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Dean RS, Hamama BA, Cavinatto L, Nho SJ, Chahla J, Hinckel BB. Chemoprophylaxis for heterotopic ossification following hip arthroscopy: A systematic review. J ISAKOS 2023; 8:484-489. [PMID: 37619960 DOI: 10.1016/j.jisako.2023.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 08/05/2023] [Accepted: 08/17/2023] [Indexed: 08/26/2023]
Abstract
INTRODUCTION Heterotopic ossification (HO) is a known complication diagnosed following hip arthroscopy. PURPOSE/HYPOTHESIS This study sought to review the current literature on chemoprophylaxis for HO following hip arthroscopy and to describe what agents and doses are being utilized. STUDY DESIGN Systematic Review. METHODS A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines on the use of chemoprophylactic medications for HO prevention following hip arthroscopy. Mechanical and radiation prophylaxis were not included in the current analysis. RESULTS A total of 203 studies were identified, of which 15 were included with 6463 patients. There was one randomized control trial (RCT) and 4 additional comparative studies. The most commonly utilized chemoprophylactic agents were the following: naproxen (n = 8), celecoxib (n = 3), indomethacin (n = 3), aspirin (n = 1), etoricoxib (n = 1), and etodolac (n = 1), and non-specific non-steroidal anti-inflammatory drugs (NSAIDs) (n = 1). Naproxen was either given at a dose of 500 mg once or twice daily for 2-4 weeks. RCTs and additional comparative studies showed significant HO prevention using chemoprophylactic agents following hip arthroscopy. CONCLUSIONS HO is a known and common complication following hip arthroscopy. The current systematic review found significant heterogeneity across the literature with respect to specific chemoprophylactic agents and their dosing regimens aimed to reduce the incidence and severity of HO following hip arthroscopy. Additionally, this review demonstrates that most studies that utilize chemoprophylaxis use NSAIDs with successful reduction in the incidence of HO. LEVEL OF EVIDENCE Level IV Evidence.
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Affiliation(s)
| | - Britanny A Hamama
- Central Michigan University College of Medicine, Mount Pleasant, MI, 48073, USA
| | | | - Shane J Nho
- Midwest Orthopaedics at Rush, Chicago, IL, 48073, USA
| | - Jorge Chahla
- Midwest Orthopaedics at Rush, Chicago, IL, 48073, USA
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Olivero M, Capurro B, Reis-Campos P, Aprato A, Ayeni O, Chawla A, Larrainzar Garijo R, Marín-Peña O. Low-dose prophylaxis protocol for heterotopic ossification after hip preservation surgery in a sport participants cohort. SICOT J 2023; 9:27. [PMID: 37668540 PMCID: PMC10478760 DOI: 10.1051/sicotj/2023024] [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: 04/17/2023] [Accepted: 07/30/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Heterotopic ossification (HO) is a well-known complication of arthroscopic and open surgical treatment of femoroacetabular impingement (FAI). Incidence of heterotopic ossification has been reported in the literature between 0% and 44% after hip arthroscopy and between 18.2% and 25% after anterior mini-open surgery. Currently, pharmacological prophylaxis with NSAIDs and selective COX-2 inhibitors are commonly used and their effectiveness is well documented in literature. HYPOTHESIS We hypothesized that the low-dose prophylaxis protocol with selective cox-2 inhibitors decreases the risk of heterotopic ossification in open or arthroscopic hip preservation surgery in athletes. METHODS This study is an analysis of prospectively gathered data on 98 sport participant patients who underwent arthroscopic or anterior mini-open treatment for FAI between April 2008 and April 2018. All the patients received postoperative oral prophylaxis with 60 mg etoricoxib once daily for two weeks. Post-operative X-rays were performed at 1, 3, and 12 months after surgery and reviewed by two orthopedic surgeons blinded to the type and side of surgery. HO were graded according to the Brooker classification. Descriptive statistics was used to analyze demographic data. Bivariate analysis was performed to analyze the association of HO with each of the following variables: type of surgery, physical activity, time of evolution of symptoms, age at surgery, and sex. Finally, a regression model analysis was performed to determine the presence of confounding effects between variables. RESULTS The study cohort was composed of 54 patients in the arthroscopic treatment group and 44 patients in the anterior mini-open group. HO was identified in 6 (13.6%) patients in the mini-open group. No HO was identified in the arthroscopic group. In the bivariate analysis, "type of surgery" was the only variable that showed a statistically significant association with HO (p = 0.007). CONCLUSION Results of this study suggest that anterior mini-open treatment was characterized by a higher risk of HO development compared to hip arthroscopy for femoroacetabular impingement treatment regardless of pharmacological prophylaxis. The treatment regimen of 60 mg etoricoxib daily for two weeks was an effective prophylaxis for HO formation in sport participant patients compared with data available in the literature.
