Study of three-dimensional morphology of the proximal femur in developmental adult dysplasia of the hip suggests that the on-shelf modular prosthesis may not be an ideal choice for patients with Crowe type IV hips

Abstract Background When performing femoral reconstruction in patients with Crowe type IV developmental dysplasia of the hip (DDH), anatomical deformity presents many technical challenges to orthopedic surgeons. The false acetabulum is suggested to influence load transmission and femoral development. The aim of this study was to describe the morphological features of dysplastic femurs in Crowe type IV DDH and further evaluate the potential effect of the false acetabulum on morphological features and medullary canal of Crowe type IV femurs. Methods We analyzed preoperative computed tomography scans from 45 patients with 51 hips (25 hips without false acetabulum in the IVa group and 26 hips with false acetabulum in the IVb group) who were diagnosed with Crowe type IV DDH and 30 normal hips in our hospital between January 2009 and January 2019. Three-dimensional reconstruction was performed using Mimics software, and the coronal femoral plane was determined to evaluate the following parameters: dislocation height, dislocation ratio, height of the femoral head (FH), height of the greater trochanter (GT), GT–FH height discrepancy, height of the isthmus, neck-shaft angle, femoral offset and anteversion of the femoral neck. The mediolateral (ML) width, anterolateral (AP) width and diameter of medullary canal of the proximal femur were measured on the axial sections. Further, canal flare index (CFI), metaphyseal-CFI and diaphyseal-CFI were also calculated. Results Compared with the normal femurs, the Crowe type IV DDH femurs had a higher femoral head, larger GT–FH height discrepancy, larger femoral neck anteversion, higher isthmus position and smaller femoral offset. Dislocation height and dislocation rate were significantly larger in the IVa DDH group (65.34 ± 9.83 mm vs. 52.24 ± 11.42 mm). Further, the IVb femurs had a significantly lower isthmus position, larger neck-shaft angle and smaller femoral neck anteversion than IVa femurs. The ML, AP canal widths and the diameter of medullary canal in both DDH groups were significantly smaller than the normal group. Dimensional parameters of IVa femurs were also narrower than IVb femurs in most sections, but with no difference at the level of isthmus. According to the CFIs, the variation of proximal medullary canal in IVb femurs was mainly located in the diaphyseal region, while that in IVa femurs was located in the whole proximal femur. Conclusions High dislocated femurs are associated with more anteverted femoral neck, smaller femoral offset and narrower medullary canal. Without stimulation of the false acetabulum, IVa DDH femurs were associated with higher dislocation and notably narrower medullary canal, whose variation of medullary canal was located in the whole proximal femur.

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Comparison of two different on-shelf femoral stems for Crowe type IV developmental dysplasia of the hip

Journal of International Medical Research ◽

10.1177/0300060520947888 ◽

2020 ◽

Vol 48 (8) ◽

pp. 030006052094788

Author(s):

Tong Liu ◽

Yuhui Yang ◽

Xianyue Shen ◽

Jianlin Xiao ◽

Jianlin Zuo ◽

...

Keyword(s):

Average Distance ◽

Three Dimensional ◽

Developmental Dysplasia ◽

Type Iv ◽

Negative Point ◽

Femoral Stems ◽

Modular Implants ◽

Distance Deviation ◽

Dysplasia Of The Hip ◽

Comparison Technique

Objective This study was performed to evaluate the proximal anatomical compatibility of stems for treatment of Crowe IV developmental dysplasia of the hip (DDH) using a previously developed three-dimensional comparison technique. Methods Patients with Crowe IV DDH who underwent computed tomography were retrospectively analyzed. The femoral medullary canals were three-dimensionally reconstructed, and models of cementless modular (S-ROM; DePuy Synthes) and conical (Wagner Cone; Zimmer Biomet) implants were used for virtual implantation. The negative point percentages (NPPs) were applied to verify fitting. The average distance (deviation) and the root mean square of the distance (RMSd) were used to quantify geometric compatibilities. Results Four (16.7%) and 12 (50.0%) femoral medullary canals could not be fitted properly with either the modular or conical implant. The NPPs in the distal comparison region were significantly greater in the conical than modular group. The deviation was significantly smaller in the modular than conical group. The RMSd was also significantly smaller in the modular than conical group. Conclusions Compared with conical implants, modular implants might be more effectively used in patients with Crowe type IV DDH. However, some Crowe IV DDH femurs with severe deformity cannot be fitted with either of these two on-shelf implants.

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The Variation of the Pelvis in Unilateral Crowe Type IV Developmental Dysplasia of the Hip

Orthopaedic Surgery ◽

10.1111/os.12903 ◽

2021 ◽

Author(s):

Yin‐qiao Du ◽

Bohan Zhang ◽

Jing‐yang Sun ◽

Hai‐yang Ma ◽

Jun‐min Shen ◽

...

