Diagnosis and Management of Borderline Hip Dysplasia and Acetabular Retroversion

2018 ◽  
Vol 02 (04) ◽  
pp. 156-166
Author(s):  
Tai Holland ◽  
Holly Thomas-Aitken ◽  
Jessica Goetz ◽  
Michael Willey
Keyword(s):  
Surgical Treatment ◽  
Hip Dysplasia ◽  
Groin Pain ◽  
Periacetabular Osteotomy ◽  
Hip Pain ◽  
Acetabular Retroversion ◽  
Short Term ◽  
Radiographic Findings ◽  
Lateral Hip Pain

AbstractBorderline hip dysplasia and acetabular retroversion are common radiographic findings in young individuals with and without hip pain. Orthopaedic surgeons should be knowledgeable about the radiographic findings, diagnosis, and appropriate nonsurgical and surgical treatment of these conditions. Borderline hip dysplasia is generally defined by a lateral center edge angle of Wiberg from 20 to 25° (some define as 18–25°) and is a cause of joint microinstability. The degree of soft tissue laxity can have significant implications for joint stability in patients with borderline hip dysplasia. The most common presenting symptoms are groin pain and lateral hip pain. Acetabular retroversion is defined by radiographic findings of crossover sign, ischial spine sign, and posterior wall sign. Individuals with symptomatic retroversion have a clinical presentation consistent with impingement, groin pain with flexion activities, and less commonly lateral hip pain. Physical therapy has been shown to improve symptoms in a subset of individuals with these conditions. There are multiple recent publications about arthroscopic treatment of patients with borderline hip dysplasia. These reports generally find that good short-term outcomes can be expected when using arthroscopic techniques that include labral preservation/repair and capsular plication. There are limited reports of periacetabular osteotomy as a treatment for borderline hip dysplasia. Publications focusing specifically on surgical treatment of acetabular retroversion are also infrequent. Periacetabular osteotomy has been shown to have superior long-term clinical outcomes to surgical hip dislocation with anterior rim trimming in patients with all three radiographic findings of retroversion. Arthroscopic treatment has been shown to have good short-term outcomes. Future work in the areas of borderline hip dysplasia and acetabular retroversion should focus on reporting long-term clinical follow-up of these surgical treatments and using computation techniques as a tool to determine appropriate surgical and nonsurgical treatment for each individual patient.

scholarly journals Treatment Algorithm for Patients with Non-arthritic Hip Pain, Suspect for an Intraarticular Pathology

2016 ◽  
Vol 10 (1) ◽  
pp. 404-411 ◽  
Author(s):  
R. Wejnold Jørgensen ◽  
C. Dippmann ◽  
L. Dahl ◽  
J. Stürup
Keyword(s):  
Hip Dysplasia ◽  
Periacetabular Osteotomy ◽  
Treatment Algorithm ◽  
Posterior Wall ◽  
Hip Pain ◽  
Acetabular Retroversion ◽  
Ischial Spine ◽  
Radiographic Findings ◽  
Posterior Wall Sign ◽  
The Right

Background: The amount of patients referred with longstanding, non-arthritic hip pain is increasing, as are the treatment options. Left untreated hip dysplasia, acetabular retroversion and femoroacetabular impingement (FAI) may lead to osteoarthritis (OA). Finding the right treatment option for the right patient can be challenging in patients with non-arthritic hip pain. Purpose: The purpose of this study was to categorize the radiographic findings seen in patients with longstanding hip pain, suspect for an intraarticular pathology, and provide a treatment algorithm allocating a specific treatment option for each clinical condition. Material and Methods: A review of the literature was performed using Public Medline searches of MeSH terms combined with synonyms for femoroacetabular impingement, acetabular retroversion, periacetabular osteotomy and hip arthroscopy. Results: Radiographic findings associated with acetabular retroversion described in the literature were the crossover sign, the posterior wall sign and the ischial spine sign, while Wiberg’s lateral center-edge angle (CE-angle) together with Leqeusne’s acetabular index indicate hip dysplasia. A Tönnis index >2 indicates osteoarthritis, however unsatisfying results are documented following joint preserving surgery with a Tönnis index >1. Furthermore, ischial spine sign in combination with the posterior wall sign indicates total acetabular retroversion prone to periacetabular osteotomy in contrast to focal retroversion prone to hip arthroscopy. These findings were used creating a treatment algorithm for intraarticular pathologies in patients with longstanding hip pain. Conclusion: Based on the radiographic findings, the algorithm presented in this study can be a helpful tool in the decision-making for the treatment of patients with non-arthritic hip pain, suspect for intraarticular pathologies.

