developmental dysplasia of the hip: A retrospective study. J Child Orthop 2023; 17:598-606. [PMID: 38050594 PMCID: PMC10693839 DOI: 10.1177/18632521231199519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 08/16/2023] [Indexed: 12/06/2023] Open
Abstract
Purpose Some articles have focused on the effectiveness of the Pavlik harness treatment for unstable and dislocated hips, yet data on monitoring its effectiveness with the acetabular index remains elusive. Therefore, this study aimed to assess Pavlik harness effectiveness in infants ≤6 months diagnosed with grade I developmental dysplasia of the hip using acetabular index improvement and identify the possible predictors of successful Pavlik harness treatment. Methods A retrospective review of infants with grade I acetabular dysplasia treated with a Pavlik harness and monitored with anteroposterior pelvis X-rays at presentation and follow-up. Successful treatment was defined as achieving an acetabular index <30°. Results A total of 231 infants with acetabular dysplasia were treated with a Pavlik harness. A successful outcome was achieved in 135 infants (58.4%). Younger age, lower initial acetabular index, and patients with unilateral developmental dysplasia of the hip were significant predictors of a successful outcome. An age of 4.5 months or older was found to be the threshold for an unsuccessful result following Pavlik harness treatment, with a sensitivity of 65.2% and specificity of 57.3%. An initial acetabular index of 35.5° was found to be the threshold for an unsuccessful result, with a sensitivity of 83.7% and specificity of 61.5%. Conclusion Pavlik Harness's success in correcting the acetabular index in acetabular dysplasia patients was related to unilateral cases, a younger age at presentation, and a lower initial acetabular index. The thresholds for unsuccessful treatment were an age of 4.5 months or greater and an acetabular index of 35.5° or higher.
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Affiliation(s)
- Mohamad Samih Yasin
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan
| | - Joud Al Karmi
- Faculty of Medicine, The University of Jordan, Amman, Jordan
| | | | | | - Mohammad A Alshrouf
- Medical Internship, Jordan University Hospital, The University of Jordan, Amman, Jordan
| | - Ahmad Abu Halaweh
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan
| | - Mohammad Hamdan
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan
| | - Omar Samarah
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan
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Wu T, Lohse KR, Van Dillen L, Song K, Clohisy JC, Harris MD. Are Abnormal Muscle Biomechanics and Patient-reported Outcomes Associated in Patients With Hip Dysplasia? Clin Orthop Relat Res 2023; 481:2380-2389. [PMID: 37289006 PMCID: PMC10642886 DOI: 10.1097/corr.0000000000002728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 03/17/2023] [Accepted: 05/10/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Developmental dysplasia of the hip (DDH) is a major risk factor for the early development of hip osteoarthritis. Recent studies have demonstrated how DDH alters hip muscle moment arms and elevates muscle-induced biomechanical variables such as joint reaction forces and acetabular edge loads. Understanding the link between abnormal biomechanics and patient-reported outcome measures (PROMs) is important for evidence-based clinical interventions that improve patient symptoms and functional outcomes. To our knowledge, there are no reports of the relationships between muscle-induced biomechanics and PROMs. QUESTIONS/PURPOSES (1) Are there associations between PROMs and muscle-induced hip biomechanics during gait for patients with DDH and controls? (2) Are there associations among PROMs and separately among biomechanical variables? METHODS Participants in this prospective cross-sectional comparative study included 20 female patients with DDH who had no prior surgery or osteoarthritis and 15 female individuals with no evidence of hip pathology (controls) (age: median 23 years [range 16 to 39 years]; BMI: median 22 kg/m 2 [range 17 to 27 kg/m 2 ]). Muscle-induced biomechanical variables for this cohort were reported and had been calculated from patient-specific musculoskeletal models, motion data, and MRI. Biomechanical variables included joint reaction forces, acetabular edge loads, hip center lateralization, and gluteus medius muscle moment arm lengths. PROMs included the Hip Disability and Osteoarthritis Outcome Score (HOOS), the WOMAC, International Hip Outcome Tool-12, National Institutes of Health Patient-Reported Outcome Measure Information System (PROMIS) Pain Interference and Physical Function subscales, and University of California Los Angeles activity scale. Associations between PROMs and biomechanical variables were tested using Spearman rank-order correlations and corrected for multiple comparisons using the Benjamini-Yekutieli method. For this study, associations between variables were considered to exist when correlations were statistically significant (p < 0.05) and were either strong (ρ ≥ 0.60) or moderate (ρ = 0.40 to 0.59). RESULTS Acetabular edge load impulses (the cumulative acetabular edge load across the gait cycle), medially directed joint reaction forces, and hip center lateralization most commonly demonstrated moderate or strong associations with PROMs. The strongest associations were a negative correlation between acetabular edge load impulse on the superior acetabulum and the HOOS function in daily living subscale (ρ = -0.63; p = 0.001), followed by a negative correlation between hip center lateralization and the HOOS pain subscale (ρ = -0.6; p = 0.003), and a positive correlation between hip center lateralization and the PROMIS pain subscale (ρ = 0.62; p = 0.002). The University of California Los Angeles activity scale was the only PROM that did not demonstrate associations with any biomechanical variable. All PROMs, aside from the University of California Los Angeles activity scale, were associated with one another. Although most of the biomechanical variables were associated with one another, these relationships were not as consistent as those among PROMs. CONCLUSION The associations with PROMs detected in the current study suggest that muscle-induced biomechanics may have wide-reaching effects not only on loads within the hip, but also on patients' perceptions of their health and function. As the treatment of DDH evolves, patient-specific joint preservation strategies may benefit from targeting the underlying causes of biomechanical outcomes associated with PROMs. LEVEL OF EVIDENCE Level III, prognostic study.
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Affiliation(s)
- Tina Wu
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Keith R. Lohse
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Linda Van Dillen
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Ke Song
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - John C. Clohisy
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Michael D. Harris
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
- Department of Mechanical Engineering and Materials Science, Washington University School of Medicine, St. Louis, MO, USA
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21
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Ondeck NT, Borsinger TM, Chalmers BP, Blevins JL. Correcting Hip Dysplasia in Young Adults: Intraoperative Navigation and Outcomes. HSS J 2023; 19:501-506. [PMID: 37937090 PMCID: PMC10626937 DOI: 10.1177/15563316231193003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/10/2023] [Indexed: 11/09/2023]
Abstract
Developmental dysplasia of the hip (DDH) often leads to characteristic acetabular dysplasia and typical femoral anomalies. There are numerous treatments for skeletally mature patients with DDH including hip arthroscopy, pelvic and femoral osteotomies, as well as total hip arthroplasty. Before proceeding to an arthroplasty procedure, it can be helpful to obtain an opinion of a hip preservation specialist to ascertain if alternative surgical treatments could contribute to the patient's care. In general, the use of robotic navigation has been associated with a higher proportion of cups placed in the Lewinnek safe zone, larger improvements in Harris Hip Scores, and no difference in overall complication rates in comparison to manual total hip arthroplasty. The use of robotic navigation allows for both 2-dimensional and 3-dimensional preoperative templating, enabling the surgeon to plan the position of the construct such that it achieves maximum bony purchase and hip stability. In complex DDH cases, surgeons can work with a biomechanics department to complete a fit check assessment, which utilizes 3-dimensional templating software to ascertain the appropriateness of the implant's geometry with the patient's anatomy. Furthermore, a 3-dimensional printed plastic model of the pelvis and/or femur can be constructed in order to complete a rehearsal procedure, which may be particularly helpful for those cases involving osteotomies. The literature on the use of robotic-assisted total hip arthroplasty in patients with DDH demonstrates improved component positioning in comparison to navigated as well as manual methods; however, studies with long-term follow-up in this patient population are lacking.
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Affiliation(s)
- Nathaniel T Ondeck
- Adult Reconstruction Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
| | - Tracy M Borsinger
- Adult Reconstruction Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
| | - Brian P Chalmers
- Adult Reconstruction Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
| | - Jason L Blevins
- Adult Reconstruction Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
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Kim JS, Agricola R, Kim YJ, Lane NE, Millis MB, Nelson AE, Runhaar J, Shefelbine SJ, Bostrom MP. Arthritis Foundation/HSS Workshop on Hip Osteoarthritis, Part 1: Epidemiology, Early Development, and Cohorts From Around the World. HSS J 2023; 19:395-401. [PMID: 37937080 PMCID: PMC10626936 DOI: 10.1177/15563316231189748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 06/02/2023] [Indexed: 11/09/2023]
Abstract
Far more publications are available for osteoarthritis of the knee than of the hip. Recognizing this research gap, the Arthritis Foundation, in partnership with the Hospital for Special Surgery, convened an in-person meeting of thought leaders to review the state of the science of and clinical approaches to hip osteoarthritis. This article summarizes the recommendations and clinical research gaps gleaned from 5 presentations given in the "how hip osteoarthritis begins" session of the 2023 Hip Osteoarthritis Clinical Studies Conference, which took place on February 17 and 18, 2023, in New York City.
