The Variation of the Pelvis in Unilateral Crowe Type IV 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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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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Segmental uncoverage ratio analysis of Crowe type-IV developmental dysplasia of the hip via 3-dimensional implantation simulation

Arthroplasty ◽

10.1186/s42836-020-00032-w ◽

2020 ◽

Vol 2 (1) ◽

Author(s):

Yiming Dou ◽

Jianlin Xiao ◽

Xinggui Wen ◽

Jianpeng Gao ◽

Hao Tian ◽

...

Keyword(s):

Developmental Dysplasia ◽

Ratio Analysis ◽

3 Dimensional ◽

Type Iv ◽

Dysplasia Of The Hip

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The ‘clicky hip’

The Bone & Joint Journal ◽

10.1302/0301-620x.100b9.bjj-2018-0184.r1 ◽

2018 ◽

Vol 100-B (9) ◽

pp. 1249-1252 ◽

Cited By ~ 3

Author(s):

S. Humphry ◽

D. Thompson ◽

N. Price ◽

P. R. Williams

Keyword(s):

Service Provision ◽

Closed Reduction ◽

Developmental Dysplasia ◽

Ultrasound Screening ◽

Ultrasound Scan ◽

Type Iv ◽

Referral Practices ◽

Adductor Tenotomy ◽

The Mean ◽

Dysplasia Of The Hip

Aims The significance of the ‘clicky hip’ in neonatal and infant examination remains controversial with recent conflicting papers reigniting the debate. We aimed to quantify rates of developmental dysplasia of the hip (DDH) in babies referred with ‘clicky hips’ to our dedicated DDH clinic. Patients and Methods A three-year prospective cohort study was undertaken between 2014 and 2016 assessing the diagnosis and treatment outcomes of all children referred specifically with ‘clicky hips’ as the primary reason for referral to our dedicated DDH clinic. Depending on their age, they were all imaged with either ultrasound scan or radiographs. Results There were 69 ‘clicky hip’ referrals over the three-year period. This represented 26.9% of the total 257 referrals received in that time. The mean age at presentation was 13.6 weeks (1 to 84). A total of 19 children (28%) referred as ‘clicky hips’ were noted to have hip abnormalities on ultrasound scan, including 15 with Graf Type II hips (7 bilateral), one Graf Type III hip, and three Graf Type IV hips. Of these, ten children were treated with a Pavlik harness, with two requiring subsequent closed reduction in theatre; one child was treated primarily with a closed reduction and adductor tenotomy. In total, 11 (15.9%) of the 69 ‘clicky hip’ referrals required intervention with either harness or surgery. Conclusion Our study provides further evidence that the ‘clicky hip’ referral can represent an underlying diagnosis of DDH and should, in our opinion, always lead to further clinical and radiological assessment. In the absence of universal ultrasound screening, we would encourage individual units to carefully assess their own outcomes and protocols for ‘clicky hip’ referrals and tailor ongoing service provision to local populations and local referral practices. Cite this article: Bone Joint J 2018;100-B:1249–52.

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Preliminary application of 3D-printed individualised guiding templates for total hip arthroplasty in Crowe type IV developmental dysplasia of the hip

Hip International ◽

10.1177/1120700020948006 ◽

2020 ◽

pp. 112070002094800

Author(s):

Qiang Tu ◽

Huan-wen Ding ◽

Hu Chen ◽

Jian-jian Shen ◽

Qiu-ju Miao ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Surgical Planning ◽

