Radiological Measurement of Femoral Head Position in Legg-Calvé-Perthes Disease

1996 ◽  
Vol 37 (3P2) ◽  
pp. 863-869 ◽  
Author(s):  
C. Kaniklides ◽  
P. Dimopoulos
Keyword(s):  
Femoral Head ◽  
Normal Values ◽  
Lateral Displacement ◽  
Weight Bearing ◽  
Joint Space ◽  
Perthes Disease ◽  
Radiological Measurement ◽  
Migration Percentage ◽  
The Mean ◽  
Methods Of Treatment

Purpose: Since the establishment of the principle of weight-bearing methods of treatment in Legg-Calvé-Perthes disease (LCPD), lateral displacement of the femoral head has become an important prognostic factor. Material and Methods: In order to establish reliable boundary lines between orthotopic and subluxated hip, the migration percentage (MP) and the medial joint space (MJS) were determined retrospectively: a) on 166 normal hip radiographs; b) on bilateral arthrograms and radiographs from 37 patients with unilateral LCPD. Results and Conclusion: The mean upper normal values for MP and MJS on normal radiographs were 20.8 and 11.5 respectively. On arthrograms, the corresponding values were 31 and 5.7. The MP is easy to determine on both radiographs and arthrograms, and is recommended for detecting and measuring subluxation in cases with LCPD. MJS is of no advantage for detecting containment in LCPD but may be used in other diseases such as coxitis simplex.

The modified Stulberg classification is a strong predictor of the radiological outcome 20 years after the diagnosis of Perthes’ disease

2021 ◽  
Vol 103-B (12) ◽  
pp. 1815-1820
Author(s):  
Stefan Huhnstock ◽  
Ola Wiig ◽  
Else Merckoll ◽  
Svein Svenningsen ◽  
Terje Terjesen
Keyword(s):  
Femoral Head ◽  
Skeletal Maturity ◽  
Strong Predictor ◽  
Perthes Disease ◽  
Radiological Outcome ◽  
Long Term Follow Up ◽  
The Mean ◽  
Stulberg Classification

Aims The aim of this study was to assess the prognostic value of the modified three-group Stulberg classification, which is based on the sphericity of the femoral head, in patients with Perthes’ disease. Methods A total of 88 patients were followed from the time of diagnosis until a mean follow-up of 21 years. Anteroposterior pelvic and frog-leg lateral radiographs were obtained at diagnosis and at follow-up of one, five, and 21 years. At the five- and 21-year follow-up, the femoral heads were classified using a modified three-group Stulberg classification (round, ovoid, or flat femoral head). Further radiological endpoints at long-term follow-up were osteoarthritis (OA) of the hip and the requirement for total hip arthroplasty (THA). Results There were 71 males (81%) and 17 females. A total of 13 patients had bilateral Perthes’ disease; thus 101 hips were analyzed. At five-year follow-up, 37 hips were round, 38 ovoid, and 26 flat. At that time, 66 hips (65%) were healed and 91 (90%) were skeletally immature. At long-term follow-up, when the mean age of the patients was 28 years (24 to 34), 20 hips had an unsatisfactory outcome (seven had OA and 13 had required THA). There was a strongly significant association between the modified Stulberg classification applied atfive-year follow-up and an unsatisfactory outcome at long-term follow-up (p < 0.001). Between the five- and 21-year follow-up, 67 hips (76%) stayed in their respective modified Stulberg group, indicating a strongly significant association between the Stulberg classifications at these follow-ups (p < 0.001). Conclusion The modified Stulberg classification is a strong predictor of long-term radiological outcome in patients with Perthes’ disease. It can be applied at the healing stage, which is usually reached five years after the diagnosis is made and before skeletal maturity. Cite this article: Bone Joint J 2021;103-B(12):1815–1820.

scholarly journals Arthrodiastasis in the Management of Perthes’ Disease: A Systematic Review

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
H Fahmy ◽  
M Alkersh ◽  
Y H Ibrahim
Keyword(s):  
Systematic Review ◽  
Femoral Head ◽  
Weight Bearing ◽  
Relevant Literature ◽  
Perthes Disease ◽  
Inclusion Criteria ◽  
Hip Distraction ◽  
Index Terms ◽  
Tract Infections ◽  
Good Environment

