Why do subchondral cysts occur at the medial aspect of the femoral head in hip dysplasia?

2020 ◽  
pp. 112070002091216
Author(s):  
Jae Suk Chang ◽  
Joo Ho Song ◽  
Ji Wan Kim ◽  
Hun-Kyu Shin ◽  
Hee-Jin Park ◽  
...  
Keyword(s):  
Femoral Head ◽  
Hip Dysplasia ◽  
Ligamentum Teres ◽  
Lateral Side ◽  
X Rays ◽  
3 Dimensional ◽  
Medial Side ◽  
Significant Difference ◽  
Group A ◽  
Tönnis Grade

Introduction: Osteoarthritis in dysplastic hips should develop from the lateral side of the acetabulum and the femoral head just below. However, the existence of subchondral cysts located more on the medial side contradicts the weight-loading theory. The aim of this study was to confirm the presence of medial cysts at the femoral head and to investigate the relationship between medial cysts and injuries of the ligamentum teres in hip dysplasia. Methods: A retrospective analysis was conducted on 257 cases of hip dysplasia. All patients had x-rays and 3-dimensional computed tomographies (3D CT) preoperatively and 123 patients had magnetic resonance arthrographies. A comparison was performed between cases with and without medial cysts according to the severity of damage to the ligamentum teres, the presence of bony spurs around the fovea capitis, and the Tönnis grade. Results: Medial subchondral cysts around the fovea capitis were found in 100 cases. Mild osteoarthritis (Tönnis grade 0 or 1) was present in 89% of cases in the medial cyst group. A significant difference between the groups was observed in the incidence of bony spurs around the fovea capitis ( p < 0.05) and injuries of the ligamentum teres ( p < 0.05). Conclusions: The formation of subchondral cysts at the medial femoral head in hip dysplasia may be related to damage in the ligamentum teres. Considering that subchondral cysts develop in early osteoarthritis, the progression of arthritis in hip dysplasia appears to correlate with damage to the ligamentum teres, as well as compressive pressure on the joint.

scholarly journals Assessment of Acetabulum Deformity During Preoperative Planning for Hip Arthroplasty

2019 ◽  
Vol 25 (3) ◽  
pp. 153-164
Author(s):  
D. V. Martynenko ◽  
V. P. Voloshin ◽  
L. A. Sherman ◽  
K. V. Shevyrev ◽  
S. A. Oshkukov ◽  
...  
Keyword(s):  
Acetabular Component ◽  
Hip Joint ◽  
Preoperative Planning ◽  
Bone Defects ◽  
Lateral Side ◽  
X Rays ◽  
Two Dimensional ◽  
Acetabular Coverage ◽  
Anatomical Features ◽  
Medial Side

Purpose of the study — to improve the two-dimensional planning of total hip joint arthroplasty to ensure precise positioning of the acetabular component in the deformed acetabulum. Materials and methods. Features of roentgenological anatomy of acetabulum and its coverage were studied on 1058 hip joint x-rays in the AP view in accordance with the procedure developed by the authors to define acetabular square — the site of standard positioning of a spherical femoral head in the acetabulum or of a hemispherical acetabular component. The method consisted of identifying the apex of “teardrop” figure; the most lateral points of the pelvic terminal line and roof of the acetabulum; superior part of the acetabular cavity; medial and inferior points of acetabular coverage, and building the sides of acetabular square — medial, inferior, lateral and superior boundary lines. Connection of “teardrop” apex and lateral point of the pelvic terminal line formed the medial side of acetabular square, and a perpendicular to that line drawn through the “teardrop” apex to its inferior side. The lateral side was drawn either through the intersection of the ascending diagonal line — bisector from the top of the “teardrop” figure with the contour of the acetabulum roof, or was a part of the projection of the most lateral point of the acetabular roof on the inferior side of the square. The superior side was a perpendicular connecting the intersection of the ascending diagonal and lateral bounding lines with the medial side of the acetabular square. The area of the deformed acetabular cavity located outside of the acetabular square was assessed as the acetabular defect. Results. Method of defining the acetabular square allowed to identify types of ratios between acetabular cavity and acetabular coverage in transverse (9 types) and longitudinal (7 types) direction. Combination of transverse ratio of acetabular cavity and coverage with longitudinal type allowed to define the options of acetabular deformities in two-dimensional view. The authors identified 25 types of acetabular deformities. Bone defects of acetabular walls were of the major importance among all anatomical features. Cranial defect of acetabulum was observed in 450 cases, medial wall defect — in 38 cases, defect including cranial and medial areas — in 7 cases. Conclusion. The method suggested by the authors to determine acetabular square and acetabular deformity variations allows to screen the anatomical features of the acetabulum during two-dimensional preoperative planning and to make an informed decision on the need to use other planning techniques. The type of acetabular deformity identified during preoperative planning allows to elaborate the indications for replacement of acetabular bone defects and/or resection of acetabular osteophytes.