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Affiliation(s)
| | - Rintje Agricola
- Department of Orthopaedic Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Young-Jo Kim
- Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Nancy E Lane
- Department of Medicine and Rheumatology, University of California, Davis Medical Center, Sacramento, CA, USA
| | - Michael B Millis
- Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Amanda E Nelson
- Division of Rheumatology, Allergy, and Immunology, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jos Runhaar
- Department of General Practice, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Sandra J Shefelbine
- Department of Mechanical and Industrial Engineering, Northeastern University, Boston, MA, USA
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Sha J, Huang L, Chen Y, Lin J, Fan Z, Li Y, Yan Y. A novel approach for screening standard anteroposterior pelvic radiographs in children. Eur J Pediatr 2023; 182:4983-4991. [PMID: 37615891 DOI: 10.1007/s00431-023-05164-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/04/2023] [Accepted: 08/13/2023] [Indexed: 08/25/2023]
Abstract
Anteroposterior pelvic radiography is the first-line imaging modality for diagnosing developmental dysplasia of the hip (DDH). Nonstandard radiographs with pelvic malposition make the correct diagnosis of DDH challenging. However, as the only method available for screening standard pelvic radiographs, traditional manual assessment is relatively laborious and potentially erroneous. We retrospectively collected 3,247 pelvic radiographs. There were 2,887 radiographs randomly selected to train and optimize the AI model. Then 362 radiographs were used to test the model's diagnostic performance. Its diagnostic accuracy was assessed using receiver operating characteristic (ROC) curves and measurement consistency using Bland-Altman plots. In 362 radiographs, the AI model's area under ROC curves, accuracy, sensitivity, and specificity for quality assessment was 0.993, 99.4% (360/362), 98.6% (138/140), and 100.0% (222/222), respectively. Compared with clinicians, the 95% limits of agreement (Bland-Altman analysis) for pelvic tilt index (PTI) and pelvic rotation index (PRI), as determined by the model, were -0.052-0.072 and -0.088-0.055, respectively. CONCLUSIONS The artificial intelligence-assisted method was more efficient and highly consistent with clinical experts. This method can be used for real-time validation of the quality of pelvic radiographs in current picture archiving and communications systems (PACS). WHAT IS KNOWN • Nonstandard pediatric radiographs with pelvic malposition make the correct diagnosis of developmental dysplasia of the hip (DDH) challenging. • Traditional manual assessment remains the only method available for screening standard pediatric pelvic radiographs, which is relatively laborious and potentially erroneous. WHAT IS NEW • This study proposed an artificial intelligence-assisted model to assess the quality of pediatric pelvic radiographs accurately and efficiently. • We recommend the integration of the model into current picture archiving and communications systems (PACS) for real-time screening of standard pediatric pelvic radiographs.
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Affiliation(s)
- Jia Sha
- Department of Orthopedics, Xijing Hospital, Air Force Medical University, No.15 Changle Xi Road, Xi'an, 710032, China
| | - Luyu Huang
- Department of Orthopedics, Xijing Hospital, Air Force Medical University, No.15 Changle Xi Road, Xi'an, 710032, China
| | - Yaopeng Chen
- School of Telecommunications Engineering, Xidian University, Xi'an, China
| | - Jincong Lin
- Department of Orthopedics, Xijing Hospital, Air Force Medical University, No.15 Changle Xi Road, Xi'an, 710032, China
| | - Zongzhi Fan
- Department of Orthopedics, Xijing Hospital, Air Force Medical University, No.15 Changle Xi Road, Xi'an, 710032, China
| | - Yi Li
- School of Telecommunications Engineering, Xidian University, Xi'an, China
| | - Yabo Yan
- Department of Orthopedics, Xijing Hospital, Air Force Medical University, No.15 Changle Xi Road, Xi'an, 710032, China.
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Gong R, Shi J, Wang J, Wang J, Zhou J, Lu X, Du J, Shi J. Hybrid-supervised bidirectional transfer networks for computer-aided diagnosis. Comput Biol Med 2023; 165:107409. [PMID: 37672923 DOI: 10.1016/j.compbiomed.2023.107409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/10/2023] [Accepted: 08/27/2023] [Indexed: 09/08/2023]
Abstract
Medical imaging techniques have been widely used for diagnosis of various diseases. However, the imaging-based diagnosis generally depends on the clinical skill of radiologists. Computer-aided diagnosis (CAD) can help radiologists improve diagnostic accuracy as well as the consistency and reproducibility. Although convolutional neural network (CNN) has shown its feasibility and effectiveness in CAD, it generally suffers from the problem of small sample size when training CAD models. Nowadays, self-supervised learning (SSL) has shown its effectiveness in the field of medical image analysis, especially when there are only limited training samples. However, the backbone of downstream task sometimes cannot be well pre-trained in the conventional SSL framework due to the limitation of the pretext task and fine-tuning mechanism. In this work, an improved SSL framework, named Hybrid-supervised Bidirectional Transfer Networks (HBTN), is proposed to improve the performance of CAD models. Specifically, a novel Gray-Scale Image Mapping (GSIM) task is developed, which still takes the widely used image restoration task in SSL as the pretext task, but further embeds the class label information into it to improve discriminative feature learning of its corresponding network model. The proposed HBTN then integrates two different network architectures, i.e. the image restoration network for the pretext task and the classification network for the downstream task, into a unified hybrid-supervised learning (HSL) framework. It jointly trains both networks and collaboratively transfers the knowledge between each other. Consequently, the performance of downstream network is thus improved. The proposed HBTN is evaluated on two medical image datasets for CAD tasks. The experimental results indicate that HBTN outperforms the conventional SSL algorithms for CAD with limited training samples.
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Affiliation(s)
- Ronglin Gong
- Key Laboratory of Specialty Fiber Optics and Optical Access Networks, Joint International Research Laboratory of Specialty Fiber Optics and Advanced Communication, School of Communication and Information Engineering, Shanghai University, China; Shanghai Institute for Advanced Communication and Data Science, Shanghai University, China
| | - Jing Shi
- Department of Radiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, China
| | - Jian Wang
- Key Laboratory of Specialty Fiber Optics and Optical Access Networks, Joint International Research Laboratory of Specialty Fiber Optics and Advanced Communication, School of Communication and Information Engineering, Shanghai University, China; Shanghai Institute for Advanced Communication and Data Science, Shanghai University, China
| | - Jun Wang
- Key Laboratory of Specialty Fiber Optics and Optical Access Networks, Joint International Research Laboratory of Specialty Fiber Optics and Advanced Communication, School of Communication and Information Engineering, Shanghai University, China; Shanghai Institute for Advanced Communication and Data Science, Shanghai University, China
| | - Jianwei Zhou
- Key Laboratory of Specialty Fiber Optics and Optical Access Networks, Joint International Research Laboratory of Specialty Fiber Optics and Advanced Communication, School of Communication and Information Engineering, Shanghai University, China; Shanghai Institute for Advanced Communication and Data Science, Shanghai University, China
| | - Xiaofeng Lu
- Key Laboratory of Specialty Fiber Optics and Optical Access Networks, Joint International Research Laboratory of Specialty Fiber Optics and Advanced Communication, School of Communication and Information Engineering, Shanghai University, China; Shanghai Institute for Advanced Communication and Data Science, Shanghai University, China
| | - Jun Du
- Department of Radiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, China.
| | - Jun Shi
- Key Laboratory of Specialty Fiber Optics and Optical Access Networks, Joint International Research Laboratory of Specialty Fiber Optics and Advanced Communication, School of Communication and Information Engineering, Shanghai University, China; Shanghai Institute for Advanced Communication and Data Science, Shanghai University, China.
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Voegt C, Gunston G, Nortje M, Sealy JC, He L, le Roux P, Namayega C, Gibbon VE. Bilateral hip dysplasia in a South African male: A case study from the 17-18th century. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2023; 42:27-33. [PMID: 37527585 DOI: 10.1016/j.ijpp.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 07/18/2023] [Accepted: 07/21/2023] [Indexed: 08/03/2023]
Abstract
OBJECTIVE To identify, critically analyse and describe severe bilateral skeletal pathology involving the ossa coxae of an individual from historic era Cape Town. MATERIALS A single individual from the University of Cape Town's Human Skeletal Repository was analysed under research approval (HREC# 035/2021). METHODS An osteobiography was constructed, radiocarbon dating and isotopic analyses were conducted. Pathological description and contextualised disability analyses followed, along with differential diagnosis. The pelvis and femora were visualised macroscopically and radiographically. RESULTS This individual was a non-European middle-aged adult male who lived in the 17-18th centuries CE. Morphological changes showed hypoplastic hips with collapsed femoral heads and neoacetabulae. A diagnosis of developmental dysplasia of the hips (DDH) was made. Then a contextualised disability analysis including consideration of the clinical and functional impacts of the condition were applied. No signs of maltreatment, physiological stress or persistent infections were present. His bones were well developed, illustrating mobility and use. CONCLUSIONS He developed DDH early in life and lived through adulthood, and his strong, healthy bones suggest resilience, some mobility and contribution to society through less physically demanding tasks. SIGNIFICANCE Value for palaepathological analyses to inform and understand disability and culturally significant health mediation to offer a more objective interpretation and improve understanding of past people. It expands our understanding of the presence of DDH globally and in Africa and provides insight into disease impact for individuals with bilateral expression. SUGGESTIONS FOR FUTURE RESEARCH Further contextual research is required. LIMITATIONS Poor scene recovery hindered in-depth care analysis and interpretation of the condition.