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Affiliation(s)
- Matteo Olivero
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Centro Traumatológico Ortopédico, (CTO), University of Torino 10126 Torino Italy
| | - Bruno Capurro
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Department of Orthopaedic Surgery and Sport Traumatology, IMSKE Hospital 46024 Valencia Spain
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European Hip Preservation Associates, EHPA-ESSKA Section Europe
| | - Pedro Reis-Campos
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Orthopedic and Traumatology Department, Hospital Vila Franca de Xira 2600-009 Portugal
| | - Alessandro Aprato
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Centro Traumatológico Ortopédico, (CTO), University of Torino 10126 Torino Italy
| | - Olufemi Ayeni
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Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Center L8S 4S4 Hamilton Canada
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European Hip Preservation Associates, EHPA-ESSKA Section Europe
| | - Anuj Chawla
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Department of Orthopaedic Surgery, Tan Tock Seng Hospital PC 308433 Novena Singapore
| | - Ricardo Larrainzar Garijo
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Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Infanta Leonor 28031 Madrid Spain
| | - Oliver Marín-Peña
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Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Infanta Leonor 28031 Madrid Spain
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European Hip Preservation Associates, EHPA-ESSKA Section Europe
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Complications following posterior spinal fusion for adolescent idiopathic scoliosis: a retrospective cohort study using the modified Clavien-Dindo-Sink system. Spine Deform 2022; 10:607-614. [PMID: 35112274 DOI: 10.1007/s43390-021-00468-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 12/18/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Published complication rates after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) range from 1 to 22%. Complications are often minor and may be underestimated in registries. This study describes complications of PSF for AIS, classifies them according to a Clavien-Dindo-Sink (CDS) system, and investigates risk factors for occurrence of a complication. METHODS This retrospective cohort study at two academic centers included all AIS patients aged 10-18 who underwent primary PSF 4/2014-12/2019. Data included demographics, comorbidities, curve magnitude, Lenke classification, levels osteotomized/fused, implant density, 90-day emergency department visits, readmissions, reoperations, and complications as defined by Harms Study Group. RESULTS Among 424 patients, mean age was 14.7, mean BMI 22, 77% were female, and 57% had no comorbidities. There were 270 complications (0.64 per patient); 198 patients (47%) had ≥ 1 complication; and 63 patients (15%) had CDS grade ≥ II complications (deviation from standard postoperative course). Complications not related to persistent pain occurred in 103 patients (24%). Ninety-three percent of complications did not require readmission or reoperation (CDS I-II). Within 90 days, 8% presented to an ED, 2% required readmission, and 2% required reoperation. Common complications were back pain > 6 weeks postoperatively (26%), surgical site complications (7%), and ileus/prolonged constipation (3%). Risk factors for experiencing any complication were BMI ≥ 34 (OR 3.44) and Lenke 6 curve (OR 1.95). CONCLUSION One in four AIS patients experiences a complication not related to persistent pain after primary PSF, higher than rates published from self-reported registries. Obesity and Lenke 6 curve may increase risk. While most do not require readmission or surgery, 15% of patients have their postoperative course altered by complications. LEVEL OF EVIDENCE III-retrospective cohort study.