Long-term results of Bernese periacetabular osteotomy using a dual approach in hip dysplasia

2021 ◽  
Author(s):  
Hyun Chul Shon ◽  
Woo Sung Park ◽  
Jae-Suk Chang ◽  
Seong-Eun Byun ◽  
Dong-Wook Son ◽  
...  
Keyword(s):  
Hip Dysplasia ◽  
Periacetabular Osteotomy ◽  
Long Term Results ◽  
Dual Approach

scholarly journals Residual hip dysplasia: is there a place for hip shelf operation?

2018 ◽  
Vol 12 (4) ◽  
pp. 358-363 ◽  
Author(s):  
T. Terjesen
Keyword(s):  
Periacetabular Osteotomy ◽  
Developmental Dysplasia ◽  
Hip Pain ◽  
Older Children ◽  
Long Term Effects ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Shelf Procedure ◽  
Shelf Operation

Purpose After modern acetabular osteotomies were introduced, hip shelf operations have become much less commonly used. The aims of this study were to assess the short-term and long-term outcome of a modified Spitzy shelf procedure and to compare the results with those of periacetabular osteotomy (PAO). Methods In all, 44 patients (55 hips) with developmental dysplasia of the hip and residual dysplasia had a modified Spitzy shelf operation. Mean age at surgery was 13.2 years (8 to 22). Indication for surgery was a centre-edge angle < 20° with or without hip pain. Outcome was evaluated using duration of painless period and survival analysis with conversion to total hip arthroplasty (THA) as endpoints. Results Preoperative hip pain was present in 46% of the hips and was more common in patients ≥ 12 years at surgery (p < 0.001). One year postoperatively, 93% of the hips were painless. Analysis of pain in hips with more than ten years follow-up showed a mean postoperative painless period of 20.0 years (0 to 49). In all, 44 hips (80%) had undergone THA at a mean patient age of 50.5 years (37 to 63). Mean survival of the shelf procedure (time from operation to THA) was 39.3 years (21 to 55). Conclusions The Spitzy operation had good short and long-term effects on hip pain and a 30-year survival (no THA) of 72% of the hips. These results compare favourably with those of PAO and indicate that there is still a place for the shelf procedure in older children and young adults.

Longitudinal Analysis of Visual Outcomes After Surgical Treatment of Adult Craniopharyngiomas

Neurosurgery ◽  
2012 ◽  
Vol 71 (3) ◽  
pp. 715-721 ◽  
Author(s):  
Young-Hoon Kim ◽  
Chae-Yong Kim ◽  
Jin Wook Kim ◽  
Yong Hwy Kim ◽  
Jung Ho Han ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Visual Impairment ◽  
Tumor Recurrence ◽  
Significant Risk ◽  
Tumor Control ◽  
Total Removal ◽  
Short Term ◽  
Visual Outcomes ◽  
Short And Long Term

Abstract BACKGROUND: Craniopharyngiomas (CRPs) often cause visual deterioration (VD) due to the close vicinity of the optic apparatus. OBJECTIVE: To evaluate longitudinal visual outcomes after surgery of CRP and determine the prognostic factors thereof. METHODS: One hundred forty-six adult patients who underwent surgery for newly diagnosed CRP were retrospectively reviewed. There were 87 male patients (60%), and the median age was 41 years (range, 18–75). The mean follow-up duration was 88.7 months (range, 24–307). A visual impairment score was used to assess the short-term (&lt;1 month) and long-term (&gt;2 years) visual outcomes. RESULTS: Gross total removal was performed in 53 patients (36%), and tumor recurrence occurred in 40 patients (27%). The average preoperative, short- and long-term visual impairment scores were 44.4, 38.5, and 38.1, respectively, on a 0- to 100-point scale (with 100 indicating the worst vision). Short- and long-term VD occurred in 28 (19%) and 39 patients (27%), respectively. Subtotal removal (STR) alone (P = .010; OR = 4.8), short-term VD (P &lt; .001; OR = 39.7), and tumor recurrence (P &lt; .001; OR = 28.2) were significant risk factors for long-term VD in the multivariate analysis. Patients undergoing STR alone had higher tumor recurrence rates in comparison with those who underwent gross total removal or STR with adjuvant therapy (P &lt; .001). CONCLUSION: Short-term VD secondary to the surgical insult and the recurrence of the tumor were strong predictors of long-term visual outcomes after surgical treatment for CRP. STR alone may be an ineffective strategy for achieving tumor control and optimal visual outcomes in patients with CRP.