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Affiliation(s)
- Chelsey Voegt
- Division of Clinical Anatomy and Biological Anthropology, Department of Human Biology, University of Cape Town, Private Bag X3, Rondebosch 7701, South Africa
| | - Geney Gunston
- Division of Clinical Anatomy and Biological Anthropology, Department of Human Biology, University of Cape Town, Private Bag X3, Rondebosch 7701, South Africa
| | - Marc Nortje
- Department of Orthopaedic Surgery, University of Cape Town, Vincent Pallotti and Kingsbury Hospitals, Cape Town, South Africa
| | - Judith C Sealy
- Department of Archaeology, University of Cape Town, Private Bag X3, Rondebosch 7701, South Africa
| | - Letian He
- School of History and Culture, Department of Archaeology and Museology, Lanzhou University, Lanzhou, Gansu 730000, China
| | - Petrus le Roux
- Department of Geological Sciences, University of Cape Town, Private Bag X3, Rondebosch 7701, South Africa
| | - Catherine Namayega
- Medical Imaging Inferencing and Distributed Diagnostics laboratory (Mi2d2), Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, Private Bag X3, Rondebosch 7701, South Africa
| | - Victoria E Gibbon
- Division of Clinical Anatomy and Biological Anthropology, Department of Human Biology, University of Cape Town, Private Bag X3, Rondebosch 7701, South Africa.
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26
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Chang WC, Hsu KH, Su YP. Natural progression of the pubofemoral distance with age and its correlation with future acetabular index. Eur Radiol 2023; 33:6473-6481. [PMID: 37012547 PMCID: PMC10415516 DOI: 10.1007/s00330-023-09579-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 03/14/2023] [Accepted: 03/20/2023] [Indexed: 04/05/2023]
Abstract
OBJECTIVES This study investigated the progression of pubofemoral distance (PFD) with age and assessed the correlation between PFD and late acetabular index (AI) measurements. METHODS This prospective observational study was conducted between January 2017 and December 2021. We enrolled 223 newborns who underwent the first, second, and third hip ultrasounds, and pelvis radiograph at a mean age of 18.6 days, 3.1 months, 5.2 months, and 6.8 months, respectively. The difference between PFD measured at serial ultrasounds and the correlation with AI were analyzed. RESULTS The PFD increased significantly (p < 0.001) at serial measurements. The mean PFD at the first, second, and third ultrasounds were 3.3 (2.0-5.7), 4.3 (2.9-7.2), and 5.1 (3.3-8.0) mm, respectively. The PFD at three ultrasounds were all significantly (p < 0.001) and positively correlated with AI, with the Pearson correlation coefficients being 0.658, 0.696, and 0.753 for the first, second, and third ultrasounds, respectively. Using AI as reference, the diagnostic ability of PFD was calculated by the areas under the receiver operating characteristic curve, which was 0.845, 0.902, and 0.938 for the first, second, and third PFD, respectively. For the first, second, and third ultrasounds, PFD cutoff values of ≥ 3.9, ≥ 5.0, and ≥ 5.7 mm, respectively, yielded the greatest sensitivity and specificity in predicting late abnormal AI. CONCLUSION The PFD naturally progresses with age and is positively correlated with AI. The PFD has potential for predicting residual dysplasia. However, the cutoff for abnormal PFD values may require adjustment according to the patient's age. KEY POINTS • The pubofemoral distance measured in hip ultrasonography naturally increases as the infant's hips mature. • The early pubofemoral distance demonstrates a positive correlation with late acetabular index measurements. • The pubofemoral distance may help physicians predict abnormal acetabular index. However, the cutoff for abnormal pubofemoral distance values may require adjustment according to patient's age.
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Affiliation(s)
- Wen-Chieh Chang
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Kuei-Hsiang Hsu
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yu-Ping Su
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Alhaddad A, Gronfula AG, Alsharif TH, Khawjah AA, Alali MY, Jawad KM. An Overview of Developmental Dysplasia of the Hip and Its Management Timing and Approaches. Cureus 2023; 15:e45503. [PMID: 37868507 PMCID: PMC10585185 DOI: 10.7759/cureus.45503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
Developmental dysplasia of the hip (DDH), if uncorrected, can result in several chronic abnormalities, including chronic hip pain, degenerative arthritis, and gait abnormalities. The outcome of DDH generally depends on the age of presentation; a worse prognosis is linked to a higher age of presentation. Although treatment continues to be a challenge, recent advancements in the field have improved our understanding of the disease, which has resulted in advancements in DDH surveillance during infancy and the reduction of complications with early intervention. The databases used for this overview include Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Library, MEDLINE, and EMBASE. These databases were used to search for ongoing trials related to the management and diagnosis of DDH.
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Affiliation(s)
- Ali Alhaddad
- Orthopedic Surgery, East Jeddah General Hospital, Jeddah, SAU
| | - Amin G Gronfula
- Orthopaedic Surgery, Royal College of Surgeons in Ireland, Dublin, IRL
| | | | - Ahmed A Khawjah
- Neurosurgery, Royal College of Surgeons in Ireland, Dublin, IRL
| | - Mohammed Y Alali
- Emergency Medicine, Royal College of Surgeons in Ireland, Dublin, IRL
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Suqaty R, Alomran AK, Alkhalifah MK, Aldughaythir SS, Albeshry AM, Aldilaijan Y, Alzahrani MT, Alhussainan T. How Ready are Pediatricians and Family Physicians in Saudi Arabia to Perform Clinical Screening of Developmental Dysplasia of the Hip? J Multidiscip Healthc 2023; 16:2567-2576. [PMID: 37667798 PMCID: PMC10475280 DOI: 10.2147/jmdh.s416459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 08/21/2023] [Indexed: 09/06/2023] Open
Abstract
Background Developmental dysplasia of the hip (DDH) is one of the most common hip pathologies in pediatric age group and late diagnosis remains a major concern in Saudi Arabia. Objective The aim of this study is to examine the ability of Saudi Arabian pediatricians and family physicians to conduct clinical screening for (DDH) by estimating their clinical knowledge and skills and analyzing the gaps therein to determine whether there is potential to launch a national screening protocol for DDH in Saudi Arabia. Methods This is a multicenter cross-sectional study from three major regions in Saudi Arabia (Central, Eastern and Western provinces). The assessed aspects are risk factors, age of screening, incidence in Saudi Arabia, physical signs and diagnostic markers, and treatment, along with their 'clinical knowledge and skills' score. Results Half of the participants were pediatricians, while the rest were family physicians. More than a third of the participants were considered to have adequate knowledge, ie, above the mean score. Dimensions with the most significant knowledge gaps included the incidence of DDH in Saudi Arabia, adverse effects of swaddling, and the management of a high-risk infants presenting with a negative physical examination. Additionally, there were relatively low rates of awareness regarding positive risk factors as well as a generally poor ability to identify physical signs. Clinical knowledge and skill levels were significantly lower among family physicians. Conclusion Pediatricians and family physicians in Saudi Arabia still need further training to improve their clinical skills for DDH screening. The proper administration of training programs could eventually enable the gradual implementation of a national systematic screening program.
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Affiliation(s)
- Rayyan Suqaty
- Department of Orthopedic Surgery, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Ammar K Alomran
- Department of Orthopedics, College of Medicine, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Mohammed K Alkhalifah
- Department of Family Medicine & Polyclinics King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Saad S Aldughaythir
- Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Abdulrahman M Albeshry
- Department of Family and Community Medicine, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - Yousif Aldilaijan
- Primary Health Care Centers, Eastern Health Cluster, Khobar, Saudi Arabia
| | - Mohammed T Alzahrani
- Department of Orthopedic Surgery, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Thamer Alhussainan
- Department of Orthopedic Surgery, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
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29
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Poacher AT, Hathaway I, Crook DL, Froud JLJ, Scourfield L, James C, Horner M, Carpenter EC. The impact of the introduction of selective screening in the UK on the epidemiology, presentation, and treatment outcomes of developmental dysplasia of the hip. Bone Jt Open 2023; 4:635-642. [PMID: 37607720 PMCID: PMC10444535 DOI: 10.1302/2633-1462.48.bjo-2022-0158.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2023] Open
Abstract
Aims Developmental dysplasia of the hip (DDH) can be managed effectively with non-surgical interventions when diagnosed early. However, the likelihood of surgical intervention increases with a late presentation. Therefore, an effective screening programme is essential to prevent late diagnosis and reduce surgical morbidity in the population. Methods We conducted a systematic review and meta-analysis of the epidemiological literature from the last 25 years in the UK. Articles were selected from databases searches using MEDLINE, EMBASE, OVID, and Cochrane; 13 papers met the inclusion criteria. Results The incidence of DDH within the UK over the last 25 years is 7.3/1,000 live births with females making up 86% of the DDH population (odds ratio 6.14 (95% confidence interval 3.3 to 11.5); p < 0.001). The incidence of DDH significantly increased following the change in the Newborn and Infant Physical Examination (NIPE) guidance from 6.5/1,000 to 9.4/1,000 live births (p < 0.001). The rate of late presentation also increased following the changes to the NIPE guidance, rising from 0.7/1,000 to 1.2/1,000 live births (p < 0.001). However, despite this increase in late-presenting cases, there was no change in the rates of surgical intervention (0.8/1,000 live births; p = 0.940). Conclusion The literature demonstrates that the implementation of a selective screening programme increased the incidence of DDH diagnosis in the UK while subsequently increasing the rates of late presentation and failing in its goal of reducing the rates of surgical intervention for DDH.