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Parilla FW, Nepple JJ, Pashos GE, Schoenecker PL, Clohisy JC. Is combined surgical dislocation and proximal femoral osteotomy a safe procedure for correction of complex hip deformities? J Hip Preserv Surg 2022; 9:126-133. [PMID: 35854803 PMCID: PMC9291356 DOI: 10.1093/jhps/hnac011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/14/2022] [Accepted: 03/08/2022] [Indexed: 11/30/2022] Open
Abstract
Complex deformities of the hip requiring intra-articular and proximal femoral correction are challenging with regard to surgical access and complication risk. Combined surgical dislocation and proximal femoral osteotomy (SD/PFO) is a surgical strategy that provides unrestricted access to the joint with the capability for adjunctive PFO. Although providing excellent surgical access, concerns over a potentially high risk of postoperative complications remain, and published information on the safety of this technique remain scarce. In this study, we defined the early complication profile of combined surgery across 48 hips with a variety of complex deformities using a standardized, validated complication grading scheme for hip preservation surgery. Patients were mean age 19.1 years 13–33 years and 60% had previous surgery. At the early mean follow-up of 2.9 years, considerable improvement was seen across all outcome scores. Major complications (Grade III or higher) occurred at a rate of 4.2% (n = 2). Both were osteotomy non-unions, and both were treated successfully with revision PFO and bone grafting at mean 1.1 years. To our knowledge, the current series of combined SD-PFO surgeries represents the largest to date for which detailed complication data have been reported. Given the complexity of these disorders, a major complication rate of 4.2% is acceptable. Our complication rates were comparable to those reported for isolated SD and PFO procedures. These rates did not vary significantly across morphologic variants or patient-specific characteristics. Additionally, our complication risk profile is consistent with previous, smaller reports, which supports the generalizability of these results among appropriately experienced surgeons.
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Affiliation(s)
- Frank W Parilla
- Department of Orthopaedic Surgery, Washington University School of Medicine, Campus Box 8233, 660 S. Euclid Ave., Saint Louis, MO 63110, USA
| | - Jeffrey J Nepple
- Department of Orthopaedic Surgery, Washington University School of Medicine, Campus Box 8233, 660 S. Euclid Ave., Saint Louis, MO 63110, USA
| | - Gail E Pashos
- Department of Orthopaedic Surgery, Washington University School of Medicine, Campus Box 8233, 660 S. Euclid Ave., Saint Louis, MO 63110, USA
| | - Perry L Schoenecker
- Department of Orthopaedic Surgery, Washington University School of Medicine, Campus Box 8233, 660 S. Euclid Ave., Saint Louis, MO 63110, USA
| | - John C Clohisy
- Department of Orthopaedic Surgery, Washington University School of Medicine, Campus Box 8233, 660 S. Euclid Ave., Saint Louis, MO 63110, USA
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Schaver AL, Willey MC, Westermann RW. Incidence of Heterotopic Ossification with NSAID Prophylaxis Is Low After Open and Arthroscopic Hip Preservation Surgery. Arthrosc Sports Med Rehabil 2021; 3:e1309-e1314. [PMID: 34712968 PMCID: PMC8527257 DOI: 10.1016/j.asmr.2021.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 06/07/2021] [Indexed: 12/05/2022] Open
Abstract
Purpose We evaluate the incidence of heterotopic ossification (HO) development with nonsteroidal anti-inflammatory drug (NSAID) prophylaxis in patients after open and arthroscopic hip preservation surgery. Methods A retrospective review identified patients who underwent hip preservation surgery at a single institution within the past 3 years. Patients who underwent hip arthroscopy with or without periacetabular osteotomy (PAO) or femoral osteotomy (FO) were included. Those who did not receive 3-month postoperative radiographs were excluded. The incidence and Brooker classification (BC) of HO in patients taking Naproxen or another NSAID (meloxicam, celecoxib, indomethacin, or aspirin alone) was assessed using AP radiographs available from 3-, 6-, and 12-month follow-up appointments. Univariate analysis was conducted to compare numerical means and categorical data (significance level P = .05). Results A total of 328 hips (284 patients) were included. All patients received hip arthroscopy, while 71 patients (21.6%) received concurrent periacetabular osteotomy (PAO; n = 65) or femoral osteotomy (FO; n = 6). Overall, 276 hips (84.4%) received Naproxen for HO prophylaxis. In total, 5 of 328 hips (1.5%) developed HO (4, BC I; 1, BC III). The rate of HO development was significantly higher in males versus females (4 of 121 (3.31%) vs 1 of 207 (.48%), P = .0441). All 5 patients received arthroscopic cam resection and labral repair, and 1 patient also received PAO. Three patients in the Naproxen group (.91%) developed HO, which was not statistically different from those taking a different NSAID (.61%, P = .1797). Conclusion The incidence of HO development was low with NSAID prophylaxis after hip preservation surgery.
