The Development of Leg Length Difference and Influence on Persistent Dysplasia in Patients with Developmental 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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Pirogow’s Amputation: A Modification of the Operation Method

Advances in Orthopedics ◽

10.1155/2013/460792 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6

Author(s):

M. Bueschges ◽

T. Muehlberger ◽

K. L. Mauss ◽

J. C. Bruck ◽

C. Ottomann

Keyword(s):

Kirschner Wire ◽

Original Method ◽

Patient Questionnaire ◽

Control Group ◽

Leg Length ◽

Valuable Alternative ◽

Length Difference ◽

Operation Method ◽

Postoperative Mobility ◽

Leg Length Difference

Introduction. Pirogow’s amputation at the ankle presents a valuable alternative to lower leg amputation for patients with the corresponding indications. Although this method offers the ability to stay mobile without the use of a prosthesis, it is rarely performed. This paper proposes a modification regarding the operation method of the Pirogow amputation. The results of the modified operation method on ten patients were objectified 12 months after the operation using a patient questionnaire (Ankle Score).Material and Methods. We modified the original method by rotating the calcaneus. To fix the calcaneus to the tibia, Kirschner wire and a 3/0 spongiosa tension screw as well as a Fixateur externe were used.Results. 70% of those questioned who were amputated following the modified Pirogow method indicated an excellent or very good result in total points whereas in the control group (original Pirogow’s amputation) only 40% reported excellent or very good result. In addition, the level of pain experienced one year after the completed operation showed different results in favour of the group being operated with the modified way. Furthermore, patients in both groups showed differences in radiological results, postoperative leg length difference, and postoperative mobility.Conclusion. The modified Pirogow amputation presents a valuable alternative to the original amputation method for patients with the corresponding indications. The benefits are found in the significantly reduced pain, difference in reduced radiological complications, the increase in mobility without a prosthesis, and the reduction of postoperative leg length difference.

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The positive predictive value of asymmetrical skin creases in the diagnosis of pathological developmental dysplasia of the hip

The Bone & Joint Journal ◽

10.1302/0301-620x.100b5.bjj-2017-0994.r2 ◽

2018 ◽

Vol 100-B (5) ◽

pp. 675-679 ◽

Cited By ~ 8

Author(s):

M. J. Anderton ◽

G. R. Hastie ◽

R. W. Paton

Keyword(s):

Risk Factors ◽

Positive Predictive Value ◽

Predictive Value ◽

Clinical Signs ◽

Senior Author ◽

Developmental Dysplasia ◽

Inclusion Criteria ◽

Leg Length ◽

One Stop ◽

Dysplasia Of The Hip

Aims The aim of this study was to identify the association between asymmetrical skin creases of the thigh, buttock or inguinal region and pathological developmental dysplasia of the hip (DDH). Patients and Methods Between 1 January 1996 and 31 December 2016, all patients referred to our unit from primary or secondary care with risk factors for DDH were assessed in a “one stop” clinic. All had clinical and sonographic assessment by the senior author (RWP) with the results being recorded prospectively. The inclusion criteria for this study were babies and children referred with asymmetrical skin creases. Those with a neurological cause of DDH were excluded. The positive predictive value (PPV) for pathological DDH was calculated. Results A total of 105 patients met the inclusion criteria. There were 71 girls and 34 boys. Only two were found to have pathological DDH. Both also had unilateral limited abduction of the hip in flexion and a positive Galeazzi sign with apparent leg-length discrepancy. Thus, if the specialist examination of a patient with asymmetrical skin creases was normal, the PPV for DDH was 0%. Conclusion Isolated asymmetrical skin creases are an unreliable clinical sign in the diagnosis of pathological DDH. Greater emphasis should be placed on the presence of additional clinical signs to guide radiological screening in babies and children. Cite this article: Bone Joint J 2018;100-B:675–9.

