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Aly AS, Fayyad TA, El-Beshry SS, Elhusseiny KT, El Ghazawy AK. Modified triple pelvic osteotomy for residual acetabular dysplasia through double incisions: Technical note and review of short-term results. SICOT J 2024; 10:14. [PMID: 38687149 PMCID: PMC11060049 DOI: 10.1051/sicotj/2024012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 04/12/2024] [Indexed: 05/02/2024] Open
Abstract
PURPOSE To assess validity, safety, and efficacy of the modified triple pelvic osteotomy (TPO) approach for correction of residual acetabular dysplasia. METHODS This is a retrospective case series conducted on 15 hips in 15 patients from 2019 to 2023 with residual acetabular dysplasia treated by modified TPO as described by Tonnis with two modifications. The first modification is using a single medial incision for pubic and ischial cuts (the Vladimirov modification). The second modification is having the ischial cut closer to the acetabulum (Li modification) allowing free movement of the acetabular fragment for better femoral head coverage. The mean age at the time of surgery was 11.85 years, (range 8-23). Cases presenting were 10 males (66.7%) and 5 females (33.3%). The mean follow-up period was 36.533 months (24-60 months). RESULTS Our study revealed significant clinical and radiological improvement. The CE angle improved from a mean value of 10° (range 2-17) pre-operatively to 32.785° (range 18°-40°) post-operatively. The AI improved from a mean value of 32° pre-operatively to a mean value of 13.89° post-operatively. HHS increased from a preoperative mean value of 74.80° to a post-operative mean value of 90.67°. Also, there was a significant improvement in ROM (abduction and internal rotation). LLD improved from a mean value of 2.60 cm preoperatively to a mean value of 0.37 cm postoperatively. Delayed union was found in 3 cases. No cases of osteonecrosis or neurovascular complication were encountered in our study. CONCLUSION The modified TPO technique using dual incisions can be considered safe and effective, providing adequate coverage of the femoral head in acetabular dysplasia with less surgical time, satisfactory functional outcomes, and minimal complications. LEVEL OF EVIDENCE IV.
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Treu EA, Sato EH, Omotowa O, Heaton T, Erickson JA, Blackburn BE, Peters CL, Anderson LA. Dysplastic Hips That Are Too Late For Periacetabular Osteotomy Are Not Too Early For Total Hip Arthroplasty. J Arthroplasty 2024:S0883-5403(24)00383-8. [PMID: 38677342 DOI: 10.1016/j.arth.2024.04.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 04/29/2024] Open
Abstract
INTRODUCTION Total hip arthroplasty (THA) is often performed in symptomatic patients who have hip dysplasia and do not qualify for periacetabular osteotomy (PAO). The impact of osteoarthritis (OA) severity on postoperative outcomes in dysplasia patients who undergo THA is not well described. We hypothesized that dysplasia patients who have mild OA have slower initial recovery postoperatively, but similar one-year patient-reported outcome measures (PROMs) compared to dysplasia patients who have severe OA. METHODS We performed a retrospective review at a single academic institution over a six-year period of patients who have dysplasia who underwent THA compared to patients who have primary OA who underwent THA. There were 263 patients who had dysplasia were compared to 1,225 THA patients who did not have dysplasia. Within the dysplasia cohort, we compared PROMs stratified by dysplasia and OA severity. The diagnosis of dysplasia was verified using the radiographic lateral center edge angle (LCEA). A minimum one-year follow-up was required. The PROMs were collected through one year postoperatively. Logistic and linear regression models were used, adjusting for age, sex, body mass index, and Charlson comorbidity index. RESULTS No significant differences were found in postoperative PROMs or revision rates (P = 0.58). When stratified by dysplasia severity, patients who had lower LCEA had more improvement in physical function scores from pre-operative to 2-weeks (P < 0.01) and higher physical function scores at 2-weeks (P = 0.03). When stratified by OA severity, patients who had a worse Tönnis score had more improvement in physical function scores from pre-operative to 2 weeks (P < 0.01). Recovery curves in dysplasia patients based on dysplasia and OA severity were not significantly different at 6-weeks, 1-year, and 2-years post-operative. CONCLUSION Patients who had hip dysplasia and mild OA had similar recovery curves compared to those who had severe OA or who did not have dysplasia. We believe that THA is a reasonable surgical intervention for symptomatic dysplasia patients who have mild arthritis and do not qualify for PAO.
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Zheng H, Feng E, Xiao Y, Liu X, Lai T, Xu Z, Chen J, Xie S, Lin F, Zhang Y. Is AI 3D-printed PSI an accurate option for patients with developmental dysplasia of the hip undergoing THA? BMC Musculoskelet Disord 2024; 25:308. [PMID: 38649919 PMCID: PMC11034034 DOI: 10.1186/s12891-024-07449-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 04/16/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND In traditional surgical procedures, significant discrepancies are often observed between the pre-planned templated implant sizes and the actual sizes used, particularly in patients with congenital hip dysplasia. These discrepancies arise not only in preoperative planning but also in the precision of implant placement, especially concerning the acetabular component. Our study aims to enhance the accuracy of implant placement during Total Hip Arthroplasty (THA) by integrating AI-enhanced preoperative planning with Patient-Specific Instrumentation (PSI). We also seek to assess the accuracy and clinical outcomes of the AI-PSI (AIPSI) group in comparison to a manual control group. METHODS This study included 60 patients diagnosed with congenital hip dysplasia, randomly assigned to either the AIPSI or manual group, with 30 patients in each. No significant demographic differences between were noted the two groups. A direct anterior surgical approach was employed. Postoperative assessments included X-rays and CT scans to measure parameters such as the acetabular cup anteversion angle, acetabular cup inclination angle, femoral stem anteversion angle, femoral offset, and leg length discrepancy. Functional scores were recorded at 3 days, 1 week, 4 weeks, and 12 weeks post-surgery. Data analysis was conducted using SPSS version 22.0, with the significance level was set at α = 0.05. RESULTS AND CONCLUSION The AIPSI group demonstrated greater prosthesis placement accuracy. With the aid of PSI, AI-planned THA surgery provides surgeons with enhanced precision in prosthesis positioning. This approach potentially offers greater insights and guidelines for managing more complex anatomical variations or cases.
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Affiliation(s)
- Han Zheng
- Department of Arthrosis Surgery, Fuzhou Second Hospital, Fuzhou, China
- The Second School of Medicine, Fujian University of Traditional Chinese, Fujian, China
| | - Eryou Feng
- Department of Arthrosis Surgery, Fuzhou Second Hospital, Fuzhou, China.
- Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma(2020Y2014), Fuzhou, China.
| | - Yao Xiao
- Fuzhou Changle Hospital of Traditional Chinese Medicine, Fuzhou, China
| | - Xingyu Liu
- Longwood Valley Medical Technology Co Ltd, Beijing, China
| | - Tianyu Lai
- Department of Arthrosis Surgery, Fuzhou Second Hospital, Fuzhou, China
| | - Zhibiao Xu
- Department of Arthrosis Surgery, Fuzhou Second Hospital, Fuzhou, China
| | - Jingqiao Chen
- Department of Arthrosis Surgery, Fuzhou Second Hospital, Fuzhou, China
| | - Shiwei Xie
- Department of Arthrosis Surgery, Fuzhou Second Hospital, Fuzhou, China
| | - Feitai Lin
- Department of Arthrosis Surgery, Fuzhou Second Hospital, Fuzhou, China
| | - Yiling Zhang
- Longwood Valley Medical Technology Co Ltd, Beijing, China.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Alrashdi N, Alotaibi M, Alharthi M, Kashoo F, Alanazi S, Alanazi A, Alzhrani M, Alhussainan T, Alanazi R, Almutairi R, Ithurburn M. Incidence, Prevalence, Risk Factors, and Clinical Treatment for Children with Developmental Dysplasia of the Hip in Saudi Arabia. A Systematic Review. J Epidemiol Glob Health 2024:10.1007/s44197-024-00217-5. [PMID: 38483754 DOI: 10.1007/s44197-024-00217-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 03/09/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Developmental dysplasia of the hip (DDH) leads to pain, joint instability, and early degenerative joint disease. Incidence, prevalence, and management strategies of DDH have been well-documented in several countries, but not in Saudi Arabia. OBJECTIVE We synthesized the current evidence regarding incidence, prevalence, risk factors, and clinical treatment for children with DDH in Saudi Arabia. METHODS We searched 3 databases to locate studies. Studies that included children with DDH in Saudi Arabia; reported either incidence rate, prevalence, risk factors, and/or clinical practice; and were available in English or Arabic were included. We excluded reviews, case studies, or animal studies. Two independent authors reviewed potential studies and assessed study's quality. RESULTS Our search yielded 67 potential studies, of which 16 studies were included (total DDH sample = 3,127; age range = 2.5 to 86.4 months). Three studies reported incidence rates ranging from 3.1 to 4.9 per 1000 births, and 3 studies reported prevalence ranging from 6 to 78%. Nine studies reported that female sex, breech position, family history, and age less than 3 years were risk factors associated with DDH. Four studies reported that brace applications and closed reduction were conservative treatments, and 9 studies reported that open hip reduction, adductor tenotomy, and/or pelvic osteotomy were surgical approaches to treat DDH. CONCLUSIONS In Saudi Arabia, the Incidence and prevalence rates of DDH are 3.1 to 4.9 per 1,000 births, and 6-78%, respectively (differ from what has been reported in other countries), but the risk factors of DDH in Saudi Arabia appear to be similar in comparison to other countries (female, breech presentation, family history of DDH).
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Affiliation(s)
- Naif Alrashdi
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, AL-Majmaah, 11952, Saudi Arabia.
| | - Mansour Alotaibi
- Department of Physical Therapy, College of Applied Medical Sciences, Northern Border University, Arar, Saudi Arabia
| | - Moqfa Alharthi
- Rehabilitation Services Department, King Abdullah Specialized Children's Hospital, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Faizan Kashoo
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, AL-Majmaah, 11952, Saudi Arabia
| | - Sultan Alanazi
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, AL-Majmaah, 11952, Saudi Arabia
| | - Ahmad Alanazi
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, AL-Majmaah, 11952, Saudi Arabia
| | - Msaad Alzhrani
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, AL-Majmaah, 11952, Saudi Arabia
| | - Thamer Alhussainan
- Department of Orthopedics, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Rami Alanazi
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, AL-Majmaah, 11952, Saudi Arabia
- Department of Physical Therapy and Rehabilitation, King Khaled Hospital, Almajmaah, Saudi Arabia
| | - Rakan Almutairi
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, AL-Majmaah, 11952, Saudi Arabia
- Physiotherapy Department, Al Iman General Hospital, Riyadh First Health Cluster, Riyadh, Saudi Arabia
| | - Matthew Ithurburn
- American Sports Medicine Institute, Birmingham, AL, USA
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
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Jenner EA, Chauhan GS, Burahee A, Choudri J, Gardner A, Bache CE. Comparison of clinical and radiological outcomes for the anterior and medial approaches to open reduction in the treatment of bilateral developmental dysplasia of the hip: a systematic review protocol. Syst Rev 2024; 13:72. [PMID: 38396003 PMCID: PMC10885537 DOI: 10.1186/s13643-023-02444-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 12/21/2023] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Developmental dysplasia of the hip (DDH) affects 1-3% of newborns and 20% of cases are bilateral. The optimal surgical management strategy for patients with bilateral DDH who fail bracing, closed reduction or present too late for these methods to be used is unclear. There are proponents of both medial approach open reduction (MAOR) and anterior approach open reduction (AOR); however, there is little evidence to inform this debate. METHODS We will perform a systematic review designed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocol. We will search the medical and scientific databases including the grey and difficult to locate literature. The Medical Subject Headings "developmental dysplasia of the hip", "congenital dysplasia of the hip", "congenital hip dislocation", "developmental hip dislocation", and their abbreviations, "DDH" and "CDH" will be used, along with the qualifier "bilateral". Reviewers will independently screen records for inclusion and then independently extract data on study design, population characteristics, details of operative intervention and outcomes from the selected records. Data will be synthesised and a meta-analysis performed if possible. If not possible we will analyse data according to Systematic Review without Meta-Analysis guidance. All studies will be assessed for risk of bias. For each outcome measure a summary of findings will be presented in a table with the overall quality of the recommendation assessed using the Grading of Recommendations Assessment Development and Evaluation approach. DISCUSSION The decision to perform MAOR or AOR in patients with bilateral DDH who have failed conservative management is not well informed by the current literature. High-quality, comparative studies are exceptionally challenging to perform for this patient population and likely to be extremely uncommon. A systematic review provides the best opportunity to deliver the highest possible quality of evidence for bilateral DDH surgical management. SYSTEMATIC REVIEW REGISTRATION The protocol has been registered in the International Prospective Register of Systematic Reviews (PROSPERO ID CRD42022362325).
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Affiliation(s)
- Edward Alan Jenner
- Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK.
| | | | - Abdus Burahee
- Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP, UK
- University of Birmingham, College of Medical & Dental Sciences, Birmingham, UK
| | - Junaid Choudri
- Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP, UK
| | - Adrian Gardner
- Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP, UK
- University of Birmingham, College of Medical & Dental Sciences, Birmingham, UK
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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. Eur J Orthop Surg Traumatol 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Rangasamy K, Ghosh AK, Ksheerasagar VP, Gopinathan NR, Sudesh P. Medial versus anterior approach for open reduction of hip in children with DDH under two years - A meta-analysis of comparative studies. J Orthop 2024; 47:72-79. [PMID: 38059048 PMCID: PMC10696192 DOI: 10.1016/j.jor.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 12/08/2023] Open
Abstract
Purpose Open reduction (OR) is usually required in developmental dysplasia of hip (DDH) for children below 24 months of age, those who failed to achieve a satisfactory reduction by the closed method. OR in this age group can be performed either through a medial or anterior approach. However, there is a paucity of literature and a lack of more substantial evidence regarding which approach (medial versus anterior) is superior for performing OR in this age group with minimal complications. Methods Four databases (PubMed, Embase, Scopus, and Cochrane Library) were searched for relevant articles reporting outcomes and complication rates of DDH children less than 24 months undergone OR either through medial or anterior approach using pre-defined keywords. Data on avascular necrosis (AVN) rates, further corrective surgery (FCS) rates, and clinical and radiological grading using McKay clinical criteria and Severin radiological criteria were assessed. Meta-analysis was carried out using RevMan (Review Manager 5.4) software. Results Five comparative studies, having a minimum of two-year follow-up, were included for final analysis. According to the MINORS tool assessment, all five studies were of good to high quality. Of 257 hips, 151 and 106 underwent OR through medial and anterior approaches, respectively. Our meta-analysis showed a statistically significant (p = 0.01) number of AVN cases with the anterior approach compared to the medial approach. The overall random effect showed the odds of having AVN with an anterior approach to be 2.27 (95% CI: 1.18,4.38) times more than the same with a medial approach. Regarding FCS rates, the meta-analysis depicted no significant difference between the two groups (p = 0.63). The two groups had no statistically significant difference regarding clinical and radiological outcomes using McKay and Severin criteria, respectively. Following surgery, improvement in the acetabular index from pre-operative value showed no statistically significant difference between the two groups (p = 0.48). Conclusions Medial approach is safe and effective for OR of the hip in DDH up to 24 months of age. Our analysis showed that AVN rates are lower with a medial approach than the anterior approach, with similar clinical and radiological outcomes and rates of FCS. However, one should consider the surgeon's expertise while choosing between these approaches.
