scholarly journals Correlations and Reproducibility Between Radiographic and Radial Alpha Angles in the Evaluation of Cam Morphology

2020 ◽  
Vol 8 (7) ◽  
pp. 232596712093292
Author(s):  
Naomi Kobayashi ◽  
Kosuke Sumi ◽  
Shota Higashihira ◽  
Hyonmin Choe ◽  
Taro Tezuka ◽  
...  
Keyword(s):  
Alpha Angle ◽  
Developmental Dysplasia ◽  
Lateral View ◽  
Level Of Evidence ◽  
3 Dimensional ◽  
Recent Developments ◽  
The Cross ◽  
Magnetic Resonance Imaging Mri ◽  
Cam Morphology ◽  
Dysplasia Of The Hip

Background: The alpha angle used to evaluate cam morphology can be determined on different imaging views; however, 2-dimensional (2D) imaging can present limitations in terms of the reproducibility of the radial alpha angle. Recent developments in 3-dimensional (3D) high-resolution magnetic resonance imaging (MRI) have allowed detailed evaluations of the radial alpha angle. Purpose: To determine whether there are any correlations or discrepancies between the 2D alpha angle on plain radiography and the maximum radial alpha angle on 3D MRI. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: A total of 42 hips from 39 patients (19 males, 20 females) were analyzed, including 22 hips with femoroacetabular impingement (FAI; mean age, 41 years) and 20 hips with borderline developmental dysplasia of the hip (BDDH; mean age, 43 years). Radial images were reconstructed from 3D multiple echo recombined gradient echo (MERGE) MRI. Differences in the maximum radial alpha angle on MRI between hips with FAI and BDDH were evaluated. Correlations and discrepancies between the maximum radial alpha angle on MRI and alpha angles on the anteroposterior, cross-table lateral, and 45° Dunn views of radiography were also evaluated. Results: The maximum radial alpha angle was significantly higher for hips with FAI than for hips with BDDH. On average, the greatest alpha angle on radial MRI was higher than the alpha angle on each of the 3 radiographic views for both FAI and BDDH. The 45° Dunn view revealed the smallest discrepancy for both FAI ( P = .005) and BDDH ( P = .002). The cross-table lateral view had the highest correlation with the maximum radial alpha angle for BDDH ( P < .001). Conclusion: We reconfirmed the utility of the 45° Dunn view, with it presenting the best reproducibility for the maximum radial alpha angle in the evaluation of cam morphology, while the cross-table lateral view revealed the best correlation with the maximum radial alpha angle, particularly for hips with BDDH.

scholarly journals Should paediatricians initiate orthopaedic hip dysplasia referrals for infants with isolated asymmetric skin folds?

2019 ◽  
Vol 13 (6) ◽  
pp. 593-599 ◽  
Author(s):  
C. R. Louer ◽  
J. D. Bomar ◽  
M. E. Pring ◽  
S. J. Mubarak ◽  
V. V. Upasani ◽  
...  
Keyword(s):  
Alpha Angle ◽  
Developmental Dysplasia ◽  
Clinical Environment ◽  
Single Institution ◽  
Level Of Evidence ◽  
Radiographic Findings ◽  
Mild Dysplasia ◽  
Paediatric Practice ◽  
Patient Referrals ◽  
Dysplasia Of The Hip

Purpose Asymmetric skin folds (ASFs) have been linked to developmental dysplasia of the hip (DDH) in select studies, leading to their inclusion in paediatric practice guidelines regarding orthopaedic referral for hip evaluation. The purpose of this study was to investigate the utility of isolated ASFs as a screening tool for DDH in a series of patient referrals evaluated at a single institution. Methods We performed a retrospective review of consecutive patients between 0 and 12 months of age referred to orthopaedic clinics for isolated ASFs. We recorded radiographic findings (acetabular inclination or alpha angle), diagnosis rendered and treatment administered. Results A total of 66 patients were included (mean age 6.4 months; 2.47 to 10.76). All patients received pelvic radiographs or ultrasound. In all, 36 patients (55%) were considered normal by their treating physician and 25 (38%) were considered dysplastic and underwent brace treatment. One hip with an isolated ASF was found to have a dislocated hip on radiograph prior to their initial orthopaedic visit. None of the patients in this study have required surgery to date. Conclusion Using ASFs as a reason for referral led to increased diagnosis of mild dysplasia resulting in orthotic treatment. Thus, in our particular clinical environment, isolated ASFs can be an indicator of mild dysplasia and warrant further workup or referral. Because treatment philosophies regarding recognition and treatment of mild dysplasia vary amongst centres, the value of screening with ASFs likewise depends on the treating orthopaedic surgeon’s threshold for treatment of mild dysplasia. Level of evidence Level IV- Retrospective

scholarly journals Prevalence of trochlear dysplasia in infants evaluated for developmental dysplasia of the hip