scholarly journals Medial and Lateral Malleoli Impose Anatomical Constraints on Total Ankle Arthroplasty Design

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0010
Author(s):  
Jeffrey E. Bischoff ◽  
Sandra Snyder ◽  
J. Chris Coetzee ◽  
Stuart Miller ◽  
Terrence Philbin
Keyword(s):  
Total Ankle Arthroplasty ◽  
Lateral Side ◽  
Talar Dome ◽  
Taper Angle ◽  
Ankle Arthroplasty ◽  
Medial Side ◽  
Paired Student ◽  
Significant Difference ◽  
Lateral Lines ◽  
Statistical Shape

Category: Ankle Introduction/Purpose: Contemporary total ankle arthroplasty (TAA) techniques reconstruct the tibiotalar articulation while preserving the medial and lateral malleoli. The malleoli place anatomic constraints on the design of the talar component of the TAA system. If these constraints are not respected, then proper placement of the talar component may be compromised intra- operatively, or unintended contact between the prosthesis and bone may occur post-operatively. The goal of this study was therefore to quantify the medial and lateral malleolar boundaries. Methods: The orientation of the talus from a frontal view was quantified based on CT scans of left leg, non-arthritic specimens (n=89; 52M/37F) (Figure 1a). The talar dome was identified as the portion of the talus superior to the talar neck. The frontal profile of the dome defined by a plane positioned through the medial and lateral high points was extracted for each specimen. Statistical shape analysis was performed to identify the modes of variation of the frontal profile. Medial and lateral lines were fit to each profile, and resulting angles relative to the superior-inferior axis were measured. A paired student t-test (P<.05) was used to assess differences between the medial and lateral malleolus. Results: Figure 1b shows the average frontal profile of the talar dome, as well as ±1 and ±2 standard deviations. The average medial and lateral taper angles of the talus were 15.5° ± 5.9° and 7.6° ± 2.9°, respectively, with the lateral taper angle being significantly smaller than the medial taper angle (P<.001). The medial taper increased with talus size (as measured by the medial- lateral width of the dome) whereas the lateral taper decreased with talus size (Figure 1c), though both regressions were weak (R2 < 0.1). No statistically significant difference in taper angles was found between genders. Conclusion: Restoration of the bicondylar articulation geometry of the tibiotalar joint is an important design goal for TAA. One aspect of this geometry is the anatomic constraints imposed by the medial and lateral malleoli, to minimize unexpected impingement of the TAA prostheses with surrounding anatomic structures. Here, we have quantified those constraints through analysis of the medial and lateral taper of the talus, showing an increased taper angle on the medial side of the talus as compared to the lateral side.

3D Assessment of Nasolabial Appearance in Patients With Complete Unilateral Cleft Lip and Palate

2017 ◽  
Vol 55 (2) ◽  
pp. 220-225 ◽  
Author(s):  
Ieva Bagante ◽  
Inta Zepa ◽  
Ilze Akota
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Cross Sectional Study ◽  
Control Group ◽  
Cross Sectional ◽  
3 Dimensional ◽  
Significant Difference ◽  
Group A ◽  
Left And Right ◽  
The Difference

