Femoral Anteversion in Developmental Dysplasia of the Hip

2009 ◽  
Vol 29 (8) ◽  
pp. 885-888 ◽  
Author(s):  
Wudbhav N. Sankar ◽  
Christopher O. Neubuerger ◽  
Colin F. Moseley
Keyword(s):  
Femoral Anteversion ◽  
Developmental Dysplasia ◽  
Dysplasia Of The Hip

scholarly journals Effect of altered proximal femoral geometry on predicting femoral stem anteversion in patients with developmental dysplasia of the hip

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Chenhui Huang ◽  
Haitao Tan ◽  
Willem Alexander Kernkamp ◽  
Rongshan Cheng ◽  
Junjie Liang ◽  
...  
Keyword(s):  
Femoral Stem ◽  
Femoral Anteversion ◽  
Developmental Dysplasia ◽  
Prediction Errors ◽  
Strong Positive Correlation ◽  
Positive Correlation ◽  
Press Fit ◽  
Preoperative Ct ◽  
Dysplasia Of The Hip ◽  
Anatomical Parameters

Abstract Background The deformity of the proximal femur and acetabular in patients with developmental dysplasia of the hip (DDH) renders an intraoperative decision for ideal component placement challenging. We hypothesized that the altered morphology of calcar femorale (CF) in DDH patients changed the fixation mechanism of the cementless metaphyseal-filling stem and aimed to predict stem anteversion using proximal femoral anatomical parameters from preoperative CT. Methods Preoperative and postoperative CT scans of 34 DDHs with a metaphyseal-filling stem in THA were retrospectively analyzed. Proximal femoral anatomical parameters, including the femoral anteversion (FA) and the CF angles at the low femoral neck (LFN) and the center of the lesser trochanter (CLT) levels (FA-LFN, FA-CLT, CF-LFN, and CF-CLT) were measured. The dysplastic hips were divided into the CF group (n = 21) and the non-CF group (n = 13) according to the presence of the CF-LFN. The association between the anatomical parameters and the postoperative stem anteversion was statistically analyzed, and the predicted stem anteversion was compared with postoperative stem anteversion. Results In the CF group, the combination of the CF-LFN and FA-CLT exhibited a strong positive correlation (R = 0.870, p < 0.001) with the postoperative stem anteversion. In the non-CF group, only the FA-LFN had a strong positive correlation (R = 0.864, p < 0.001). Average prediction errors were 5.9° and 6.4° in the CF and non-CF groups. Conclusions The presence of CF-LFN is related to the press-fit mechanism of the metaphyseal-filling stem, and the preoperative measurements from CT images can be employed as a tool to predict postoperative stem anteversion in DDH patients.

scholarly journals Biomechanical evaluation of femoral anteversion in developmental dysplasia of the hip and potential implications for closed reduction

2020 ◽  
Vol 72 ◽  
pp. 179-185
Author(s):  
Victor Huayamave ◽  
Blake Lozinski ◽  
Christopher Rose ◽  
Hessein Ali ◽  
Alain Kassab ◽  
...  
Keyword(s):  
Closed Reduction ◽  
Femoral Anteversion ◽  
Developmental Dysplasia ◽  
Biomechanical Evaluation ◽  
Dysplasia Of The Hip

Relationship between femoral anteversion and tibial torsion: CT evaluation of 38 unilateral developmental dysplasia of the hip patients

2018 ◽  
Vol 28 (5) ◽  
pp. 548-553
Author(s):  
Kyu-Jin Cho ◽  
Kyung-Soon Park ◽  
Young-Rok Shin ◽  
Hong-Yeol Yang ◽  
Taek-Rim Yoon
Keyword(s):  
Wide Spectrum ◽  
Group Analysis ◽  
Femoral Anteversion ◽  
Developmental Dysplasia ◽  
Tibial Torsion ◽  
Individual Comparison ◽  
Significant Difference ◽  
Ct Evaluation ◽  
Group B ◽  
Dysplasia Of The Hip