2021 ◽  
pp. 1-6
Author(s):  
Clarabelle A. DeVries ◽  
Peter Hahn ◽  
James D. Bomar ◽  
Vidyadhar V. Upasani ◽  
Andrew T. Pennock
Keyword(s):  
Trochlear Dysplasia ◽  
Alpha Angle ◽  
Developmental Dysplasia ◽  
Ultrasound Screening ◽  
Level Of Evidence ◽  
Sulcus Angle ◽  
Entire Cohort ◽  
Potential Risk Factors ◽  
Dysplasia Of The Hip ◽  
Dysplastic Hip

Purpose The purpose of this study was to define the incidence of trochlear dysplasia in an infant cohort being screened for developmental dysplasia of the hip (DDH). Methods Newborns screened for DDH that were evaluated with ultrasound for the presence of trochlear dysplasia were retrospectively reviewed. The sulcus angle and trochlear depth were measured. Based on previous work, trochlear dysplasia was defined as a sulcus angle of > 159°. Our newborn cohort was then analyzed to identify potential risk factors for trochlear dysplasia. Results A total of 383 knees in 196 infants were studied. In total, 52% were referred for breech intrauterine positioning and 21% were ultimately diagnosed with DDH and had treatment initiated with a Pavlik harness. Of the entire cohort, 8% of knees were deemed to have trochlear dysplasia. Breech patients were found to have a flatter sulcus angle than those that were not breech (149.5° (sd 7.2°) versus 147.9° (sd 7.5°); p = 0.028). Similarly, a shallower trochlear depth was identified in breech patients versus non-breech patients (1.6 mm (sd 0.4) versus 1.8 mm (sd 0.4); p = 0.019). Those with trochlear dysplasia (as defined by sulcus angle > 159°) did show a smaller alpha angle (i.e. more dysplastic hip) as compared with those without trochlear dysplasia (59.2° (sd 10.2°) versus 65.9° (sd 7.5°); p < 0.001). Hips with DDH were 2.4-times more likely to have knees with trochlear dysplasia (95% confidence interval 1.1 to 5.3). Conclusion Ultrasound screening of newborn knees reveals that trochlear dysplasia is relatively common in breech babies with DDH. Level of Evidence III

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.

scholarly journals The potential role of the Alsberg angle as a predictor of lateral growth disturbance of the capital femoral epiphysis in children with developmental dysplasia of the hip treated by closed reduction

2020 ◽  
Vol 14 (2) ◽  
pp. 106-111 ◽  
Author(s):  
Ronghua Gui ◽  
Federico Canavese ◽  
Shuang Liu ◽  
Lianyong Li ◽  
Lijun Zhang ◽  
...  
Keyword(s):  
Closed Reduction ◽  
Normal Values ◽  
Developmental Dysplasia ◽  
Lateral Growth ◽  
Growth Disturbance ◽  
Level Of Evidence ◽  
Normal Children ◽  
One Year ◽  
Dysplasia Of The Hip

Purpose Early diagnosis and prevention of lateral growth disturbance of the capital femoral epiphysis is challenging after treatment for developmental dysplasia of the hip (DDH). The aim of the study was to evaluate the radiographic changes of the Alsberg angle (AA) in normal children and those with DDH, and to assess the role of AA as a potential predictor of lateral growth disturbance of the capital femoral epiphysis. Methods AA was measured on the anterior-posterior pelvic radiographs of 1000 normal children ranging in age from one to ten years and in 66 children (92 hips) with DDH treated by closed reduction (CR). A comparative analysis was performed. Results In the normal children, mean AA decreased linearly with age, from 76° at age one year to 65° at age ten years, irrespective of gender and laterality. In children with DDH, the average AA was 81.5°(sd 3.9°; 74° to 87°) prior to CR; it was 75.9° (sd 4.5°; 68° to 83°) in normal children of the same age (p < 0.001). Among the 42 children (64 hips) with successfully and uneventfully treated DDH, AA reached normal values between the ages of five and six years. In contrast, children with lateral growth disturbance of the proximal femur physis (24 children, 28 hips) showed significantly higher AA values in comparison with the age-matched controls. Conclusion In DDH patients with successful CR, AA could be expected to match normal values in children between the ages of five and six years. On the other hand, AA can be used as an early predictor for lateral growth disturbance of the capital femoral epiphysis. Level of Evidence Level III

scholarly journals Segmental uncoverage ratio analysis of Crowe type-IV developmental dysplasia of the hip via 3-dimensional implantation simulation