Objective: Rhinoplasty in patients with complete unilateral cleft lip and palate (UCLP) is challenging, and the surgical outcome of the nose is complicated to evaluate. The aim of this study was to assess the nasolabial appearance of patients with UCLP compared with a control group. Design: Cross-sectional study. Setting: Riga Cleft Lip and Palate Centre, Latvia. Participants: All consecutive 35 patients born between 1994 and 2004 with nonsyndromic complete UCLP were included. Of 35 patients, 29 came for checkup; the mean age was 14.7 years (range 10-18). In the control group, 35 noncleft participants at 10 years of age were included. Interventions: Nasolabial appearance was evaluated from 3-dimensional images using a 3-dimensional stereo-photogrammetric camera setup (3dMDface System), the results being analysed statistically. Results: In UCLP group, a statistically significant difference between cleft and noncleft side was found only in alar wing length ( P < .05). The difference of nasolabial anthropometric distances in the control group between the left and right side was not significant. The difference between the UCLP group and the control group was significant in all anthropometric distances except the lateral lip length to cupid’s bow. Conclusions: The nasolabial appearance with acceptable symmetry after cleft lip and reconstructive surgery of the nose was achieved. Symmetry of the nasolabial appearance in patients with UCLP differed from those in the control group. The 3D photographs with a proposed set of anthropometric landmarks for evaluation of nasolabial appearance seems to be a convenient, accurate, and noninvasive way to follow and evaluate patients after surgery.

scholarly journals Thermographic images from healthy knees between dogs with long and short hair

2018 ◽  
Vol 48 (12) ◽  
Author(s):  
Roberto Harutomi Corrêa Nomura ◽  
Itallo Barros de Freitas ◽  
Rogério Luizari Guedes ◽  
Frederico Fernandes Araújo ◽  
Amanda Cristina Duarte Neves Mafra ◽  
...  
Keyword(s):  
Statistical Analysis ◽  
Radiographic Examination ◽  
Contralateral Limb ◽  
Inflammatory Reactions ◽  
Non Invasive ◽  
Medial Side ◽  
Significant Difference ◽  
Group A ◽  
Healthy Dogs ◽  
Group B

ABSTRACT: The aim of this study was to investigate the influence of fur length in the evaluation of knees temperature in healthy dogs, using infrared thermography. This is a non-invasive diagnosis that is able to assess the microcirculation of the internal skin. Changes in temperature reflect from inflammatory reactions and vascular infarction to neurological disorders. Knees of 30 healthy dogs were analyzed, with up to 11 pounds of weight, screened by clinical examination and radiographic examination. Group A, consisting of 13 dogs with short fur, with 26 knees evaluated in total. Group B included animals with long fur, consisting of 17 animals, with 29 knees evaluated in total. The average temperatures of the cranial, lateral, caudal and medial sides of knees were analyzed. A significant difference between the groups was observed, with group A temperature being greater than the group B in all four analyzed faces. Comparing the temperatures of the faces in the contralateral limb, in both groups, the statistical analysis revealed no significant difference. In group A it was observed that temperatures in the cranial and lateral sides were similar, but different from the others. In group B, the statistical analysis showed the cranial lateral and caudal faces was similar, but differed from the medial side. The thermographic examination proved to be sensitive in the evaluation of temperature of small dogs’ knees;however, the length of the fur influenced the result.

scholarly journals The role and clinical relevance of the ligamentum teres: long-term outcomes after hip arthroscopic surgery of cam-type femoroacetabular impingement

2021 ◽  
Author(s):  
Jeong-Kil Lee ◽  
Deuk-Soo Hwang ◽  
Sang-Bum Kim ◽  
Chan Kang ◽  
Jung-Mo Hwang ◽  
...  
Keyword(s):  
Femoroacetabular Impingement ◽  
Arthroscopic Surgery ◽  
Hip Osteoarthritis ◽  
Ligamentum Teres ◽  
Thermal Shrinkage ◽  
Radiologic Evaluation ◽  
Chondral Damage ◽  
Group A ◽  
Tönnis Grade

ABSTRACT We aimed to compare clinical and radiologic outcomes in patients with cam-type femoroacetabular impingement (FAI), with and without a partial ligamentum teres (LT) tear, who underwent hip arthroscopy (HA) with ≥10 years of follow-up. Among the patients who underwent HA for a cam-type FAI diagnosis with a labral tear, 28 patients (28 hips) with a partial LT tear and 87 patients (99 hips) with an intact LT were assigned to Groups A and B, respectively. All patients underwent partial labral debridement and femoroplasty. Debridement and thermal shrinkage were performed for LT tears. The grade of chondral damage was measured intraoperatively. Clinical items were assessed preoperatively and at the last follow-up. Patients’ satisfaction with the surgery and changes in postoperative sports ability in those who had previously been active in sports were assessed at the last follow-up. The Tönnis grade was assessed preoperatively and at the last follow-up for radiologic evaluation. Chondral damage to the acetabular and femoral head detected intraoperatively was significantly different between the groups (P = 0.005 and P &lt; 0.001). At the last follow-up, Group A patients experienced more difficulty performing sports activities than Group B patients (P = 0.056), and significantly, more Group A patients had stopped exercising despite their active participation in sports preoperatively (P = 0.002). Regarding the Tönnis grade, significant differences were found only at the final follow-up (P = 0.020). Patients with partial LT tear showed a higher grade of chondral damage, experienced decreased exercise capacity and had significantly worsened Tönnis grades, suggesting hip osteoarthritis progression compared to those with an intact LT.