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Affiliation(s)
- Karthick Rangasamy
- Paediatric Orthopaedic Division, Victoria Hospital, London Health Sciences Centre, London, Ontario, Canada
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Akash Kumar Ghosh
- Paediatric Orthopaedic division, Department of Orthopaedics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vivek P. Ksheerasagar
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Nirmal Raj Gopinathan
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Pebam Sudesh
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Huang YY, Lee WC, Chang CH, Yang WE, Kao HK. Environmental factors associated with incidence of developmental dysplasia of the hip: a systematic review and meta-analysis. BMC Musculoskelet Disord 2023; 24:942. [PMID: 38053132 DOI: 10.1186/s12891-023-07073-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 11/27/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Established associated factors for DDH include female sex, breech presentation, family history, congenital malformations, oligohydramnios, and maternal hyperthyroidism. However, evidence for environmental factors that may contribute to DDH is limited and inconsistent. METHODS A systematic review of medical literature was conducted to collect data on environmental factors, including latitude, longitude, average yearly precipitation, average yearly temperature, minimum monthly temperature, and maximum monthly temperature, from all institutions that published articles on DDH. Univariate linear regression analysis was used to examine the correlation between environmental factors and DDH incidence, while multiple regression analysis was conducted to identify significant associated factors for DDH incidence. RESULTS Data from a total of 93 unique manuscripts were analyzed, revealing a significant negative correlation between DDH incidence and temperature, including average yearly temperature (r = -0.27, p = 0.008), minimum monthly temperature (r = -0.28, p = 0.006), and maximum monthly temperature (r = -0.23, p = 0.029). Additionally, there was a significant positive correlation between DDH incidence and latitude (r = 0.27, p = 0.009), and a significant negative correlation between DDH incidence and average yearly precipitation (r = -0.29, p = 0.004). In the final multiple regression analysis, temperature, including average yearly temperature, minimum monthly temperature, and maximum monthly temperature, were identified as significant associated factors for DDH incidence. CONCLUSION The findings of this study suggest an association between cold weather and DDH incidence. Further research should explore the link between cold weather and DDH incidence, offering insights into potential interventions for cold climates.
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Affiliation(s)
- Yu-Yi Huang
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Chun Lee
- Department of Pediatric Orthopaedics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Hsieh Chang
- Department of Pediatric Orthopaedics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wen-E Yang
- Department of Pediatric Orthopaedics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsuan-Kai Kao
- Department of Pediatric Orthopaedics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Shahbazi P, Jalilvand AH, Ghaseminejad-Raeini A, Ghaderi A, Sheikhvatan M, Fallah Y, Shafiei SH. Risk Factors for Dislocation following Total Hip Arthroplasty in Developmental Dysplasia of the Hip: A Systematic Review and Meta-Analysis. Int Orthop 2023; 47:3063-3075. [PMID: 37688602 DOI: 10.1007/s00264-023-05949-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/16/2023] [Indexed: 09/11/2023]
Abstract
PURPOSE This systematic review and meta-analysis aimed to identify risk factors of dislocation after total hip arthroplasty (THA) in patients with developmental dysplasia of the hip (DDH). METHODS A systematic literature review was performed on 18th August 2022 using Medline, Embase, Scopus, Web of Science electronic databases, and a manual search. The study was conducted according to the PRISMA guidelines and registered with PROSPERO. Statistical analysis includes assessment of heterogeneity and data synthesis using RevMan 5.4. RESULTS Review of five studies including 2865 patients and 116 dislocated hips found that lower body mass index (BMI) (SMD = 0.22, p = 0.04, I2 = 0%), Crowe classification type IV versus I, II, and III (OR = 2.70, p = 0.004, I2 = 51%), higher cup inclination (SMD = 0.39 p = 0.0007, I2 = 0%), femoral head size < 28 mm (OR = 5.07, p = 0.003, I2 = 71%), lateral surgical approach (OR = 1.96, p = 0.02, I2 = 0%), and postoperative infection (OR = 6.26, p < 0.0001, I2 = 0%) were significant risk factors. However, age, gender, cup anteversion, femoral osteotomy, vertical (V-COR) centre of rotation, intraoperative fracture, preoperative and postoperative leg length discrepancy (LLD) and previous hip surgery were not found to be significant risk factors. CONCLUSION This study underscores importance of these risk factors in THA planning for DDH patients to reduce dislocation risk. Further research needed to understand mechanisms.
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Affiliation(s)
- Parmida Shahbazi
- Orthopedic Department, Orthopedic Surgery Research Center (OSRC), Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Hossein Jalilvand
- Orthopedic Department, Orthopedic Surgery Research Center (OSRC), Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Ghaseminejad-Raeini
- Orthopedic Department, Orthopedic Surgery Research Center (OSRC), Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Ghaderi
- Orthopedic Department, Orthopedic Surgery Research Center (OSRC), Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrdad Sheikhvatan
- Orthopedic Department, Orthopedic Surgery Research Center (OSRC), Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Heidelberg Medical Hospital, Heidelberg, Germany
| | - Yousef Fallah
- Orthopedic Department, Orthopedic Surgery Research Center (OSRC), Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyyed Hossein Shafiei
- Orthopedic Department, Orthopedic Surgery Research Center (OSRC), Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Laborie LB, Rosendahl K, Dhouib A, Simoni P, Tomà P, Offiah AC. The effect of selective ultrasound screening on the incidence of late presentation of developmental hip dysplasia-a meta-analysis. Pediatr Radiol 2023; 53:1977-1988. [PMID: 37099154 PMCID: PMC10497659 DOI: 10.1007/s00247-023-05666-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/03/2023] [Accepted: 04/04/2023] [Indexed: 04/27/2023]
Abstract
Different screening strategies for developmental dysplasia of the hip (DDH) exist. Despite screening efforts, cases of late presentation continue to occur, often necessitating surgery. This systematic review and meta-analysis assess the effect of newborn selective ultrasound screening for DDH on the incidence of late presentation in infants and children, compared to a universal ultrasound strategy. A systematic search across Medline and EMBASE databases was performed between January 1950 and February 2021. A consensus-based evaluation of abstracts led to retrieval of relevant full text, original articles or systematic reviews in English only. These were assessed according to agreed eligibility criteria, and their reference lists were reviewed to identify additional eligible publications. Following final consensus on included publications, data was extracted, analysed and reported as per PRISMA and Prospero (CRD42021241957) guidelines. The 16 eligible studies consisted of 2 randomised controlled trials and 14 cohort studies, published between 1989 and 2014, with a total of 511,403 participants. In total, 121,470 (23.8%) received a neonatal hip ultrasound, of whom 58,086 and 63,384 were part of a selective or a universal ultrasound screening strategy, respectively. The difference in the proportion of late presentation between the universal and selective strategies was 0.0904 per 1,000 (P = 0.047). The time effect, i.e. the difference between early and late presentation defined respectively, as less than and more than 3 months of age, regardless of screening strategy, was not significant (P = 0.272). Although there was variability in study design and reporting, the quality of the evidence, based on the critical appraisal skills programme appraisal tools, was generally good. Compared to universal ultrasound screening for DDH, selective screening resulted in a slightly higher rate of late presentation. Uniformity in design and reporting of DDH studies and a cost-effectiveness analysis are needed.
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Affiliation(s)
- Lene B Laborie
- Section for Pediatric Radiology, Department of Radiology, Haukeland University Hospital, Jonas Lies vei 65, 5021, Bergen, Norway.
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.
| | - Karen Rosendahl
- Department of Clinical Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromso, Norway
- Section of Paediatric Radiology, University Hospital of North Norway, Tromso, Norway
| | - Amira Dhouib
- Department of Radiology, Reseau hospitalier Neuchatelois, Neuchatel, Switzerland
| | - Paolo Simoni
- Paediatric Imaging Department, 'Reine Fabiola' University Children's Hospital, Université libre de Bruxelles, Brussels, Belgium
| | - Paolo Tomà
- Department of Imaging, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy
| | - Amaka C Offiah
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
- Department of Radiology, Sheffield Children's NHS Foundation Trust, Sheffield, UK
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Candussi IL, Ene D, Bușilă C, Mihailov R, Sârbu I, Lungu CN, Ciongradi CI. The Influence of Risk Factors in the Early Detection of Developmental Dysplasia of the Hip in a Country with Limited Material Resources. Healthcare (Basel) 2023; 11:2416. [PMID: 37685450 PMCID: PMC10486788 DOI: 10.3390/healthcare11172416] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/25/2023] [Accepted: 08/26/2023] [Indexed: 09/10/2023] Open
Abstract
Developmental dysplasia of the hip (DDH) is a condition that includes a wide spectrum of anomalies ranging from simple instability with ligamentous hyperlaxity to the complete displacement of the femoral head outside the abnormally developed cotyloid cavity. Early detection and initiation of treatment allow "restitutio ad integrum" healing, which has raised the medical community's interest in early diagnosis. However, in countries with limited material resources, where echographic screening is not performed, efforts are being made to increase the sensitivity of clinical screening. Thus, the concept of "hip at risk" is taking shape worldwide. This is the normal clinical hip, but associated with one or more risk factors. We conducted a retrospective study for the period 2010-2015 with patients who presented in the ambulatory clinic of the St. John Children's Clinical Hospital, Galati. The study included 560 patients, who were all examined clinically and sonographically, according to the Graf method, by a senior orthopedic doctor with competence in hip sonography. The data obtained from the anamnesis, clinical examination, and ultrasound examination were recorded in the DDH file. The goal of the statistical analysis of the group of patients was to find a correlation between DDH and the risk factors used in the clinical detection of this pathology. In the studied group, four risk factors were identified that have an increased association with DDH: female sex, pelvic presentation, limitation of coxo-femoral abduction, and congenital clubfoot; thus, the conclusion of the study is that patients who have at least one of the listed risk factors should be examined sonographically as quickly as possible. The early ultrasound examination will allow the identification of the disease and the initiation of treatment.
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Affiliation(s)
- Iuliana-Laura Candussi
- Department of Pediatric and Orthopaedic Surgery, Clinical County Children Emergency Hospital, “Dunarea de Jos” University, 800010 Galati, Romania; (I.-L.C.)
| | - Daniela Ene
- Department of Pediatric and Orthopaedic Surgery, Clinical County Children Emergency Hospital, “Dunarea de Jos” University, 800010 Galati, Romania; (I.-L.C.)
| | - Camelia Bușilă
- Department of Pediatrics, Clinical County Children Emergency Hospital, “Dunarea de Jos” University, 800010 Galati, Romania;
| | - Raul Mihailov
- Department of Surgery, Faculty of Medicine and Pharmacy, “Dunarea de Jos” University, 800010 Galati, Romania;
| | - Ioan Sârbu
- 2nd Department of Surgery—Pediatric Surgery and Orthopedics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania;
| | - Claudiu N. Lungu
- Department of Surgery, Clinical County Emergency Hospital, 810325 Braila, Romania
| | - Carmen Iulia Ciongradi
- 2nd Department of Surgery—Pediatric Surgery and Orthopedics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania;
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Zein A, Khalifa AA, Elsherif ME, Elbarbary H, Badaway MY. Are the outcomes of single-stage open reduction and Dega osteotomy the same when treating DDH in patients younger than 8 years old? A prospective cohort study. J Orthop Traumatol 2023; 24:43. [PMID: 37592192 PMCID: PMC10435432 DOI: 10.1186/s10195-023-00725-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 07/22/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND The primary objective was to report our early results after a one-stage procedure [open reduction (OR), Dega pelvic osteotomy (DPO), and femoral osteotomy (FO) when needed] for surgical management of a cohort of patients with developmental dysplasia of the hip (DDH). The secondary objective was to compare the functional, radiological, and complications among patients younger and older than 30 months. MATERIALS AND METHODS This prospective cohort study included 71 hips with DDH in 61 patients with a mean age of 34.3 ± 19.5 months. All patients underwent one-stage surgical procedures, including OR + DPO and FO, if needed. Functional and radiographic assessment at the last follow-up was conducted using the modified Severin grading system and the Severin classification system, respectively, in addition to assessing the acetabular index (AI), osteotomies healing, and presence of complications. We divided patients into two groups, younger than 30 months (group I) and older than 30 months (group II). RESULTS We included 35 hips in group I and 36 in group II. All hips received OR + DPO, while 25 (69.4%) hips in group II had FO. The operative time was significantly longer in group II (103.19 ± 20.74 versus 72.43 ± 11.59 min, p < 0.001). After a mean follow up of 21.3 ± 2.3 months, the functional outcomes were satisfactory in 62 (87.3%) hips (94.3% in group I and 80.6% in group II, p = 0.35). There was a significant improvement in the AI in all patients compared with preoperative values (27.2° ± 2.9 versus 37° ± 4.2, p < 0.05). Furthermore, 63 (88.7%) hips had satisfactory radiographic outcomes (94.3% in group I and 83.3% in group II, p = 0.26), and all osteotomies showed radiographic healing. The overall complications incidence was significantly lower in group I compared with group II (5.7% versus 30.6%, p < 0.05), and avascular necrosis occurred in 4 (5.6%) hips, all in group II (p = 0.06). CONCLUSION One-stage procedure entailing open reduction, Dega pelvic osteotomy, and femoral osteotomy when needed for managing DDH in patients younger than eight years old revealed acceptable clinical and radiological outcomes. However, there was a higher need for a concomitant femoral osteotomy in patients older than 2.5 years, and complications were more frequent. LEVEL OF EVIDENCE III
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Affiliation(s)
- AboBakr Zein
- Orthopedics and Traumatology Department, Cairo University, Giza, Egypt
| | - Ahmed A Khalifa
- Orthopaedic Department, Qena Faculty of Medicine, South Valley University, Kilo 6 Qena-Safaga Highway, Qena, 83523, Egypt.
| | | | - Hassan Elbarbary
- Orthopedics and Traumatology Department, Cairo University, Giza, Egypt
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Merckaert S, Zambelli PY. Treatment perspective after failed open reduction of congenital hip dislocation. A systematic review. Front Pediatr 2023; 11:1146332. [PMID: 37622079 PMCID: PMC10445129 DOI: 10.3389/fped.2023.1146332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 07/27/2023] [Indexed: 08/26/2023] Open
Abstract
Background Failure of open reduction of developmental hip dislocation is a serious complication and revision surgery appear to be technically demanding with high complication rates. Little attention has been given in literature to patients in whom open reduction of developmental hip dislocation has failed. We present a systematic review about current perspectives and timing when to perform surgical revision after failed open reduction of developmental hip dislocation in children. Methods Following the recommendations of the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" (PRISMA) statements we performed a comprehensive search of the PubMed and Google Scholar bibliographic database in order to select all studies published between 1980 and 2022. Studies were screened for the reasons for failure of open reduction, timing when revision surgery was performed, and for the surgical techniques used for revision. Results A total of 10 articles including 252 patients and 268 hips has been recorded. The most common causes of re-dislocation after open reduction are inadequate exposure and failure to release the obstructing soft tissues inside and around the hip. In 90% of the cases the anterolateral approach was performed for revision surgery. Avascular necrosis occurred in 5%-67% of cases and was the most encountered complication. Conclusion Redislocation of developmental hip dislocation after an open reduction has poor long-term outcomes mainly due to a high rate of avascular necrosis of the femoral head. It is mandatory to obtain a stable reduction at the second surgery combining soft tissue release, capsulorrhaphy, pelvic and femoral osteotomies.
