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Wang J, Li T, Yao Y, Lu C, Wang Y. The role of the cartilaginous to osseous acetabular angle ratio in children with developmental dysplasia of the hip. Front Pediatr 2024; 12:1347556. [PMID: 38596247 PMCID: PMC11002089 DOI: 10.3389/fped.2024.1347556] [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: 12/01/2023] [Accepted: 03/08/2024] [Indexed: 04/11/2024] Open
Abstract
Purpose This study aims to demonstrate the use of the cartilaginous to osseous acetabular angle ratio (AAR) in surgical decision-making for hip dysplasia. Methods Data were collected from patients who underwent an MRI of the hip after conservative treatment for developmental dysplasia of the hip between August 2019 and 2022. The data included demographic information as well as an anteroposterior pelvic radiograph. The osseous acetabular index (OAI) was measured using x-ray, while the cartilaginous acetabular index (CAI) and the cartilaginous acetabulum head index (CAHI) were measured using MRI. The square of the CAI to OAI, AAR, was calculated. The patients in the residual hip dysplasia (RHD) group were categorized as having an OAI above 20°. During the postoperative follow-up, we evaluated the patients in this group who underwent Bernese triple pelvic osteotomy. Data on surgical patients with an observation period that exceeded 1 year were collected and analyzed. The distribution of the AAR among the different groups was analyzed. A receiver operating characteristic (ROC) predictive model was constructed using the AAR of the patients in the normal and surgical groups to evaluate the need for surgery. Results It was found that there was a significant difference in the OAI, CAI, CAHI, and AAR between the RHD group (OAI 26.15 ± 3.90°, CAI 11.71 ± 4.70°, CAHI 79.75 ± 6.27%, and AAR 5.88 ± 4.24) and the control group patients (OAI 16.77 ± 5.39°, CAI 6.16 ± 3.13°, CAHI 85.05 ± 4.91%, and AAR 2.71 ± 2.08) (p < 0.001). A total of 93.5% of the control group patients had an AAR ≤5, while only 6.5% had an AAR >5. The results of postoperative imaging follow-up were "excellent" in 52 patients and "good" in 3, while the functional follow-up results were excellent in 53 and good in 2. In 15 patients, the observation period exceeded 1 year. The mean observation period was 633.1 ± 259.6 days and the preoperative CAHI was 71.7 ± 4.8%. Of the patients with an AAR >5, a substantial 94.8% (55/58) of them were reported to have undergone surgery, while all patients with an AAR less than or equal to 5 did not undergo surgery (91/91). Based on the ROC, a cutoff value of 5.09 was identified for the need for surgery in children with RHD. Conclusions A surgical decision for residual hip dysplasia can be based on the AAR. An AAR >5 may be a potential indicator for surgical intervention in patients with RHD.
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Affiliation(s)
- Jiaqi Wang
- Department of Pediatric Orthopedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Tianyou Li
- Department of Pediatric Orthopedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Yangyang Yao
- Department of Pediatric Orthopedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Chaoqun Lu
- Department of Radiology, Shandong Public Health Clinical Center, Jinan, Shandong, China
| | - Yanzhou Wang
- Department of Pediatric Orthopedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
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Husum HC, Bach Hellfritzsch M, Henriksen M, Gottliebsen M, Rahbek O. MRI May Be More Valuable than Pelvic Radiographs in the Assessment of Paediatric Borderline Acetabular Dysplasia. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10040758. [PMID: 37190007 DOI: 10.3390/children10040758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/11/2023] [Accepted: 04/20/2023] [Indexed: 05/17/2023]
Abstract
The osseous acetabular index (OAI) and cartilaginous acetabular index (CAI) is often used in diagnosing acetabular dysplasia (AD) in children. We examined the reliability of OAI and CAI in AD diagnostics and compared OAI measurements obtained from radiographs versus MRI. Four raters performed retrospective repeated measurements of the OAI and CAI on pelvic radiographs and MRI scans of 16 consecutive patients (mean age 5 years (2-8)) examined for borderline AD during a period of 2½ years. In MRI, the image selected for analysis by the raters was also registered. Spearman's correlation, scatter plots, and Bland-Altman (BA) plots were analysed for correlation between OAI on pelvic radiographs (OAIR) and MRI scans (OAIMRI), while intra- and interrater reliability was assessed for OAIR, OAIMRI, CAI, and MRI image selection using intraclass correlation coefficients (ICC). ICC values for inter- and intrarater reliability of OAIR, OAIMRI, and CAI were all above 0.65, with no significant differences observed. ICC values (CI) for individual raters' MRI image selection was 0.99 (0.998-0.999). The mean difference (95% CI) between OAIR and OAIMRI was -0.99 degrees (-1.84; -0.16), while the mean absolute difference (95% CI) between OAIR and OAIMRI was 3.68 degrees (3.17; 4.20). Absolute differences between OAIR and OAIMRI was independent of pelvic positioning or time interval between radiographs and MRI scans. OAI and CAI had high Intrarater reliability but mediocre interrater reliability. There was an absolute difference of 3.7 degrees in OAI between pelvic radiographs and MRI scans.
