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

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.

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Anatomical parameters of and differences in the proximal femoral cavity in adult patients with developmental hip dysplasia

Journal of the Pakistan Medical Association ◽

10.47391/jpma.267 ◽

2021 ◽

pp. 1-12

Author(s):

Ran Zhao ◽

Hong Cai ◽

Hua Tian ◽

Ke Zhang ◽

Admin

Keyword(s):

Femoral Head ◽

Developmental Dysplasia ◽

Adult Patients ◽

Control Group ◽

Marrow Cavity ◽

Significant Difference ◽

Group A ◽

Group B ◽

Dysplasia Of The Hip ◽

Anatomical Parameters

Objective: To explore the anatomical parameters proximal femoral cavity and developmental dysplasia of the hip. Methods: The retrospective study was conducted at Peking University Third Hospital, Beijing, China, and comprised data of adult patients of either gender who underwent total hip arthroplasty from January 2009 to August 2015. Paients with a diagnosis of primary osteoarthrosis or aseptic necrosis of the femoral head were taken as the control group A, while patients with developmental dysplasia of the hip in group B were graded into subgroups I-IV using the Crowe classification. For each patient, the inner diameter of the proximal femoral medullary cavity was measured on preoperative radiographs using Noble’s technique. Data was analysed using SPSS 20. Results: Of the 835 hips, 571(68.4%) were in group A and 264(31.6%) in group B. The mean age of the patients at the time of surgery was 58.3 ± 12.3 years. Overall, there were 404(48.4%) hips of male patients; 59(22.3%) in group B. There were 431(51.6%) hips of female patients; 205(77.7%) in group B. In group B, 186(70.5%) hips were graded I, 38(14.4%)grade II, 22(8.3%)grade III, and 18(6.8%) hips were graded IV. There were significant differences in femoral offset, height of the femoral head, and canal flare index of the metaphysis between groups A and B (p<0.05). There was no significant difference in the morphology of the marrow cavity between subgroups II and III.

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

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-019-1408-2 ◽

2019 ◽

Vol 14 (1) ◽

Cited By ~ 2

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.

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

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-019-1491-4 ◽

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.

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Developmental dysplasia of the hip: update of management

EFORT Open Reviews ◽

10.1302/2058-5241.4.180019 ◽

2019 ◽

Vol 4 (9) ◽

pp. 548-556 ◽

Cited By ~ 7

Author(s):

Alfonso Vaquero-Picado ◽

Gaspar González-Morán ◽

Enrique Gil Garay ◽

Luis Moraleda

Keyword(s):

Physical Examination ◽

Open Reduction ◽

Acetabular Dysplasia ◽

Wide Spectrum ◽

Positive Family History ◽

Developmental Dysplasia ◽

Ultrasound Screening ◽

Spontaneous Correction ◽

Hip Reduction ◽

Dysplasia Of The Hip

The term ‘developmental dysplasia of the hip’ (DDH) includes a wide spectrum of hip alterations: neonatal instability; acetabular dysplasia; hip subluxation; and true dislocation of the hip. DDH alters hip biomechanics, overloading the articular cartilage and leading to early osteoarthritis. DDH is the main cause of total hip replacement in young people (about 21% to 29%). Development of the acetabular cavity is determined by the presence of a concentrically reduced femoral head. Hip subluxation or dislocation in a child will cause an inadequate development of the acetabulum during the remaining growth. Clinical screening (instability manoeuvres) should be done universally as a part of the physical examination of the newborn. After two or three months of life, limited hip abduction is the most important clinical sign. Selective ultrasound screening should be performed in any child with abnormal physical examination or in those with high-risk factors (breech presentation and positive family history). Universal ultrasound screening has not demonstrated its utility in diminishing the incidence of late dysplasia. Almost 90% of patients with mild hip instability at birth are resolved spontaneously within the first eight weeks and 96% of pathologic changes observed in echography are resolved spontaneously within the first six weeks of life. However, an Ortolani-positive hip requires immediate treatment. When the hip is dislocated or subluxated, a concentric and stable reduction without forceful abduction needs to be obtained by closed or open means. Pavlik harness is usually the first line of treatment under the age of six months. Hip arthrogram is useful for guiding the decision of performing a closed or open reduction when needed. Acetabular dysplasia improves in the majority due to the stimulus provoked by hip reduction. The best parameter to predict persistent acetabular dysplasia at maturity is the evolution of the acetabular index. Pelvic or femoral osteotomies should be performed when residual acetabular dysplasia is present or in older children when a spontaneous correction after hip reduction is not expected. Avascular necrosis is the most serious complication and is related to: an excessive abduction of the hip; a force closed reduction when obstacles for reduction are present; a maintained dislocated hip within the harness or spica cast; and a surgical open reduction.Cite this article: EFORT Open Rev 2019;4:548-556. DOI: 10.1302/2058-5241.4.180019