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Affiliation(s)
- Andrew L Schaver
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Michael C Willey
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Robert W Westermann
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
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Randelli F, Papavasiliou A, Mazzoleni MG, Fioruzzi A, Basile G, Ganz R. Femoral head necrosis and progressive osteoarthritis of a healed intracapital osteotomy in a severe sequelae of Legg-Calvé-Perthes disease with aplasia of tensor fasciae latae. J Hip Preserv Surg 2021; 8:i16-i24. [PMID: 34178367 PMCID: PMC8221380 DOI: 10.1093/jhps/hnab019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Filippo Randelli
- Hip Department (CAD) Gaetano Pini, CTO Orthopedic Institute, University of Milan, Italy
| | | | - Manuel G Mazzoleni
- Department of Life Health & Environmental Sciences, Unit of Orthopedics and Traumatology, University of L'Aquila, L'Aquila, Italy
| | - Alberto Fioruzzi
- Hip Department (CAD) Gaetano Pini, CTO Orthopedic Institute, University of Milan, Italy
| | - Giuseppe Basile
- Department of Trauma Surgery, IRCCS Orthopaedic Institute R. Galeazzi, University of Milan, Milan, Italy
| | - Reinhold Ganz
- Faculty of Medicine, University of Bern, Bern, Switzerland
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Palazón-Quevedo Á, Galán-Olleros M, Egea-Gámez RM. Bilateral femoral head reshaping and mosaicplasty in Legg-Calvé-Perthes disease residual deformity. J Hip Preserv Surg 2021; 8:i9-i15. [PMID: 34178366 PMCID: PMC8221381 DOI: 10.1093/jhps/hnab021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 03/14/2021] [Accepted: 03/15/2021] [Indexed: 11/21/2022] Open
Abstract
Residual hip deformity secondary to Perthes disease may lead to early symptomatic joint degeneration. The altered anatomy results in biomechanical and biological problems that can be surgically addressed in adolescents or young adults with hip preservation procedures. This case report aims to demonstrate a customized surgical treatment performed on a 15-year-old male who developed painful hips with significant intra- and extra-articular impingement, secondary to bilateral Leg–Calvé–Perthes disease residual deformity. Intra-articular procedures were executed through a safe surgical dislocation of the hip, with a mosaicplasty using osteochondral autografts from the exceeding peripheral ipsilateral femoral head, a femoral head–neck osteochondroplasty and a labrum repair. A relative lengthening of the femoral neck was also carried out with a trochanteric advancement to solve the extra-articular issues. On follow-up, he referred to a substantial improvement in pain and function, being his radiographic studies satisfactory. At 4 and 5 years from surgery, the patient was able to exercise regularly with minimal complaints, with a Harris Hip Score of 85.85% and a Hip Outcome Score of 94.1% for activities of daily life and 86.1% for sports. In patients with hip deformity after healed Perthes disease, treatment strategies that address both the morphological disturbance of coxa magna, plana and breva, as well as the biological concerns arising from osteochondral injuries or labral tears, and mechanical dysfunctions lead to improvements in symptomatology, function and medium-term prognosis. Further procedures to address residual adaptative acetabular dysplasia would favor outcomes of conservative hip surgery in the sequelae of LCPD.