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Affiliation(s)
| | | | | | | | | | - Catherine James
- Trauma Department, University Hospital of Wales, Cardiff, UK
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Bakarman K, Alsiddiky AM, Zamzam M, Alzain KO, Alhuzaimi FS, Rafiq Z. Developmental Dysplasia of the Hip (DDH): Etiology, Diagnosis, and Management. Cureus 2023; 15:e43207. [PMID: 37692580 PMCID: PMC10488138 DOI: 10.7759/cureus.43207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 09/12/2023] Open
Abstract
Developmental dysplasia of the hip (DDH) is a complex disorder that refers to different hip problems, ranging from neonatal instability to acetabular or femoral dysplasia, hip subluxation, and hip dislocation. It may result in structural modifications, which may lead to early coxarthrosis. Despite identifying the risk factors, the exact aetiology and pathophysiology are still unclear. Neonatal screening, along with physical examination and ultrasound, is critical for the early diagnosis of DDH to prevent the occurrence of early coxarthrosis. This review summarizes the currently practised strategies for the detection and treatment of DDH, focusing particularly on current practices for managing residual acetabular dysplasia (AD). AD may persist even after a successful hip reduction. Pelvic osteotomy is required in cases of persistent AD. It could also be undertaken simultaneously with an open hip reduction. Evaluation of the residual dysplasia (RD) of the hip and its management is still a highly active area of discussion. Recent research has opened the door to discussion on this issue and suggested treatment options for AD. But there is still room for more research to assist in managing AD.
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Affiliation(s)
| | - Abdulmonem M Alsiddiky
- Pediatric Orthopedics & Spinal Deformities, Research Chair of Spinal Deformities, King Saud University, Riyadh, SAU
| | - Mohamed Zamzam
- Pediatric Orthopedics, King Saud University, Riyadh, SAU
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Quan T, Pizzarro J, Mcdaniel L, Manzi JE, Agarwal AR, Chen FR, Tabaie S. Is seizure disorder a risk factor for complications following surgical treatment of hip dysplasia in the pediatric population? J Pediatr Orthop B 2023; 32:318-323. [PMID: 35762671 DOI: 10.1097/bpb.0000000000000998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The impact of seizure disorders on pediatric patients who undergo hip dysplasia surgery has yet to be elucidated. This study focused on identifying the effect of seizure disorders on the incidence of complications following surgical management of hip dysplasia. Pediatric patients undergoing surgical treatment for hip dysplasia from 2012 to 2019 were identified in the National Surgical Quality Improvement Program-Pediatric database. Patients were divided into two cohorts: patients with and patients without a seizure disorder. Patient demographics, comorbidities and postoperative outcomes were compared between the two groups. Bivariate and multivariate analyses were performed. Of 10 853 pediatric patients who underwent hip dysplasia surgery, 8117 patients (74.8%) did not have a seizure disorder whereas 2736 (25.2%) had a seizure disorder. Bivariate analyses revealed that compared to patients without a seizure disorder, patients with a seizure disorder were at increased risk of developing surgical site infections, pneumonia, unplanned reintubation, urinary tract infection, postoperative transfusion, sepsis, extended operation time and length of stay and readmission ( P < 0.05 for all). Following adjustment for patient demographics and comorbidities on multivariate analysis, there were no differences in any postoperative complications between pediatric patients with and without a seizure disorder. There were no differences in 30-day postoperative complications in patients with and without a seizure disorder. Due to potential decreased bone mineral density as an effect of antiepileptic drugs and the risk of femur fracture during surgery for hip dysplasia, pediatric patients with a seizure disorder should be closely monitored as they may be more susceptible to injury. Level of Evidence: III.
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Affiliation(s)
- Theodore Quan
- Department of Orthopedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Ghaseminejad-Raeini A, Shahbazi P, Roozbahani G, Sharafi A, Shafiei SH, Fallah Y, Baghdadi S. Preterm birth does not increase the risk of developmental dysplasia of the Hip: a systematic review and meta-analysis. BMC Pediatr 2023; 23:268. [PMID: 37246230 DOI: 10.1186/s12887-023-04083-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/18/2023] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND The purpose of this systematic review was to appraise the literature on the association between preterm birth and developmental dysplasia of the hip (DDH). METHODS Medline, Embase, Scopus, and Web of Science databases were queried for all studies pertaining to DDH and preterm birth. Data were imported and analyzed in Revman5 and Comprehensive Meta-Analysis (CMA) for pooled prevalence estimation. RESULTS Fifteen studies were included in the final analysis. There were 759 newborns diagnosed with DDH in these studies. DDH was diagnosed in 2.0% [95%CI:1.1-3.5%] of the premature newborns. Pooled incidence rate of DDH was not statistically different between those groups (2.5%[0.9%-6.8%] vs. 0.7%[0.2%-2.5%] vs. 1.7%[0.6%-5.3%];Q = 2.363,p = 0.307). CONCLUSIONS In this systematic review and meta-analysis, we did not find preterm birth to be a significant risk factor for DDH. Data suggests that female sex and breech presentation are associated with DDH in preterm infants, but the data is scarce in the literature.
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Affiliation(s)
| | - Parmida Shahbazi
- Orthopedic Surgery Research Center (OSRC), Sina University Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ghazale Roozbahani
- Orthopedic Surgery Research Center (OSRC), Sina University Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirmohammad Sharafi
- Orthopedic Surgery Research Center (OSRC), Sina University Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyyed Hossein Shafiei
- Orthopedic Surgery Research Center (OSRC), Sina University Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Yousof Fallah
- Orthopedic Surgery Research Center (OSRC), Sina University Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Soroush Baghdadi
- Division of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
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Akcal MA, Eke I, Mutlu T. Femoral Neck Fractures in Elderly Patients With Coxarthrosis and High Dislocation: The Application of Conservative Treatment. Cureus 2023; 15:e35805. [PMID: 37025706 PMCID: PMC10074014 DOI: 10.7759/cureus.35805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2023] [Indexed: 03/08/2023] Open
Abstract
OBJECTIVE In this study, our aim was to evaluate the results obtained by conservative treatment of femoral neck fracture in patients with untreated Crowe type 4 coxarthrosis with high dislocation. METHODS This was was a retrospective study done at the Orthopaedics and Traumatology Clinic in a secondary care public hospital between 2002 and 2022, in Türkiye. Femur neck fractures were evaluated in six patients who had untreated Crowe type 4 coxarthrosis with high dislocation. RESULTS In the study, we had six patients with undiagnosed developmental dysplasia of the hip (DDH) who suffered femoral neck fractures. The youngest among these patients was 76 years old. Conservative treatment (bed rest, analgesics, non-steroidal anti-inflammatory drugs, and, if needed, opiates and low molecular weight heparin for antiembolic treatment) was found to reduce Harris Hip Score (HHS) and Visual Analogue Scale (VAS) scores significantly (p<0,05). Stage 1 sacral decubitus ulcer occurred in two (33.3%) patients. Patients acquired daily activity capacity similar to their situations before fracture within five to six months. None of the patients suffered embolisms and there was no union in the fracture line of the patients. Conclusion: Based on our data, we think that conservative treatment is a remarkable option for these patients, as the complication risks are low and positive results can be obtained. Thus, we may conclude that conservative treatment can be considered in femoral neck fractures of elderly patients with DDH.