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Affiliation(s)
- Sophie Merckaert
- Unit of Pediatric Orthopedics, Department of Women-Mother – Child’s Care, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
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Muddaluru V, Boughton O, Donnelly T, O’Byrne J, Cashman J, Green C. Developmental dysplasia of the hip is common in patients undergoing total hip arthroplasty under 50 years of age. SICOT J 2023; 9:25. [PMID: 37560993 PMCID: PMC10414020 DOI: 10.1051/sicotj/2023020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 06/23/2023] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION Developmental dysplasia of the hip (DDH) refers to congenital and/or developmental hip instability that can result in hip joint subluxation or dislocation. When detected neonatally, conservative treatment with hip bracing can restore normal hip anatomy. Missed detection of DDH in the neonatal period or late development of DDH often requires surgical intervention to correct the abnormal anatomy. Furthermore, despite surgical intervention, residual sequelae may persist leading to early osteoarthritis of the hip joint requiring joint replacement surgery. AIM This study investigates the prevalence of hip dysplasia in patients undergoing total hip arthroplasty (THA) under 50 years of age. METHODS The hip arthroplasty database at a national referral centre was investigated from January 2014 to December 2020. In patients under 50 years of age, those with an adequate pre-operative anteroposterior pelvic radiograph without previous hip arthroplasty were included, while those with inadequate radiographs were excluded. The following measurements were made on the contralateral non-operated hip: (1) lateral centre-edge angle (LCEA), (2) Tönnis angle, (3) acetabular version, (4) acetabular depth, (5) femoral head lateralisation, (6) femoral head extrusion index, and (7) acetabular depth-to-width ratio. RESULTS In total, 451 patients were included in this study. Twenty two percent of the patients had hip dysplasia, based on a LCEA of <25° and 42.6% of patients had hip dysplasia, based on a Tönnis angle of > 10°. The mean LCEA and Tönnis angle were 31.47 ± 9.64 and 9.82 ± 6.79°, respectively. CONCLUSION Hip dysplasia is common in patients undergoing THA under the age of 50 years with over 40% having dysplasia according to the Tönnis angle. Classification of primary and secondary osteoarthritis in the joint registries will benefit our knowledge on the prevalence of DDH in the adult population.
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Affiliation(s)
- Varun Muddaluru
- National Orthopaedic Hospital Cappagh Finglas Dublin
- Children’s Health Ireland at Temple Street Rotunda Dublin
| | | | - Thomas Donnelly
- National Orthopaedic Hospital Cappagh Finglas Dublin
- Children’s Health Ireland at Temple Street Rotunda Dublin
| | - John O’Byrne
- National Orthopaedic Hospital Cappagh Finglas Dublin
| | - James Cashman
- National Orthopaedic Hospital Cappagh Finglas Dublin
| | - Connor Green
- National Orthopaedic Hospital Cappagh Finglas Dublin
- Children’s Health Ireland at Temple Street Rotunda Dublin
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Alomran AK, Almulhim H, Alabdulqader S, Almutairi DS, Alrusayyis DF, Althwaiqb SA, Alumran A. The Utilization of Pediatric Hip Spica Tables Among Orthopedic Surgeons: Locally Customized versus Company-Manufactured (Cross-Sectional Study). J Multidiscip Healthc 2023; 16:2145-2153. [PMID: 37533876 PMCID: PMC10392810 DOI: 10.2147/jmdh.s398953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/17/2023] [Indexed: 08/04/2023] Open
Abstract
Background Hip spica tables are widely used among pediatric orthopedic surgeons to maintain the hip position during cast application and drying processes for a better outcome. Locally customized spica tables can be a significant concern if their limitations significantly interfere with the quality of care. Objective This study aims to explore the current practice of pediatric hip spica table application among hospitals in the GCC countries and report comprehensive data that help surgeons enhance their practice. Methods This is a cross-sectional study on pediatric orthopedic surgeons using a self-administered Online Questionnaire. The respondents were grouped as those using locally customized tables, where further information about the material and characteristics were collected, and those using company manufactured tables. Both groups answered analytical questions related to their current practice of hip spica tables. Results Sixty-three surgeons completed the survey. More than half the physicians in this study are using locally customized spica tables (n= 41, 65%). Compared to company-manufactured tables, locally customized tables were associated with a higher rate of difficulties when taking an X-ray, when the patient weighs more than 50.0 kg, and with anesthesia, although not statistically significant. Conclusion Obtaining a good quality spica table at a suitable price is a primary obstacle pediatric orthopedic surgeons face. This study shows no statistically significant difference between locally customized and company-manufactured tables regarding the outcomes and that spica tables have room for development to optimize their utilization.
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Affiliation(s)
- Ammar K Alomran
- Orthopedics Department, Imam Abdulrahman bin Faisal University, College of Medicine, Dammam, Saudi Arabia
| | - Hadeel Almulhim
- College of Medicine, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Shahad Alabdulqader
- College of Medicine, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Danah S Almutairi
- College of Medicine, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Danah F Alrusayyis
- College of Medicine, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Sarah A Althwaiqb
- College of Medicine, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Arwa Alumran
- Health Information Management and Technology Department, Imam Abdulrahman bin Faisal University, College of Public Health, Dammam, Saudi Arabia
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Mulder FECM, Witlox MA, Dirksen CD, de Witte PB, de Vos-Jakobs S, Ham AMT, Witbreuk MMEH, Sakkers R, Drongelen MMMHPFV, Robben SGF, Mathijssen NMC. Active monitoring versus an abduction device for treatment of infants with centered dysplastic hips: study protocol for a randomized controlled trial (TReatment with Active Monitoring (TRAM)-Trial). BMC Pediatr 2023; 23:203. [PMID: 37120559 PMCID: PMC10148463 DOI: 10.1186/s12887-023-04012-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 04/13/2023] [Indexed: 05/01/2023] Open
Abstract
BACKGROUND Developmental Dysplasia of the Hip (DDH) is one of the most common pediatric orthopedic disorders, affecting 1-3% of all newborns. The optimal treatment of centered DDH is currently under debate. This randomized controlled trial aims to study the (cost-)effectiveness of active monitoring versus abduction treatment for infants with centered DDH. METHODS This is a multicenter, parallel-group, open-label, non-inferiority randomized controlled trial studying the (cost-)effectiveness of active monitoring versus abduction treatment for infants with centered DDH in fourteen hospitals in the Netherlands. In total, 800 infants with centered DDH (Graf IIa-/IIb/IIc), aged 10-16 weeks, will be randomly allocated to the active monitoring or abduction treatment group. Infants will be followed up until the age of 24 months. The primary outcome is the rate of normal hips, defined as an acetabular index lower than 25 degrees on an antero-posterior radiograph, at the age of 12 months. Secondary outcomes are the rate of normal hips at the age of 24 months, complications, time to hip normalization, the relation between baseline patient characteristics and the rate of normal hips, compliance, costs, cost-effectiveness, budget impact, health-related quality of life (HRQoL) of the infant, HRQoL of the parents/caregivers, and parent/caregiver satisfaction with the treatment protocol. DISCUSSION The outcomes of this randomized controlled trial will contribute to improving current care-as-usual for infants with centered DDH. TRIAL REGISTRATION Dutch Trial Register, NL9714, registered September 6, 2021. https://clinicaltrialregister.nl/en/trial/29596.
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Affiliation(s)
- Frederike E C M Mulder
- Department of Orthopedic Surgery, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands.
| | - M Adhiambo Witlox
- Department of Orthopedic Surgery, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Carmen D Dirksen
- Department of Clinical Epidemiology and Medical Technology Assessment, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center, Maastricht, the Netherlands
| | - Pieter Bas de Witte
- Department of Orthopedics, Leiden University Medical Center, Leiden, the Netherlands
| | - Suzanne de Vos-Jakobs
- Department of Orthopedics and Sports Medicine, Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Arno M Ten Ham
- Department of Orthopedics, Sint Maartenskliniek, Nijmegen, the Netherlands
| | | | - Ralph Sakkers
- Department of Orthopedic Surgery, Wilhelmina Children's Hospital, University Medical Center, Utrecht, the Netherlands
| | | | - Simon G F Robben
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Nina M C Mathijssen
- Reinier Haga Orthopedic Center, Zoetermeer, the Netherlands
- Department of Orthopedics, Reinier de Graaf Hospital, Delft, the Netherlands
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18
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Elbaseet HM, Hady Abdel Zaher MA. U-shaped hip capsular incision: an easier way to do hip capsulorrhaphy in Developmental Dysplasia of the Hip -Technical Note. Orthop Traumatol Surg Res 2023:103625. [PMID: 37086945 DOI: 10.1016/j.otsr.2023.103625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/05/2023] [Accepted: 04/17/2023] [Indexed: 04/24/2023]
Abstract
Developmental dysplasia of the hip (DDH) is one of the commonest hip anomalies encountered in pediatric patients. Stabilization of the femoral head into the acetabulum is crucial for normal hip joint development. When surgical intervention is decided, open reduction is needed to remove any obstacle that hinders hip reduction. Capsulorraphy is an essential step for minimizing instability of the hip after reduction. The classic T-shaped capsular incision is done by two incisions: vertical limb parallel to femoral neck axis and a transverse one parallel to the inguinal ligament 5 mm distally to proximal capsular attachment. The cumbersomeness of this technique was noticed in suturing of the resulted two flabs from this incision. So, the suggested U-shaped incision makes suturing of the capsule easier with multiple stitches. Level of evidence: IV.
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Chand S, Afaque SF, Verma V, Singh A. Transient inferior over-reduction after open reduction in walking-age DDH: A retrospective analysis of 42 Hips. J Clin Orthop Trauma 2023; 39:102144. [PMID: 36923448 PMCID: PMC10009528 DOI: 10.1016/j.jcot.2023.102144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/15/2023] [Accepted: 02/22/2023] [Indexed: 03/14/2023] Open
Abstract
Background Due to various policy and health infrastructure issues, it is not uncommon to present developmental dysplasia of hip(DDH) at walking-age in India. The purpose of this study was retrospective analysis of operated cases of walking-age DDH with "inferior over-reduction". Methods "Inferior over-reduction" was defined as break in the Shenton's arc inferiorly in an operated hip which otherwise appears reduced. After Ethical Committee approval, we searched children operated for walking-age DDH. Children suggestive of syndromic association were excluded. We collected demographic data, follow-up, procedures performed, inferior over-reduction and complications. The IHDI grade, Acetabular Index(AI), Smith's ratio for superior (h/b) & lateral displacement(c/b) of femur, and clinical outcome (Modified McKay criteria) were evaluated. The outcomes of cases with inferior over-reduction(Group A) were compared with those without(Group B). Results 42 patients with average follow-up of 23 months were enrolled. 21 hips belonged to Group A. By 6 months follow up, all these cases recovered. On comparison of Smith's ratio, group A had significantly higher c/b for the operated hip at 3-month follow-up(p < 0.05). Patients undergoing acetabuloplasty had significantly lower c/b versus all other groups(p < 0.05). Correlation between h/b or c/b with age did not show any significant finding. 15 cases in group A and 14 cases in group B had excellent outcome as per modified McKay's criteria. None of the patients had inferior over-reduction, inferior or obturator dislocation at final follow-up. Three patients with group B had re-dislocation with poor outcome. we recorded 3 hips with AVN (7%). Conclusions This study highlights that after OR of walking-age DDH, the inferior over-reduction may be noted in as much as 50% of the cases. However, this is transient, and all cases recover by the 6 months follow up. There is no significant difference between group A & B in functional outcome, AVN rate. Long-term studies are required to see outcome differences between two groups.