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Affiliation(s)
- Hans-Christen Husum
- Interdisciplinary Orthopaedics, Aalborg University Hospital, 9000 Aalborg, Denmark
| | | | - Mads Henriksen
- Department of Radiology, Aarhus University Hospital, 8000 Aarhus, Denmark
| | - Martin Gottliebsen
- Department of Orthopaedics, Aarhus University Hospital, 8000 Aarhus, Denmark
| | - Ole Rahbek
- Interdisciplinary Orthopaedics, Aalborg University Hospital, 9000 Aalborg, Denmark
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Femoral Head Coverage Assessment in Healthy Children Younger than 6 Years. Adv Orthop 2022; 2022:6058746. [PMID: 35910811 PMCID: PMC9337923 DOI: 10.1155/2022/6058746] [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: 04/14/2022] [Revised: 06/13/2022] [Accepted: 07/07/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Developmental dysplasia of the hip (DDH) is one of the commonest hip joint pathologies in children; to treat it properly, hip surgeons should know the normal femoral head (FH) coverage by the acetabulum. This paper aims to assess the femoral head coverage in healthy children younger than 6 years. Methods 270 hip joint CT scans were selected, and digital pelvic models were created according to these scans. FH coverage by the five acetabular regions was assessed according to patient's age and sex. Results Normal reference values of FH coverage by different acetabular regions were obtained. It was found that the growth process of different acetabular regions occurs nonlinearly with the periods of acceleration. Anterior and superior-anterior acetabular regions grow more intensively in boys up to 3 years old and between 4 and 5 years old both in boys and girls; superior-posterior, posterior-superior, and posterior-inferior acetabular regions grow more intensively in boys and girls up to 3 years old and between 4 and 5 years old (p ≤ 0.005). The following sex differences in FH coverage by the acetabulum were found: more superior-anterior FH coverage was found in boys and posterior FH coverage in girls (p ≤ 0.005).
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de Courtivron B, Brulefert K, Portet A, Odent T. Residual acetabular dysplasia in congenital hip dysplasia. Orthop Traumatol Surg Res 2022; 108:103172. [PMID: 34896582 DOI: 10.1016/j.otsr.2021.103172] [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: 02/09/2021] [Revised: 06/10/2021] [Accepted: 06/14/2021] [Indexed: 02/03/2023]
Abstract
Residual hip dysplasia may exist despite appropriate treatment of congenital hip dysplasia (CHD). The abnormalities chiefly affect the acetabulum and can lead to premature osteoarthritis. Although the main cause is delayed treatment of CHD, primary lesions are also possible and may be worsened by the initial treatment itself. Residual hip dysplasia must be detected during the follow-up of patients with CHD. The antero-posterior radiograph of the pelvis is the main diagnostic tool. However, the importance of non-ossified anatomical structures requires additional investigations such as arthrography and magnetic resonance imaging. The risk of premature osteoarthritis is difficult to predict based only on the imaging-study findings. Hip dysplasia is best treated before 5 years of age. The work-up at this age should allow determination of the best treatment. Surgery is required but should not be performed unnecessarily. The decision rests on the absence of improvement in the radiographic criteria and on the findings from additional imaging studies. The usual treatment is Salter's osteotomy, during which excessive anterior displacement should be avoided. At adolescence, the information provided by radiography in the coronal plane should be completed by a three-dimensional evaluation of the acetabulum and an assessment of the quality of the labrum. The shelf procedure has been proven to relieve pain and to significantly postpone the need for hip arthroplasty, when performed early, before the development of visible osteoarthritis, and on a congruent hip. Chiari's osteotomy has a role to play in complex dysplasia affecting both the acetabulum and the femur. Periacetabular osteotomy is getting more used thanks to cooperation between paediatric and adult orthopaedic surgeons. This osteotomy provides optimal correction in all three dimensions.