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Mullins K, Filan D, Carton P. High Survivorship and Comparable Patient-Reported Outcomes at a Minimum 5 Years After Hip Arthroscopic Surgery in Patients With Femoroacetabular Impingement, With and Without Lateral Rim Dysplasia. Am J Sports Med 2023; 51:678-686. [PMID: 36688631 DOI: 10.1177/03635465221145018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Femoroacetabular impingement (FAI) in patients with dysplasia presents a unique challenge to surgeons. Short-term outcomes are conflicting, while longer term follow-up data are only emerging. PURPOSE To quantify midterm (minimum 5-year follow-up) outcomes after the arthroscopic correction of FAI in the presence of lateral rim dysplasia compared with a matched control group with FAI with normal acetabular coverage. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Prospective outcome data, collected in a consecutive series of patients undergoing arthroscopic FAI correction with lateral rim dysplasia (lateral center-edge angle [LCEA] of 13°-25°), were reviewed (N = 75 cases). An age- and sex-matched control group of 120 cases was also formed (LCEA >25°). Survivorship was defined as the avoidance of total hip replacement and assessed using a Kaplan-Meier curve with the log-rank test. Survival rates and patient-reported outcome measure (PROM) scores (modified Harris Hip Score [mHHS], University of California, Los Angeles [UCLA], 36-Item Short Form Health Survey [SF-36], and Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] preoperatively and at 5 years postoperatively) were compared between the groups. The proportion of patients across groups achieving the minimal clinically important difference (MCID) was compared for each PROM. The dysplasia group was also analyzed independently to identify any factors that may indicate a less favorable outcome using regression analysis. The group was divided into 2 subgroups: borderline dysplasia (LCEA of 20°-25°) and severe dysplasia (LCEA <20°). RESULTS The survival rate in the dysplasia group was 97%. There was no statistical difference with respect to survival rates or any PROM scores (P > .05 for all) between the groups. There were similar rates of achieving the MCID between the groups for the mHHS, UCLA, and WOMAC. The FAI control group had a higher rate of achieving the MCID for the SF-36 (P = .012; effect size = 0.274 [small]). Subgroup analysis indicated a lower survival rate (78% vs 100%, respectively; P < .001) in female cases in the dysplasia group (n = 9) compared with male cases in the dysplasia group (n = 66). The UCLA score in female cases in the dysplasia group at 5 years was statistically lower compared with that in male cases in the dysplasia group (6 vs 10, respectively; P = .003; effect size = 0.378 [medium]), but no other outcome revealed any differences between the sexes. There were also no variables identified on regression analysis that accurately predicted a poorer outcome in the dysplasia group. When stratified by severity, there was no difference in survivorship or outcomes between those with severe dysplasia (LCEA <20°; n = 11) and those with borderline dysplasia (LCEA of 20°-25°; n = 64). CONCLUSION An arthroscopic intervention was a successful treatment option for FAI in the presence of lateral rim dysplasia at midterm follow-up. Irrespective of the severity of dysplasia, patients can expect similar improvements to those in patients with normal femoral head coverage.
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Affiliation(s)
| | - David Filan
- UPMC Sports Medicine Clinic, Carriganore, Ireland
| | - Patrick Carton
- UPMC Sports Medicine Clinic, Carriganore, Ireland
- The Hip and Groin Clinic, Waterford, Ireland
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Pakarinen O, Ponkilainen V, Uimonen M, Haapanen M, Helenius I, Kuitunen I. A comparison of different selective ultrasound screening strategies for developmental dysplasia of the hip. Bone Joint J 2023; 105-B:247-253. [PMID: 36876446 DOI: 10.1302/0301-620x.105b3.bjj-2022-1068.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
To analyze whether the addition of risk-based criteria to clinical examination-based selective ultrasound screening would increase the rates of early detected cases of developmental dysplasia of the hip (DDH) and decrease the rate of late detected cases. A systematic review with meta-analysis was performed. The initial search was performed in the PubMed, Scopus, and Web of Science databases in November 2021. The following search terms were used: (hip) AND (ultrasound) AND (luxation or dysplasia) AND (newborn or neonate or congenital). A total of 25 studies were included. In 19 studies, newborns were selected for ultrasound based on both risk factors and clinical examination. In six studies, newborns were selected for ultrasound based on only clinical examination. We did not find evidence indicating that there are differences in the incidence of early- and late-detected DDH, or in the incidence of nonoperatively treated DDH between the risk-based and clinical examination-based groups. The pooled incidence of operatively treated DDH was slightly lower in the risk-based group (0.5 (95% confidence interval (CI) 0.3 to 0.7)) compared with the clinical examination group (0.9 per 1,000 newborns, (95% CI 0.7 to 1.0)). The use of risk factors in conjunction with clinical examination in the selective ultrasound screening of DDH might lead to fewer operatively treated cases of DDH. However, more studies are needed before stronger conclusions can be drawn.
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Affiliation(s)
- Oskari Pakarinen
- Tampere University, Faculty of Medicine and Health Technologies, Tampere, Finland
| | - Ville Ponkilainen
- Tampere University, Faculty of Medicine and Health Technologies, Tampere, Finland.,Department of Surgery, Central Finland Hospital Nova, Jyvaskyla, Finland
| | - Mikko Uimonen
- Tampere University, Faculty of Medicine and Health Technologies, Tampere, Finland.,Department of Surgery, Central Finland Hospital Nova, Jyvaskyla, Finland
| | - Marjut Haapanen
- University of Eastern Finland, Institute of Clinical Medicine and Department of Pediatrics, Kuopio, Finland
| | - Ilkka Helenius
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Department of Paediatric Orthopaedics, Helsinki University Hospital, New Children's Hospital, Helsinki, Finland
| | - Ilari Kuitunen
- University of Eastern Finland, Institute of Clinical Medicine and Department of Pediatrics, Kuopio, Finland.,Department of Pediatrics and Neonatology, Mikkeli Central Hospital, Mikkeli, Finland
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Radiographic markers of hip dysplasia in young adults: predictive effect of factors in early life. BMC Musculoskelet Disord 2023; 24:119. [PMID: 36774465 PMCID: PMC9921356 DOI: 10.1186/s12891-023-06199-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/25/2023] [Indexed: 02/13/2023] Open
Abstract
ABSTRAC BACKGROUND AND OBJECTIVES: Acetabular dysplasia in young adults occurs, despite screening for developmental hip dysplasia (DDH) in the neonatal period. We aimed to examine how early life factors predict radiographic measurements of acetabular dysplasia at 18-19 years of age. METHODS From a previous randomized trial (n = 12,014; 1988-90) evaluating the role of hip ultrasound in newborn screening of DDH, 4469 participants (2193 males) were invited to a follow-up 18 years later (2007-09), of which 2370 (53% attendance; 932 males) met. We examined associations between early life factors and four radiographic measurements for acetabular dysplasia at skeletal maturity. Hierarchical regressions, with addition of variables observed/measured consecutively in time, were analyzed using mixed effects models considering hip as the unit in the analyses. The study is approved by the Regional Ethics Committee. RESULTS In total, 2340 participants (921 boys), mean age 18.7 years, (SD 0.6) had hip radiographs performed at follow-up and were included. Early life factors significantly predicting radiographic acetabular dysplasia at age 18-19-years included female gender, breech, low acetabular inclination (alpha) angle and sonographic instability, abduction treatment, as well as the velocity of growth during childhood. A positive family history of DDH was not associated with acetabular dysplasia at skeletal maturity. CONCLUSION The acetabular inclination (alpha) angle as measured on ultrasound at birth turned out to be a significant predictor of dysplasia at 18-19 years of age. The discordant role of a positive family history in early versus adult hip dysplasia is intriguing, warranting further studies on the genetic mechanisms of DDH.
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Whole exome sequencing of 28 families of Danish descent reveals novel candidate genes and pathways in developmental dysplasia of the hip. Mol Genet Genomics 2023; 298:329-342. [PMID: 36454308 PMCID: PMC9938029 DOI: 10.1007/s00438-022-01980-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 11/15/2022] [Indexed: 12/05/2022]
Abstract
Developmental dysplasia of the hip (DDH) is a common condition involving instability of the hip with multifactorial etiology. Early diagnosis and treatment are critical as undetected DDH is an important cause of long-term hip complications. Better diagnostics may be achieved through genetic methods, especially for patients with positive family history. Several candidate genes have been reported but the exact molecular etiology of the disease is yet unknown. In the present study, we performed whole exome sequencing of DDH patients from 28 families with at least two affected first-degree relatives. Four genes previously not associated with DDH (METTL21B, DIS3L2, PPP6R2, and TM4SF19) were identified with the same variants shared among affected family members, in more than two families. Among known association genes, we found damaging variants in DACH1, MYH10, NOTCH2, TBX4, EVC2, OTOG, and SHC3. Mutational burden analysis across the families identified 322 candidate genes, and enriched pathways include the extracellular matrix, cytoskeleton, ion-binding, and detection of mechanical stimulus. Taken altogether, our data suggest a polygenic mode of inheritance for DDH, and we propose that an impaired transduction of the mechanical stimulus is involved in the etiopathological mechanism. Our findings refine our current understanding of candidate causal genes in DDH, and provide a foundation for downstream functional studies.