Abstract Background This systematic review explores the relevant literature to assess the efficacy of the use of arthrodiastasis in the management of Perthes disease. Until this moment, arthrodiastasis is not well established for its use in Perthes disease as opposed to other containment procedures. Furthermore, there are no clear indications for its use in this disease. Methodology 12 articles were matched to the inclusion criteria and all articles were reviewed and radiological and clinical data was collected and compiled. Results a significant increase in postoperative range of motion compared to the preoperative ones was found. Final Stullberg classification was ascertained showing majority of patients ending with stages two and three. Complications were also assessed with majority of them being superficial pin tract infections. Conclusion the use of arthrodiastasis is a valid treatment option for Perthes disease however more articles need to be produced showing comparative data of arthrodiastasis versus other containment procedures. Index Terms- Arthrodiastasis, Perthes’ Disease, LCPD, Hinged Distraction the preservation of an intact and congruent femoral head. It is proposed that by applying distraction early in the disease, before any significant collapse of the femoral head had occurred, further fragmentation would be halted.[3]Articulated hip distraction maintains the proper head position by containment in abduction, extension, and neutral rotation. It also decreases joint pressure and thus decreases the deforming force and provides a good environment for cartilage repair. The femoral head deformity that develops in Perthes’ disease is believed to occur during this fragmentation phase of the disease. The possibility for joint motion allows for articular cartilage nutrition and the molding effect of the acetabulum. The aim of the articulated distraction method is to neutralize muscle and weight-bearing forces, to prevent stress fractures of subchondral immature bone, and to encourage synovial circulation and promote creeping substitution by breaking the ‘vicious circle’ of necrosis.[4]

Management of Early Avascular necrosis of femoral head with Core Decompression and Platelet Rich Plasma infiltration

2021 ◽  
Vol 12 (4) ◽  
pp. 2434-2440
Author(s):  
Aditya Pundkar ◽  
Sandeep Shrivastav ◽  
Swapnil Date
Keyword(s):  
Femoral Head ◽  
Bone Grafting ◽  
Platelet Rich Plasma ◽  
Weight Bearing ◽  
Core Decompression ◽  
Good Alternative ◽  
Harris Hip Score ◽  
Pharmacological Agents ◽  
Replacement Surgery ◽  
The Mean

Various modalities available for the treatment of AVN range from conservative modalities like observation and non-weight-bearing mobilization, various pharmacological agents like Bisphosphonates, Enoxaparin are shown to be useful in some studies, Hyperbaric oxygen therapy to Surgical modalities like femoral head preserving procedures (core decompression with or without additional procedure, i.e. bone grafting, biologic adjuvants – Platelet Rich Plasma, Stem cells etc. and rotational osteotomies) and replacement surgeries. 20 patients of Early AVN who met inclusion criteria and operated with core decompression and PRP infiltration were included in this study. Out of 20 patients, 2 patients (10%) had superficial infections which healed on its own without any intervention, 5 patients (25%) had restriction of movements and 3 patients (15%) required replacement surgery. The mean pre-operative Harris Hip Score of our study was 64.3, and the mean post-operative Harris hip score of our study was 80.2. Out of 20 cases, 6 patients (30%) showed limitation of the progression of the disease, 3 (15%) patients progressed to the further stages of the disease and 11 patients (55%) had remission of the disease. The final outcome, on the basis of Harris Hip Score in 5 patients (25%), was excellent, 7 patients (35%) was good, 5 patients (25%) was fair, and in 3 patients (15%) was poor. Our study concludes that Core decompression along with PRP infiltration can be used as a good alternative for or in addition with traditionally performed core decompression and bone grafting. 