Keyword(s):

Developmental Dysplasia ◽

Type Iv ◽

Dysplasia Of The Hip

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Purification and Three-Dimensional Electron Microscopy Structure of the Neisseria meningitidis Type IV Pilus Biogenesis Protein PilG

Journal of Bacteriology ◽

10.1128/jb.00648-07 ◽

2007 ◽

Vol 189 (17) ◽

pp. 6389-6396 ◽

Cited By ~ 25

Author(s):

Richard F. Collins ◽

Muhammad Saleem ◽

Jeremy P. Derrick

Keyword(s):

Electron Microscopy ◽

Neisseria Meningitidis ◽

Metal Ion ◽

Polyacrylamide Gel Electrophoresis ◽

Three Dimensional ◽

Type Ii Secretion ◽

Type Ii ◽

Type Iv Pilus ◽

Type Iv ◽

Pilus Biogenesis

ABSTRACT Type IV pili are surface-exposed retractable fibers which play a key role in the pathogenesis of Neisseria meningitidis and other gram-negative pathogens. PilG is an integral inner membrane protein and a component of the type IV pilus biogenesis system. It is related by sequence to the extensive GspF family of secretory proteins, which are involved in type II secretion processes. PilG was overexpressed and purified from Escherichia coli membranes by detergent extraction and metal ion affinity chromatography. Analysis of the purified protein by perfluoro-octanoic acid polyacrylamide gel electrophoresis showed that PilG formed dimers and tetramers. A three-dimensional (3-D) electron microscopy structure of the PilG multimer was determined using single-particle averaging applied to samples visualized by negative staining. Symmetry analysis of the unsymmetrized 3-D volume provided further evidence that the PilG multimer is a tetramer. The reconstruction also revealed an asymmetric bilobed structure approximately 125 Å in length and 80 Å in width. The larger lobe within the structure was identified as the N terminus by location of Ni-nitrilotriacetic acid nanogold particles to the N-terminal polyhistidine tag. We propose that the smaller lobe corresponds to the periplasmic domain of the protein, with the narrower “waist” region being the transmembrane section. This constitutes the first report of a 3-D structure of a member of the GspF family and suggests a physical basis for the role of the protein in linking cytoplasmic and periplasmic protein components of the type II secretion and type IV pilus biogenesis systems.

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The Influence of Geometrical Distortions of Three-Dimensional Finite Elements, Used to Model Proximal Femoral Bone

Proceedings of the Institution of Mechanical Engineers Part H Journal of Engineering in Medicine ◽

10.1243/pime_proc_1995_209_314_02 ◽

1995 ◽

Vol 209 (1) ◽

pp. 31-36 ◽

Cited By ~ 7

Author(s):

J Vander Sloten ◽

G van der Perre

Keyword(s):

Proximal Femur ◽

Hoop Stress ◽

Three Dimensional ◽

Element Model ◽

Bending Stress ◽

Different Types ◽

Dimensional Finite Element ◽

Middle Node ◽

Three Dimensional Finite Element ◽

Hoop Stresses

A realistic three-dimensional finite element model of the proximal femur requires the use of irregularly shaped elements to represent this geometry, unless the geometry is considerably simplified. The authors have investigated the influence of different types of element distortions upon the accuracy of two stresses which are relevant in the proximal femur: the bending stress and the tangential (hoop) stress. While most angular and geometric distortions did not influence the bending stress significantly, the position of the middle node on the edge of a quadratic element was very critical, as were some types of element skewness. The hoop stresses can only be calculated accurately if the geometry is modelled as well as possible by a cylinder, and not by a cone.

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Three-dimensional observations of an aperiodic oscillatory gliding motility behaviour in Myxococcus xanthus using confocal interference reflection microscopy

10.1101/722231 ◽

2019 ◽

Author(s):

Liam M. Rooney ◽

Lisa S. Kölln ◽

Ross Scrimgeour ◽

William B. Amos ◽

Paul A. Hoskisson ◽

...

Keyword(s):

Myxococcus Xanthus ◽

Three Dimensional ◽

Basal Membrane ◽

Gliding Motility ◽

The Novel ◽

Force Transmission ◽

Topological Information ◽

Type Iv ◽

Microscopy Techniques

The Delta-proteobacterium, Myxococcus xanthus, has been used as a model for bacterial motility and to provide insights of bacterial swarming behaviours. Fluorescence microscopy techniques have shown that various mechanisms are involved in gliding motility, but these have almost entirely been limited to 2D studies and there is currently no understanding of gliding motility in a 3D context. We present here the first use of confocal interference reflection microscopy (IRM) to study gliding bacteria, and we reveal aperiodic oscillatory behaviour with changes in the position of the basal membrane relative to the coverglass on the order of 90 nm in vitro. Firstly, we use a model plano-convex lens specimen to show how topological information can be obtained from the wavelength-dependent interference pattern in IRM. We then use IRM to observe gliding M. xanthus and show that cells undergo previously unobserved changes in their height as they glide. We compare the wild-type with mutants of reduced motility, which also exhibit the same changes in adhesion profile during gliding. We find that the general gliding behaviour is independent of the proton motive force-generating complex, AglRQS, and suggest that the novel behaviour we present here may be a result of recoil and force transmission along the length of the cell body following firing of the Type IV pili.