Arthroplasty ◽  
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

scholarly journals The lateral edge and sourcil acetabular indices for surgical decision-making in developmental dysplasia of the hip

2020 ◽  
Vol 14 (6) ◽  
pp. 513-520
Author(s):  
Alpesh Kothari ◽  
Saqib Noor ◽  
Connor L. Maddock ◽  
Jan H. H. Vanderstappen ◽  
Catharine S. Bradley ◽  
...  
Keyword(s):  
Decision Making ◽  
Acetabular Dysplasia ◽  
Developmental Dysplasia ◽  
Poor Agreement ◽  
Level Of Evidence ◽  
Surgical Decision ◽  
Lateral Edge ◽  
Surgical Decision Making ◽  
Dysplasia Of The Hip ◽  
Level Of Agreement

Purpose The acetabular index (AI) is a radiographic measure that guides surgical decision-making in developmental dysplasia of the hip (DDH). Two AI measurement methods are described; to the lateral edge of the acetabulum (AI-L) and to the lateral edge of the sourcil (AI-S). The purpose of this study was to determine the level of agreement between AI-L and AI-S on the diagnosis and degree of acetabular dysplasia in DDH. Methods A total of 35 patients treated for DDH with Pavlik harness were identified. The AI-L and AI-S were measured on radiographs (70 hips) at two and five years of age. AI-L and AI-S were then transformed relative to published normative data (tAI-L and tAI-S). Bland-Altman plots, linear regression and heat mapping were used to evaluate the agreement between tAI-L and tAI-S. Results There was poor agreement between tAI-S and tAI-L on the Bland-Altman plots with wide limits of agreement and no proportional bias. The two AI measurements were in agreement as to the presence and severity of dysplasia in only 63% of hips at two years of age and 81% at five years of age, leaving the remaining hips classified as various combinations of normal, mildly and severely dysplastic. Conclusion AI-L and AI-S have poor agreement on the presence or degree of acetabular dysplasia in DDH and cannot be used interchangeably. Clinicians are cautioned to prudently evaluate both measures of AI in surgical decision-making. Level of evidence I

scholarly journals Does the vascular development of the femoral head correlate with the incidence of avascular necrosis of the proximal femoral epiphysis in children with developmental dysplasia of the hip treated by closed reduction?

2021 ◽  
pp. 1-7
Author(s):  
JianPing Wu ◽  
Zhe Yuan ◽  
JingChun Li ◽  
MingWei Zhu ◽  
Federico Canavese ◽  
...  
Keyword(s):  
Femoral Head ◽  
Avascular Necrosis ◽  
Closed Reduction ◽  
Vascular Development ◽  
Contralateral Side ◽  
Developmental Dysplasia ◽  
Level Of Evidence ◽  
Class B ◽  
Class C ◽  
Dysplasia Of The Hip

Purpose The purpose of this study was to identify the correlation between the vascular development of the femoral head and avascular necrosis (AVN) in patients with developmental dysplasia of the hip (DDH) treated by closed reduction (CR). Methods We retrospectively reviewed 78 patients with DDH treated by CR (83 hips). The vascular maturity, number of vessels and perfusion changes of the femoral head were assessed on perfusion MRI (pMRI) before and after CR. Results The number of vessels (mean 4.2 sd 1.4) of the femoral head and the ratio (36.1%) of mature vessels (type III) on the dislocated side were significantly less than those at contralateral side (mean 6.0 sd 1.2; 82.2%) (p < 0.001). Of the included 83 hips, 39 hips (61.5%) showed decreased perfusion of the femoral head, including partial decreased (Class B, 47.0%) and global decreased (Class C, 14.5%), at the dislocated side, which was significantly more than those at contralateral side (0.0%) (p < 0.001). In total, 32 out of 83 hips (38.5%) developed AVN. The rate of AVN with Class A (18.8%) which perfusion of the femoral head was normal (unchanged or enhanced) was significantly less than those with Class C (66.7%) (p = 0.006). Conclusion The vascular development and perfusion changes of the femoral head on the dislocated side are significantly worse than those at contralateral side. Immature vascularity of the femoral head before CR and poor perfusion of the femoral head after CR may be risk factors for AVN in patients with DDH. Level of evidence III

scholarly journals Universal or selective ultrasound screening for developmental dysplasia of the hip? A discussion of the key issues

