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Nayar SK, Marks A, Hashemi-Nejad A, Roposch A. An in-depth analysis of young adults with osteonecrosis secondary to developmental dysplasia of the hip who underwent total hip arthroplasty. BMC Musculoskelet Disord 2024; 25:436. [PMID: 38835008 DOI: 10.1186/s12891-024-07517-8] [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: 11/03/2023] [Accepted: 05/13/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Patients with osteonecrosis of the femoral head secondary to DDH frequently require total hip arthroplasty (THA), but it is not well understood which factors necessitate this requirement. We determined the incidence of THA in patients who have osteonecrosis secondary to DDH and factors associated with need for THA. METHODS We included patients who received closed or open reductions between 1995 and 2005 with subsequent development of osteonecrosis. We determined osteonecrosis according to Bucholz and Ogden; osteoarthritis severity (Kellgren-Lawrence), subluxation (Shenton's line); neck-shaft angle; and acetabular dysplasia (centre-edge and Sharp angles). We also recorded the number of operations of the hip in childhood and reviewed case notes of patients who received THA to describe clinical findings prior to THA. We assessed the association between radiographic variables and the need for THA using univariate logistic regression. RESULTS Of 140 patients (169 hips), 22 patients received 24 THA (14%) at a mean age of 21.3 ± 3.7 years. Associated with the need for THA were grade III osteonecrosis (OR 4.25; 95% CI 1.70-10.77; p = 0.0019), grade IV osteoarthritis (21.8; 7.55-68.11; p < 0.0001) and subluxation (8.22; 2.91-29.53; p = 0.0003). All patients who required THA reported at least 2 of: severe pain including at night, stiffness, and reduced mobility. Acetabular dysplasia and number of previous operations were not associated with the need for THA. CONCLUSIONS We identified a 14% incidence of THA by age 34 years in patients with osteonecrosis secondary to DDH. Grade III osteonecrosis (global involvement femoral head and neck) was strongly associated with THA, emphasising the importance to avoid osteonecrosis when treating DDH.
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Affiliation(s)
| | - Avi Marks
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
| | | | - Andreas Roposch
- Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK.
- UCL Institute of Child Health, 30 Guildford Street, London, WC1N 3EH, UK.
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Wolfe PN, Stoker AM, Leary E, Crist BD, Bozynski CC, Cook JL. Evaluation of Serum and Urine Biomarker Panels for Developmental Dysplasia of the Hip Prior to Onset of Secondary Osteoarthritis. Cartilage 2024; 15:164-174. [PMID: 37051936 DOI: 10.1177/19476035231163032] [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: 04/14/2023] Open
Abstract
OBJECTIVE Evaluate serum and urine biomarker panels for their capabilities in discriminating between individuals (13- to 34-years-olds) with healthy hips versus those with developmental dysplasia of the hip (DDH) prior to diagnosis of secondary hip osteoarthritis (OA). DESIGN Urine and serum were collected from individuals (15-33 years old) with DDH, prior to and following diagnosis of hip OA, and from age-matched healthy-hip controls. Samples were analyzed for panels of protein biomarkers with potential for differentiation of hip status using receiver operator characteristic curve (area under curve [AUC]) assessments. RESULTS Multiple urine and serum biomarker panels effectively differentiated individuals with DDH from healthy-hip controls in a population at risk for developing secondary hip OA with the best performing panel demonstrating an AUC of 0.959. The panel comprised of two serum and two urinary biomarkers provided the highest combined values for sensitivity, 0.85, and specificity, 1.00, while a panel of four serum biomarkers provided the highest sensitivity, 0.93, while maintaining adequate specificity, 0.71. CONCLUSION Results of this study indicate that panels of protein biomarkers measured in urine and serum may be able to differentiate young adults with DDH from young adults with healthy hips. These data suggest the potential for clinical application of a routine diagnostic method for cost-effective and timely screening for DDH in at-risk populations. Further development and validation of these biomarker panels may result in highly sensitive and specific tools for early diagnosis, staging, and prognostication of DDH, as well as treatment decision making and monitoring capabilities. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Preston N Wolfe
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, MO, USA
| | - Aaron M Stoker
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, MO, USA
| | - Emily Leary
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, MO, USA
- School of Medicine, University of Missouri, Columbia, MO, USA
| | - Brett D Crist
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA
| | - Chantelle C Bozynski
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, MO, USA
| | - James L Cook
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, MO, USA
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA