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Affiliation(s)
- Suresh Chand
- Department of Paediatric Orthopaedics, King George's Medical University, Lucknow, India
| | - Syed Faisal Afaque
- Department of Paediatric Orthopaedics, King George's Medical University, Lucknow, India
| | - Vikas Verma
- Department of Paediatric Orthopaedics, King George's Medical University, Lucknow, India
| | - Ajai Singh
- Department of Paediatric Orthopaedics, King George's Medical University, Lucknow, India
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Lankinen V, Helminen M, Bakti K, Välipakka J, Laivuori H, Hyvärinen A. Known risk factors of the developmental dysplasia of the hip predicting more severe clinical presentation and failure of Pavlik harness treatment. BMC Pediatr 2023; 23:148. [PMID: 37004001 PMCID: PMC10064754 DOI: 10.1186/s12887-023-03935-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 02/27/2023] [Indexed: 04/03/2023] Open
Abstract
PURPOSE Developmental dysplasia of the hip (DDH) varies from mild instability of the hip to subluxation or total dislocation of the joint. Well-known risk factors of DDH include pre-natal breech position, female sex, positive family history, hip side, primiparity and the mode of delivery. Aim of the present study was to further evaluate known risk-factors of DDH, find associations with more severe dysplasia (characterized with Ortolani positivity) and find risk factors of failure of the Pavlik harness treatment. MATERIAL AND METHODS All children with the diagnosis of DDH treated in Tampere University hospital in the years 1998-2018 were retrospectively identified for the study and the data was collected from the medical records. Teratological dislocations (n = 3) were excluded from the analysis. Total of 945 patients were included. RESULTS Breech presentation was strongly associated with Ortolani positivity (p < 0.001). Breech presentation was not associated with ending up for spica casting and/or operative treatment (p = 0.291) despite the association with Ortolani positivity. Ortolani positivity (p = 0.002), positive family history (p = 0.013) and girl sex (p = 0.029) were associated with ending up for spica casting and/or operative treatment. CONCLUSION Breech presentation seems to increase the risk of Ortolani positive DDH. However, these infants are likely to recover with initially started Pavlik harness treatment, as it was not associated with elevated risk for undergoing more robust treatments. Positive family history and girl sex are associated with the most severe cases of developmental dysplasia of the hip, and it may predispose to the failure of the Pavlik harness treatment.
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Affiliation(s)
- Vilma Lankinen
- Department of Pediatric Surgery, Turku University Hospital, Turku, Finland.
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
| | - Mika Helminen
- Faculty of Social Sciences, Health Sciences, Tampere University, Tampere, Finland
- Tays Research Services, Tampere University Hospital, Tampere, Finland
| | - Karim Bakti
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | | | - Hannele Laivuori
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Faculty of Medicine and Health Technology, Center for Child, Adolescent, and Maternal Health Research, Tampere University, Tampere, Finland
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
- Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anna Hyvärinen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Surgery, Mehiläinen Länsi-Pohja Oy, Kemi, Finland
- Department of Otorhinolaryngology and Head and Neck Surgery, Oulu University Hospital, Oulu, Finland
- Clinical Medicine Research Unit, Medical Research Center, University of Oulu, Oulu, Finland
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Jia CQ, Wu YJ, Cao SQ, Hu FQ, Zheng ZR, Xu C, Zhang XS. Mid-term low back pain improvement after total hip arthroplasty in 306 patients with developmental dysplasia of the hip. J Orthop Surg Res 2023; 18:212. [PMID: 36932447 PMCID: PMC10022041 DOI: 10.1186/s13018-023-03701-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 03/12/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Low back pain (LBP) from hip and spinal disorders has been one of the main reasons for visiting physicians in patients with developmental dysplasia of the hip (DDH). It is essential to identify the LBP improvement among all grades of DDH patients treated with total hip arthroplasty (THA) at 5-year follow-up. METHODS The study included 407 hips of 306 patients (38 males, 268 females) who underwent THA between July 2007 and December 2016. There were 65 hips in Crowe I, 61 hips in Crowe II, 69 hips in Crowe III, and 212 hips in Crowe IV. One hundred and fourteen hips received subtrochanteric shortening. Patients included 101 bilateral THA (BTHA) and 205 unilateral THA (UTHA). The evaluation was performed through Back Pain Function Scale (BPFS), Harris hip score, Visual Analogue Scale (VAS), operative data and radiographic examinations. RESULTS The BPFS in patients of unilateral Crowe III and IV relieved significantly more (p < 0.05). However, the BPFS in patients with bilateral symmetry DDH hips relieved significantly less than other groups of DDH hips (p < 0.05). Harris in hips of Crowe II improved significantly more (p < 0.05). The VAS in hips of Crowe II and III improved significantly more (p < 0.05). The unilateral THA surgical time, blood loss, blood transfusion, and osteotomy number and length in Crowe IV were significantly more (p < 0.05). CONCLUSION THA is reliable to relieve LBP in DDH patients of unilateral Crowe III and IV; however, in patients with unilateral Crowe I, Crowe II, and bilateral DDH hips, the LBP improvements were limited. This should assist shared decision-making between orthopedic surgeons and patients. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Cheng-Qi Jia
- grid.414252.40000 0004 1761 8894Department of Orthopedics, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853 China
- grid.488137.10000 0001 2267 2324Medical School of Chinese PLA, Beijing, China
- grid.414360.40000 0004 0605 7104Present Address: Department of Orthopedics, Beijing Jishuitan Hospital, Beijing, 100035 China
| | - Yu-Jie Wu
- grid.414252.40000 0004 1761 8894Department of Orthopedics, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853 China
- Department of Nursing, The Third People’s Hospital of Datong, Datong, Shanxi China
- grid.414360.40000 0004 0605 7104Present Address: Department of Orthopedics, Beijing Jishuitan Hospital, Beijing, 100035 China
| | - Shi-Qi Cao
- grid.414252.40000 0004 1761 8894Department of Orthopedics, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853 China
- grid.414252.40000 0004 1761 8894Department of Orthopedics of TCM Clinical Unit, 6th Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Fan-Qi Hu
- grid.414252.40000 0004 1761 8894Department of Orthopedics, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853 China
| | - Zhi-Rong Zheng
- grid.414252.40000 0004 1761 8894Department of Orthopedics, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853 China
| | - Chi Xu
- grid.414252.40000 0004 1761 8894Department of Orthopedics, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853 China
| | - Xue-Song Zhang
- grid.414252.40000 0004 1761 8894Department of Orthopedics, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853 China
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Vasilcova V, AlHarthi M, Jawadi AH, Zvonař M. The Use of Visual Analysis for Gait and Foot Posture in Children with Developmental Dysplasia of the Hip. Diagnostics (Basel) 2023; 13. [PMID: 36900117 DOI: 10.3390/diagnostics13050973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 02/25/2023] [Accepted: 02/27/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Developmental dysplasia of the hip (DDH) is recognized as a leading cause of significant long-term complications, including inaccurate gait patterns, persistent pain, and early regressive joint disorder, and it can influence families functionally, socially, and psychologically. METHODS This study aimed to determine foot posture and gait analysis across patients with developmental hip dysplasia. We retrospectively reviewed participants referred to the pediatric rehabilitation department of KASCH from the orthopedic clinic between 2016 and 2022 (patients born 2016-2022) with DDH for conservative brace treatment. RESULTS The foot postural index for the right foot showed a mean of 5.89 (n = 203, SD 4.15) and the left food showed a mean of 5.94 (n = 203, SD 4.19). The gait analysis mean was 6.44 (n = 406, SD 3.84). The right lower limb mean was 6.41 (n = 203, SD 3.78), and the left lower limb mean was 6.47 (n = 203, SD 3.91). The correlation for general gait analysis was r = 0.93, presenting the very high impact of DDH on gait. Significant correlation results were found between the right (r = 0.97) and left (r = 0.25) lower limbs. Variation between the right and left lower limb p-values was 0.88 (p < 0.05). DDH affects the left lower limb more than the right during gait. CONCLUSION We conclude that there is a higher risk of developing foot pronation on the left side, which is altered by DDH. Gait analysis has shown that DDH affects the right lower limb more than the left. The results of the gait analysis showed gait deviation in the sagittal mid- and late stance phases.
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Abstract
BACKGROUND Periacetabular osteotomy (PAO) has become a popular procedure for re-orientation of the acetabulum in patients with a developmental pathomorphology. Since its first description by Reinhold Ganz in 1988, many institutions worldwide have adopted the procedure for the treatment of developmental hip dysplasia (DDH) and have subsequently reported their results. The aim of this study was to provide a meta-analysis of the likelihood of long-term survival of a dysplastic hip after PAO. METHODS A systematic literature review was conducted using Medline, Cochrane and "Web of Science" databases to identify articles reporting survival estimates for PAO in patients with DDH. To be included in the analysis, studies had to include patient cohorts aged <40 years, with Osteoarthritis grade < Tönnis III and no form of neuromuscular dysplasia. Adjustment for cohort overlap was performed. Quality assessment included level of evidence (LOE) according to the oxford center for LOE criteria and the "Methodological index for non-randomized studies (MINORS)". After data extraction, a random-effects meta-analytical model was applied to provide weighted mean estimates of survival at 5 years, 10 years, 15 years and 20 years. RESULTS Nine relevant articles included 2268 dysplastic hips that underwent PAO in 9 institutions. Of the included studies, 5 presented level III evidence and 4 presented level IV evidence. The MINORS score was 11 for 3 studies, 12 for 4 studies and 13 for 2 studies. The 5-year survival after PAO was 96.1% (95% CI, 94.9-97.3), the 10-year survival was 91.3% (95% CI, 87.7-94.8), 15-year survival 85.0% (95% CI, 78.9-91.1), 20-year survival 67.6% (95% CI, 53.9-81.3). CONCLUSIONS The results provide a representative survival estimate of a dysplastic hip after PAO based on global evidence. This should provide clinicians and patients with an adequate reflection of prognostic expectations after this kind of surgery.
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Affiliation(s)
- Sufian S Ahmad
- Centre for Musculoskeletal Surgery,
Charité-University Medical Centre Berlin, Berlin, Germany,Sufian S Ahmad, Centre for Musculoskeletal
Surgery, Charité-University Medical Centre Berlin, Augustenburger Platz 1,
Berlin, 10117, Germany.
| | - Gregor M Giebel
- Centre for Musculoskeletal Surgery,
Charité-University Medical Centre Berlin, Berlin, Germany
| | - Carsten Perka
- Centre for Musculoskeletal Surgery,
Charité-University Medical Centre Berlin, Berlin, Germany
| | - Sebastian Meller
- Centre for Musculoskeletal Surgery,
Charité-University Medical Centre Berlin, Berlin, Germany
| | - Matthias Pumberger
- Centre for Musculoskeletal Surgery,
Charité-University Medical Centre Berlin, Berlin, Germany
| | - Sebastian Hardt
- Centre for Musculoskeletal Surgery,
Charité-University Medical Centre Berlin, Berlin, Germany
| | - Ulrich Stöckle
- Centre for Musculoskeletal Surgery,
Charité-University Medical Centre Berlin, Berlin, Germany
| | - Christian Konrads
- Department for Trauma and
Reconstructive Surgery, BG Klinik, University of Tübingen, Germany
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Alshehri F, Almalki Y. Developmental dysplasia of the hip in infants younger than six months: Ultrasonographic assessment in relation with risk factors. Int J Health Sci (Qassim) 2023; 17:37-45. [PMID: 36891040 PMCID: PMC9986879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023] Open
Abstract
Objectives In newborns, developmental dysplasia of the hip (DDH) is an abnormal development of the hip joint but its accurate detection is challenging. This study was designed to determine an accurate detection of DDH and their associated risk factors in infants younger than 6 months using sonographic and clinical examinations. Methods Infants younger than 6 months (n = 404) with their hip instability were recruited. Infants' hips were examined by ultrasonographic and clinical examinations. Ultrasonographic data were accessed in relation with the risk factors. Omni calculator was used to measure sensitivity, specificity and accuracy. Results Out of 808 hips, 97.3% hips were categorized as Graf I type, 1.4% hips were Graf type IIa, 0.87% were type IIb, and 0.49% were type IIc. The data revealed that 93.9% hips were congruous and 6.1% hips were immature. Importantly, the data showed that risk factors such as mode of delivery, breech presentation, oligohydramnios, family history, and malformations were proportionally associated with positive DDH cases. Interestingly, the sensitivity, specificity, and accuracy of ultrasonography in relation with clinical positivity of DDH infants were 51.83%, 99.43%, and 73.16%, respectively. Conclusions This study proved that ultrasonographic assessments are highly sensitive, specific and accurate for the detection of DDH onset in infants younger than 6 months. In addition, the study investigated a number of risk factors associated with the onset of DDH; therefore, it is extremely important that ultrasonography and clinical examination should be performed by those sonographers and orthopedic surgeons, who will have the knowledge of associated risk factors.
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Affiliation(s)
- Fahad Alshehri
- Department of Radiology, College of Medicine, Qassim University, Buraydah, Saudi Arabia
| | - Yahya Almalki
- Department of Pediatric, College of Medicine, Qassim University, Buraydah, Saudi Arabia
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Kołodziejczyk K, Czwojdziński A, Czubak-Wrzosek M, Czubak J. Radiologic Predictors for Clinical Improvement in PAO-A Perspective Study. J Clin Med 2023; 12:jcm12051837. [PMID: 36902624 PMCID: PMC10003375 DOI: 10.3390/jcm12051837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/15/2023] [Accepted: 02/22/2023] [Indexed: 03/02/2023] Open
Abstract
The aim of this study was to evaluate the results of surgical treatment of developmental dysplasia of the hip (DDH) with periacetabular osteotomy (PAO) and determine the values of radiological parameters that would allow us to obtain an optimal clinical result. Radiological evaluation included determining the center-edge angle (CEA), medialization, distalization, femoral head coverage (FHC), and ilioischial angle as measured on a standardized AP radiograph of the hip joints. Clinical evaluation was based on the HHS, WOMAC, Merle d'Aubigne-Postel scales and Hip Lag Sign. The results of PAO presented decreased medialization (mean 3.4 mm), distalization (mean 3.5 mm), and ilioischial angle (mean 2.7°); improvement in femoral head bone cover; an increased CEA (mean 16.3°) and FHC (mean 15.2%); clinically increased HHS (mean 22 points) and M. Postel-d'Aubigne (mean 3.5 points) scores; and a decrease in WOMAC (mean 24%). HLS improved in 67% of patients after surgery. Qualification of patients with DDH for PAO should be based on the following values of three parameters: CEA < 26°, FHC < 75%, and ilioischial angle >85.9°. To achieve better clinical results, it is necessary to increase the average CEA value by 11° and the average FHC by 11% and reduce the average ilioischial angle by 3°.