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Affiliation(s)
- Benoît de Courtivron
- Centre de pédiatrie Gatien de Clocheville, CHU Tours, 49, Boulevard Béranger, 37000 Tours, France.
| | - Kevin Brulefert
- Service d'orthopédie, CHU Nantes Hotel Dieu, 1, place Alexis-Ricordeau, 44093 Nantes Cedex 1, France
| | - Adrien Portet
- Centre de pédiatrie Gatien de Clocheville, CHU Tours, 49, Boulevard Béranger, 37000 Tours, France
| | - Thierry Odent
- Centre de pédiatrie Gatien de Clocheville, CHU Tours, 49, Boulevard Béranger, 37000 Tours, France; Université François Rabelais de Tours, PRES Centre-Val de Loire, 37000 Tours, France
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Impact of bone deformities and labral and cartilage lesions on early functional results of arthroscopic treatment of femoroacetabular impingement. Orthop Traumatol Surg Res 2021; 107:103069. [PMID: 34547539 DOI: 10.1016/j.otsr.2021.103069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 06/28/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Femoroacetabular impingement (FAI) is a frequent cause of inguinal pain. Treatment failure rates range between 2.9% and 13.2%. The aim of the present study was to assess the impact of preoperative bone deformities (BD), labral lesions (LL) and cartilage lesions (CL) on clinical results of arthroscopic treatment of FAI. MATERIAL AND METHOD A prospective operational study included patients undergoing hip arthroscopy for FAI. All patients had full radiographic work-up and clinical assessment on Non-Arthritic Hip Score (NAHS), preoperatively and at 1year. Hips with Tönnis grade>1, coxa profunda [VCE (vertical center edge angle)>35°] or borderline dysplasia (VCE<25°) were excluded. The Czerny classification was used for the labrum and the Beck classification for the cartilage. The aim of the study was to assess the impact of preoperative BD, LL and CL on clinical results of arthroscopic treatment of FAI. The study hypothesis was that type of lesion does not influence early functional results at 1year, whatever the technique used for the labrum. RESULTS One hundred and ninety-seven patients were included. Mean preoperative NAHS was 59.1±17.5. There were 145 patients with labral suture (73.6%), 42 with labral debridement (21.3%) and 10 with conservative treatment (5.1%). At 1year, mean NAHS was 88.1±15.3: i.e., a significant improvement (p<2.2×10-16). Improvement was also significant in the debridement, non-operative and suture subgroups. BD showed significant correction in the overall population (alpha angle 48.2° postoperatively versus 66.7° preoperatively; crossing sign in 14.5% versus 62.9% of cases). There were no significant differences in functional scores according to extension or type of labral or cartilage lesion. At follow-up, 3 patients (1.5%) required repeat arthroscopy. CONCLUSION The present study showed that early functional results of arthroscopic treatment of FAI were unaffected by the severity of bone deformity (alpha and VCE angles), or extension or type of labral or cartilage lesion. Regardless of BD, LL and CL, 1-year clinical progression was satisfactory when all bone deformities were treated by the arthroscopic procedure. LEVEL OF EVIDENCE IV; prospective non-comparative study.