scholarly journals The effect of taping on maximum plantar pressure and ground reaction force in people with flat foot after applying a fatigue protocol

2021 ◽  
Author(s):  
Fatemeh Aghakeshizadeh ◽  
Amir Letafatkar ◽  
Peyman Aghaei Ataabadi ◽  
Mahdi Hosseinzadeh
Keyword(s):  
Ground Reaction Force ◽  
Plantar Pressure ◽  
Reaction Force ◽  
External Support ◽  
Lateral Side ◽  
Flat Foot ◽  
Fatigue Protocol ◽  
Medial Side ◽  
Significant Difference ◽  
Before And After

Abstract Background: People suffering from flat foot show more movements in hindfoot and midfoot joints as compared to the others. The anti-pronation tapings are supposed to provide temporary external support for the medial longitudinal arch. The aim of this study was to examine the effects of two types of anti-pronation taping on the lower limb kinetics in flat foot people before and after performing a physical fatigue protocol. Methods: 20 male and female with flat foot aged 22.39 ± 2.02 years old were studied under three conditions (untaping, reverse-6 taping and low-dye taping) either before or after fatigue states. The maximum plantar pressure and ground reaction force were measured by an RSscan foot scan system during walking. Results: A statistically significant difference was observed after applying two types of taping (reverse-6 vs. low-dye taping) in the maximum plantar pressure perceived in metatarsus 1 (P = 0.016) and lateral heel (P = 0.044). In the post-fatigue conditions, there were significant differences between the two taping types in metatarsus 4 (P = 0.024). The maximum ground reaction force in toe 1 (P = 0.001), toe 2-5 (P = 0.001), metatarsus 5 (P = 0.001), and medial heel (P = 0.001) was significantly different between reverse-6 and Low-dye tapings. Conclusions: The results indicated that the low-dye and reverse-6 taping types can reduce the pressure on the medial side of the foot, and push it towards the lateral side. It is therefore suggested using taping as an effective treatment for redistribution of the pressure and force in sole of the foot in people with flat foot.

scholarly journals Dysplastic Hip Joint Configuration After Bernese Periacetabular Osteotomy

2021 ◽  
Author(s):  
Kamil Kołodziejczyk ◽  
Adam Czwojdziński ◽  
Andrzej Sionek ◽  
Jarosław Czubak
Keyword(s):  
Surgical Treatment ◽  
Femoral Head ◽  
Normal Distribution ◽  
Hip Joint ◽  
Hip Dysplasia ◽  
Periacetabular Osteotomy ◽  
Hip Joints ◽  
Radiological Parameters ◽  
Significant Difference ◽  
Dysplastic Hip

Abstract Background: Residual hip dysplasia is one of the factors contributing to early hip joint osteoarthritis. The main problems caused by residual dysplasia are pain and instability of the hip joint caused by the lack of sufficient bony covering of the femoral head. The aim of this work was to radiologically assess the configuration change of a dysplastic hip joint after surgical treatment using the Bernese periacetabular osteotomy procedure.Methods: We assessed the radiological parameters of patients with hip dysplasia treated by Bernense periacetabular osteotomy by performing a digital antero-posterior pelvis X-ray: central edge angle and femoral head coverage, medialization, distalization and ilio-ischial angle parameters. For normally distributed parameters, we used Student’s t-test; for parameters without a normal distribution, we used the Wilcoxon signed-rank test. Correlations were assessed according to a normal distribution using the Pearson and Spearman method.Results: For all parameters, we observed statistically significant differences in the measurements of dysplastic hip joints before and after the surgery. We also observed a statistically significant difference between the structure of dysplastic hip joints prior to the surgery and healthy hip joints from the control group based on all radiological parameters. The resulting medialization was 2.68 mm, distalization was 3.65 mm, and the ilio-ischial angle was changed by 2.62°. There was also an improvement in the femoral head bony covering: CEA by 17.61° and FHC by 16.46%.Conclusions: Based on all the radiological parameters, we presented the difference between healthy and dysplastic hip joints. Learning the parameter values that are used to describe dysplastic hip joints will allow us to improve the imaging of the condition and will also allow for better planning and proper qualification of patients for surgical treatment of hip joint dysplasia.Trial registration: Consent of the bioethics commission Medical Centre of Postgraduate Education 83/PB/2015 18.11.2015 Warsaw