Introduction: Patients with developmental dysplasia of the hip (DDH) present with a wide spectrum of deformities. Few studies have assessed the relationship between femoral anteversion (FA) and rotational profile. The aim of this study is to evaluate the influence of FA on the lower extremity rotational profile by comparing tibial torsion (TT) between the extremities on both sides in patients with unilateral DDH, using computed tomography (CT). Patients and methods: Thirty eight patients with unilateral developmental dysplasia of the hip, who underwent a preoperative rotational profile CT scan at our institution, were evaluated. 3D rotational profile CT was performed, and FA and TT of the extremities on both sides were measured. Results: On individual comparison of the rotational profile, mean FA of the affected extremity showed a significantly higher value ( p = 0.006). But, there was no significant difference in mean TT between the 2 extremities. On group analysis, the excessive FA group (group B) showed significantly higher values of tibial torsion and tibial torsion side-to-side difference compared to the normal FA group (group A) ( p = 0.000, p = 0.011, respectively). Conclusions: Our study suggests that patients with DDH can present with excessive FA. Therefore, while treating patients who show excessive FA, surgeons must consider the possibility of a higher rotational profile of the affected extremity, before performing surgical treatments for DDH.

scholarly journals Total hip arthroplasty with modular stem for Crowe I and II developmental dysplasia of the hip

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Xiangpeng Kong ◽  
Yunming Sun ◽  
Minzhi Yang ◽  
Yonggang Zhou ◽  
Jiying Chen ◽  
...  
Keyword(s):  
Operating Time ◽  
Femoral Anteversion ◽  
Developmental Dysplasia ◽  
Harris Hip Score ◽  
Leg Length ◽  
Intraoperative Complication ◽  
Modular Stem ◽  
Significant Difference ◽  
Tapered Stem ◽  
Dysplasia Of The Hip

Abstract Background The variation of femoral anteversion is not completely consistent with the grade of developmental dysplasia of the hip (DDH), which poses challenges to hip replacement with the non-modular tapered stem. Currently, whether the modular stem should be used in Crowe I and II DDH is still controversial. The aim of this study is to compare the clinical efficacy of the modular stem and the non-modular tapered stem in Crowe I and II DDH patients. Methods We retrospective analyzed the clinical data of 196 patients with unilateral Crowe I and II DDH from January 2015 to January 2017. One hundred patients were operated by an experienced surgeon with the modular stems; the remaining 96 patient was operated by another equivalent surgeon with the non-modular tapered stems. The preoperative basic information, operating time, intraoperative and postoperative complications, postoperative leg length discrepancy (LLD) and offset, Harris hip score (HHS), and forgotten joint score (FJS) in postoperative 2 years were collected and analyzed. Results Postoperative LLD (P = 0.010) and FJS (P = 0.001) had significant difference between two groups. Concurrent acceptable LLD and offset were achieved in 87% of patients with the modular stem and in 68% of patients with the non-modular stem (P = 0.001). There was no significant difference in the operating time (P = 0.086), intraoperative complication (P = 0.096), postoperative dislocation rate (P = 0.056), postoperative offset difference (P = 0.108), and Harris score (P = 0.877) between two groups. Conclusions Compared with the non-modular tapered stem, the modular stem was more likely to provide accurate reconstruction and forgotten artificial hip for Crowe I and II DDH patients. We recommend the modular stem as routine choice for these patients.

Combined Anteversion Technique in Total Hip Arthroplasty for Crowe IV Developmental Dysplasia of the Hip

2017 ◽  
Vol 27 (6) ◽  
pp. 589-594 ◽  
Author(s):  
Biao Zhu ◽  
Changzheng Su ◽  
Yeteng He ◽  
Xingyu Chai ◽  
Zhen Li ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Femoral Anteversion ◽  
Safe Zone ◽  
Developmental Dysplasia ◽  
Acetabular Anteversion ◽  
Combined Anteversion ◽  
The Mean ◽  
Postoperative Dislocation ◽  
Dysplasia Of The Hip

