Femoral morphology asymmetry in hip dysplasia makes radiological leg length measurement inaccurate

2019 ◽  
Vol 101-B (3) ◽  
pp. 297-302 ◽  
Author(s):  
K. Tamura ◽  
M. Takao ◽  
H. Hamada ◽  
W. Ando ◽  
T. Sakai ◽  
...  
Keyword(s):  
Developmental Dysplasia ◽  
Absolute Difference ◽  
Control Group ◽  
Leg Length ◽  
Greater Trochanter ◽  
Related Factors ◽  
Unaffected Side ◽  
Femoral Length ◽  
Lesser Trochanter ◽  
Neck Shaft Angle

Aims The aim of this study was to examine whether hips with unilateral osteoarthritis (OA) secondary to developmental dysplasia of the hip (DDH) have significant asymmetry in femoral length, and to determine potential related factors. Patients and Methods We enrolled 90 patients (82 female, eight male) with DDH showing unilateral OA changes, and 43 healthy volunteers (26 female, 17 male) as controls. The mean age was 61.8 years (39 to 93) for the DDH groups, and 71.2 years (57 to 84) for the control group. Using a CT-based coordinate measurement system, we evaluated the following vertical distances: top of the greater trochanter to the knee centre (femoral length GT), most medial prominence of the lesser trochanter to the knee centre (femoral length LT), and top of the greater trochanter to the medial prominence of the lesser trochanter (intertrochanteric distance), along with assessments of femoral neck anteversion and neck shaft angle. Results The percentages of hips with an absolute difference of > 5 mm in femoral GT and LT lengths were significantly larger in the DDH group (24% for both) compared with those of the control group (2% and 7%, respectively). The femoral length GT of the affected femur was significantly shorter in Crowe I and longer in Crowe IV than that of the unaffected side. The affected-to-unaffected difference of the intertrochanteric distance showed positive correlation with that of the femoral length GT in Crowe I and Crowe II/III, and negative correlation with that of the femoral length LT in the Crowe I and Crowe IV groups. Conclusion Hips with unilateral end-stage OA secondary to DDH show significant asymmetry in femoral length between both the greater and lesser trochanter and the knee compared with controls. The intertrochanteric distance was a morphological factor related to femoral-length asymmetry. When undertaking total hip arthroplasty (THA) in the presence of DDH, long leg radiographs or CT measurements should be used to assess true leg-length discrepancy. Cite this article: Bone Joint J 2019;101-B:297–302.

How to equalize the leg length in total hip arthroplasty for patients with unilateral Crowe type IV developmental dysplasia of the hip

2020 ◽  
Author(s):  
Yinqiao Du ◽  
Jingyang Sun ◽  
Haiyang Ma ◽  
Sen Wang ◽  
Ming Ni ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Developmental Dysplasia ◽  
Leg Length ◽  
Greater Trochanter ◽  
Femoral Length ◽  
Total Hip ◽  
Type Iv ◽  
The Mean ◽  
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.

scholarly journals Reverse Wedge Effect Following Intramedullary Nailing of a Basicervical Trochanteric Fracture Variant Combined with a Mechanically Compromised Greater Trochanter

2019 ◽  
Author(s):  
Yu Zhang ◽  
Jun Hu ◽  
Xiaodong Qin ◽  
Xiang Li ◽  
Guqi Hong
Keyword(s):  
Intramedullary Nailing ◽  
Trochanteric Fracture ◽  
Femoral Shaft ◽  
Fracture Line ◽  
Greater Trochanter ◽  
Intraoperative Complication ◽  
Lesser Trochanter ◽  
Neck Shaft Angle ◽  
Mean Width ◽  
The Mean

Abstract Background: To introduce an unreported intraoperative complication in intramedullary nailing (IN) of a trochanteric fracture variant characterized by a basicervical fracture line and coronally disrupted greater trochanter (GT).Materials and Methods : A total of 414 trochanteric fractures (TF) treated with INs from 2013 to 2017 were included. After analysis of intraoperative fluoroscopy, 33 cases, including 21 females and 12 males, with a mean age of 72.5 years (33 to 96 years) were identified for internal rotation of the cephalocervical fragment and inferior opening at the basicervical fracture line caused by nailing a satisfactorily reduced TF. The morphological features of those patients were analyzed on CT scan. On radiograph, the magnitude of the displacement and final femoral neck-shaft angle were measured.Results: CT analysis demonstrated that the basicervical fracture line and the posterolateral fragment (PLF) detached from the GT were the two dominant features of this cohort. They were classified according to the number of main fragments: a 3-fragmentary subgroup containing three consistent fragments (cephalocervical fragment, PLF and distal femoral shaft) and a 4-fragmentary subgroup embracing one additional fragment (lesser trochanter). The four subtypes were as follows: the 3-fragmentary S indicating a small PLF (6 cases), the 3-fragmentary M presenting a moderate PLF (3 cases), the 3-fragmentary L standing for the PLF involving whole lesser trochanter (LT) (4 cases) and the 4-fragmentary GL incorporating separated PLF and LT fragments (20 cases). Geological analysis demonstrated that the majority of the basicervical fracture lines (81.8%) just crossed the center of the piriformis fossa, while the others marginally involved the medial wall of the GT. Postoperatively, the mean width of the inferior opening at the basicervical region was 9.2±4.6 mm. The mean NSA was 135.2±7.8 degrees. The comparison between the 3- and 4-fragmentary subgroups revealed no significant differences in magnitude of displacement and NSA. Conclusion: This unreported intraoperative complication predominantly occurred in the intramedullary nailed basicervical trochanteric fracture variant combined with a PLF from the GT. This secondary displacement was caused by an impingement of the reamer with the superolateral cortex of the cephalocervical fragment and should be addressed during the operation.