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Sha J, Huang L, Chen Y, Fan Z, Lin J, Yang Q, Li Y, Yan Y. Clinical thought-based software for diagnosing developmental dysplasia of the hip on pediatric pelvic radiographs. Front Pediatr 2023; 11:1080194. [PMID: 37063681 PMCID: PMC10098126 DOI: 10.3389/fped.2023.1080194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 03/06/2023] [Indexed: 04/18/2023] Open
Abstract
Background The common methods of radiographic diagnosis of developmental dysplasia of the hip (DDH) include measuring hip parameters and quantifying the degree of hip dislocation. However, clinical thought-based analysis of hip parameters may be a more effective way to achieve expert-like diagnoses of DDH. This study aims to develop a diagnostic strategy-based software for pediatric DDH and validate its clinical feasibility. Methods In total, 543 anteroposterior pelvic radiographs were retrospectively collected from January 2017 to December 2021. Two independent clinicians measured four diagnostic indices to compare the diagnoses made by the software and conventional manual method. The diagnostic accuracy was evaluated using the receiver operator characteristic (ROC) curves and confusion matrix, and the consistency of parametric measurements was assessed using Bland-Altman plots. Results In 543 cases (1,086 hips), the area under the curve, accuracy, sensitivity, and specificity of the software for diagnosing DDH were 0.988-0.994, 99.08%-99.72%, 98.07%-100.00%, and 99.59%, respectively. Compared with the expert panel, the Bland-Altman 95% limits of agreement for the acetabular index, as determined by the software, were -2.09°-2.91° (junior orthopedist) and -1.98°-2.72° (intermediate orthopedist). As for the lateral center-edge angle, the 95% limits were -3.68°-5.28° (junior orthopedist) and -2.94°-4.59° (intermediate orthopedist). Conclusions The software can provide expert-like analysis of pelvic radiographs and obtain the radiographic diagnosis of pediatric DDH with great consistency and efficiency. Its initial success lays the groundwork for developing a full-intelligent comprehensive diagnostic system of DDH.
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Affiliation(s)
- Jia Sha
- Department of Orthopedics, Xijing Hospital, Air Force Military Medical University, Xi’an, China
| | - Luyu Huang
- Department of Orthopedics, Xijing Hospital, Air Force Military Medical University, Xi’an, China
| | - Yaopeng Chen
- School of Telecommunications Engineering, Xidian University, Xi’an, China
- Guangzhou Institute, Xidian University, Xi’an, China
| | - Zongzhi Fan
- Department of Orthopedics, Xijing Hospital, Air Force Military Medical University, Xi’an, China
| | - Jincong Lin
- Department of Orthopedics, Xijing Hospital, Air Force Military Medical University, Xi’an, China
| | - Qinghai Yang
- School of Telecommunications Engineering, Xidian University, Xi’an, China
| | - Yi Li
- School of Telecommunications Engineering, Xidian University, Xi’an, China
- Correspondence: Yabo Yan Yi Li
| | - Yabo Yan
- Department of Orthopedics, Xijing Hospital, Air Force Military Medical University, Xi’an, China
- Correspondence: Yabo Yan Yi Li
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Sun J, Cui Y, Qu J, Lian F. Mathematical calculation of the difference in shortening length after two types of proximal femoral varus and an investigation of their applicable conditions: an own-pair design. J Orthop Surg Res 2022; 17:563. [PMID: 36564807 PMCID: PMC9783977 DOI: 10.1186/s13018-022-03462-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The shortening length of the lower extremity after the proximal femoral osteotomy is an important issue to be considered in preoperative planning of developmental dysplasia of the hip (DDH) in children. There is still a lack of research on shortening the length of the lower extremities in different proximal femoral osteotomy varus styles. We aimed to verify the relationship between the shortening length after "point-to-face" and "face-to-face" varus osteotomy and proposed a formula for calculating the difference in shortening length and verified its feasibility. METHODS Fifty-five children with unilateral DDH were enrolled. The preoperative hip CT data were imported into mimics 21, 3-Matic 10 (Materialise, Leuven, Belgium) for femoral reconstruction and simulated osteotomy, and the difference (t) was calculated by directly measuring the length of the proximal femur after osteotomy. d* sinθ was measured in a three-dimensional environment to calculate the difference in femoral shortening length between the two osteotomy methods (t'). RESULTS The results of the direct measurement method and the formula measurement method are shown in the table; the differences in the results of the femoral shortening length difference were not statistically significant (P > 0.05). The limits of agreement (95%) of the difference values using Bland-Altman analysis were between - 0.50 and 0.46 mm, with a mean of - 0.02 mm, indicating a high agreement between the two methods. r = 0.99 (P < 0.05) for the Pearson correlation analysis between the direct measurement method and the calculated method showed that the two methods were significantly correlated. CONCLUSIONS The derived formula can accurately calculate the difference in the shortening length of the proximal femur after "point-to-face" and "face-to-face" varus osteotomy in children with DDH, which is suitable for clinical application.
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Affiliation(s)
- Jian Sun
- grid.410736.70000 0001 2204 9268Department of Orthopaedics, The Fourth Hospital of Harbin Medical University, 37 Yiyuan Street, Nangang District, Harbin City, Heilongjiang Province China
| | - Yong Cui
- grid.410736.70000 0001 2204 9268Department of Orthopaedics, The Fourth Hospital of Harbin Medical University, 37 Yiyuan Street, Nangang District, Harbin City, Heilongjiang Province China
| | - Jing Qu
- grid.410736.70000 0001 2204 9268Department of Orthopaedics, The Fourth Hospital of Harbin Medical University, 37 Yiyuan Street, Nangang District, Harbin City, Heilongjiang Province China
| | - Feng Lian
- grid.410736.70000 0001 2204 9268Department of Orthopaedics, The Fourth Hospital of Harbin Medical University, 37 Yiyuan Street, Nangang District, Harbin City, Heilongjiang Province China
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40
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Zhu D, Zhu H. Incidence and Epidemiological Characters of Developmental Dysplasia of the Hip in Lianyungang: Based on Ultrasound Screening: A Retrospective Study. Int J Gen Med 2022; 15:8547-8555. [DOI: 10.2147/ijgm.s389145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
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Sarna M, Pereira GF, Foo D, Baynam GS, Regan AK. The risk of major structural birth defects associated with seasonal influenza vaccination during pregnancy: A population-based cohort study. Birth Defects Res 2022; 114:1244-1256. [PMID: 35678518 PMCID: PMC9796878 DOI: 10.1002/bdr2.2049] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 04/08/2022] [Accepted: 04/13/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Seasonal inactivated influenza vaccine (IIV) is routinely recommended during pregnancy to protect both mothers and infants from complications following influenza infection. While previous studies have evaluated the risk of major structural birth defects in infants associated with prenatal administration of monovalent pandemic IIV, fewer studies have evaluated the risk associated with prenatal seasonal IIV. METHODS We conducted a population-based cohort study of 125,866 singleton births between 2012 and 2016 in Western Australia. Birth registrations were linked to the state's registers for congenital anomalies and a state prenatal vaccination database. We estimated prevalence ratios (PR) of any major structural birth defect and defects by organ system. Vaccinated pregnancies were defined as those with a record of IIV in the first trimester. Inverse probability treatment weighting factored for baseline probability for vaccination. A Bonferroni correction was applied to account for multiple comparisons. RESULTS About 3.9% of births had a major structural birth defect. Seasonal IIV exposure during the first trimester was not associated with diagnosis of any major structural birth defect diagnosed within 1 month of birth (PR 0.98, 95% CI: 0.77, 1.28) or within 6 years of life (PR 1.02, 95% CI: 0.78, 1.35). We identified no increased risk in specific birth defects associated with seasonal IIV. CONCLUSION Based on registry data for up to 6 years of follow-up, results suggest there is no association between maternal influenza vaccination and risk of major structural birth defects. These results support the safety of seasonal IIV administration during pregnancy.