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Disantis AE, Martin RL, Enseki K, Spaid V, McClincy M. Non-Operative Rehabilitation Principles for Use in Individuals with Acetabular Dysplasia: A North American Based Delphi Study. Int J Sports Phys Ther 2023; 18:1331-1345. [PMID: 38050551 PMCID: PMC10693488 DOI: 10.26603/001c.89265] [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: 06/23/2023] [Accepted: 09/24/2023] [Indexed: 12/06/2023] Open
Abstract
Background Acetabular dysplasia (AD) is defined as a structurally deficient acetabulum and is a well-recognized cause of hip pain in young adults. While treatment of severe AD with a periacetabular osteotomy has demonstrated good long-term outcomes, a trial of non-operative management is often recommended in this population. This may be especially true in patients with milder deformities. Currently, there is a paucity of research pertaining to non-operative management of individuals with AD. Purpose To present expert-driven non-operative rehabilitation guidelines for use in individuals with AD. Study Design Delphi study. Methods A panel of 15 physiotherapists from North America who were identified as experts in non-operative rehabilitation of individuals with AD by a high-volume hip preservation surgeon participated in this Delphi study. Panelists were presented with 16 questions regarding evaluation and treatment principles of individuals with AD. A three-step Delphi method was utilized to establish consensus on non-operative rehabilitation principles for individuals presenting with AD. Results Total (100%) participation was achieved for all three survey rounds. Consensus, defined a piori as > 75%, was reached for 16/16 questions regarding evaluation principles, activity modifications, appropriate therapeutic exercise progression, return to activity/sport criteria, and indications for physician referral. Conclusion This North American based Delphi study presents expert-based consensus on non-operative rehabilitation principles for use in individuals with AD. Establishing guidelines for non-operative management in this population will help reduce practice variation and is the first step in stratifying individuals who would benefit from non-operative management. Future research should focus on patient-reported outcomes and rate of subsequent surgical intervention to determine the success of the guidelines reported in this study. Level of Evidence Level V.
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Affiliation(s)
- Ashley E Disantis
- Adolescent and Young Adult Hip Preservation Program UPMC Childrens Hospital of Pittsburgh
- Rangos School of Health Sciences, Department of Physical Therapy Duquesne University
| | - RobRoy L Martin
- Rangos School of Health Sciences, Department of Physical Therapy Duquesne University
| | - Keelan Enseki
- UPMC Freddie Fu Center for Sports Medicine UPMC Rehabilitation Institute
| | - Victoria Spaid
- Department of Orthopaedic Surgery UPMC Children's Hospital of Pittsburgh
| | - Michael McClincy
- Adolescent and Young Adult Hip Preservation Program UPMC Children's Hospital of Pittsburgh
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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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Shepherd MC, Clohisy JC, Nepple JJ, Harris MD. Derotational femoral osteotomy locations and their influence on joint reaction forces in dysplastic hips. J Orthop Res 2023; 41:2474-2483. [PMID: 36929842 PMCID: PMC10505249 DOI: 10.1002/jor.25559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/08/2023] [Accepted: 03/14/2023] [Indexed: 03/18/2023]
Abstract
Femoral version (FV) deformities are common in patients with developmental dysplasia of the hip (DDH) and may contribute to cartilage damage due to abnormal joint loading. Derotational femoral osteotomy (DFO) surgery corrects FV deformities. However there is little consensus about the femoral transection location for DFO, and its influence on joint loads is unknown. The purpose of this study was to compare the effects of two common DFO locations on muscle forces and hip joint reaction forces (JRFs) in patients with DDH. DFO was simulated in nine patients with DDH and abnormal FV using patient-specific musculoskeletal models. Femoral transection for DFO was separately simulated proximal and distal to the lesser trochanter and FV values were corrected to an idealized 15°. JRFs during early and late stance of gait were compared between the two simulated transection locations. Most changes to JRFs were similar between proximal and distal DFO, however, statistically significant differences were found for the medial JRF component during late stance among patients with femoral anteversion (p = 0.01). Force changes from five hip muscles were significantly different between DFO locations, however, changes were minimal. Most changes after DFO in patients with femoral retroversion were opposite of those with femoral anteversion, with anteroposterior and superior JRFs increasing after retroversion correction. After DFO correction, superior and medial JRFs in DDH patients remained elevated compared to controls. Understanding the influence of DFO location on muscle-generated hip forces can help surgeons justify decisions and potentially standardize surgical correction of FV deformities in patients with DDH.