scholarly journals Reliability study of measuring leg length discrepancy in patients with total hip arthroplasty using the tip of the greater trochanter

2020 ◽  
Author(s):  
Yufeng Lu ◽  
Xuechao Yuan ◽  
Peng Xu ◽  
Yangquan Hao
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Leg Length Discrepancy ◽  
P Value ◽  
Leg Length ◽  
Greater Trochanter ◽  
P Values ◽  
Lesser Trochanter ◽  
Total Hip ◽  
Length Discrepancy

Abstract Background Although the tip of the greater trochanter is widely used in THA to adjust leg length discrepancy (LLD), its accuracy and reliability are still unknown. The aim of this study was to investigate the reliability of measuring LLD in patients with total hip arthroplasty using the distance from the tip of the greater trochanter to the inter-teardrop line Methods 128 patients who underwent THA in our department with preoperative and postoperative bilateral hips anteroposterior(AP) radiographs were reviewed. The distance between the bilateral anterior superior iliac spine and the medial malleolus (ASIS-MM) was measured before and after the operation. The distances from the vertex of the lesser trochanter to the bi-ischial line(LT-BI), the distance from the vertex of the lesser trochanter to the inter-teardrop line(LT-IT) and the distance from the tip of greater trochanter to the inter-teardrop line(GT-IT) were measured on the bilateral hips AP radiograph preoperatively and postoperatively. Taking X-ray magnification into account when measuring data. Use one-way ANOVA and paired t test to compare the differences between the four methods. The agreements between the four methods was evaluated using Bland-Altman analysis. Results There was no statistical difference between the four methods. Comparing GT-IT with MM-ASIS, ,LT-IT and LT-BI, the preoperative P values were 0.369, 0.581, and 0.402, and the postoperative P values were 0.755, 0.502 and 0.233. Comparing LT-BI with MM-ASIS and LT-IT, the P values were 0.151 and 0.372 preoperatively, and 0.179 and 0.917 postoperatively. Comparing LT-IT with MM-ASIS, the P value was 0.924 before surgery and 0.291 after surgery. Bland-Altman indicated that there were good agreements between GT-IT and LT-IT. Conclusion It is highly reliable to evaluate the LLD of patients with THA by using the difference in the distance between the tip of the greater trochanter and the inter-teardrop line.

scholarly journals The variation of pelvis in unilateral Crowe type IV developmental dysplasia of the hip

2020 ◽  
Author(s):  
Yinqiao Du ◽  
Jingyang Sun ◽  
Haiyang Ma ◽  
Junmin Shen ◽  
Ming Ni ◽  
...  
Keyword(s):  
Iliac Crest ◽  
Ischial Tuberosity ◽  
Developmental Dysplasia ◽  
Leg Length ◽  
Unaffected Side ◽  
Pelvic Morphology ◽  
Type Iv ◽  
The Mean ◽  
Preoperative Plan ◽  
Dysplasia Of The Hip

Abstract BackgroundThe whole pelvic morphology is very common in developmental dysplasia of the hip (DDH). The abnormalities may influence the pelvic landmarks, and then misguide the surgeon’s preoperative plan. The purpose of this study was to investigate the variation of pelvis in unilateral Crowe type IV DDH and analyze the reliability of pelvic landmarks.MethodsWe received preoperative anteroposterior pelvic radiographs examined for 89 adult patients with unilateral Crowe type IV DDH at our institution between September 2008 and May 2019. 48 patients without a false acetabulum was type IVA and 41 with a false acetabulum was type IVB. The heights of the ilium, acetabulum and ischium areas in affected and unaffected sides were measured, the discrepancies of bilateral iliac crest, inferior sacroiliac articulation, teardrop and ischial tuberosity on the bisector of the pelvis were also measured.ResultsThe mean heights of the ilium, acetabulum, ischium areas in the affected side were 74.4 mm, 88.6 mm and 37.0 mm, respectively, in type IVA group and 77.7 mm, 83.5 mm and 37.8 mm, respectively, in type IVB group. The heights in the unaffected side were 82.1 mm, 84.6 mm and 43.8 mm, respectively, in type IVA group and 84.6 mm, 82.0 mm and 44.0 mm, respectively, in type IVB group. The discrepancies of bilateral iliac crest, inferior sacroiliac articulation, teardrop and ischial tuberosity on the line of the bisector of the pelvis were 6.7 mm, 4.4 mm, 2.7 mm and 6.1 mm, respectively.ConclusionsThe pelvic asymmetry was a common occurrence in adults unilateral Crowe type IV DDH. Furthermore, it should be reliable to use teardrop as pelvic landmark to balance leg length discrepancy in preoperative planning.