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Affiliation(s)
- Kamil Kołodziejczyk
- Department of Orthopaedics, Children’s Orthopaedics and Traumatology, Centre of Postgraduate Medical Education, Professor A. Gruca Teaching Hospital, Konarskiego 13, 05-400 Otwock, Poland
- Correspondence: ; Tel.: +48-508472244
| | - Adam Czwojdziński
- Department of Orthopaedics, Children’s Orthopaedics and Traumatology, Centre of Postgraduate Medical Education, Professor A. Gruca Teaching Hospital, Konarskiego 13, 05-400 Otwock, Poland
| | - Maria Czubak-Wrzosek
- Department of Spine Disorders and Orthopedics, Centre of Postgraduate Medical Education, Professor A. Gruca Teaching Hospital, Konarskiego 13, 05-400 Otwock, Poland
| | - Jarosław Czubak
- Department of Orthopaedics, Children’s Orthopaedics and Traumatology, Centre of Postgraduate Medical Education, Professor A. Gruca Teaching Hospital, Konarskiego 13, 05-400 Otwock, Poland
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Wen J, Ping H, Kong X, Chai W. Developmental dysplasia of the hip: A systematic review of susceptibility genes and epigenetics. Gene 2023; 853:147067. [PMID: 36435507 DOI: 10.1016/j.gene.2022.147067] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/29/2022] [Accepted: 11/18/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Developmental dysplasia of the hip (DDH) is a complex developmental deformity whose pathogenesis and susceptibility-related genes have yet to be elucidated. This systematic review summarizes the current literature on DDH-related gene mutations, animal model experiments, and epigenetic changes in DDH. METHODS We performed a comprehensive search of relevant documents in the Medline, Scopus, Cochrane, and ScienceDirect databases covering the period from October 1991 to October 2021. We analyzed basic information on the included studies and summarized the DDH-related mutation sites, animal model experiments, and epigenetic changes associated with DDH. RESULTS A total of 63 studies were included in the analysis, of which 54 dealt with the detection of gene mutations, 7 presented details of animal experiments, and 6 were epigenetic studies. No genetic mutations were clearly related to the pathogenesis of DDH, including the most frequently studied genes on chromosomes 1, 17, and 20. Most gene-related studies were performed in Han Chinese or North American populations, and the quality of these studies was medium or low. GDF5 was examined in the greatest number of studies, and mutation sites with odds ratios > 10 were located on chromosomes 3, 9, and 13. Six mutations were found in animal experiments (i.e., CX3CR1, GDF5, PAPPA2, TENM3, UFSP2, and WISP3). Epigenetics research on DDH has focused on GDF5 promoter methylation, three microRNAs (miRNAs), and long noncoding RNAs. In addition, there was also a genetic test for miRNA and mRNA sequencing. CONCLUSIONS DDH is a complex joint deformity with a considerable genetic component whose early diagnosis is significant for preventing disease. At present, no genes clearly involved in the pathogenesis of DDH have been identified. Research on mutations associated with this condition is progressing in the direction of in vivo experiments in animal models to identify DDH susceptibility genes and epigenetics analyses to provide novel insights into its pathogenesis. In the future, genetic profiling may improve matters.
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Affiliation(s)
- Jiaxin Wen
- School of Medicine, Nankai University, Tianjin, China
| | - Hangyu Ping
- School of Medicine, Nankai University, Tianjin, China
| | | | - Wei Chai
- School of Medicine, Nankai University, Tianjin, China.
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Ma Y, Ma X, Cheng S, Lv S, Qi X. Implant loosening following THA with S-ROM prosthesis and subtrochanteric osteotomy: Three case reports. Front Surg 2023; 9:1090067. [PMID: 36793511 PMCID: PMC9922855 DOI: 10.3389/fsurg.2022.1090067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 12/21/2022] [Indexed: 01/31/2023] Open
Abstract
Prosthesis loosening after THA is a rather common complication. For DDH patients with Crowe IV, the surgical risk and complexity is significant. THA with S-ROM prosthesis combined with subtrochanteric osteotomy is a common treatment. However, loosening of a modular femoral prosthesis (S-rom) is uncommon in THA and has a very low incidence. With modular prostheses distal prosthesis looseness are rarely reported. Non-union osteotomy is a common complication of subtrochanteric osteotomy. We report three patients with Crowe IV DDH who developed prosthesis loosening following THA with an S-ROM prosthesis and subtrochanteric osteotomy. We addressed the management of these patients and prosthesis loosening as likely underlying causes.
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Affiliation(s)
- Yingkai Ma
- Department of Orthopedics, Second Affiliated Hospital of Harbin Medical University, Haerbin, China
| | - Xinnan Ma
- Department of Orthopedics, Second Affiliated Hospital of Harbin Medical University, Haerbin, China,Correspondence: Songcen Lv Xinnan Ma
| | - Shi Cheng
- Department of Orthopedics, Second Affiliated Hospital of Harbin Medical University, Haerbin, China
| | - Songcen Lv
- Department of Orthopedics, Second Affiliated Hospital of Harbin Medical University, Haerbin, China,Correspondence: Songcen Lv Xinnan Ma
| | - Xin Qi
- Department of Orthopaedic Surgery, The First Hospital of Jilin University, Changchun, China
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28
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Erratum: Comparison of treatment outcomes of stable and unstable developmental dysplasia of the hip with the Tübingen splint. Front Pediatr 2023; 11:1178331. [PMID: 37025286 PMCID: PMC10071995 DOI: 10.3389/fped.2023.1178331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 03/02/2023] [Indexed: 04/08/2023] Open
Abstract
[This corrects the article DOI: 10.3389/fped.2022.976367.].
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Huang YY, Chen IJ, Wu CT, Chan YS, Chen DWC, Tang HC. The posterior capsule is distended in dysplastic hips, but the anterior capsule is not. Knee Surg Sports Traumatol Arthrosc 2023; 31:79-85. [PMID: 36315266 DOI: 10.1007/s00167-022-07207-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 10/21/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE In the setting of acetabular dysplasia, the increased translational motion of the femur may damage the labrum and cartilage, as well as stretch the capsule. The purpose of the study was to investigate the relationship between the acetabular coverage and the capsular stiffness by assessing the distension of anterior and posterior joint recesses on the hip computed tomography arthrography. METHODS One hundred thirty-three patients (138 hips) with a median age of 36 years (range 18-50 years) who received the computed tomography arthrography for evaluation of nonarthritic hip pain in our institute between 2015 and 2017 were retrospectively reviewed. The maximal distance between the anterior/posterior capsule and the anterior femoral head-neck junction/posterior femoral head on the axial imaging of computed tomography arthrography was defined as the width of anterior/posterior joint recess. The width of anterior/posterior joint recess was adjusted with the diameter of the femoral head and was then compared between acetabular dysplasia (lateral center-edge angle < 25°), normal acetabulum (lateral center-edge angle between 25 and 39°), and deep acetabulum (lateral center-edge angle > 39°). In addition, the standard univariate linear regression analysis was used to investigate the relationship between the adjusted width of anterior/posterior joint recess and anterior/posterior coverage of the hip, determined by the anterior/posterior wall index. RESULTS The adjusted width of posterior joint recess was significantly greater in the acetabular dysplasia group than the normal acetabulum and deep acetabulum groups (p < 0.01 and p = 0.02, respectively). There was no significant difference of the adjusted width of anterior joint recess between the groups (n.s.). The adjusted width of posterior joint recess had a significant but weak negative correlation with the anterior wall index (r = - 0.25, p < 0.001), and no correlation with the posterior wall index (r = - 0.0004, n.s.). There was no significant correlation between the adjusted width of anterior joint recess and the anterior/posterior wall index (r = 0.05, n.s./r = 0.07, n.s.). CONCLUSIONS The distension of posterior capsule on the computed tomography arthrography was significantly greater in acetabular dysplasia. In addition, there was a significant but weak negative correlation between the distension of posterior capsule and the anterior coverage of the hip. It indicated a looser posterior capsule was observed in a dysplastic hip. The relevance of posterior capsular laxity to clinical outcomes warrants further investigation. Given the fact that the distension of anterior capsule was not significantly higher in acetabular dysplasia, the need of anterior capsular plication in a dysplastic hip should be carefully evaluated. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Yu-Yi Huang
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No.222, Maijin Rd., Anle Dist, Keelung, 204, Taiwan
| | - I-Jung Chen
- College of Medicine, Chang Gung University, No.259, Wunhua 1st Rd., Guishan Dist, Taoyuan, 333,, Taiwan.,Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 5, Fusing St., Gueishan, Taoyuan, 333, Taiwan
| | - Chen-Te Wu
- College of Medicine, Chang Gung University, No.259, Wunhua 1st Rd., Guishan Dist, Taoyuan, 333,, Taiwan.,Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, No. 5, Fusing St., Gueishan, Taoyuan, 333, Taiwan
| | - Yi-Sheng Chan
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No.222, Maijin Rd., Anle Dist, Keelung, 204, Taiwan.,College of Medicine, Chang Gung University, No.259, Wunhua 1st Rd., Guishan Dist, Taoyuan, 333,, Taiwan
| | - Dave Wei-Chih Chen
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No.222, Maijin Rd., Anle Dist, Keelung, 204, Taiwan.,College of Medicine, Chang Gung University, No.259, Wunhua 1st Rd., Guishan Dist, Taoyuan, 333,, Taiwan
| | - Hao-Che Tang
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No.222, Maijin Rd., Anle Dist, Keelung, 204, Taiwan. .,College of Medicine, Chang Gung University, No.259, Wunhua 1st Rd., Guishan Dist, Taoyuan, 333,, Taiwan.
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Morello R, Bocchi B, Mariani F, Bononi A, Giuli C, Bonfiglio N, Valentini P, Lazzareschi I, Rendeli C, Palmacci O, Buonsenso D. Assessment for late developmental hip dysplasia in a cohort of infants with risk factors and normal hip ultrasound. Front Pediatr 2023; 11:1140349. [PMID: 37025287 PMCID: PMC10070681 DOI: 10.3389/fped.2023.1140349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 02/21/2023] [Indexed: 04/08/2023] Open
Abstract
Background Developmental dysplasia of the hip (DDH) is a known orthopedic pathology of newborns that, if not diagnosed and treated, can lead to debilitating long-term consequences. Ultrasound has proven to be an effective method for the early diagnosis of this condition. Recently, reports of late DDH in populations at risk (breech presentation) and after negative ultrasound examination have emerged in the literature. Aim The objective of the study was to assess the possible appearance of late DDH in Italian children with risk factors but negative ultrasound screening. Materials and methods We selected patients with risk factors for DDH and a negative hip ultrasound from the medical records of children referred to the Hip Ultrasound Clinic (Rome, Italy) from January 2018 to November 2021. To identify possible cases of late DDH, from February 2022 to July 2022, all patients who met the inclusion criteria were submitted to orthopedic follow-up clinical evaluation. In the case of a pathological objective examination, radiography was performed. Results Fifty-five patients (52.7% female, 52.7% with breech presentation, and 41.8% with a positive family history) met the inclusion criteria. The median age of gait onset was 13 months. The median age of orthopedic follow-up examination was 45 months. Only three patients (5.5%) had a pathological examination, but no x-ray were pathological. Conclusion Our study has not documented cases of late DDH. Considering the small study population and the only clinical follow-up, further studies are needed to clarify the possible late development of this condition.
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Affiliation(s)
- Rosa Morello
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Beatrice Bocchi
- Department of Orthopedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Orthopedics, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Francesco Mariani
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alice Bononi
- Department of Woman and Child Health and Public Health, Medical School, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Cristina Giuli
- Department of Orthopedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Orthopedics, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Nadia Bonfiglio
- Department of Orthopedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Orthopedics, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Piero Valentini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Ilaria Lazzareschi
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Claudia Rendeli
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Osvaldo Palmacci
- Department of Orthopedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Centro di Salute Globale, Università Cattolica del Sacro Cuore, Roma, Italy
- Correspondence: Danilo Buonsenso
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Pisecky L, Großbötzl G, Gahleitner M, Stevoska S, Stadler C, Haas C, Gotterbarm T, Klotz MC. Progressive lateralization and constant hip geometry in children with DDH, NDH, and LCPD following hip reconstructive surgery: a cohort study of 73 patients with a mean follow-up of 4.9 years. Arch Orthop Trauma Surg 2023; 143:1193-1202. [PMID: 34687350 PMCID: PMC9958182 DOI: 10.1007/s00402-021-04227-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 10/13/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND Pelvic and femoral osteotomies have been effective methods to treat developmental dysplasia of the hip (DDH), neurogenic dislocation of the hip (NDH), and Legg-Calvé-Perthes disease (LCPD). The aim of this study was to evaluate the mid-term results after hip reconstruction in children with DDH, NDH, and LCPD. METHODS In a retrospective study, X-rays of 73 children (2-19 years) with DDH, NDH, and LCPD were measured before, 3 months, and at final follow-up (FU) after hip reconstructive surgery (open reduction, and femoral and/or pelvic osteotomy ± soft-tissue procedures between 2008 and 2018). Measurement of hip geometry included acetabular index (AI), center-edge angle (CE), and Reimers migration index (RMI). Mean follow-up time at final FU was 4.9 years. P value was set P < 0.05. RESULTS After surgery (femoral osteotomy: 84 hips, Salter innominate osteotomy: 21 hips, Pemberton osteotomy: 30 hips, open reduction: 28 hips, Chiari osteotomy: 4 hips, and soft-tissue release: 24 hips), hip geometry parameters improved significantly. Nevertheless, at final FU, there was deterioration in hip geometry with femoral head lateralization (RMI) compared to the data at 3 months after surgery (RMI: preop/3 months/final FU: 40.6 ± 16.1%/6.1 ± 9.0/15.4 ± 16.0%; CE: 11.3° ± 20.0°/30.2° ± 9.5°/27.9 ± 15.4°; AI: 28.8° ± 9.6°/19.1° ± 7.6°/18.3 ± 7.6°). Sub-group analysis did not show differences concerning the progression of RMI in DDH, NDH, and LCPD at final FU. Regardless of basic disease, the lateralization was observed in all three groups (DDH, NDH, and LCPD) and statistically significant comparing X-rays 3 months postoperatively to maximum follow-up (DDH; NDH; LCPD: 2.7 ± 6.8%/7.6 ± 10.1%; 13.7 ± 15.3%/22.8 ± 19.8%; 1.7 ± 4.1%/14.9 ± 11.3%). Additional soft-tissue release techniques in patients with DDH or NDH did not show postoperative differences with statistical significance. Concerning surgical techniques, a connection between the lower RMI and the procedure of osteotomy of the ilium was found. In 25 patients, (34%) complications were observed: superficial skin lesions in 8, deep skin lesions in 3, contraction of adductors in 3, subluxation in 2, dislocations of the cast in 2, osteonecrosis of the femoral head in 2 cases, reluxation in 1, infection of the implanted plate in 1, compliance problem in 1, delayed bone healing in 1, and contraction of knee flexors in 1 case. DISCUSSION The basic results of this study show a significant improvement of hip geometry at a follow-up of 4.9 years and prove findings of previously published literature. Moreover, the study was able to show a progression of RMI in all patient groups, which have undergone reconstructive surgery, despite basic hip geometry data (AI, CE angle) did not change. Those findings were independent from underlying pathology. Complications were counted in 34% of the patients and involved all known adverse events after hip reconstructive surgery. This makes clear why annual follow-up checks are needed not to miss the right indication for revision surgery. CLINICAL RELEVANCE Evidence level: Level IV, case series. TRIAL REGISTRATION This manuscript is part of a prospective randomized clinical trial, registered in the German Clinical Trials Register DRKS-ID: DRKS00016861.