Developmental Dysplasia ◽

Femoral Osteotomy ◽

Lower Limbs ◽

Total Hip ◽

Type Iv ◽

3D Printed ◽

Dysplasia Of The Hip

Objective: To evaluate the feasibility and accuracy of three-dimensional (3D)-printed individualised guiding templates in total hip arthroplasty (THA) for the treatment of developmental dysplasia of the hip (DDH). Methods: 12 hips in 12 patients with Crowe type IV DDH were treated with THA. A 3D digital model of the pelvis and lower limbs was reconstructed using the computed tomography data of the patients. Preoperative surgical simulations were performed to determine the most suitable surgical planning, including femoral osteotomy and prosthesis placement. Based on the ideal surgical planning, individualised guiding templates were designed by software, manufactured using a 3D printer, and used in acetabulum reconstruction and femoral osteotomy during surgery. Results: 12 patients were followed up for an average of 72.42 months (range 38–135 months). During surgery, the guiding template for each case was matched to the bony markers of the acetabulum and proximal femur. Preoperative and follow-up Harris hip scores were 34.2 ± 3.7 and 85.2 ± 4.2; leg length discrepancy, 51.5 ± 6.5 mm and 10.2 ± 1.5 mm; and visual analogue scale scores, 6.2 ± 0.8 and 1.3 ± 0.3, respectively, with statistical difference. Shortened deformity and claudication of the affected limb were obviously improved after surgery. However, 1 patient had artificial hip dislocation 2 weeks after surgery, and another patient had sciatic nerve traction injury, both of whom recovered after physical treatment. Conclusions: Preoperative surgical simulation and 3D-printed individualised guiding templates can fulfil surgeon-specific requirements for the treatment of Crowe type IV DDH. Accurate THA can be achieved using 3D-printed individualised templates, which provide a new personalised surgical plan for the precise positioning and orientation of acetabular reconstruction and femoral osteotomy.

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Equalisation of leg lengths in total hip arthroplasty for patients with Crowe type-IV developmental dysplasia of the hip

The Bone & Joint Journal ◽

10.1302/0301-620x.99b7.bjj-2016-1328.r1 ◽

2017 ◽

Vol 99-B (7) ◽

pp. 872-879 ◽

Cited By ~ 14

Author(s):

Y. Li ◽

X. Zhang ◽

Q. Wang ◽

X. Peng ◽

Q. Wang ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Developmental Dysplasia ◽

Total Hip ◽

Type Iv ◽

Dysplasia Of The Hip

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Total hip arthroplasty (S-ROM stem) and subtrochanteric osteotomy for Crowe type IV developmental dysplasia of the hip

Indian Journal of Orthopaedics ◽

10.4103/0019-5413.177575 ◽

2016 ◽

Vol 50 (2) ◽

pp. 195 ◽

Cited By ~ 9

Author(s):

Guishan Gu ◽

Liangtao Li ◽

Mingyang Yu ◽

Chen Yang

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Developmental Dysplasia ◽

Total Hip ◽

Type Iv ◽

Dysplasia Of The Hip

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Three-dimensional morphological study of the proximal femur in Crowe type IV developmental dysplasia of the hip

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02789-5 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Yuhui Yang ◽

Weihong Liao ◽

Weiqun Yi ◽

Hai Jiang ◽

Guangtao Fu ◽

...

Keyword(s):

Femoral Neck ◽

Proximal Femur ◽

Three Dimensional ◽

Developmental Dysplasia ◽

Medullary Canal ◽

Femoral Offset ◽

Neck Shaft Angle ◽

Type Iv ◽

Shaft Angle ◽

Dysplasia Of The Hip

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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The use of 3D printing pelvis and hip in a complex THA: clinical experience and reports of literature

10.21203/rs.3.rs-52917/v2 ◽

2020 ◽

Author(s):

Chenyu Huang ◽

Qingqiang Yao ◽

Wei Liu ◽

Yan Xu ◽

Cheng Tang ◽

...

Keyword(s):

3D Printing ◽

Recovery Time ◽

Computer Software ◽

Operation Time ◽

Developmental Dysplasia ◽

3D Printer ◽

Case Presentation ◽

Type Iv ◽

Short Recovery Time ◽

Dysplasia Of The Hip

Abstract Background: Total hip arthroplasty(THA) is a good solution of developmental dysplasia of the hip(DDH). However, patients diagnosed with Crowe type IV are difficult to deal with. With traditional operation skills, the operation time is quite long and the patients will lose a lot of blood.Case presentation: We present the case of a 58-year-old male patient who underwent left THA due to Crowe type IV DDH with the help of 3D printing models. Before the operation, we put the CT image into a computer software named mimics. After getting the stl. document, we use 3D printer to print the models out. By using the models, we planned the operation in advance. And after sterilizing the models, we put them in the operation area, which saves a lot of operation time and reduces much blood loss by giving surgeons a better anatomy view. Conclusion: THA with the help of 3D printing pelvis and femur can result in a relatively short recovery time and provide good clinical efficacy of type IV DDH patients.

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