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Affiliation(s)
- Ángel Palazón-Quevedo
- Pediatric Orthopaedic and Traumatology Department, Hospital Infantil Universitario Niño Jesús, Av. de Menéndez Pelayo 65, 28009, Madrid, Spain
| | - María Galán-Olleros
- Pediatric Orthopaedic and Traumatology Department, Hospital Infantil Universitario Niño Jesús, Av. de Menéndez Pelayo 65, 28009, Madrid, Spain.,Orthopaedic Surgery and Traumatology Department, Hospital Clínico San Carlos, Calle Profesor Martín Lagos s/n 28004, Madrid, Spain
| | - Rosa M Egea-Gámez
- Pediatric Orthopaedic and Traumatology Department, Hospital Infantil Universitario Niño Jesús, Av. de Menéndez Pelayo 65, 28009, Madrid, Spain
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Zhu J, Chen K, Peng J, Li Y, Shen C, Chen X. Femoral neck rotational osteotomy: a modified method for treating necrotic femoral heads with large and laterally located lesions. J Hip Preserv Surg 2021; 7:713-720. [PMID: 34377514 PMCID: PMC8349588 DOI: 10.1093/jhps/hnab016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 02/23/2021] [Accepted: 03/11/2021] [Indexed: 11/12/2022] Open
Abstract
In this study, we retrospectively investigated the short-term outcome of femoral neck rotational osteotomy (FNRO) for treating necrotic femoral heads with large and laterally located lesions. Twelve necrotic femoral heads (ARCO stage II or III) with an average Kerboul angle of 210° underwent FNRO through surgical hip dislocation. By circumferential release of capsule and retinaculum, femoral neck osteotomy was performed at the base of femoral neck just 1.5 cm above lesser trochanter. The severed femoral neck was rotated with a mean angle of 120.4° and fixed with a mean varus angulation of 10.2°. Both Harris hip score and International hip outcome tool improved at a mean follow-up of 29 months. The average post-operative intact rate was 55.3%. Subsequent collapse or progression to osteoarthritis was found in four hips but only one hip failed with a Harris hip score of 44 and converted to hip replacement. Post-operative leg length discrepancy was 1.1 cm. Limp presented in seven hips. Six hips had osteophyte formation. FNRO through surgical hip dislocation had the advantages of safe exposure, direct visualization of necrotic lesion and high reorientation of healthy bone and articular cartilage on femoral head. We observed satisfactory short-term survivorship and improved patient-reported outcomes in necrotic femoral heads treated with FNRO.