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Husum HC, Hellfritzsch MB, Henriksen M, Duch KS, Gottliebsen M, Rahbek O. What is the association between MRI and conventional radiography in measuring femoral head migration? Acta Orthop 2021; 92:269-273. [PMID: 33390057 PMCID: PMC8231345 DOI: 10.1080/17453674.2020.1864124] [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] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Pelvic radiographs are traditionally used for assessing femoral head migration in residual acetabular dysplasia (RAD). Knowledge of the heightened importance of cartilaginous structures in this condition has led to increased use of MRI in assessing both osseous and cartilaginous structures of the pediatric hip. Therefore, we assessed the relationship between migration percentages (MP) found on MRI and conventional radiographs. Second, we analyzed the reliability of MP in MRI and radiographs.Patients and methods - We retrospectively identified 16 patients (mean age 5 years [2-8], 14 girls), examined for RAD during a period of 2½ years. 4 raters performed blinded repeated measurements of osseous migration percentage (MP) and cartilaginous migration percentage (CMP) in MRI and radiographs. Pelvic rotation and tilt indices were measured in radiographs. Bland-Altman (B-A) plots and intraclass correlation coefficients (ICC) were calculated for agreement and reliability.Results - B-A plots for MPR and MPMRI produced a mean difference of 6.4 with limits of agreement -11 to 24, with higher disagreements at low average MP values. Mean MPR differed from mean MPMRI (17% versus 23%, p < 0.001). MPR had the best interrater reliability with an ICC of 0.92 (0.86-0.96), compared with MPMRI and CMP with ICC values of 0.61 (0.45-0.70) and 0.52 (0.26-0.69), respectively. Intrarater reliability for MPR, MPMRI and CMP all had ICC values above 0.75 and did not differ statistically significantly. Differences inMPMRI and MPR showed no correlation to pelvic rotation index, pelvic tilt index, or interval between radiograph and MRI exams.Interpretation - Pelvic radiographs underestimated MP when compared with pelvic MRI. We propose CMP as a new imaging measurement, and conclude that it has good intrarater reliability but moderate interrater reliability. Measurement of MP in radiographs and MRI had mediocre to excellent reliability.
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Affiliation(s)
- Hans-Christen Husum
- Interdisciplinary Orthopaedics, Aalborg University Hospital, Aalborg;
- Danish Pediatric Orthopaedic Research;
| | - Michel Bach Hellfritzsch
- Department of Radiology, Aarhus University Hospital, Aarhus;
- Danish Pediatric Orthopaedic Research;
| | - Mads Henriksen
- Department of Radiology, Aarhus University Hospital, Aarhus;
- Danish Pediatric Orthopaedic Research;
| | | | - Martin Gottliebsen
- Department of Orthopedics, Aarhus University Hospital, Aarhus;
- Danish Pediatric Orthopaedic Research;
| | - Ole Rahbek
- Interdisciplinary Orthopaedics, Aalborg University Hospital, Aalborg;
- Danish Pediatric Orthopaedic Research;
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Theunissen WW, van der Steen M, van Douveren FQ, Witlox AM, Tolk JJ. Timing of Repeat Ultrasound Examination in Treatment of Stable Developmental Dysplasia of the Hip. J Pediatr Orthop 2021; 41:203-208. [PMID: 33655899 PMCID: PMC8048726 DOI: 10.1097/bpo.0000000000001766] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Worldwide a wide variation exists in duration of Pavlik harness treatment for infants up to 6 months with stable developmental dysplasia of the hip (DDH). The purpose of this study was to evaluate whether shortening the time to first routine follow-up ultrasound after initiation of Pavlik harness treatment would reduce treatment duration and whether this influenced radiologic outcome at 1 year of age. Furthermore, predictors of higher acetabular index (AI) at 1 year of age were investigated. METHODS A retrospective study was conducted in infants with stable DDH (Graf IIb and IIc) diagnosed and treated between 2015 and 2017. Two groups were identified: first routine follow-up ultrasound at 12 weeks after Pavlik harness initiation (group I) and first routine follow-up ultrasound at 6 weeks after Pavlik harness initiation (group II). In both groups, treatment was continued until repeat ultrasound measurements (every 6 wk) showed a normalized hip. Radiologic outcome at 1 year of age was defined as residual dysplasia measured on an anteroposterior hip radiograph according to the Tönnis table. RESULTS A total of 222 infants were included. The median time of Pavlik harness treatment was 12 weeks (interquartile range, 11.9 to 12.3) in group I compared with 6.1 weeks (interquartile range, 6.0 to 7.5) in group II (P<0.001). Residual dysplasia at 1 year of age was detected in 20 infants (16.8%) in group I compared with 11 infants (10.7%) in group II (P=0.189). The multivariable prediction model showed that positive family history and lower baseline alpha angle correlate with a higher AI at 1 year of age. CONCLUSIONS First routine follow-up ultrasound can be safely brought forward from 12 to 6 weeks after Pavlik harness initiation. Furthermore, infants with a positive family history for DDH and an initial low alpha angle are at higher risk to have a higher AI at 1 year of age. LEVEL OF EVIDENCE Level III-retrospective study.