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Affiliation(s)
- Lorenz Pisecky
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria.
- Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria.
| | - Gerhard Großbötzl
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria
- Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria
| | - Manuel Gahleitner
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria
- Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria
| | - Stella Stevoska
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria
- Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria
| | - Christian Stadler
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria
- Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria
| | - Christina Haas
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria
- Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria
| | - Tobias Gotterbarm
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria
- Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria
| | - Matthias C Klotz
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria
- Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria
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Dembic M, van Brakel Andersen L, Larsen MJ, Mechlenburg I, Søballe K, Hertz JM. 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; 298:329-42. [PMID: 36454308 DOI: 10.1007/s00438-022-01980-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [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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Bakti K, Lankinen V, Helminen M, Välipakka J, Laivuori H, Hyvärinen A. Clinical and sonographic improvement of developmental dysplasia of the hip: analysis of 948 patients. J Orthop Surg Res 2022; 17:538. [PMID: 36510263 PMCID: PMC9743506 DOI: 10.1186/s13018-022-03432-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 12/04/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Developmental dysplasia of the hip is a common condition, which varies in severity. Abduction treatment is widely used to correct the development of the hips, but mild forms of DDH can also recover spontaneously. The purpose of this study was to evaluate factors affecting the rate of improvement of developmental dysplasia of the hip, and evaluate any risk factors slowing the process. MATERIAL AND METHODS The study population consisted of patients diagnosed with DDH in Tampere University hospital in the years 1998-2018. Data were retrospectively collected, and associations between clinical variables and rate of improvement were analyzed. Alpha angles were assessed monthly, and associations between risk factors and improvement of alpha angles were studied. A total of 948 patients were included in the analysis. RESULTS More severe first status of the hips was associated with faster improvement in dynamic ultrasound compared to milder DDH in univariate design in first 3 months of age; in the multivariable design, Ortolani positivity was conversely associated with lower alpha angles in 1-month follow-up. Immediate abduction treatment was associated with faster recovery rate compared to delayed abduction or watchful waiting. Female sex and positive family history were associated with slower rate of improvement and lower alpha angles. In multivariable design, female sex, positive family history and treatment strategy remained statistically significant as initiation time of the treatment explained the first found association of clinical hip status and the recovery rate after 2 months of age. CONCLUSION Female sex and positive family history might be independent risk factors for slower recovery in DDH before 6 months of age. These children might need special attention in their follow-up plans and abduction treatment.
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Affiliation(s)
- Karim Bakti
- grid.502801.e0000 0001 2314 6254Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Vilma Lankinen
- grid.502801.e0000 0001 2314 6254Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland ,grid.410552.70000 0004 0628 215XDepartment of Pediatric Surgery, Turku University Hospital, Savitehtaankatu 5, 20520 Turku, Finland
| | - Mika Helminen
- grid.502801.e0000 0001 2314 6254Faculty of Social Sciences, Health Sciences, Tampere University, Tampere, Finland ,grid.412330.70000 0004 0628 2985Tays Research Services, Tampere University Hospital, Tampere, Finland
| | | | - Hannele Laivuori
- grid.502801.e0000 0001 2314 6254Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland ,grid.502801.e0000 0001 2314 6254Center for Child, Adolescent, and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland ,grid.412330.70000 0004 0628 2985Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland ,grid.7737.40000 0004 0410 2071Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland ,grid.7737.40000 0004 0410 2071Medical and Clinical Genetics, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Anna Hyvärinen
- grid.502801.e0000 0001 2314 6254Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland ,grid.412330.70000 0004 0628 2985Tays Research Services, Tampere University Hospital, Tampere, Finland ,Department of Surgery, Mehiläinen Länsi-Pohja Oy, Kemi, Finland ,grid.412326.00000 0004 4685 4917Department of Otorhinolaryngology and Head and Neck Surgery, Oulu University Hospital, Oulu, Finland ,grid.10858.340000 0001 0941 4873Clinical Medicine Research Unit, Medical Research Center, University of Oulu, Oulu, Finland
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Holstad IG, Faergemann C. Surgical procedures in infants with early diagnoses of developmental dysplasia of the hip. A prospective 4-year follow-up study. J Orthop 2022; 34:373-378. [PMID: 36275488 PMCID: PMC9579446 DOI: 10.1016/j.jor.2022.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/16/2022] [Accepted: 09/30/2022] [Indexed: 10/31/2022] Open
Abstract
Background Dysplastic hips infants may normalize spontaneously without any intervention due to the natural growth. However, some infants need one or more surgical interventions to achieve stable and non-dysplastic hips. The purpose of this study is to determine the proportion of infants diagnosed with DDH before the age of 6 months undergoing surgical procedures of the hip(s) before the age of four years and to determine the number and types of surgical procedures in each infant. Methods A prospective and consecutive study of all infants aged 0-6 months diagnosed with dysplasia of the hips in the combined paediatric orthopaedic and radiologic examination in the Region of Southern Denmark 2013-2017. From medical records, we obtained information about all surgical procedures in the hips including open or closed reductions, arthrographies, tenotomies, and pelvic osteotomies before the age of 4 years. Results Overall, 281 infants with hip dysplasia were included. The median age at first examination was 48 days. In 254 (90%) of the infants, the hips resolved spontaneously, and 27 (10%) needed one or more surgical interventions. Overall, the 27 infants had 47 surgical intervention as 12 infants had more than one intervention. One infants had five surgical interventions. The most frequent surgical procedures were closed reduction and arthrography with or without adductor tenotomy (58%) and pelvic osteotomy (27%). Among infants with surgical interventions, 23 (8.2%) had unstable hips, and four (1.4%) had stable hips. All four infants with stable hips had an arthrography and none required a pelvic osteotomy. Discussion This study supports the propensity for spontaneous normalization early dysplasia of the hips in infants. Only a small proportion of the infants needed surgical interventions to achieve stable and non-dysplastic hips.
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Affiliation(s)
- Ingebrigt Grimstad Holstad
- Section for Pediatric Orthopaedics, Department of Orthopaedics and Traumatology, Odense University Hospital, J.B. Winslow Vej 4, DK-5000, Odense C, Denmark
- Orthopaedic Research Unit, Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, J. B. Winslow Vej 4, DK-5000, Odense C, Denmark
| | - Christian Faergemann
- Section for Pediatric Orthopaedics, Department of Orthopaedics and Traumatology, Odense University Hospital, J.B. Winslow Vej 4, DK-5000, Odense C, Denmark
- Orthopaedic Research Unit, Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, J. B. Winslow Vej 4, DK-5000, Odense C, Denmark
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Behman AL, Bradley CS, Maddock CL, Sharma S, Kelley SP. Testing of an Ultrasound-Limited Imaging Protocol for Pavlik harness Supervision (TULIPPS) in developmental dysplasia of the hip: a randomized controlled trial. Bone Joint J 2022; 104-B:1081-1088. [PMID: 36047018 DOI: 10.1302/0301-620x.104b9.bjj-2022-0350.r2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS There is no consensus regarding optimum timing and frequency of ultrasound (US) for monitoring response to Pavlik harness (PH) treatment in developmental dysplasia of the hip (DDH). The purpose of our study was to determine if a limited-frequency hip US assessment had an adverse effect on treatment outcomes compared to traditional comprehensive US monitoring. METHODS This study was a single-centre noninferiority randomized controlled trial. Infants aged under six months whose hips were reduced and centred in the harness at initiation of treatment (stable dysplastic or subluxable), or initially decentred (subluxated or dislocated) but reduced and centred within four weeks of PH treatment, were randomized to our current standard US monitoring protocol (every clinic visit) or to a limited-frequency US protocol (US only at end of treatment). Groups were compared based on α angle and femoral head coverage at the end of PH treatment, acetabular indices, and International Hip Dysplasia Institute (IHDI) grade on one-year follow-up radiographs. RESULTS Overall, 100 patients were included; 42 patients completed the standard protocol (SP) and 40 completed the limited protocol (LP). There was no significant difference in mean right α angle at the end of treatment (SP 70.0° (SD 3.2°) ; LP 68.7° (SD 2.9°); p = 0.033), nor on the left (SP 69.0° (SD 3.5°); LP 68.1° (SD 3.3°); p = 0.128). There was no significant difference in mean right acetabular index at follow-up (SP 23.1° (SD 4.3°); LP 22.0° (SD 4.1°); p = 0.129), nor on the left (SP 23.3° (SD 4.2°); LP 22.8° (SD 3.9°); p = 0.284). All hips had femoral head coverage of > 50% at end of treatment, and all were IHDI grade 1 at follow-up. In addition, the LP group underwent a 60% reduction in US use once stable. CONCLUSION Our study supports reducing the frequency of US assessment during PH treatment of DDH once a hip is reduced and centred.Cite this article: Bone Joint J 2022;104-B(9):1081-1088.
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Affiliation(s)
- Amy L Behman
- Department of Surgery, University of Toronto, Toronto, Canada.,Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, Canada
| | - Catharine S Bradley
- Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, Canada
| | - Connor L Maddock
- Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, Canada
| | - Smriti Sharma
- Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, Canada
| | - Simon P Kelley
- Department of Surgery, University of Toronto, Toronto, Canada.,Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, Canada
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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) 2022; 58:medicina58091158. [PMID: 36143835 PMCID: PMC9502116 DOI: 10.3390/medicina58091158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Fraiwan M, Al-Kofahi N, Ibnian A, Hanatleh O. Detection of developmental dysplasia of the hip in X-ray images using deep transfer learning. BMC Med Inform Decis Mak 2022; 22:216. [PMID: 35964072 PMCID: PMC9375244 DOI: 10.1186/s12911-022-01957-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 07/30/2022] [Indexed: 01/14/2023] Open
Abstract
Background Developmental dysplasia of the hip (DDH) is a relatively common disorder in newborns, with a reported prevalence of 1–5 per 1000 births. It can lead to developmental abnormalities in terms of mechanical difficulties and a displacement of the joint (i.e., subluxation or dysplasia). An early diagnosis in the first few months from birth can drastically improve healing, render surgical intervention unnecessary and reduce bracing time. A pelvic X-ray inspection represents the gold standard for DDH diagnosis. Recent advances in deep learning artificial intelligence have enabled the use of many image-based medical decision-making applications. The present study employs deep transfer learning in detecting DDH in pelvic X-ray images without the need for explicit measurements. Methods Pelvic anteroposterior X-ray images from 354 subjects (120 DDH and 234 normal) were collected locally at two hospitals in northern Jordan. A system that accepts these images as input and classifies them as DDH or normal was developed using thirteen deep transfer learning models. Various performance metrics were evaluated in addition to the overfitting/underfitting behavior and the training times. Results The highest mean DDH detection accuracy was 96.3% achieved using the DarkNet53 model, although other models achieved comparable results. A common theme across all the models was the extremely high sensitivity (i.e., recall) value at the expense of specificity. The F1 score, precision, recall and specificity for DarkNet53 were 95%, 90.6%, 100% and 94.3%, respectively. Conclusions Our automated method appears to be a highly accurate DDH screening and diagnosis method. Moreover, the performance evaluation shows that it is possible to further improve the system by expanding the dataset to include more X-ray images.
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Affiliation(s)
- Mohammad Fraiwan
- Department of Computer Engineering, Jordan University of Science and Technology, Irbid, Jordan.
| | - Noran Al-Kofahi
- Department of Internal Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Ali Ibnian
- Department of Internal Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Omar Hanatleh
- Department of Internal Medicine, Jordan University of Science and Technology, Irbid, Jordan
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de Witte PB, van Bergen CJA, de Geest BL, Willeboordse F, van Linge JH, den Hartog YM, Margret M H P Foreman-van Drongelen M, Pereboom RM, Robben SGF, Burger BJ, Witlox MA, Witbreuk MMEH. Treatment of decentered developmental dysplasia of the hip under the age of 1 year: an evidence-based clinical practice guideline - Part 2. EFORT Open Rev 2022; 7:542-553. [PMID: 35924650 PMCID: PMC9458947 DOI: 10.1530/eor-21-0126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background and purpose Materials and methods Results Interpretation
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Affiliation(s)
| | | | | | | | - Joost H van Linge
- Juliana Children's Hospital, The Hague & Reinier HAGA Orthopaedic Centre, Zoetermeer and Delft, the Netherlands
| | | | | | - Renske M Pereboom
- Dutch Hip Patient Association "Vereniging Afwijkende Heupontwikkeling", Nijkerk, the Netherlands
| | - Simon G F Robben
- Department Radiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Bart J Burger
- Department Orthopedic Surgery, North West Hospital Group, Alkmaar, the Netherlands
| | - M Adhiambo Witlox
- Department Orthopedic Surgery, CAPHRI Care and Public Health Research Institute, Maastricht University Medical Center, Maastricht, the Netherlands
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Xu J, Ye W, Li H, Xu L. WNT1 expression influences the development of dysplasia of the hip via regulating RBPMS2/NOG-BMP2/4-GDF5- WISP2 pathway. Nucleosides Nucleotides Nucleic Acids 2022; 41:765-777. [PMID: 35675541 DOI: 10.1080/15257770.2022.2081337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To explore the role of WNT family member 1 (WNT1) in the development of dysplasia of the hip (DDH) and the molecular mechanism involved in this process. Methods: Si-WNT1, pcDNA3.1-WNT1 or corresponding negative controls were transfected into human osteoblast hFOB1.19 and human chondrocyte C28/I2, respectively. The proliferation of cells was measured by EdU assay. The relative expressions of human noggin gene (NOG), growth differentiating factor 5 (GDF5), WNT1, and WNT1-inducible-signaling pathway protein 2 (WISP2) were determined by immunofluorescence analysis. The protein expressions of RNA-binding protein of multiple splice forms 2 (RBPMS2), NOG, bone morphogenetic protein 2 (BMP2), BMP4, WNT1 and WISP2 were determined by western blot. Animal experiment was also performed and the morphological development of hip joint was observed. Results: Overexpression of WNT1 promoted osteoblast proliferation and inhibited chondrocyte proliferation, while knockdown of WNT1 inhibited osteoblast proliferation. In chondrocytes, knockdown of WNT1 upregulated NOG expression, while overexpression of WNT1 downregulated its expression. In osteoblasts and chondrocytes, overexpression of WNT1 increased BMP2, BMP4, WNT1, and WISP2 expression. RBPMS2 and NOG were slightly expressed in each group. Conclusion: Overexpression of WNT1 promoted osteoblast proliferation, inhibited chondrocyte proliferation, and increased the expressions of BMP2, BMP4, WNT1, and WISP2. Therefore, WNT1 may be a new therapeutic target for DDH.