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Developmental Dysplasia of Hip: Perspectives in Genetic Screening

Medical Sciences ◽

10.3390/medsci7040059 ◽

2019 ◽

Vol 7 (4) ◽

pp. 59 ◽

Cited By ~ 5

Author(s):

Zamborsky ◽

Kokavec ◽

Harsanyi ◽

Attia ◽

Danisovic

Keyword(s):

Psychological Health ◽

Screening Program ◽

Wide Spectrum ◽

Association Studies ◽

Modern Medicine ◽

Developmental Dysplasia ◽

Developmental Dysplasia Of Hip ◽

Lack Of Information ◽

Genome Wide ◽

Dysplasia Of The Hip

Development dysplasia of the hip (DDH) is a complex developmental disorder despite being a relatively common condition mainly caused by incompatibility of the femoral head and the abnormal joint socket. Development dysplasia of the hip describes a wide spectrum of disorders ranging from minor acetabular dysplasia to irreducible dislocation of the hip. Modern medicine still suffers from lack of information about screening and precise genetic examination. Genome wide linkage and association studies have brought significant progress to DDH diagnosis. Association studies managed to identify many candidate (susceptible) genes, such as PAPPA2, COL2A1, HOXD9, GDF-5, and TGFB1, which play a considerable role in the pathogenesis of DDH. Early detection of DDH has a big chance to help in preventing further disability and improve the psychological health and quality of life in those children. This emphasizes the importance to establish a universal screening program along with the genetic counseling.

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

Clinical Biomechanics ◽

10.1016/j.clinbiomech.2019.11.017 ◽

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

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Femoral Anteversion in Developmental Dysplasia of the Hip

Journal of Pediatric Orthopaedics ◽

10.1097/bpo.0b013e3181c1e961 ◽

2009 ◽

Vol 29 (8) ◽

pp. 885-888 ◽

Cited By ~ 43

Author(s):

Wudbhav N. Sankar ◽

Christopher O. Neubuerger ◽

Colin F. Moseley

Keyword(s):

Femoral Anteversion ◽

Developmental Dysplasia ◽

Dysplasia Of The Hip

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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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Enhanced recovery care versus traditional non- ERAS care following osteotomies in developmental dysplasia of the hip in children : a retrospective case-cohort study

10.21203/rs.2.21179/v2 ◽

2020 ◽

Author(s):

Jin Li ◽

Saroj Rai ◽

Renhao Ze ◽

Xin Tang ◽

Ruikang Liu ◽

...