scholarly journals A study to compare effects of shoulder position on infraclavicular central venous catheterization in critically ill patients.

2020 ◽  
Vol 27 (10) ◽  
pp. 2216-2222
Author(s):  
Sairah Sadaf ◽  
Babar Bashir
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Lateral Side ◽  
Radiographic Findings ◽  
Medical College ◽  
Skin Puncture ◽  
Venous Catheterization ◽  
Significant Difference ◽  
Group A ◽  
Group B

Objectives: Aim of this study was to compare the effects of two different shoulder positions on infraclavicular subclavian venous catheterization in critically ill patients. Study Design: Prospective Comparative study. Setting: Sheikh Zayed Medical College Rahim Yar Khan Pakistan. Period: 1st July 2017 to 30th June 2018. Material & Methods: Enrolling 100 patients thru convenient sampling, divided into two groups, Group A & Group B, 50 in each group. In group A patients were put in supine position, with head turned to contra lateral side and caudal pull was applied on ipsilateral shoulder. While in group B patients were lying supine, head turned to contra lateral side and shoulders were retracted by placing a small pillow vertically under the chest between the scapulae. In both groups, subclavian vein was approached through infra clavicular route. Number of attempts of venous punctures (1st attempt / 2nd attempt), total time spent on procedure (from 1st skin puncture to CVC insertion), complications (arterial puncture, pneumothorax, hydrothorax, malpositioning), any hemodynamic irregularity (ECG changes), radiographic findings to confirm successful CVC insertion was recorded. Results: Number of successful subclavian venous catheterizations was same in both groups (94% vs. 94%) with no significant difference (p= 1.000). 1st attempt success was more in group A  as compared to group B, though statistically this was not significant (p= 0.275). Total time spent on CVC insertion (from 1st skin puncture to catheter insertion) was less than 05 mints in 84% patient in group A and 82% in group B. While more than 05 mints were spent on 16% vs. 18% patients in group A vs. B. This was also not statistically significant (p=0.790). In group A 2/50 (4%) while in group B 1/50 (2%) cases were recorded as malpositioning on post-CVC radiograph. Other complications were not encountered in either group. Conclusion: Lowered shoulder and retracted shoulder positions are equally effective for SVC insertion in terms of success, 1st attempt success, total time spent and number of complications.

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

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.

scholarly journals Cell technologies in the treatment of femoral head osteonecrosis

2019 ◽  
Vol 15 (4) ◽  
pp. 429-441
Author(s):  
A. E. Murzich ◽  
O. L. Eismont ◽  
J. I. Isaykina ◽  
D. V. Bukach ◽  
R. S. Sirotkin
Keyword(s):  
Bone Marrow ◽  
Femoral Head ◽  
Mononuclear Cells ◽  
Bone Marrow Cells ◽  
Core Decompression ◽  
Autologous Bone Marrow ◽  
X Rays ◽  
Femoral Head Osteonecrosis ◽  
Group A ◽  
Group B

The review of the literature data and our results of surgical treatment of femoral head osteonecrosis in adult patients with the minimally invasive technologies are presented in this article. Using clinical scales, X-rays, MRI, the hip joint condition of 46 patients who underwent “core” decompression in combination with bone plastic (group A, 31 patients) and bone marrow mononuclear cells (group B, 15 patients) were evaluated. The percentage of osteonecrosis progression during the observation period up to 3 years in group A was higher than in group B, where the bone marrow concentrate was used (38.7 and 26.7 %, respectively). The methods of treatment used for femoral head osteonecrosis are not traumatic, have no complications and allow delaying hip replacement. The use of autologous bone marrow cells, in addition to decompression of the necrosis focus, creates the prerequisites for a better outcome of bone regeneration of the necrotic area. 

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