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Affiliation(s)
- Mohinder Sarna
- Curtin School of Population HealthCurtin UniversityBentleyWestern AustraliaAustralia,Wesfarmers Centre of Vaccines & Infectious DiseasesTelethon Kids InstitutePerthWestern AustraliaAustralia
| | - Gavin F. Pereira
- Curtin School of Population HealthCurtin UniversityBentleyWestern AustraliaAustralia,Wesfarmers Centre of Vaccines & Infectious DiseasesTelethon Kids InstitutePerthWestern AustraliaAustralia,Centre for Fertility and HealthNorwegian Institute of Public HealthOsloNorway
| | - Damien Foo
- Curtin School of Population HealthCurtin UniversityBentleyWestern AustraliaAustralia,Wesfarmers Centre of Vaccines & Infectious DiseasesTelethon Kids InstitutePerthWestern AustraliaAustralia
| | - Gareth S. Baynam
- King Edward Memorial Hospital, Western Australian Department of HealthSubiacoWestern AustraliaAustralia,Faculty of Health and Medical Sciences, Division of PediatricsThe University of Western AustraliaCrawleyWestern AustraliaAustralia
| | - Annette K. Regan
- Curtin School of Population HealthCurtin UniversityBentleyWestern AustraliaAustralia,Wesfarmers Centre of Vaccines & Infectious DiseasesTelethon Kids InstitutePerthWestern AustraliaAustralia,School of Nursing and Health ProfessionsUniversity of San FranciscoSan FranciscoCaliforniaUSA
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Hareendranathan AR, Wichuk S, Punithakumar K, Dulai S, Jaremko J. Normal variation of infant hip development. Bone Jt Open 2022; 3:913-923. [DOI: 10.1302/2633-1462.311.bjo-2022-0081.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Aims Studies of infant hip development to date have been limited by considering only the changes in appearance of a single ultrasound slice (Graf’s standard plane). We used 3D ultrasound (3DUS) to establish maturation curves of normal infant hip development, quantifying variation by age, sex, side, and anteroposterior location in the hip. Methods We analyzed 3DUS scans of 519 infants (mean age 64 days (6 to 111 days)) presenting at a tertiary children’s hospital for suspicion of developmental dysplasia of the hip (DDH). Hips that did not require ultrasound follow-up or treatment were classified as ‘typically developing’. We calculated traditional DDH indices like α angle (αSP), femoral head coverage (FHCSP), and several novel indices from 3DUS like the acetabular contact angle (ACA) and osculating circle radius (OCR) using custom software. Results α angle, FHC, and ACA indices increased and OCR decreased significantly by age in the first four months, mean αSP rose from 62.2° (SD 5.7°) to 67.3° (SD 5.2°) (p < 0.001) in one- to eight- and nine- to 16-week-old infants, respectively. Mean αSP and mean FHCSP were significantly, but only slightly, lower in females than in males. There was no statistically significant difference in DDH indices observed between left and right hip. All 3DUS indices varied significantly between anterior and posterior section of the hip. Mean 3D indices of α angle and FHC were significantly lower anteriorly than posteriorly: αAnt = 58.2° (SD 6.1°), αPost = 63.8° (SD 6.3°) (p < 0.001), FHCAnt = 43.0 (SD 7.4), and FHCPost = 55.4° (SD 11.2°) (p < 0.001). Acetabular rounding measured byOCR indices was significantly greater in the anterior section of the hip (p < 0.001). Conclusion We used 3DUS to show that hip shape and normal growth pattern vary significantly between anterior and posterior regions, by magnitudes similar to age-related changes. This highlights the need for careful selection of the Graf plane during 2D ultrasound examination. Whole-joint evaluation by obtaining either 3DUS or manual ‘sweep’ video images provides more comprehensive DDH assessment. Cite this article: Bone Jt Open 2022;3(11):913–923.
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Xu M, He Y, Du B. Pericapsular nerve group block for a child with spina malformation for hip surgery. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Sun K, Jin M, Zhang X. Ultrasound-guided lumbar plexus block versus transversus abdominis plane block for analgesia in children with hip dislocation: A double-blind, randomized trial. Open Med (Wars) 2022; 17:1664-1673. [PMID: 36349190 PMCID: PMC9587528 DOI: 10.1515/med-2022-0581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 09/22/2022] [Accepted: 09/22/2022] [Indexed: 11/06/2022] Open
Abstract
Lumbar plexus block is often used as analgesia for adult hip surgery, but it is rarely used in pediatric patients. This study aimed to compare the efficacy and feasibility of ultrasound-guided lumbar plexus block versus transversus abdominis plane block for postoperative analgesia in children with hip dislocation. Eighty children undergoing unilateral hip dislocation surgeries at our hospital from October 2019 to February 2021 were randomized to the lumbar plexus block group (group L) and transversus abdominis plane block group (group T). Compared with group L, the regional block time in group T was lower (8.0 ± 2.5 vs 11.5 ± 2.3 min, P < 0.05), and the ultrasound image definition was better (P < 0.05). There were no significant differences in mean blood pressure and heart rate within 24 h (all P > 0.05). Children’s Hospital of Eastern Ontario Pain Scale scores were lower in group L than in group T at 18–24 h only (all P < 0.05). The satisfying analgesia rate in group L was higher than in group T (87.5 vs 65%, P < 0.05). No regional block-related complications were found in both groups. Ultrasound-guided lumbar plexus block showed a longer postoperative analgesic effect in children with hip dislocation compared with transversus abdominis plane block.
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Affiliation(s)
- Ke Sun
- Department of Anesthesiology, Jishuitan Hospital , Beijing , 100035 , China
| | - Mei Jin
- Department of Anesthesiology, Jishuitan Hospital , Beijing , 100035 , China
| | - Xiaoguang Zhang
- Department of Anesthesiology, Jishuitan Hospital , Beijing , 100035 , China
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Heterozygous LRP1 deficiency causes developmental dysplasia of the hip by impairing triradiate chondrocytes differentiation due to inhibition of autophagy. Proc Natl Acad Sci U S A 2022; 119:e2203557119. [PMID: 36067312 PMCID: PMC9477389 DOI: 10.1073/pnas.2203557119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Developmental dysplasia of the hip (DDH) is one of the most common congenital skeletal malformations; however, its etiology remains unclear. Here, we conducted whole-exome sequencing and identified likely pathogenic variants in the LRP1 (low-density lipoprotein receptor-related protein 1) gene in two families and seven unrelated patients. We found that the timing of triradiate cartilage development was brought forward 1 or 2 wk earlier in the LRP-deficient mice, which leads to malformation of the acetabulum and femoral head. Furthermore, Lrp1 deficiency caused a significant decrease of chondrogenic ability in vitro. Our study reveals a critical role of LRP1 in the etiology and pathogenesis of DDH, opening an avenue for its treatment. Developmental dysplasia of the hip (DDH) is one of the most common congenital skeletal malformations; however, its etiology remains unclear. Here, we conducted whole-exome sequencing in eight DDH families followed by targeted sequencing of 68 sporadic DDH patients. We identified likely pathogenic variants in the LRP1 (low-density lipoprotein receptor-related protein 1) gene in two families and seven unrelated patients. All patients harboring the LRP1 variants presented a typical DDH phenotype. The heterozygous Lrp1 knockout (KO) mouse (Lrp1+/−) showed phenotypes recapitulating the human DDH phenotypes, indicating Lrp1 loss of function causes DDH. Lrp1 knockin mice with a missense variant corresponding to a human variant identified in DDH (Lrp1R1783W) also presented DDH phenotypes, which were milder in heterozygotes and severer in homozygotes than those of the Lrp1 KO mouse. The timing of triradiate cartilage development was brought forward 1 or 2 wk earlier in the LRP-deficient mice, which leads to malformation of the acetabulum and femoral head. Furthermore, Lrp1 deficiency caused a significant decrease of chondrogenic ability in vitro. During the chondrogenic induction of mice bone marrow stem cells and ATDC5 (an inducible chondrogenic cell line), Lrp1 deficiency caused decreased autophagy levels with significant β-catenin up-regulation and suppression of chondrocyte marker genes. The expression of chondrocyte markers was rescued by PNU-74654 (a β-catenin antagonist) in an shRNA-Lrp1–expressed ATDC5 cell. Our study reveals a critical role of LRP1 in the etiology and pathogenesis of DDH, opening an avenue for its treatment.
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Crnogaca K, Sulje Z, Delimar D. Previous corrective osteotomies of femur and pelvis are a risk factor for complications following total hip arthroplasty in hip dysplasia. J Orthop 2022; 33:100-104. [PMID: 35942332 PMCID: PMC9356201 DOI: 10.1016/j.jor.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/13/2022] [Accepted: 07/12/2022] [Indexed: 10/17/2022] Open
Abstract
Background Modified anatomy of dysplastic hips, bone defects and previous operations make THA (total hip arthroplasty) in patients with hip dysplasia a technically challenging procedure. Methods One hundred and ten patients (mean 49.2 years of age, range 19-76, female:103, male:7) underwent 122 subsequent hip arthroplasties from 2012 to 2019. These patients were reviewed at least two years after THA. Plain radiography was used to determine Crowe classification of the affected hips. Fifty-three patients had an operation in childhood before THA was done (mean 47.0 years of age, standard deviation 8.3, range 19-62) and formed the "operated group". Among these patients, there were Chiari pelvic osteotomies, periacetabular osteotomies, femoral osteotomies, greater trochanter distalizations and soft tissue operations. Fifty-seven were not operated in childhood (mean 52.3 years of age, standard deviation 10.9, range 19-76) and formed the "non operated group". The functional status of the patients was assessed with the Oxford Hip Score (OHS). Results 122 total hip arthroplasties were performed using uncemented femoral and acetabular components. There were 13 major complications identified. Ten were in the "operated group", of which 5 needed revision surgery. Only 3 were in the "non operated group", with no need for revision. Aseptic loosenings of the femoral component were seen in the patients that had femoral osteotomy done in childhood. Acetabular component migration and intrapelvic migration occurred due to the initial malposition and lack of osteointegration, thus requiring early revision after just 6 months. Other major complications were peroneal palsy, deep periprosthetic infection, severe trochanteritis and intraoperative femoral fracture. OHS was significantly higher in the "non operated group" 42.3 (10-48), opposed to 39.1 (10-48) in the "operated group" (p 0.017). Conclusion Corrective osteotomies in childhood are a risk factor for complications and lower medium-term survivorship of the THA in hip dysplasia patients.