Keyword(s):

Hospital Stay ◽

Enhanced Recovery ◽

Perioperative Complications ◽

Length Of Hospital Stay ◽

Developmental Dysplasia ◽

Control Group ◽

Postoperative Fever ◽

Vas Score ◽

Significant Difference ◽

Dysplasia Of The Hip

Abstract Background: Enhanced recovery after surgery (ERAS) has been shown to shorten the length of hospital stay and reduce the incidence of perioperative complications in many surgical fields. However, there has been a paucity of research examining the application of ERAS in major pediatric orthopedic surgeries. This study aims to compare the perioperative complications and length of hospital stay after osteotomies in children with developmental dysplasia of the hip (DDH) between ERAS and traditional non-ERAS group. Methods: The ERAS group consisted of 86 patients included in the ERAS program from January 2016 to December 2017. The Control group consisted of 82 DDH patients who received osteotomies from January 2014 to December 2015. Length of hospital stay, physiological function, postoperative visual analogue scale (VAS) score, and postoperative complications were compared between the two groups. Results: The mean duration of hospital stay was significantly reduced from 10.0±3.1 in the traditional care group to 6.0±0.8 days in the ERAS(P<0.001). The VAS score in 3-day was significantly lower in ERAS group (2.9±0.8) than traditional non-ERAS group (4.0±0.8) (P<0.001). However, there was no significant difference in the frequency of breakout pain (VAS >4) between two groups (29.5±6.3 vs.30.6±6.5, P=0.276). The frequency of postoperative fever was lower in the ERAS group. The frequency of urinary tract infection in both groups were not noticeable because the catheter was removed promptly after the surgery. Conclusion: The ERAS protocol is both safe and feasible for pediatric DDH patients undergoing osteotomies, and it can shorten the length of hospital stay without increasing the risk of perioperative complications.

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High Hip Center Technique in Total Hip Arthroplasty for Crowe Type II-III Developmental Dysplasia: Results of Midterm Follow-up

10.21203/rs.3.rs-16950/v3 ◽

2020 ◽

Author(s):

Junmin Shen ◽

Jingyang Sun ◽

Haiyang Ma ◽

Yinqiao Du ◽

Tiejian Li ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Confidence Interval ◽

Hip Arthroplasty ◽

Developmental Dysplasia ◽

Harris Hip Score ◽

Group A ◽

The Mean ◽

Group B ◽

Dysplasia Of The Hip

Abstract Background: High hip center technique is still controversial about the survivorship of prothesis and postoperative complications. We aimed to show the utility of high hip center technique used in patients with Crowe II-III developmental dysplasia of the hip at the midterm follow-up and evaluated the clinical and radiographic results between different heights of hip center.Methods: We retrospectively evaluated 69 patients (85 hips) with Crowe II-III dysplasia who underwent a high hip center cementless total hip arthroplasty at a mean follow up of 8.9 years (range, 6.0-14.1years). The patients were divided into two groups according to the height of hip center, respectively group A (≥22mm and <28mm) and group B (≥28mm). Radiographic, functional and survivorship outcomes were evaluated.Results: The mean location of the hip center from the inter-teardrop was 25.1mm vertically and 30.0mm horizontally in the group A, and 33.1mm vertically and 31.4mm horizontally in the group B. There were no statistically significant differences between two groups in postoperative femoral offset, abductor lever arm, leg length discrepancy and cup inclination. At the final follow up, the mean WOMAC and Harris hip score were significantly improved in both groups. Of the 85 hips, 7 hips (8.2%) showed a positive Trendelenburg sign. Additionally, 6 patients (8.7%) presented with a limp. No significant differences were shown regarding the Harris hip score, WOMAC score, Trendelenburg sign and limp between two groups. The Kaplan-Meier implants survivorship rates at the final follow-up for all-causes revisions in the group A and group B were similar (96.7% [95% confidence interval, 90.5%-100%] and 96.2% [95% confidence interval, 89.0%-100%], respectively).Conclusions: The high hip center technique is a valuable alternative to achieve excellent midterm results for Crowe II-III developmental dysplasia of the hip. Further, we reported good results and could not demonstrate any significant differences in outcomes or survivorship between the groups with differing degrees of HHC in our study, however the relatively small sample size must be considered and larger comparative studies are required to confirm the value of high hip center technique.

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