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Affiliation(s)
- Junfeng Zhu
- Department of Orthopaedics, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Building 8, No.1665, Kongjiang Road, Shanghai 200092, China
| | - Kangming Chen
- Department of Orthopaedics, Huashan Hospital, Fudan University, No. 12, Wulumuqizhong Road, Shanghai 200040, China
| | - Jianping Peng
- Department of Orthopaedics, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Building 8, No.1665, Kongjiang Road, Shanghai 200092, China
| | - Yang Li
- Department of Orthopaedics, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Building 8, No.1665, Kongjiang Road, Shanghai 200092, China
| | - Chao Shen
- Department of Orthopaedics, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Building 8, No.1665, Kongjiang Road, Shanghai 200092, China
| | - Xiaodong Chen
- Department of Orthopaedics, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Building 8, No.1665, Kongjiang Road, Shanghai 200092, China
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Maranho DA, Ferrer M, Kalish LA, Hovater W, Novais EN. The acetabulum in healed Legg-Calvé-Perthes disease is cranially retroverted and associated with global reduction of femoral head coverage: a matched-cohort study. J Hip Preserv Surg 2020; 7:49-56. [PMID: 32382429 PMCID: PMC7195929 DOI: 10.1093/jhps/hnaa003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 12/29/2019] [Accepted: 01/09/2020] [Indexed: 12/02/2022] Open
Abstract
To evaluate the acetabular morphology in healed Legg–Calvé–Perthes disease after skeletal maturity using computed tomography (CT) scan and to compare with matched controls. We identified 33 (37 hips) patients with healed Legg–Calvé–Perthes disease and closed triradiate cartilage who underwent pelvic CT scan. Each patient was matched based on sex, age and side to a subject with no history of hip disease who had undergone pelvic CT evaluation because of abdominal pain. Both cohorts had 23 (70%) males and mean age of 16.4–16.5 ± 3.6 years. Two independent readers assessed lateral center-edge angle (LCEA), acetabular inclination angle (IA), acetabular depth-width ratio (ADR), acetabular version 10 mm below the dome (cranial) and at the acetabular center and anterior (AASA) and posterior acetabular sector angles (PASA). All measurements had good to excellent interobserver agreement (intraclass coefficients ≥ 0.87). The hips in the Legg–Calvé–Perthes disease cohort had a smaller mean ± standard deviation (SD) superior, anterior and posterior acetabular coverage as assessed by LCEA (13.2° ± 10.7° versus 28.2° ± 3.4°; P < 0.0001), IA (11.6° ± 6.7° versus 3.5° ± 2.8°; P < 0.0001), AASA (52.4° ± 9.5° versus 59.3° ± 5.0°; P = 0.001) and PASA (79.3° ± 5.9° versus 92.3° ± 5.5°; P < 0.0001) compared with controls. The acetabulum was shallower (ADR 287 ± 45 versus 323 ± 28; P = 0.0002) and the acetabular version was decreased cranially (0.4°±9.2° versus 8.2°±6.8°; P = 0.0002) and at the acetabular center (13.7°±5.1° versus 17.2° ±3.8°; P = 0.004) in Legg–Calvé–Perthes disease hips. After skeletal maturity, hips with healed Legg–Calvé–Perthes disease have shallower and more cranially retroverted acetabula, with globally reduced coverage of the femoral head compared with age-, sex- and side-matched control hips.
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Affiliation(s)
- Daniel A Maranho
- Department of Orthopedic Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.,Department of Biomechanics, Medicine and Rehabilitation of the Locomotor System, Ribeirao Preto Medical School, University of Sao Paulo, Av Bandeirantes 3900, 11° Floor, Ribeirao Preto, Sao Paulo 14049-900, Brazil
| | - Mariana Ferrer
- Department of Orthopedic Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Leslie A Kalish
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Whitney Hovater
- Department of Orthopedic Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Eduardo N Novais
- Department of Orthopedic Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
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Total hip arthroplasty in an adult patient with pelvic dysmorphism, unilateral sacroiliac joint autofusion, and developmental hip dysplasia. Arthroplast Today 2019; 6:41-47. [PMID: 32211473 PMCID: PMC7083716 DOI: 10.1016/j.artd.2019.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 10/23/2019] [Accepted: 10/26/2019] [Indexed: 11/22/2022] Open
Abstract
This case describes the challenges associated with total hip arthroplasty in a patient with unique anatomy, including developmental dysplasia of the hip, pelvic dysmorphism, and unilateral sacroiliac joint autofusion. A 30-year-old female, with a history of developmental dysplasia of the hip treated with presumed pelvic osteotomy complicated by postoperative infection, presented with hip pain refractory to conservative management. Radiographic studies demonstrated a 10-cm leg length discrepancy, 20° of acetabular retroversion, severe hemipelvic dysmorphism, ipsilateral sacroiliac joint autofusion, and significant femoral head dysplasia. Total hip arthroplasty was performed using a revision acetabular component and modular femoral component, resulting in improvement in the postoperative leg length discrepancy. There were no neurovascular or other perioperative complications, and the patient was ambulating without pain or assistive devices at 1-year follow-up.
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