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Affiliation(s)
| | - Marieke van der Steen
- Department of Orthopaedic Surgery and Trauma, Máxima MC, Veldhoven
- Department of Orthopaedic Surgery, Catharina Hospital, Eindhoven
| | | | - Adhiambo M.A. Witlox
- Department of Orthopaedic Surgery and Trauma, Máxima MC, Veldhoven
- Department of Orthopaedic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jaap J. Tolk
- Department of Orthopaedic Surgery and Trauma, Máxima MC, Veldhoven
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Stiel N, Moritz M, Babin K, Suling A, Rupprecht M, Beil FT, Stuecker R, Spiro AS. The Use of Bovine Xenogeneic Bone Graft for Dega Pelvic Osteotomy in Children with Hip Dysplasia: A Retrospective Study of 147 Treated Hips. J Clin Med 2020; 9:jcm9072241. [PMID: 32679727 PMCID: PMC7408747 DOI: 10.3390/jcm9072241] [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: 06/08/2020] [Revised: 07/03/2020] [Accepted: 07/10/2020] [Indexed: 11/16/2022] Open
Abstract
Backgrounds: Dega pelvic osteotomy is commonly used to correct acetabular dysplasia in children with open triradiate cartilage. The use of bovine xenogeneic bone graft (Tutobone®) for Dega osteotomy has not been reported so far. This study aimed to determine the clinical and radiological outcome in a large series of children with hip dysplasia who were treated by Dega osteotomy using a bovine xenogeneic block for stabilisation. Methods: A retrospective, single-centre study was conducted including 101 patients (147 hips) with different underlying diseases. The acetabular angle of Hilgenreiner (AA) and the lateral center-edge angle (LCA) were analysed to quantify the correction of acetabular indices. Graft incorporation was assessed using the Goldberg scoring system. Results: the mean preoperative AA improved from 28.1 (SD: 6.7) to 14.7 (SD: 5.1) after surgery (p < 0.001). The mean preoperative LCA improved from 9.9 (SD: 6.7) to 21.8 (SD: 6.8) postoperatively (p < 0.001). Both indices remained stable at the one-year follow-up examination. Graft incorporation was excellent with a mean Goldberg score of 6.6. Heterotopic ossification occurred in one hip without clinical relevance. Graft-related complications were not noted. Conclusions: Dega osteotomy using Tutobone® is safe and effective in the treatment of acetabular dysplasia in children independent of the underlying disease.
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Affiliation(s)
- Norbert Stiel
- Department of Pediatric Orthopaedics, Altonaer Children’s Hospital, 22763 Hamburg, Germany; (N.S.); (M.M.); (M.R.); (R.S.)
| | - Menard Moritz
- Department of Pediatric Orthopaedics, Altonaer Children’s Hospital, 22763 Hamburg, Germany; (N.S.); (M.M.); (M.R.); (R.S.)
| | - Kornelia Babin
- Department of Pediatric Orthopaedics, Schoen Clinic Hamburg Eilbek, 22081 Hamburg, Germany;
| | - Anna Suling
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany;
| | - Martin Rupprecht
- Department of Pediatric Orthopaedics, Altonaer Children’s Hospital, 22763 Hamburg, Germany; (N.S.); (M.M.); (M.R.); (R.S.)
| | - Frank T. Beil
- Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany;
| | - Ralf Stuecker
- Department of Pediatric Orthopaedics, Altonaer Children’s Hospital, 22763 Hamburg, Germany; (N.S.); (M.M.); (M.R.); (R.S.)
| | - Alexander S. Spiro
- Department of Pediatric Orthopaedics, Altonaer Children’s Hospital, 22763 Hamburg, Germany; (N.S.); (M.M.); (M.R.); (R.S.)
- Correspondence: ; Tel.: +49-40-88908-382
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