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Affiliation(s)
- Jingfang Xu
- Department of Orthopaedics, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, P.R. China.,National Clinical Research Center for Child Health, Hangzhou, Zhejiang, P.R. China
| | - Wensong Ye
- Department of Orthopaedics, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, P.R. China.,National Clinical Research Center for Child Health, Hangzhou, Zhejiang, P.R. China
| | - Haibing Li
- Department of Orthopaedics, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, P.R. China.,National Clinical Research Center for Child Health, Hangzhou, Zhejiang, P.R. China
| | - Lujie Xu
- Department of Orthopaedics, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, P.R. China.,National Clinical Research Center for Child Health, Hangzhou, Zhejiang, P.R. China
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Håberg Ø, Bremnes T, Foss OA, Angenete O, Lian ØB, Holen KJ. Children treated for developmental dysplasia of the hip at birth and with normal acetabular index at 1 year: How many had residual dysplasia at 5 years? J Child Orthop 2022; 16:183-190. [PMID: 35800653 PMCID: PMC9254022 DOI: 10.1177/18632521221106376] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/28/2022] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The purpose of the study was to assess the effect of further follow-up for children treated for developmental dysplasia of the hip, with normal clinical and radiological findings at 1-year time point. The effect was quantified by the number of hips with a pathologic deterioration up to 5 years. METHODS Among 47,289 children born in Sør-Trøndelag county in Norway between 2003 and 2015, 265 children had developmental dysplasia of the hip. Of these, 164 children (239 hips) treated for developmental dysplasia of the hip with normal clinical findings and normal acetabular index at the 1-year time point were included in the study. The number of hips with pathologic acetabular index at the 5-year time point were reported. The diagnostic uncertainty related to radiological measurements was quantified together with the effect of introducing a second radiographic measurement, the center edge angle. RESULTS A total of 239 treated hips were normal at the 1-year time point. At 5-year time point, 10 (4.2%) hips had a pathologic acetabular index measurement and none classified to have developmental dysplasia of the hip caused by measurement inaccuracy. Eight (3.3%) hips had pathologic center edge angle measurement. Four hips had both pathologic acetabular index and center edge angle measurements, with three later treated with surgery. The intra- and interobserver repeatability coefficients were within 3.1°-6.6°. CONCLUSION The repeatability coefficient of the acetabular index measurements was high and no hips could be classified to have developmental dysplasia of the hip at the 5-year time point when taking this repeatability into account. Hips classified as pathologic combining acetabular index and center edge angle measurements were likely to be treated with surgery for residual dysplasia. We recommend further follow-up for these children. LEVEL OF EVIDENCE level II.
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Affiliation(s)
- Øyvind Håberg
- Department of Orthopedic Surgery,
Kristiansund Hospital, Kristiansund, Norway,Institute of Neuromedicine and Movement
Science, Faculty of Medicine and Health Services, NTNU, Trondheim, Norway,Øyvind Håberg, Department of Orthopedic
Surgery, Kristiansund Hospital, Herman Døhlens vei 1, N-6508 Kristiansund,
Norway.
| | - Thomas Bremnes
- Department of Radiology and Nuclear
Medicine, St. Olav’s Hospital, Trondheim University Hospital, Trondheim,
Norway
| | - Olav A Foss
- Institute of Neuromedicine and Movement
Science, Faculty of Medicine and Health Services, NTNU, Trondheim, Norway,Department of Orthopedic Surgery,
Trondheim University Hospital, Trondheim, Norway
| | - Oskar Angenete
- Department of Radiology and Nuclear
Medicine, St. Olav’s Hospital, Trondheim University Hospital, Trondheim,
Norway,Institute of Circulation and Medical
Imaging, Faculty of Medicine and Health Services, NTNU, Trondheim, Norway
| | - Øystein B Lian
- Department of Orthopedic Surgery,
Kristiansund Hospital, Kristiansund, Norway,Institute of Neuromedicine and Movement
Science, Faculty of Medicine and Health Services, NTNU, Trondheim, Norway
| | - Ketil J Holen
- Institute of Neuromedicine and Movement
Science, Faculty of Medicine and Health Services, NTNU, Trondheim, Norway,Department of Orthopedic Surgery,
Trondheim University Hospital, Trondheim, Norway
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Abstract
PURPOSE OF REVIEW Many aspects of developmental hip dysplasia (DDH) care and evaluation are still active areas of debate. Recent studies have provided more insight into these topics such as strategies for reducing osteonecrosis, assessing hip reduction after closed and open reduction, and the management of residual acetabular dysplasia. RECENT FINDINGS The presence of the ossific nucleus at the time of reduction does not alter the risk of osteonecrosis. The risk of osteonecrosis may be higher when hips are immobilized in excessive abduction. Limited sequence MRI may be the best choice for assessing hip reduction after closed and open reduction; however, new technologies are emerging such as 3D fluoroscopy and perfusion MRI. The treatment of residual acetabular dysplasia with bracing has been shown to be effective and the decision to perform a pelvic osteotomy is based on patient-specific factors. The spectrum of DDH treatment has evolved over the past several decades. Recent studies have provided insights into strategies for osteonecrosis prevention, hip evaluation during after reduction, and the management of residual acetabular dysplasia. However, there is ample room for additional and more rigorous studies guiding advanced imaging for assessing hip reduction such as 3D fluoroscopy and perfusion MRI, as well as the management of residual acetabular dysplasia.
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Affiliation(s)
- Steven Garcia
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Leah Demetri
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Ana Starcevich
- University of California, Davis School of Medicine, Sacramento, CA, USA
| | - Andrew Gatto
- Touro University California College of Osteopathic Medicine, Vallejo, CA, USA
| | - Ishaan Swarup
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA.
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Lebe M, van Stralen RA, Buddhdev P. Guided Growth of the Proximal Femur for the Management of the 'Hip at Risk' in Children with Cerebral Palsy-A Systematic Review. Children (Basel) 2022; 9:609. [PMID: 35626786 PMCID: PMC9140189 DOI: 10.3390/children9050609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 04/22/2022] [Accepted: 04/23/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Guided growth is frequently used to modify lower-limb alignment in children, and recently temporary medial hemiepiphysiodesis of the proximal femur (TMH-PF) has been used for the management of hips at risk of subluxation in cerebral palsy (CP) patients. The aim of our study was to evaluate the efficacy of TMH-PF in the management of neuromuscular hip dysplasia in children with cerebral palsy. METHODS A systematic search of the literature was performed by using PubMed, EMBASE, CINAHL, MEDLINE, Scopus and Cochrane databases. Pre- and postoperative radiographic changes of the migration percentage (MP), head-shaft angle (HSA) and acetabular index (AI) were included in a meta-analysis. Secondary outcomes were treatment complication rates, technical considerations and the limitations of this novel technique. RESULTS Four studies (93 patients; 178 hips) met the eligibility criteria for inclusion in the meta-analysis. All three radiographic measurements showed significant changes at a minimum of 2 years of follow-up. Mean changes for MP were 8.48% (95% CI 3.81-13.14), HSA 12.28° (95% CI 11.17-13.39) and AI 3.41° (95% CI 0.72-6.10), with I2 of 75.74%, 0% and 87.68%, respectively. The serious complication rate was overall low; however, physeal 'growing off' of the screw was reported in up to 43% of hips treated. CONCLUSION TMH-PF is an effective and predictable method to treat CP patients with 'hips at risk', and the overall complication rate is low; however, further work is required to identify the best candidates and surgical timing, as well as choice of technique and implant.
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Affiliation(s)
- Moritz Lebe
- Broomfield & Addenbrookes Hospitals, Chelmsford CM1 7ET, UK; (M.L.); (P.B.)
| | | | - Pranai Buddhdev
- Broomfield & Addenbrookes Hospitals, Chelmsford CM1 7ET, UK; (M.L.); (P.B.)
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Yasin MS, Alisi MS, Hammad YS, Samarah OQ, Abu Hassan FO. Short versus Long-Leg Hip Spica After Closed Reduction in Developmental Dysplasia of the Hip: A Retrospective Comparative Study. Orthop Res Rev 2022; 14:71-76. [PMID: 35356129 PMCID: PMC8959724 DOI: 10.2147/orr.s353279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 03/15/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose Closed reduction (CR) is a standard treatment for developmental dysplasia of the hip (DDH) after failed conservative treatment. After CR, the affected hip is held in the reduced position by a spica cast that typically extends below the knee (long). Above knee (short) spica cast is an alternative technique utilized by some pediatric orthopedic surgeons. We aimed to compare short versus long spica cast after CR in terms of success rate and complications. Methods Patients who underwent CR with short or long hip spica cast over a 3-year period (2016–2019) were evaluated for the success (sustainability of the reduction) and complications. The acute and long-term success were recorded retrospectively. Acute success was defined as concentric reduction of the hip confirmed by intraoperative arthrogram and immediate postoperative CT scan. Long-term success was defined as maintained reduction at 12 months’ post reduction. Results Forty-seven patients were included in our study. Long spica casts were used in 24 patients and short ones in the remaining 23. The overall acute and long-term success rates were 83% and 66%, respectively. The acute success rate of long spica was 87.5%, while short spica achieved 78.2%. On the long term, the success rate of short spica was higher than long one (73.9% vs 58.3%). Cox regression analysis showed that the type of cast (short vs long spica) was not correlated with acute success (P = 0.405), long-term success (P = 0.263), residual dysplasia (P = 0.405), or avascular necrosis (P = 0.053). Conclusion CR in DDH is an important line of management in the younger patient population and can save them an invasive open surgery later in life. A short leg spica could represent an easier and likely as successful alternative to the traditional long spica. More prospective future research is needed to validate our observational findings. Level of Evidence III.
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Affiliation(s)
- Mohamad S Yasin
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan
| | - Mohammed S Alisi
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan
| | - Yazan S Hammad
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan
| | - Omar Q Samarah
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan
| | - Freih O Abu Hassan
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan
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Vasilcova V, AlHarthi M, AlAmri N, Sagat P, Bartik P, Jawadi AH, Zvonar M. Developmental Dysplasia of the Hip: Prevalence and Correlation with Other Diagnoses in Physiotherapy Practice-A 5-Year Retrospective Review. Children (Basel) 2022; 9:children9020247. [PMID: 35204967 PMCID: PMC8870581 DOI: 10.3390/children9020247] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/07/2022] [Accepted: 02/09/2022] [Indexed: 01/11/2023]
Abstract
(1) Background: The objective of this study was to assess the prevalence of Developmental Dysplasia of the Hip (DDH) as a primary or secondary diagnosis during physiotherapy practice. No other studies have investigated the prevalence and associations of DDH within the practice of pediatric rehabilitation. (2) Methods: This retrospective review was performed on 12,225 physiotherapy referrals to the King Abdullah Specialized Children’s Hospital (KASCH), Riyadh, Kingdom of Saudi Arabia, from May 2016 to October 2021. Only DDH referrals for conservative treatment were included in the study. The plan for brace treatment was carried out by the pediatric orthopedics clinic in KASCH. The diagnostic methods were either a pelvic radiograph or ultrasound, depending on the participant’s age. DDH is considered one of the most common secondary complications for children with other medical diagnoses. (3) Results: The most common indication for referral was neurological diagnosis (44%), followed by orthopedic (28%), genetic (19%), cardiac (5%), ophthalmologic (3%), dermatologic (1%) and rheumatologic (0.5%) diagnoses. (4) Conclusion: The prevalence of DDH among all referrals in this study was 6%. In physiotherapy practice, neurologic, genetic, and orthopedic primary or secondary diagnoses were the most prevalent when DDH referrals were investigated. A relatively high prevalence of DDH in the pediatric rehabilitation clinic at KASCH in Riyadh was reported in this study.
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Affiliation(s)
- Veronika Vasilcova
- Department of Kinantropology, Faculty of Sport Science, Masaryk University in Brno, Kamenice 753/5, 62500 Brno, Czech Republic
- Pediatric Rehabilitation Department, King Abdullah Specialized Children Hospital, P.O. Box 22490, Riyadh 11426, Saudi Arabia; (M.A.); (N.A.)
- Correspondence: ; Tel.: +421-908-688-180 or +966-55-743-9506
| | - Moqfa AlHarthi
- Pediatric Rehabilitation Department, King Abdullah Specialized Children Hospital, P.O. Box 22490, Riyadh 11426, Saudi Arabia; (M.A.); (N.A.)
| | - Nadrah AlAmri
- Pediatric Rehabilitation Department, King Abdullah Specialized Children Hospital, P.O. Box 22490, Riyadh 11426, Saudi Arabia; (M.A.); (N.A.)
| | - Peter Sagat
- Health and Physical Education Department, Prince Sultan University, P.O. Box 66833, Riyadh 11586, Saudi Arabia; (P.S.); (P.B.)
| | - Peter Bartik
- Health and Physical Education Department, Prince Sultan University, P.O. Box 66833, Riyadh 11586, Saudi Arabia; (P.S.); (P.B.)
| | - Ayman H. Jawadi
- College of Medicine, King Saud bin Abdul-Aziz University for Health Sciences, P.O. Box 22490, Riyadh 11426, Saudi Arabia;
| | - Martin Zvonar
- Division of Sport Motoric and Methodology in Kinantropology, Department of Kinesiology, Faculty of Sport Science, Masaryk University in Brno, Kamenice 753/55, 62500 Brno, Czech Republic;
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Ziegler CM, Ertl KM, Delius M, Foerster KM, Crispin A, Wagner F, Heimkes B. Clinical examination and patients' history are not suitable for neonatal hip screening. J Child Orthop 2022; 16:19-26. [PMID: 35615397 PMCID: PMC9124910 DOI: 10.1177/18632521221080472] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 12/22/2021] [Indexed: 02/03/2023] Open
Abstract
Purpose To assess the percentage of missed developmental dysplasia of the hip, which escape the German criteria for newborn hip high-risk screening, we analyzed our data gained from the general neonatal sonographic hip screening performed at our department. The aim of the study was to determine the number of potentially belatedly treated developmental dysplasia of the hip. Methods The data from 1145 standardized newborn hip ultrasound examinations according to the Graf technique were analyzed retrospectively comparing findings for general neonatal sonographic hip screening and high-risk screening subgroups. Results We diagnosed developmental dysplasia of the hip in 18 of the 1145 newborns via ultrasound. A total of 10 out of 18 developmental dysplasia of the hip would have been missed by high-risk screening, which corresponds to a proportion of 55.6% false-negative results. The sensitivity of high-risk screening was only 44.4% and specificity, 78.3%. The positive predictive value was 3.2%. Family history as a screening criterion yielded false-negative results in 77.8% and false-positive results in 16.8%. In all, 83.3% of the children who were born with developmental dysplasia of the hip but not from breech position as a risk factor were false negative. The clinical examination was false negative in 88.9% and false positive in 0.6%. Conclusion High-risk screening detected less than every second developmental dysplasia of the hip, rendering the first month as the most effective treatment window unavailable for inapparent dysplastic hips, potentially resulting in the need for more invasive treatment. Due to the high sensitivity of ultrasound in the detection of developmental dysplasia of the hip, we recommend to replace the current German high-risk screening guidelines with a general newborn screening for all neonates using Graf ultrasound in the first week of life. Level of evidence Level II.