TO EVALUATE THE CHANGES IN HIP JOINT RELATED TO LOWER LIMB DOMINANCE AND ITS ASSOCIATION WITH HIP DISLOCATION

1969 ◽  
Vol 5 (1) ◽  
pp. 635-638
Author(s):  
NIAZ MOHAMMAD ◽  
MAQBOOL ILAHI ◽  
QAISAR ZAMAN
Keyword(s):  
Femoral Head ◽  
Hip Joint ◽  
Lower Limb ◽  
Weight Bearing ◽  
Hip Dislocation ◽  
Congenital Dislocation ◽  
Left Femur ◽  
Horizontal Diameter ◽  
The Mean ◽  
The Right

BACKGROUND: The stability of a joint depends on the arrangement of the articular surfaces. Thefailure of acetabulum to deepen along with associated relaxed capsule can be a causative factor leadingto congenital dislocation of hip in babies. The right traumatic hip dislocation is less uncommon ascompared to left side in adults.OBJECTIVE: To correlate the majority of right-footed population with the bony parameters of hipjoint bilaterally and to find out its association with left congenital and right acquired traumaticdislocation of hip.MATERIAL AND METHODS: As the right footed people are considerably more (90%) than the leftfooted and this study work was correlated with the bones collected from cadavers in Anatomydepartment of KGMC Peshawar from January 2014 to December 2014. We included 14 pairs of femurs,14 pairs of hip bones in this study to see the structural differences when dominant hip joint is comparedwith non-dominant hip joints. The measurements were performed with the help of vernier caliper.RESULTS: The mean horizontal diameter of right (dominant) and left acetabulum was 50.14±0.69 mmand 52.35±0.65mm. The mean horizontal depth of right and left acetabulum was 22.21±0.82mm and25.25±0.52mm. The horizontal diameter of right and left femur was 46.42±0.62mm and 43.85±01mm.The thickness of femoral head was 26.71±01mm on right (dominant) side but this thickness was29.17±01mm on left side.CONCLUSION: The left acetabulum was having a significant larger diameter in adult, allowing thesmaller left femoral head to fit snugly which can be correlated with the more common left congenitaldislocation hip. On the other hand, in adults, the left acetabulum is deeper, allowing the thicker left headof femur as an adjustment for weight bearing functionwhile the larger rightfemoral head fit into acomparatively shallow socket. This may be a factor to improve mobility at the cost of stability; as righttraumatic dislocationhip is less uncommon as compared to left side.KEY WORDS: Hip joint, Ball and socket joint. Dominant lower limb, Right footedness,Left footedness, Congenital dislocation hip, Traumatic dislocation hip.

Our Experience with Alumina on Alumina Weight Bearing in Everyday Orthopedic Practice

2014 ◽  
Vol 614 ◽  
pp. 212-217
Author(s):  
Dan Grecu ◽  
Dan Tarnita ◽  
Daniela Tarniţă ◽  
D.R. Nita
Keyword(s):  
Femoral Head ◽  
Hip Prosthesis ◽  
Weight Bearing ◽  
Lateral Wall ◽  
Acetabular Cup ◽  
Ceramic Bearing ◽  
The Mean ◽  
Almost All ◽  
Mid Term Results

The research for an ideal hip prosthesis has led to the development of several durable materials that have been tested very intensly during the past decades, both clinically and mechanically. Alumina on alumina bearing has proven to be a very reliable bearing and is used more and more often. Nevertheless, because of the lack of ductility of alumina ceramic, concerns have been raised regarding its risk of fracture. The purpose of our study is to evaluate the mid-term results (78 months follow-up) of alumina on alumina prosthesis and the complications that have appeared regarding to the properties of the implant. We have reviewed retrospectively 89 THA performed in our clinic during October 2005 – October 2013 on a follow-up period of maximum 78 months. The mean age of the patients included was 49,60 years for men and 48,44 years for women. It was used a single kind of implant with same type of alumina parts, applied only on a postero-lateral surgical approach. The survival rate of ceramic-on-ceramic bearing surface by itself was 98.87% (88 out of 89). The most frequent complication was the dislocation of the prosthesis that happened in 7 cases, mainly due to a malposition of the acetabular cup, without any damage done to the ceramic bearing surfaces. In the failed case we have encountered a cracked femoral head that has been previously resterilized by steam. We could conclude that the alumina on alumina prosthesis is a very reliable prosthesis regarding its durability and strength. It requires a very precise surgical technique when implanted, since almost all the complications were due to a malposition of the acetabular component. A postero-lateral wall of the liner might decrease the rate of dislocations and ceramic wear. Also, we might debate that the steam sterilization is not suitable for alumina implants, since the fractured femoral head was resterilized.