scholarly journals The Ischial Spine in Developmental Hip Dysplasia: Unraveling the Role of Acetabular Retroversion in Periacetabular Osteotomy

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Gerard El-Hajj ◽  
Hicham Abdel-Nour ◽  
Rami Ayoubi ◽  
Joseph Maalouly ◽  
Fouad Jabbour ◽  
...  
Keyword(s):  
Hip Dysplasia ◽  
Periacetabular Osteotomy ◽  
Posterior Wall ◽  
Acetabular Retroversion ◽  
Ischial Spine ◽  
Acetabular Version ◽  
Crossover Sign ◽  
Developmental Hip Dysplasia ◽  
Radiographic Sign ◽  
Posterior Wall Sign

Purpose. Radiological diagnosis of acetabular retroversion (AR) is based on the presence of the crossover sign (COS), the posterior wall sign (PWS), and the prominence of the ischial spine sign (PRISS). The primary purpose of the study is to analyze the clinical significance of the PRISS in a sample of dysplastic hips requiring periacetabular osteotomy (PAO) and evaluate retroversion in symptomatic hip dysplasia. Methods. In a previous paper, we reported the classic coxometric measurements of 178 patients with symptomatic hip dysplasia undergoing PAO where retroversion was noted in 42% of the cases and was not found to be a major factor in the appearance of symptoms. In the current study, we have added the retroversion signs PRISS and PWS to our analysis. Among the retroverted dysplastic hips, we studied the association of the PRISS with the hips requiring PAO. We also defined the ischial spine index (ISI) and studied its relationship to the coxometric measurements and AR. Results. In hips with AR, the operated hips were significantly associated with the PRISS compared to the nonoperated ones (χ2 = 4.847). Additionally, the ISI was able to classify acetabular version (anteverted, neutral, and retroverted acetabula). A direct correlation between the ISI and the retroversion index (RI) was found, and the highest degree of retroversion was found when the 3 signs of acetabular retroversion were concomitantly present (RI = 33.6%). Conclusion. The PRISS, a radiographic sign reflecting AR, was found to be significantly associated with dysplastic hips requiring PAO where AR was previously not considered a factor in the manifestation of symptoms and subsequent requirement for surgery. Moreover, the PRISS can also serve as an adequate radiographic sign for estimating acetabular version on pelvic radiographs.

SOLUBLE FORMS OF ADHESIVE MOLECULES IN BLOOD SERUM AS A MARKER OF ENDOTHELIAL DYSFUNCTION IN CHRONIC GENERALIZED PARODONTITIS

2019 ◽  
Vol 64 (12) ◽  
pp. 747-752
Author(s):  
Tatyana Valerievna Govorunova ◽  
E. B. Popykhova ◽  
V. Yu. Shirokov ◽  
A. N. Ivanov
Keyword(s):  
Surgical Treatment ◽  
Endothelial Dysfunction ◽  
Adhesion Molecules ◽  
Long Term Results ◽  
Short Term ◽  
Adhesive Properties ◽  
Systemic Manifestations ◽  
Adhesive Molecules