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How to equalize the leg length in total hip arthroplasty for patients with unilateral Crowe type IV developmental dysplasia of the hip

10.21203/rs.2.21689/v1 ◽

2020 ◽

Author(s):

Yinqiao Du ◽

Jingyang Sun ◽

Haiyang Ma ◽

Sen Wang ◽

Ming Ni ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Developmental Dysplasia ◽

Leg Length ◽

Greater Trochanter ◽

Femoral Length ◽

Total Hip ◽

Type Iv ◽

The Mean ◽

Dysplasia Of The Hip

Abstract Background: The purpose of this study was to explore that how to equalize the leg length in total hip arthroplasty (THA) with shortening subtrochanteric osteotomy (SSTO) or not for unilateral Crowe type IV developmental dysplasia of the hip (DDH) through the evaluation of the postoperative full-length anteroposterior radiographs. Methods: The postoperative radiographs of 60 patients with unilateral Crowe type IV DDH from July 2012 to May 2019 were retrospectively reviewed. These data included leg length, femoral length, height of center of rotation (COR) of hip, height of greater trochanter, and depth of the sleeve or cone. Patients with leg length discrepancy (LLD) < 10 mm were defined as the non-LLD group. Results: In the non LLD group (26 patients of SSTO and 22 of non-SSTO), the femoral length both SSTO and non-SSTO groups were significantly shorter on operated side, compared with the contralateral side, and the mean discrepancy in SSTO group was approximately equal to the mean length of SSTO. The mean height of COR of hip on operated sides both SSTO and non-SSTO groups were 13.2 mm, and the contralateral sides were 15.2 mm and 15.5 mm, respectively. The depth of the sleeve or cone between SSTO and non-SSTO groups were 21.7 mm and 30.6 mm, respectively. The depth of the sleeve or cone in SSTO group was negatively correlated with the length of SSTO. The height of the greater trochanter of the operated and contralateral sides were 5.3 mm and 16.6 mm in SSTO group, and those in the non-SSTO group were 13.2 mm and 17.2 mm. Conclusions: SSTO leaded to femoral shortening on the operated side for patients with unilateral Crowe type IV DDH. The position of sleeve or cone should be close to the apex of greater trochanter to compensate the lengh of SSTO.

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Implant Reconstruction of the Proximal Femur: Modular Prosthesis

10.1007/978-3-030-73327-8_14 ◽

2021 ◽

pp. 143-152

Author(s):

Apichat Asavamongkolkul

Keyword(s):

Proximal Femur ◽

Modular Prosthesis ◽

Implant Reconstruction

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Sagittal spinal-pelvic alignment in patients with Crowe type IV developmental dysplasia of the hip

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03717-0 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Peng Ren ◽

Xiangpeng Kong ◽

Wei Chai ◽

Yan Wang

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Vertical Axis ◽

Developmental Dysplasia ◽

Sacral Slope ◽

Low Back ◽

Sagittal Vertical Axis ◽

Type Iv ◽

The Impact ◽

Dysplasia Of The Hip

Abstract Background The impact of high dislocated dysplastic hips on spinal-pelvic alignment has not been well described. This study aims to evaluate compensatory spinal radiographic changes and presence of back pain in patients with Crowe type IV developmental dysplasia of the hip (DDH). Methods An observational study was conducted from July 2016 to December 2017, and 49 consecutive patients with Crowe IV DDH were enrolled. Forty-nine sex- and age-matched asymptomatic healthy adults were recruited as the controls. The sacral slope (SS), lumbar lordosis (LL), spino-sacral angle (SSA), C7 tilt (C7T), and sagittal vertical axis (SVA [C7]) were measured on lateral whole spine radiographs. The presence of low back pain and visual analogue scale (VAS) scores were recorded. Results The patients with Crowe IV DDH showed significantly greater SS (47.5 ± 7.5° vs. 40.4 ± 6.7°, p < 0.05), LL (− 63.7 ± 9.2° vs. − 53.3 ± 11.5°, P < 0.05), SSA (141.8° ± 7.2° vs. 130.6 ± 7.9°, p < 0.05), C7T (93.9 ± 3.6° vs. 91.1 ± 3.7°, P < 0.05), and lower SVA(C7) (− 16 mm[− 95–45] vs. 6.4 mm[− 52–47], p < 0.05) compared to the controls. The patients with bilateral Crowe IV DDH also exhibited larger SS, LL, SSA, and C7T and a smaller SVA (C7) than those with unilateral Crowe IV DDH. Sixty-three percent of the patients with Crowe IV DDH reported low back pain. Conclusion The patients with Crowe IV DDH exhibited abnormal spinal-pelvic alignment characterized by anterior pelvic tilt, lumbar hyperlordosis, and a backward-leaning trunk. Bilateral Crowe IV DDH had a greater impact on spinal-pelvic alignment than unilateral Crowe IV DDH.

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