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Affiliation(s)
- Christian Maximilian Ziegler
- Musculoskeletal University Center Munich, Department of Orthopedics and Trauma Surgery, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Katharina Maria Ertl
- Musculoskeletal University Center Munich, Department of Orthopedics and Trauma Surgery, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Maria Delius
- Department of Obstetrics and Gynecology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Kai Martin Foerster
- Department of Neonatology, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Alexander Crispin
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Ferdinand Wagner
- Musculoskeletal University Center Munich, Department of Orthopedics and Trauma Surgery, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
- Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Department of Pediatric Surgery, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Bernhard Heimkes
- Department of Pediatric Surgery, Pediatric Orthopedic Section, Klinikum Dritter Orden, Munich, Germany
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Walter SG, Ossendorff R, Yagdiran A, Hockmann J, Bornemann R, Placzek S. Four decades of developmental dysplastic hip screening according to Graf: What have we learned? Front Pediatr 2022; 10:990806. [PMID: 36186635 PMCID: PMC9520971 DOI: 10.3389/fped.2022.990806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 08/19/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Sonographic hip examination according to Graf is widely accepted standard for diagnosing developmental dysplastic hips (DDH) but it is criticized for alleged intra- and interobserver variations. This review was conducted to evaluate whether objective quality criteria according to the Graf method are fulfilled within scientific literature. METHODS A systematic literature search on Pubmed was performed using the search string: [(DDH) OR (Hip dysplasia)] AND (Graf). Studies suitable by title, abstract, manuscript, containing an image of sonographic hip examination and online accessibility were included into analysis. RESULTS 131 studies were included into final analysis. Only 68 (51.9%) presented correct sonographic images according Graf's criteria. 98 (74.8%) studies plotted alpha-angles (angle between bony roof line and base line) but only 85 (64.8%) studies beta-angles (angle between cartilage roof line and base line). Studies were contributed from 25 countries. CONCLUSION Assumingly, skepticism regarding the Graf method is based on user errors and insufficient application of the Graf quality assessment algorithm resulting in high intra- and interobserver variations. When performed correctly, the Graf method is of high diagnostic value.
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Affiliation(s)
- Sebastian G Walter
- Department for Orthopedic Surgery and Traumatology, University Hospital Cologne, Cologne, Germany
| | - Robert Ossendorff
- Department for Orthopedic Surgery and Traumatology, University Hospital Bonn, Bonn, Germany
| | - Ayla Yagdiran
- Department for Orthopedic Surgery and Traumatology, University Hospital Cologne, Cologne, Germany
| | - Jan Hockmann
- Department for Orthopedic Surgery and Traumatology, University Hospital Cologne, Cologne, Germany
| | - Rahel Bornemann
- Department for Orthopedic Surgery and Traumatology, University Hospital Bonn, Bonn, Germany
| | - Sonja Placzek
- Medical Service of the Health Funds (MDK), Cologne, Germany
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Wu Q, Ma H, Sun J, Liu C, Fang J, Xie H, Zhang S. Application of deep-learning-based artificial intelligence in acetabular index measurement. Front Pediatr 2022; 10:1049575. [PMID: 36741093 PMCID: PMC9891291 DOI: 10.3389/fped.2022.1049575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/21/2022] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To construct an artificial intelligence system to measure acetabular index and evaluate its accuracy in clinical application. METHODS A total of 10,219 standard anteroposterior pelvic radiographs were collected retrospectively from April 2014 to December 2018 in our hospital. Of these, 9,219 radiographs were randomly selected to train and verify the system. The remaining 1,000 radiographs were used to compare the system's and the clinicians' measurement results. All plain pelvic films were labeled by an expert committee through PACS system based on a uniform standard to measure acetabular index. Subsequently, eight other clinicians independently measured the acetabular index from 200 randomly selected radiographs from the test radiographs. Bland-Altman test was used for consistency analysis between the system and clinician measurements. RESULTS The test set included 1,000 cases (2,000 hips). Compared with the expert committee measurement, the 95% limits of agreement (95% LOA) of the system was -4.02° to 3.45° (bias = -0.27°, P < 0.05). The acetabular index measured by the system within all age groups, including normal and abnormal groups, also showed good credibility according to the Bland-Altman principle. Comparison of the measurement evaluations by the system and eight clinicians vs. that of, the expert committee, the 95% LOA of the clinician with the smallest measurement error was -2.76° to 2.56° (bias = -0.10°, P = 0.126). The 95% LOA of the system was -0.93° to 2.86° (bias = -0.03°, P = 0.647). The 95% LOA of the clinician with the largest measurement error was -3.41° to 4.25° (bias = 0.42°, P < 0.05). The measurement error of the system was only greater than that of a senior clinician. CONCLUSION The newly constructed artificial intelligence system could quickly and accurately measure the acetabular index of standard anteroposterior pelvic radiographs. There is good data consistency between the system in measuring standard anteroposterior pelvic radiographs. The accuracy of the system is closer to that of senior clinicians.
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Affiliation(s)
- Qingjie Wu
- Department of Pediatric Orthopedics, Anhui Provincial Children's Hospital, Hefei, China.,Fifth Clinical Medical College, Anhui Medical University, Hefei, China
| | - Hailong Ma
- Department of Pediatric Orthopedics, Anhui Provincial Children's Hospital, Hefei, China
| | - Jun Sun
- Department of Pediatric Orthopedics, Anhui Provincial Children's Hospital, Hefei, China.,Fifth Clinical Medical College, Anhui Medical University, Hefei, China
| | - Chuanbin Liu
- School of Information Science and Technology, University of Science and Technology of China, Hefei, China
| | - Jihong Fang
- Department of Pediatric Orthopedics, Anhui Provincial Children's Hospital, Hefei, China
| | - Hongtao Xie
- School of Information Science and Technology, University of Science and Technology of China, Hefei, China
| | - Sicheng Zhang
- Department of Pediatric Orthopedics, Anhui Provincial Children's Hospital, Hefei, China.,Fifth Clinical Medical College, Anhui Medical University, Hefei, China
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Chaibi E, Saugy CA, Samara E, Zambelli PY, Merckaert SR. Comparison of treatment outcomes of stable and unstable developmental dysplasia of the hip with the Tübingen splint. Front Pediatr 2022; 10:976367. [PMID: 36090577 PMCID: PMC9453388 DOI: 10.3389/fped.2022.976367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 07/19/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The Tübingen splint was initially developed for the treatment of stable developmental hip dysplasia (DDH). Later on, some authors expanded its include for the treatment of unstable DDH, but there remain some controversies in the literature. This study aims to compare the outcome between stable and unstable DDH treated with a Tübingen splint. METHODS Epidemiological data and ultrasonographic data of all infants diagnosed with DDH and initially treated with a Tübingen splint at our institution between May 2017 and February 2020 were assessed retrospectively. We divided the population into stable and unstable hips using the Graf classification. Age at treatment initiation, duration of treatment, complications, and radiological outcome between 12 and 24 months were investigated. RESULTS We included a total of 45 patients (57 hips) affected by DDH treated with the Tübingen splint. Treatment has been successful in 93% of stable hips and only 40% of unstable hips. Radiological outcome at 1-year follow-up significantly correlated with initial Graf classification (p < 0.001). CONCLUSION The Tübingen splint is a safe and effective treatment for stable hips, nevertheless, for unstable hips, closed reduction, and spica cast remains the gold standard.
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Affiliation(s)
- Emmelie Chaibi
- Unit of Pediatric Orthopedics, Department of Women - Mother - Child's Care, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Claire-Anne Saugy
- Unit of Pediatric Orthopedics, Department of Women - Mother - Child's Care, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Eleftheria Samara
- Unit of Pediatric Orthopedics, Department of Women - Mother - Child's Care, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Pierre-Yves Zambelli
- Unit of Pediatric Orthopedics, Department of Women - Mother - Child's Care, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Sophie Rosa Merckaert
- Unit of Pediatric Orthopedics, Department of Women - Mother - Child's Care, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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Pisecky L, Großbötzl G, Gahleitner M, Haas C, Gotterbarm T, Klotz MC. Results after spica cast immobilization following hip reconstruction in 95 cases: is there a need for alternative techniques? Arch Orthop Trauma Surg 2022; 142:969-977. [PMID: 33426605 PMCID: PMC9110451 DOI: 10.1007/s00402-020-03733-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 12/19/2020] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Developmental dysplasia of the hip (DDH), neurogenic dysplasia of the hip (NDH), and Perthes disease often require surgical treatment. Spica casting is a common postoperative immobilization. The purpose of this study was to evaluate the complications related to the immobilization. MATERIALS AND METHODS In a retrospective analysis, we included 83 patients (95 hips), who underwent hip reconstructive surgery between 2008 and 2018. We had 43 female and 40 male patients. Age reached from 3 months to 19 years. All patients were treated with a spica cast postoperatively for a 6-week protocol. Complications were analyzed using the full medical documentation and classified according to Clavien-Dindo. RESULTS We had complications in 23 patients (27.7%). We counted superficial skin lesions in seven, deep skin lesions in three, spasticity of adductors in three, subluxation in two, infection of the plate in one, fracture of the plate in one, compliance problem in one, dislocations of the cast in two, reluxation in one, delayed bone healing in one and spasticity of knee flexors in one case. According to the classification of Clavien-Dindo, we were able to count ten type I, four type II, nine type III, zero type IV and zero type V adverse events. CONCLUSION The usage of a spica cast after hip reconstructive surgery is still the most popular way of aftertreatment. It has a low complication rate, which may be lowered by well-applied casts and foam padding. Known complications such as spasticity in patients with cerebral palsy, skin lesions, and pressure sores should be observed and avoided. Shorter protocols for immobilization with the usage of foam padding and foam splints lead to less complications. CLINICAL RELEVANCE Evidence level level IV, case series.
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Affiliation(s)
- L. Pisecky
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Kepler University Hospital GmbH, Krankenhausstrasse 9, Altenberger Strasse 69, 4040 Linz, Austria
| | - G. Großbötzl
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Kepler University Hospital GmbH, Krankenhausstrasse 9, Altenberger Strasse 69, 4040 Linz, Austria
| | - M. Gahleitner
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Kepler University Hospital GmbH, Krankenhausstrasse 9, Altenberger Strasse 69, 4040 Linz, Austria
| | - C. Haas
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Kepler University Hospital GmbH, Krankenhausstrasse 9, Altenberger Strasse 69, 4040 Linz, Austria
| | - T. Gotterbarm
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Kepler University Hospital GmbH, Krankenhausstrasse 9, Altenberger Strasse 69, 4040 Linz, Austria
| | - M. C. Klotz
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Kepler University Hospital GmbH, Krankenhausstrasse 9, Altenberger Strasse 69, 4040 Linz, Austria
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Hurley RJ, Davey MS, Davey MG, Groarke P, Kennedy J, Moore DP. Age as a predictor of additional surgeries following initial closed reduction for children with developmental dysplasia of the hip: the 10-year experience of a national paediatric orthopaedic unit. Hip Int 2021; 33:539-543. [PMID: 34939454 DOI: 10.1177/11207000211062081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND PURPOSE Dislocated and unstable hip joints which do not stabilize in an orthosis in the neonatal period require operative intervention to achieve a stable concentric joint. The aim of this study is to assess the requirement for further operative intervention in patients who have undergone successful closed reduction to treat developmental dysplasia of the hip (DDH). METHODS We identified all patients who had undergone closed reduction of an unstable hip joint at our institution within 10 years, with further identification of patients who underwent a second procedure. We used logistic regression to evaluate correlation between age at closed reduction and the probability of secondary procedures. RESULTS A total of 694 patients (84.5% females) who underwent a closed reduction in the study period were identified. 235 were excluded (patients with underlying genetic conditions, neuromuscular disorders, syndromic disorders). 250 patients had closed reductions only. 209 patients (45.5%) had at least 1 secondary procedure after their initial closed reduction. In multivariable analysis, female gender (OR 0.310; 95% CI, 0.108-0.885; p = 0.029) and patients aged ⩽12 months at the time of first surgery (OR 0.055; 95% CI, 0.007-0.423; p = 0.005) independently predicted being less likely to require a second surgery for their DDH. DISCUSSION In conclusion, we found that a significant proportion of children (45.5%) who underwent closed reduction of a dislocated hip required additional surgical intervention in early childhood. Our data show that those children who undergo later closed reduction of a dislocated hip in DDH after 12 months of age, and male infants, have a significantly higher incidence of additional surgical intervention.
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Affiliation(s)
- Robert J Hurley
- Department of Trauma and Orthopaedics, Our Lady's Children Hospital, Crumlin, Dublin, Ireland
| | | | | | - Patrick Groarke
- Department of Trauma and Orthopaedics, Our Lady's Children Hospital, Crumlin, Dublin, Ireland
| | - Jim Kennedy
- Department of Trauma and Orthopaedics, Our Lady's Children Hospital, Crumlin, Dublin, Ireland
| | - David P Moore
- Department of Trauma and Orthopaedics, Our Lady's Children Hospital, Crumlin, Dublin, Ireland
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