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Reversible Pelvic Asymmetry: An Overlooked Syndrome Manifesting as Scoliosis, Apparent Leg-Length Difference, and Neurologic Symptoms

Journal of Manipulative and Physiological Therapeutics ◽

10.1016/j.jmpt.2006.06.024 ◽

2006 ◽

Vol 29 (7) ◽

pp. 561-565 ◽

Cited By ~ 15

Author(s):

Jussi Timgren ◽

Seppo Soinila

Keyword(s):

Leg Length ◽

Neurologic Symptoms ◽

Length Difference ◽

Leg Length Difference

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Comparison of leg length difference, hip joint range of motion, and isokinetic muscle strength among athletes in different events

Exercise Science ◽

10.15857/ksep.2008.17.2.201 ◽

2008 ◽

Vol 17 (2) ◽

pp. 201-210 ◽

Cited By ~ 1

Author(s):

조용훈 ◽

성동준 ◽

Kwang-Suk Cha

Keyword(s):

Muscle Strength ◽

Range Of Motion ◽

Hip Joint ◽

Leg Length ◽

Joint Range Of Motion ◽

Length Difference ◽

Isokinetic Muscle Strength ◽

Leg Length Difference ◽

Joint Range

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Robotic-arm assisted THA can achieve precise cup positioning in developmental dysplasia of the hip

Bone and Joint Research ◽

10.1302/2046-3758.1010.bjr-2021-0095.r1 ◽

2021 ◽

Vol 10 (10) ◽

pp. 629-638

Author(s):

Shinya Hayashi ◽

Shingo Hashimoto ◽

Yuichi Kuroda ◽

Naoki Nakano ◽

Tomoyuki Matsumoto ◽

...

Keyword(s):

Developmental Dysplasia ◽

Robotic Arm ◽

Consecutive Series ◽

Leg Length ◽

Mean Values ◽

Significant Difference ◽

The Mean ◽

Ct Data ◽

Dysplasia Of The Hip ◽

Cup Positioning

Aims This study aimed to evaluate the accuracy of implant placement with robotic-arm assisted total hip arthroplasty (THA) in patients with developmental dysplasia of the hip (DDH). Methods The study analyzed a consecutive series of 69 patients who underwent robotic-arm assisted THA between September 2018 and December 2019. Of these, 30 patients had DDH and were classified according to the Crowe type. Acetabular component alignment and 3D positions were measured using pre- and postoperative CT data. The absolute differences of cup alignment and 3D position were compared between DDH and non-DDH patients. Moreover, these differences were analyzed in relation to the severity of DDH. The discrepancy of leg length and combined offset compared with contralateral hip were measured. Results The mean values of absolute differences (postoperative CT-preoperative plan) were 1.7° (standard deviation (SD) 2.0) (inclination) and 2.5° (SD 2.1°) (anteversion) in DDH patients, and no significant differences were found between non-DDH and DDH patients. The mean absolute differences for 3D cup position were 1.1 mm (SD 1.0) (coronal plane) and 1.2 mm (SD 2.1) (axial plane) in DDH patients, and no significant differences were found between two groups. No significant difference was found either in cup alignment between postoperative CT and navigation record after cup screws or in the severity of DDH. Excellent restoration of leg length and combined offset were achieved in both groups. Conclusion We demonstrated that robotic-assisted THA may achieve precise cup positioning in DDH patients, and may be useful in those with severe DDH. Cite this article: Bone Joint Res 2021;10(10):629–638.

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Developmental hip dysplasia in adolescence

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh0908440v ◽

2009 ◽

Vol 137 (7-8) ◽

pp. 440-443 ◽

Cited By ~ 3

Author(s):

Zoran Vukasinovic ◽

Zorica Zivkovic ◽

Cedomir Vucetic

Keyword(s):

Hip Dysplasia ◽

Developmental Dysplasia ◽

Pathological Findings ◽

Leg Length ◽

Treatment Results ◽

Developmental Hip Dysplasia ◽

Treatment Protocols ◽

Management Modes ◽

Dysplasia Of The Hip

The authors define adolescence and developmental dysplasia of the hip (DDH). Special attention is paid to pathological findings characteristic of DDH in adolescence (unrecognized and untreated DDH; treated DDH, but non-terminated treatment; DDH diagnosed with delay, inadequately treated, with complications). The authors emphasise that DDH treatment has to be successfully terminated well before the adolescence; possibilities are explained on management modes at the time of adolescence, and possible persons guilty for the persistence of later hip problems are indicated. Based on the authors' experience and having in mind all surgical possibilities for the treatment (pelvic osteotomies, femoral osteotomies, trochanteroplasties, leg length equalization procedures) the authors propose treatment protocols. The intention is to provide better treatment results and to prevent secondary hip arthrosis. Furthermore, how to improve the struggle against DDH is suggested.

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