2018 ◽  
Vol 12 (4) ◽  
pp. 296-301 ◽  
Author(s):  
R. Biedermann ◽  
D. M. Eastwood
Keyword(s):  
Late Presentation ◽  
Developmental Dysplasia ◽  
Ultrasound Screening ◽  
Reduction Techniques ◽  
Alternative Outcome ◽  
Operation Rate ◽  
Hip Abduction ◽  
Recent Developments ◽  
Zero Rate ◽  
Dysplasia Of The Hip

Purpose To summarize recent developments and provide recommendations as to whether universal or selective programmes are advisable. Methods A literature review was performed and preference given to studies with higher levels of evidence. All programmes reviewed included clinical screening. Results Recent studies underline the need for high quality screening programmes to promote the early detection of developmental dysplasia of the hip (DDH). A small number of cases may be missed clinically but with universal ultrasound screening programmes the late presentation rates appear to be virtually zero. Contemporary studies show treatment rates with universal screening programmes which are now lower than those with selective ultrasound. There is little agreement over the criteria used for selective programmes. Alternative outcome measures, such as the first operation rate or the percentage undergoing major (open) surgery are both lowest with universal ultrasound screening programmes. Furthermore, a significant reduction in the rate of surgery for DDH later in life was seen after the introduction of universal ultrasound screening, whereas the defined criteria for selective screening may not detect the majority of patients who require late surgery. Abduction bracing with modern orthoses is associated with a zero rate of avascular necrosis (AVN), whereas closed reduction techniques have an overall risk of 10%. Conclusion On clinical grounds, if future studies confirm that hip abduction in flexible orthoses is not associated with AVN, it may be time for a paradigm shift of screening for DDH towards a universal ultrasound protocol. The costs associated both with each type of screening programme and with the management of late presenting cases are also important but may be secondary to clinical benefit.

scholarly journals Dega pelvic osteotomy: indications, results and complications

2018 ◽  
Vol 12 (4) ◽  
pp. 342-348 ◽  
Author(s):  
J. Czubak ◽  
K. Kowalik ◽  
A. Kawalec ◽  
M. Kwiatkowska
Keyword(s):  
Femoral Head ◽  
Open Reduction ◽  
Age Groups ◽  
Pelvic Osteotomy ◽  
Developmental Dysplasia ◽  
Femoral Osteotomy ◽  
Complication Rates ◽  
Level Of Evidence ◽  
Significant Difference ◽  
Dysplasia Of The Hip

Purpose Developmental dysplasia of the hip (DDH) after walking age is difficult to treat. Dega pelvic osteotomy is combined with open reduction and femoral osteotomy to obtain concentric stable reduction with good coverage of the femoral head. The purpose of this study is to evaluate the use of the Dega osteotomy in the treatment of DDH in two different age groups. Methods A total of 45 patients (52 hips) with a mean age of 3.9 years (1.2 to 12.8) were treated with open reduction, Dega osteotomy and femoral osteotomy. There were 38 dislocated and 14 subluxated hips. Bilateral DDH was observed in seven female patients. Radiographic parameters included acetabular index, centre-edge angle of Wiberg and migration percentage. The final radiographic outcome was evaluated according to the Severin classification. Results The mean follow-up period was four years (3 to 9). According to the Severin criteria 78.8% were types I or II whereas 21.2% showed types III or IV. There was no statistically significant difference in final outcome between children less than three years of age and older children at the time of surgery. One hip in children with unilateral involvement had developed coxa magna, that interfered with hip concentricity. Three hips (5.8%) showed avascular necrosis of the femoral head. Conclusion Dega osteotomy is a safe and adequate procedure for the management of developmental dysplasia of the hip in walking patients with low complication rates. Restoring the acetabulum to normal or nearly normal can result in good medium-term results. Level of Evidence III

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