Background A high rate of postoperative dislocation in total hip arthroplasty (THA) for Crowe IV developmental dysplasia of the hip (DDH) has been reported, 1 of the main reasons being higher true acetabular anteversion. If the cup is fixed with normal anteversion, the anterior rim will be excessively exposed, which reduces the contact areas of the cup and bone, affects prosthesis stability, and leads to iliopsoas tendinitis and persistent hip pain after THA. The aim of this study was to demonstrate that when cup anteversion is larger, adjusting femoral anteversion to bring the combined anteversion (CA) into the “safe zone” might prevent dislocation. Methods After having fixed the cup in the acetabulum according to the patients’ native acetabular anteversion, we shortened and rotated the proximal femur to reduce femoral anteversion, adjusting the CA into the “safe zone”. The Harris Hip Score (HHS) was used to evaluate hip joint function. Computerised tomography scanning was used to measure the anteversion angles. Results All patients were followed up without any dislocation. Preoperative and 12 months after surgery, the mean HHS were 43.3 ± 2.6 (38-47) and 88.1 ± 3.3 (78-92) respectively. Pre- and post-operation, the mean CA angles were 88.6° ± 9.4° (80.3°-119.4°) and 49.2° ± 2.6° (43.4°-54.4°) respectively. The bone healing time of femoral osteotomy ranged from 4 to 14 months, with a mean time of 7.5 months. Conclusions This CA technique in THA for Crowe IV DDH can effectively prevent postoperative dislocation and provide good hip function.

scholarly journals Prediction of the requirement of open reduction for developmental dysplasia of the hip

2017 ◽  
Vol 46 (1) ◽  
pp. 54-61 ◽  
Author(s):  
Nabil Alassaf
Keyword(s):  
Open Reduction ◽  
Area Under The Curve ◽  
Internal Validity ◽  
Developmental Dysplasia ◽  
Estimation Model ◽  
Cross Sectional ◽  
Noninvasive Treatment ◽  
Dysplasia Of The Hip ◽  
Logistic Regression Equation ◽  
Objective Tool

Objective Closed reduction (CR) is a noninvasive treatment for developmental dysplasia of the hip (DDH), and this treatment is confirmed intraoperatively. This study aimed to develop a preoperative estimation model of the probability of requiring open reduction (OR) for DDH. Methods The study design was cross-sectional by screening all patients younger than 2 years who had attempted CR between October 2012 and July 2016 by a single surgeon. Potential diagnostic determinants were sex, age, side, bilaterality, International Hip Dysplasia Institute (IHDI) grade, and acetabular index (AI). An intraoperative arthrogram was the reference standard. A logistic regression equation was built from a reduced model. Bootstrapping was performed for internal validity. Results A total of 164 hips in 104 patients who met the inclusion criteria were analysed. The prevalence of CR was 72.2%. Independent factors for OR were older age, higher IHDI grade, and lower AI. The probability of OR = 1/[1 + exp − (−2.753 + 0.112 × age (months) + 1.965 × IHDI grade III (0 or 1) + 3.515 × IHDI grade IV (0 or 1) − 0.058 × AI (degrees)]. The area under the curve was 0.79. Conclusion This equation is an objective tool that can be used to estimate the requirement for OR.

scholarly journals Accuracy of New Deep Learning Model-Based Segmentation and Key-Point Multi-Detection Method for Ultrasonographic Developmental Dysplasia of the Hip (DDH) Screening

Diagnostics ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. 1174
Author(s):  
Si-Wook Lee ◽  
Hee-Uk Ye ◽  
Kyung-Jae Lee ◽  
Woo-Young Jang ◽  
Jong-Ha Lee ◽  
...  
Keyword(s):  
Deep Learning ◽  
Intraclass Correlation ◽  
Alpha Angle ◽  
Learning Model ◽  
Developmental Dysplasia ◽  
Human Observer ◽  
Intraobserver Variability ◽  
Cad System ◽  
Deep Learning Model ◽  
Dysplasia Of The Hip

Hip joint ultrasonographic (US) imaging is the golden standard for developmental dysplasia of the hip (DDH) screening. However, the effectiveness of this technique is subject to interoperator and intraobserver variability. Thus, a multi-detection deep learning artificial intelligence (AI)-based computer-aided diagnosis (CAD) system was developed and evaluated. The deep learning model used a two-stage training process to segment the four key anatomical structures and extract their respective key points. In addition, the check angle of the ilium body balancing level was set to evaluate the system’s cognitive ability. Hence, only images with visible key anatomical points and a check angle within ±5° were used in the analysis. Of the original 921 images, 320 (34.7%) were deemed appropriate for screening by both the system and human observer. Moderate agreement (80.9%) was seen in the check angles of the appropriate group (Cohen’s κ = 0.525). Similarly, there was excellent agreement in the intraclass correlation coefficient (ICC) value between the measurers of the alpha angle (ICC = 0.764) and a good agreement in beta angle (ICC = 0.743). The developed system performed similarly to experienced medical experts; thus, it could further aid the effectiveness and speed of DDH diagnosis.

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