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Affiliation(s)
- Kresimir Crnogaca
- University Hospital Centre Zagreb, Department of Orthopaedic Surgery, Zagreb, Croatia
| | - Zoran Sulje
- University Hospital Centre Zagreb, Department of Orthopaedic Surgery, Zagreb, Croatia
| | - Domagoj Delimar
- University Hospital Centre Zagreb, Department of Orthopaedic Surgery, Zagreb, Croatia
- University of Zagreb, School of Medicine, University Hospital Centre Zagreb, Department of Orthopaedic Surgery, Zagreb, Croatia
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Pulik Ł, Płoszka K, Romaniuk K, Sibilska A, Jedynak A, Tołwiński I, Kumięga P, Wojtyński P, Łęgosz P. Impact of Multiple Factors on the Incidence of Developmental Dysplasia of the Hip: Risk Assessment Tool. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58091158. [PMID: 36143835 PMCID: PMC9502116 DOI: 10.3390/medicina58091158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 11/23/2022]
Abstract
Background and Objectives: Developmental dysplasia of the hip (DDH) is one of the most common musculoskeletal conditions in children. If not treated, it leads to disability, gait abnormalities, limb shortening, and chronic pain. Our study aims to determine the impact of multiple risk factors on the incidence of DDH and to develop an interactive risk assessment tool. Materials and Methods: We conducted a retrospective cohort study in the Outpatient Clinic for Children of the Medical University of Warsaw Hospital. The Graf classification system was used for universal ultrasonographic screening. In total, 3102 infants met the eligibility criteria. Results: The incidence of DDH in the study group was 4.45%. The incidence of DDH in the Warsaw population, Poland, during the study period was 3.73 to 5.17 (95% CI). According to the multivariate analysis, the risk factors for DDH were birth weight (OR = 2.17 (1.41−3.32)), week of delivery (OR = 1.18 (1.00−1.37)), female sex (OR = 8.16 (4.86−13.71)), breech presentation (OR = 5.92 (3.37−10.40)), physical signs of DDH (25.28 (8.77−72.83)) and positive family history in siblings (5.74 (2.68−12.31)). Our results support the recent hypothesis that preterm infants (<37 weeks) have a lower rate of DDH. Conclusions: A multivariate logistic regression predictive model was used to build the risk calculator. The DDH risk calculator will be evaluated in a prospective validation study.
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Affiliation(s)
- Łukasz Pulik
- Department of Orthopaedics and Traumatology, Medical University of Warsaw, 02-005 Warsaw, Poland
- Correspondence:
| | - Katarzyna Płoszka
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, 92-215 Lodz, Poland
| | - Krzysztof Romaniuk
- Department of Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Aleksandra Sibilska
- Department of Orthopaedics and Traumatology, Medical University of Warsaw, 02-005 Warsaw, Poland
| | - Andrzej Jedynak
- Department of Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Ignacy Tołwiński
- Department of Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Paulina Kumięga
- Department of Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Paweł Wojtyński
- Department of Orthopaedics and Traumatology, Medical University of Warsaw, 02-005 Warsaw, Poland
| | - Paweł Łęgosz
- Department of Orthopaedics and Traumatology, Medical University of Warsaw, 02-005 Warsaw, Poland
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Domain-aware contrastive learning for ultrasound hip image analysis. Comput Biol Med 2022; 149:106004. [DOI: 10.1016/j.compbiomed.2022.106004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 08/08/2022] [Accepted: 08/14/2022] [Indexed: 11/19/2022]
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Kuitunen I, Uimonen MM, Haapanen M, Sund R, Helenius I, Ponkilainen VT. Incidence of Neonatal Developmental Dysplasia of the Hip and Late Detection Rates Based on Screening Strategy: A Systematic Review and Meta-analysis. JAMA Netw Open 2022; 5:e2227638. [PMID: 35980635 PMCID: PMC9389349 DOI: 10.1001/jamanetworkopen.2022.27638] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Universal ultrasonographic screening for developmental dysplasia of the hip (DDH) has gained increasing popularity despite the lack of benefit in terms of reducing the rates of late-detected cases (age ≥12 weeks) in randomized clinical trials. OBJECTIVE To report the reported incidence of DDH in the English scientific literature and compare rates of late-detected cases in settings with different DDH screening strategies. DATA SOURCES PubMed, Scopus, and Web of Science databases were searched on November 25 and 27, 2021. No time filters were used in the search. STUDY SELECTION All observational studies reporting the incidence of early-detected or late-detected (age ≥12 weeks) DDH were included. Non-English reports were excluded if the abstract did not include enough information to be included for analysis. DATA EXTRACTION AND SYNTHESIS The number of newborns screened and the detection rates were extracted. Meta-analysis calculated the pooled incidence of DDH per 1000 newborns with 95% CIs using a random- or fixed-effects model. This study is reported according to the PRISMA and MOOSE guidelines. MAIN OUTCOMES AND MEASURES The main outcome measures were early detection, early treatment, late detection, and operative treatment incidences. RESULTS A total of 1899 studies were identified, 203 full texts were assessed, and 76 studies with 16 901 079 infants were included in final analyses. The early detection rate was 8.4 (95% CI, 4.8-14.8) infants with DDH per 1000 newborns with clinical screening, 4.4 (95% CI, 2.4-8.0) infants with DDH per 1000 newborns with selective ultrasonographic screening, and 23.0 (95% CI, 15.7-33.4) infants with DDH per 1000 newborns with universal ultrasonographic screening. Rates for nonoperative treatment were 5.5 (95% CI, 2.1-14) treatments per 1000 newborns with clinical screening, 3.1 (95% CI, 2.0-4.8) treatments per 1000 newborns with selective ultrasonographic screening, and 9.8 (95% CI, 6.7-14.4) treatments per 1000 newborns with universal ultrasonographic screening. The incidence of late-detected DDH was 0.5 (95% CI, 0.2-1.5) infants with DDH per 1000 newborns with clinical screening, 0.6 (95% CI, 0.3-1.3) infants with DDH per 1000 newborns with selective ultrasonographic screening, and 0.2 (95% CI, 0.0-0.8) infants with DDH per 1000 newborns with universal ultrasonographic screening. The corresponding incidences of operative treatment were 0.2 (95% CI, 0.0-0.9) operations per 1000 newborns with clinical screening, 0.5 (95% CI, 0.4-0.7) operations per 1000 newborns with selective ultrasonographic screening, and 0.4 (95% CI, 0.2-0.7) operations per 1000 newborns with universal ultrasonographic screening. CONCLUSIONS AND RELEVANCE This meta-analysis found that early detection rates and nonoperative treatments were higher with universal screening. The late detection and operative treatment rates with universal screening were similar to those among selectively and clinically screened newborns. Based on these results, universal screening may cause initial overtreatment without reducing the rates of late detection and operative treatment.
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Affiliation(s)
- Ilari Kuitunen
- Institute of Clinical Medicine, Department of Pediatrics, University of Eastern Finland, Kuopio, Finland
- Department of Pediatrics and Neonatology, Mikkeli Central Hospital, Mikkeli, Finland
| | - Mikko M. Uimonen
- Department of Surgery, Central Finland Hospital Nova, Jyväskylä, Finland
| | - Marjut Haapanen
- Institute of Clinical Medicine, Department of Pediatrics, University of Eastern Finland, Kuopio, Finland
| | - Reijo Sund
- Kuopio Musculoskeletal Research Unit, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Ilkka Helenius
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Paediatric Orthopedics, Helsinki University Hospital, New Children’s Hospital, Helsinki, Finland
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Anthropometric measurements of the pediatric hip using CT-based simulated anteroposterior radiographs of the pelvis. J Pediatr Orthop B 2022; 31:334-343. [PMID: 35620838 DOI: 10.1097/bpb.0000000000000940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Normal anatomical variants and pathological deformities of the pediatric hip can only be differentiated after a prior definition of normal ranges for anthropometric parameters with increasing age. Aim of the present study was to provide reliable reference values of the pediatric hip morphometry, using computed tomography (CT)-based rotation-corrected summation images of the pelvis that simulate the widely available plain radiograph-based measurements, but offer the higher precision of the CT technique. This retrospective study included 85 patients (170 hips) under 15 years of age (0-15). The measured anthropometric parameters included femur head extrusion index, lateral center-edge angle, acetabular inclination, Tönnis angle, and femoral neck-shaft angle. Mean values, range, SD, P values, intra-rater, and inter-rater reliability were calculated. All measurements correlated with age. None of the measurements correlated with gender or side. Rapid growth phases were noted in all measurements at the age of 12 (14 in males and 11 in females). The inter-rater and intra-rater reliability was high (range inter/intraclass correlation coefficient 0.926-0.998 Cronbach's alpha 0.986-0.998). The present work provides age- and gender-related normative values of the classically used hip measurements as well as growth phases describing pediatric hip morphology in a broad age range. A discrepancy was noted between the values measured in the current study and the classical X-ray-based reference values in the literature especially for the Tönnis angle and LCEA values. This suggests that the rotation and inclination correction in the CT-based techniques might have the advantage of compensating for a possible overestimation in the conventional X-ray-based methods.
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