scholarly journals How to prevent graft resorption or breakage in shelf acetabuloplasty for Perthes disease with hinge abduction – A modified Staheli technique successful in 31 hips in midterm results

2021 ◽  
Vol 9 (3) ◽  
pp. 287-296
Author(s):  
Nariman Abol Oyoun ◽  
Mohamed Khaled ◽  
Hesham Mohamed Elbaseet ◽  
Abdel Khalek Hafez Ibrahim
Keyword(s):  
Joint Space ◽  
Perthes Disease ◽  
Acetabular Coverage ◽  
Center Edge ◽  
The Mean ◽  
Shelf Acetabuloplasty ◽  
Center Edge Angle ◽  
Space Ratio ◽  
Graft Resorption

BACKGROUND: Shelf acetabuloplasty covers the hip and allows remodeling in hips with Legg-Calv-Perthes disease and hinge abduction. Graft resorption or breakage is a bad complication that necessitate another surgical procedure. AIM: Our report evaluates a modified Staheli technique for graft resorption or breakage. MATERIALS AND METHODS: Case series study of 31 hips (29 patients) with mean age at operation was 8.1 (range 6-14 years). Duration of complaint ranged between one year and up to three years with the mean duration 1.52 0.76 years. The different parameters evaluating the hip as: Tnnis angle, Sharp angle, center-edge angle, and acetabular coverage percentage were measured. For unilateral cases only, medial joint space ratio and epiphyseal height ratio were evaluated. RESULTS: The mean postoperative follow-up was 47.8 9.8 months. All studied joints had Catterall type IV, Salter-Thompson classification type B. Seven joints were in Fragmentation stage whereas 24 joints were in re-ossification stage. Based on Lateral Pillar classification; only two joints were classified as B/C and 29 joints were classified as C. Final follow up internal rotation, abduction, center-edge angle, and acetabular coverage percentage were found to be significantly higher. In contrast, Tnnis angle and Sharps angle were significantly decreased. For unilateral cases, it was found that medial joint space ratio and epiphyseal height ratio were significantly decreased. None of the hips had resorbed or broken graft till final follow up. CONCLUSIONS: This modified Staheli technique prevent graft resorption or breakage. Shelf provides a good acetabular coverage for the deformed aspherical head with Legg-Calv-Perthes disease and hinge abduction to improve hip clinical and radiological outcome.

scholarly journals The path to minimizing instability in developmental dysplasia of the hip: is Capsulorrhaphy a necessity or a futile habit?

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Ramin Zargarbashi ◽  
Mohammadreza Bozorgmanesh ◽  
Behnam Panjavi ◽  
Fardis Vosoughi
Keyword(s):  
Femoral Head ◽  
Joint Space ◽  
Developmental Dysplasia ◽  
Obturator Foramen ◽  
Femoral Metaphysis ◽  
Salter Osteotomy ◽  
Femoral Shortening ◽  
Before And After ◽  
The Mean ◽  
Exact Effect

Abstract Background To evaluate and quantify the intraoperative effect of capsulorrhaphy on the deep seating of femoral head within the acetabulum as measured by medial joint space, a surrogate measure of acetabular-head contact. Methods In order to determine the exact effect of capsulorrhaphy, we prospectively scrutinized a consecutive sample of 18 patients with unilateral dysplastic hips aging > 18 months and followed them for a period of at least 12 months. The procedure of open reduction is described in detail. Two pediatric orthopedists carried out the operations from August 2014 to January 2019 at a tertiary pediatric hospital. Intraoperatively, AP radiographs of the pelvis were obtained before and after capsulorrhaphy. The distance between the inferomedial edge of the proximal femoral metaphysis and the lateral edge of the obturator foramen was recorded. To determine if there were differences in medial joint space due to capsulorrhaphy, a generalized linear model was run on the study sample. All patients were followed for at least 12 months to determine the rate of re-dislocation. Results Mean age (±standard deviation) of the participants was 37.5 (±24.7) months. All cases underwent Salter osteotomy, 5 cases needed femoral shortening (27.8%) and none needed derotational osteotomy. Capsulorrhaphy lead to a statistically significant decrease in the mean medial joint space from 1.59 cm before (95% CI: 1.12–2.05) to 0.76 cm after (95% CI: 0.50–1.02) the capsulorrhaphy (P < 0.001). When we took the effect of age into account the corresponding figures were 1.47 (95% CI: 1.22–1.75) and 0.67 (95% CI: 0.39–0.94), respectively (P < 0.001). After follow up periods of 1 to 5.5 years, none of the patients experienced instability or re-dislocation. Conclusions Capsulorrhaphy, independently, of age was associated with a 1-cm decrease in the mean medial hip joint space and a more deeply seated femoral head. Furthermore, this study presents a successful experience with capsulorrhaphy to prevent hip instability.