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Affiliation(s)
- Molly C. Shepherd
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
| | - John C. Clohisy
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jeffrey J. Nepple
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Michael D. Harris
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, Missouri, USA
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Vassileva MT, Kim JS, Valle AGD, Harris MD, Pedoia V, Lattanzi R, Kraus VB, Pascual-Garrido C, Bostrom MP. Arthritis Foundation/HSS Workshop on Hip Osteoarthritis, Part 2: Detecting Hips at Risk: Early Biomechanical and Structural Mechanisms. HSS J 2023; 19:428-433. [PMID: 37937085 PMCID: PMC10626933 DOI: 10.1177/15563316231192097] [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: 05/26/2023] [Accepted: 06/01/2023] [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 (AF), in partnership with the Hospital for Special Surgery (HSS), 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 gleaned from 5 presentations given in the "early hip osteoarthritis" session of the 2023 Hip Osteoarthritis Clinical Studies Conference, which took place on February 17 and 18, 2023, in New York City. It also summarizes the workgroup recommendations from a small-group discussion on clinical research gaps.
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Affiliation(s)
| | | | | | - Michael D Harris
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Riccardo Lattanzi
- Department of Radiology, NYU Grossman School of Medicine, New York, NY, USA
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7
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Rosinsky PJ, Chen JW, Glein RM, Jimenez AE, Brayboy C, Domb BG. Lateral to Medial Joint Space Ratio is Predictive of Survivorship After Primary Hip Arthroscopy. Arthroscopy 2023; 39:300-307. [PMID: 35810975 DOI: 10.1016/j.arthro.2022.06.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 06/13/2022] [Accepted: 06/23/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess whether preoperative joint space measures would be predictive of survivorship in patients undergoing hip arthroscopy (HA) for femoroacetabular impingement (FAI). METHODS Data on consecutive patients who underwent hip arthroscopy between February 2008 and February 2018 were retrospectively reviewed. To be eligible for final analysis, patients were required to have preoperative radiographs for joint space measurements and data indicating conversion to a total hip arthroplasty (THA), hip resurfacing, or neither; at a minimum of 2 years after primary hip arthroscopy. Survivorship following HA was defined as remaining conversion free and served as the primary outcome. A multivariate logistic regression analysis and receiver operator curve (ROC) were used to evaluate the correlation between joint space measurements and survivorship following HA. RESULTS A total of 1,885 primary arthroscopy cases were included in this study. The multivariate regression analysis found preoperative lateral-to-medial joint space ratio (L/M ratio) to be the strongest predictive factor of survivorship after primary hip arthroscopy (OR = 2.084, CI95% = 1.239-3.503; P = .006). The ROC curve for the model demonstrated acceptable discrimination with an area under the curve (AUC) of 0.792. Patients with an L/M ratio ≥0.75 had a survivorship rate of 91.7% compared to a rate of 75% for patients with an L/M ratio <0.75 (OR: 3.68). CONCLUSIONS This study found that, of the factors evaluated in this study, the most significant factor in predicting survivorship at 2 years after undergoing primary hip arthroscopy was a larger lateral-to-medial joint space ratio. This may suggest an initiation of primary arthritis at the edge-loading area of the lateral acetabulum. LEVEL OF EVIDENCE: III, retrospective comparative observation study.
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Affiliation(s)
- Philip J Rosinsky
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Jeffrey W Chen
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Rachel M Glein
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Andrew E Jimenez
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Ciaran Brayboy
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A; American Hip Institute, Chicago, Illinois, U.S.A..
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Song K, Pascual-Garrido C, Clohisy JC, Harris MD. Elevated loading at the posterior acetabular edge of dysplastic hips during double-legged squat. J Orthop Res 2022; 40:2147-2155. [PMID: 35015910 PMCID: PMC9271518 DOI: 10.1002/jor.25249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 11/17/2021] [Accepted: 12/19/2021] [Indexed: 02/04/2023]
Abstract
Hips with developmental dysplasia (DDH) are at a heightened risk of premature hip osteoarthritis, which is often expedited by mechanically induced articular tissue damage. A prevalent form of damage in DDH is labral tears caused by abnormal loading at the shallow acetabular edge. Although the majority of reported DDH-related labral tears occur in the antero-superior acetabulum, posterior labral tears are prevalent in individuals whose lifestyle involves frequent high hip flexion tasks such as squatting. To better understand region-specific risks for chondrolabral damage during high hip flexion, we used image-based musculoskeletal models to compare acetabular edge loading (AEL) during double-legged squat between hips with symptomatic DDH (n = 10) and healthy controls (n = 10). Compared to controls, hips with DDH had higher instantaneous posterior AEL at the lowest point of squat (2.6 vs. 1.8 ×BW, p ≤ 0.04), and higher accumulative loading across the duration of the squatting motion (2.6 vs. 1.9 ×BW*s, p ≤ 0.04). Elevated posterior AEL coincided with increased net hip extension moments and posterior joint reaction forces, and was correlated with the severity of DDH acetabular deformity. Our findings suggest that posterior AEL is elevated in hips with symptomatic DDH during double-legged squat, which may contribute to chondrolabral damage in individuals who often perform such high hip flexion tasks. Clinical evaluation of DDH should consider patient-specific anatomy and lifestyle factors when establishing diagnoses and planning personalized treatment.