An important factor in the pathogenesis of chronic inflammation in periodontitis is endothelial dysfunction (ED). Adhesion molecules are markers of impaired barrier function, adhesive properties and vascular permeability. The study of the concentration of soluble adhesion molecules is very promising in the diagnosis of ED. The purpose of this research was to study changes in the concentration of soluble forms of adhesive molecules of the selectin family and the immunoglobulin superfamily when used as markers of systemic manifestations of ED in the dynamics of the treatment of chronic generalized periodontitis (CP) using surgical and therapeutic schemes. 60 patients with CP (33 women and 27 men) and 20 clinically healthy volunteers (10 men and 10 women) were examined. The state of the endothelium was assessed by the content in the serum of soluble forms of adhesive molecules - sP- and sE-selectins, intercellular adhesive molecules of type 1 (sICAM-1), vascular molecules of cell adhesion of type 1 (VCAM-1) by ELISA. The short-term results of non-surgical treatment of CP are more effective in correction of vascular wall adhesive properties disorders compared with surgical treatment. Conservative treatment of chronic hepatitis C effectively adjusted the blood content of adherent endothelium molecules in women than in men. The long-term results of applying this scheme were characterized by partial preservation of a positive effect on the adhesive properties of the endothelium, however, long-term results were inferior to short-term ones. Surgical treatment of CP in women in the early postoperative period was accompanied by reactive impairment of the adhesive properties of the endothelium. The long-term results of this treatment regimen testified to its greater effectiveness. In women, the effectiveness of treatment of CP in restoring the adhesive properties of the endothelium was higher than in men. The results obtained allow us to conclude that the systemic manifestations of ED in CP were characterized by an increase in the concentration in the blood of soluble forms of adhesion molecules. The dynamics of the concentration of adhesive molecules during the treatment of СР testified to the dependence of the sex of patients on the effectiveness of the influence of therapeutic and surgical treatment regimens on the systemic manifestations of ED.

Predictors of Mid- to Long-Term Outcomes in Patients Experiencing a Knee Dislocation: A Systematic Review of Clinical Studies

2021 ◽  
Author(s):  
John-Rudolph H. Smith ◽  
John W. Belk ◽  
Jamie L. Friedman ◽  
Jason L. Dragoo ◽  
Rachel M. Frank ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Clinical Outcomes ◽  
Clinical Studies ◽  
Small Sample ◽  
Cochrane Library ◽  
Long Term Outcomes ◽  
Short Term ◽  
Female Sex

AbstractKnee dislocations (KDs) are devastating injuries for patients and present complex challenges for orthopaedic surgeons. Although short-term outcomes have been studied, there are few long-term outcomes of these injuries available in the literature. The purpose of this study is to determine factors that influence mid- to long-term clinical outcomes following surgical treatment of KD. A review of the current literature was performed by searching PubMed, the Cochrane Library, and Embase to identify clinical studies published from 2010 to 2019 with a minimum 2-year follow-up that reported outcomes following surgical treatment of KDs. Ten studies (6 level III, 4 level IV) were included. At mid- (2–10 y) to long-term (>10 y) follow-up, concomitant arterial, cartilage, and combined meniscus damage were predictive factors for inferior Lysholm and International Knee Documentation Committee (IKDC) scores when compared with patients without these associated injuries. Although concomitant neurological damage may influence short-term outcomes due to decreased mobility, at longer follow-up periods it does not appear to predict worse clinical outcomes when compared with patients without concomitant neurological injury. Frank and polytrauma KDs have been associated with worse mid- to long-term outcomes when compared with transient and isolated KDs. Patients who underwent surgery within 6 weeks of trauma experienced better long-term outcomes than those who underwent surgery longer than 6 weeks after the initial injury. However, the small sample size of this study makes it difficult to make valid recommendations. Lastly, female sex, patients older than 30 years at the time of injury and a body mass index (BMI) greater than 35 kg/m2 are factors that have been associated with worse mid- to long-term Lysholm and IKDC scores. The results of this review suggest that female sex, age >30 years, BMI >35 kg/m2, concomitant cartilage damage, combined medial and lateral meniscal damage, KDs that do not spontaneously relocate, and KDs associated with polytrauma may predict worse results at mid- to long-term follow-up.

Short-Term Follow-up Results of Periacetabular Osteotomy for Hip Dysplasia

2009 ◽  
Vol 21 (2) ◽  
pp. 156 ◽  
Author(s):  
Youn Soo Park ◽  
Young Wan Moon ◽  
Seung Jae Lim ◽  
Jae Chul Park ◽  
Min Soo Son
Keyword(s):  
Hip Dysplasia ◽  
Periacetabular Osteotomy ◽  
Short Term
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