Age does not necessarily influence latency of event-related potentials

2014 ◽  
Vol 33 (10) ◽  
pp. 723-727
Author(s):  
M. Westermann ◽  
I. W. Husstedt ◽  
A. Okegwo ◽  
S. Evers
Keyword(s):  
Normal Values ◽  
Rank Correlation ◽  
Event Related Potentials ◽  
Intrinsic Property ◽  
Total Sample ◽  
Oddball Paradigm ◽  
Age Dependent ◽  
Related Potentials ◽  
The Mean ◽  
P3 Component

SummaryEvent-related potentials (ERP) are regarded as age dependent. However, it is not known whether this is an intrinsic property of ERP or an extrinsic factor. We designed a setting in which ERP were evoked using a modified oddball paradigm with highly differentiable and detectable target and non-target stimuli. A total of 98 probands were enrolled in this study. We evaluated the latency and amplitude of the P3 component of visually evoked ERP. The mean P3 latency was 294 ± 28 ms and was not related to age (r = –0.089; p = 0.382; Spearman-rank-correlation). The P3 amplitude was related to age in the total sample (r = –0.323; p = 0.001; Spearmanrank-correlation) but not in the probands under the age of 60 years. There were no significant differences regarding sex. Our findings suggest that ERP are not age dependent if highly differentiable and detectable stimuli are used. This should be considered when normal values of ERP are created for clinical use.

HAPTEN-RADIOIMMUNOASSAY OF PLASMA OESTRADIOL

1973 ◽  
Vol 72 (2) ◽  
pp. 330-344 ◽  
Author(s):  
Peter Doerr
Keyword(s):  
Adult Male ◽  
Normal Values ◽  
Normal Adult ◽  
Adult Males ◽  
Reagent Blank ◽  
Keyhole Limpet Haemocyanin ◽  
Ether Extraction ◽  
The Mean ◽  
Assay Precision ◽  
Plasma Oestradiol

ABSTRACT A hapten-radioimmunoassay for plasma oestradiol is described and information about the reliability of the method is given in detail. Oestradiol-3-hemisuccinate coupled to keyhole limpet haemocyanin is used for immunization of rabbits. The antiserum utilized for the assay is characterized by its titer, affinity and specificity. Following ether extraction and NaOH-light petroleum partition oestradiol is separated from crossreacting oestrogens by TLC. Oxidation of oestradiol on the plate is prevented by mercaptoethanol. To separate free and antibody bound ligand 250 μg dextran-coated charcoal per tube is used in the presence of bovine serum gammaglobulin (1 mg/ml). The between-assay precision based on 15 different determinations of control samples from normal adult male plasma was 9.4% (C. V.). The mean reagent blank value of 31 determinations was equivalent to 0.3 pg oestradiol and the detection limit in terms of the 99% confidence limit for a single blank value, was equivalent to 4.3 pg oestradiol. A procedure for detecting plasma blanks is described. Plasma oestradiol is separated from approximately all concomitant substances originally present in the sample by enzymatic conversion into oestrone and a second TLC. No plasma blanks could be detected with respect to normal adult male plasma. Normal values for adult males based on 51 subjects were characterized by a median of 17.2 pg/ml and the 95 percentiles of 9.5–27.6.

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