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Affiliation(s)
- Ke Song
- Movement Science Research Center, Program in Physical Therapy, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
- Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Cecilia Pascual-Garrido
- Department of Orthopaedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - John C. Clohisy
- Department of Orthopaedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Michael D. Harris
- Movement Science Research Center, Program in Physical Therapy, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
- Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, Missouri, USA
- Department of Orthopaedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
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Li F, Wu Y, Song Z, Tadum Arthur Vithran D, Li X, Fang K, Zeng M, Wen J, Xiao S, Qiu H. Characteristics of surface electromyogram signals after Pemberton pelvic osteotomy combined with femoral osteotomy in children with unilateral developmental dysplasia of the hip. Medicine (Baltimore) 2022; 101:e29794. [PMID: 35839016 PMCID: PMC11132326 DOI: 10.1097/md.0000000000029794] [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: 01/27/2022] [Accepted: 05/26/2022] [Indexed: 11/27/2022] Open
Abstract
This study aimed to assess the surface electromyogram (sEMG) signal characteristics of the muscle around the hip joint after Pemberton osteotomy in children with unilateral developmental dysplasia of the hip (DDH). A total of 21 children with unilateral DDH who had received Pemberton osteotomy were selected as the DDH group, and 21 healthy children of the same age were selected as the control group. The children in both groups were tested using sEMG, the Root mean square (RMS) values of the tensor fascia lata, rectus femurs, and medial head of the hamstring and gluteus maximum on both sides in standing and walking status were recorded. The value on the affected side in the DDH group was compared with the value on the healthy side himself and the value in the control group. The mean postoperative follow-up in the DDH group was 27.76 ± 24.30 months. The RMS value of the affected gluteus maximum muscle in the DDH group was significantly larger while standing (P < 0.05), the RMS value of bilateral tensor fascia lata muscle was significantly larger while walking (P < 0.05), and the RMS value of the affected hamstring muscle medial head was significantly less in the DDH group compared with the control group (P < 0.05). An asymmetry and compensatory increase in the sEMG activity of the muscles around the hip joint when standing and walking was noted in children with unilateral DDH who underwent Pemberton osteotomy combined with a femoral osteotomy. The rehabilitation training of the muscles around the hip joint after unilateral DDH should be strengthened.
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Affiliation(s)
- Fanling Li
- Department of Pediatric Orthopedics, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Clinical College of Hunan Normal University, Changsha, China
| | - Yuyuan Wu
- Department of Pediatric Orthopedics, Traditional Chinese Medicine Hospital in Huaihua, Huaihua, Hunan, China
| | - Zhenqi Song
- Department of Pediatric Orthopedics, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Clinical College of Hunan Normal University, Changsha, China
| | - Djandan Tadum Arthur Vithran
- Department of Pediatric Orthopedics, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Clinical College of Hunan Normal University, Changsha, China
| | - Xin Li
- Department of Pediatric Orthopedics, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Clinical College of Hunan Normal University, Changsha, China
| | - Ke Fang
- Department of Pediatric Orthopedics, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Clinical College of Hunan Normal University, Changsha, China
| | - Ming Zeng
- Department of Pediatric Orthopedics, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Clinical College of Hunan Normal University, Changsha, China
| | - Jie Wen
- Department of Pediatric Orthopedics, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Clinical College of Hunan Normal University, Changsha, China
| | - Sheng Xiao
- Department of Pediatric Orthopedics, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Clinical College of Hunan Normal University, Changsha, China
| | - Hailing Qiu
- Department of Pediatric Orthopedics, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Clinical College of Hunan Normal University, Changsha, China
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