scholarly journals Posterior Extra-articular Ischiofemoral Impingement Can Be Caused by the Lesser and Greater Trochanter in Patients With Increased Femoral Version: Dynamic 3D CT–Based Hip Impingement Simulation of a Modified FABER Test

2021 ◽  
Vol 9 (5) ◽  
pp. 232596712199062
Author(s):  
Till D. Lerch ◽  
Sébastien Zwingelstein ◽  
Florian Schmaranzer ◽  
Adam Boschung ◽  
Markus S. Hanke ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Ct Scans ◽  
Patient Specific ◽  
Control Group ◽  
3D Ct ◽  
Greater Trochanter ◽  
Lesser Trochanter ◽  
Hip Impingement ◽  
Posterior Impingement ◽  
Femoral Version

Background: Posterior extra-articular hip impingement has been described for valgus hips with increased femoral version (FV). These patients can present clinically with lack of external rotation (ER) and extension and with a positive posterior impingement test. But we do not know the effect of the combination of deformities, and the impingement location in early flexion is unknown. Purpose: To evaluate patient-specific 3-dimensional computed tomography (3D CT) scans of hips with increased FV and control hips for differences in range of motion, location and prevalence of osseous posterior intra- and extra-articular hip impingement. Study Design: Case series; Level of evidence, 4. Methods: Osseous 3D models based on segmentation of 3D CT scans were analyzed for 52 hips (38 symptomatic patients) with positive posterior impingement test and increased FV (>35°). There were 26 hips with an increased McKibbin instability index >70 (unstable hips). Patients were mainly female (96%), with an age range of 18 to 45 years. Of them, 21 hips had isolated increased FV (>35°); 22 hips had increased FV and increased acetabular version (AV; >25°); and 9 valgus hips (caput-collum-diaphyseal angle >139°) had increased FV and increased AV. The control group consisted of 20 hips with normal FV, normal AV, and no valgus (caput-collum-diaphyseal angle <139°). Validated 3D CT–based collision detection software for impingement simulation was used to calculate impingement-free range of motion and location of hip impingement. Surgical treatment was performed after the 3D CT–based impingement simulation in 27 hips (52%). Results: Hips with increased FV had significantly ( P < .001) decreased extension and ER at 90° of flexion as compared with the control group. Posterior impingement was extra-articular (92%) in hips with increased FV. Valgus hips with increased FV and AV had combined intra- and extra-articular impingement. Posterior hip impingement occurred between the ischium and the lesser trochanter at 20° of extension and 20° of ER. Impingement was located between the ischium and the greater trochanter or intertrochanteric area at 20° of flexion and 40° of ER, with a modification of the flexion-abduction-ER (FABER) test. Conclusion: Posterior extra-articular ischiofemoral hip impingement can be caused by the lesser and greater trochanter or the intertrochanteric region. We recommend performing the modified FABER test during clinical examination in addition to the posterior impingement test for female patients with high FV. In addition, 3D CT can help for surgical planning, such as femoral derotation osteotomy and/or hip arthroscopy or resection of the lesser trochanter.

scholarly journals Greater increase in femoral offset with use of collum femoris-preserving stem than Tri-Lock stem in primary total hip arthroplasty

2020 ◽  
Vol 48 (5) ◽  
pp. 030006052092599
Author(s):  
Mengxuan Yao ◽  
Yuchuan Wang ◽  
Congcong Wei ◽  
Yongtai Han ◽  
Huijie Li
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Harris Hip Score ◽  
Leg Length ◽  
Femoral Offset ◽  
Unaffected Side ◽  
Neck Shaft Angle ◽  
Total Hip ◽  
Stem Group

Objective This study was performed to compare the clinical outcomes and performance of the collum femoris-preserving (CFP) stem (Waldemar Link GmbH & Co., Hamburg, Germany) and the Tri-Lock stem (DePuy Orthopaedics, Warsaw, IN, USA) in terms of femoral offset (FO) and leg length reconstruction. Methods Clinical and radiographic data of patients who underwent total hip arthroplasty with either a CFP stem or Tri-Lock stem from January 2016 to March 2017 were compared (65 and 57 patients, respectively). The Harris hip score and Western Ontario and McMaster Universities Osteoarthritis Index were recorded. The FO, femoral vertical offset, and neck–shaft angle were measured at the last follow-up. The occurrence of dislocation and periprosthetic fracture during the follow-up period was recorded. Results The CFP stem induced significantly more FO than did the Tri-Lock stem on the operated side than contralateral side (3.63 ± 4.28 vs. 0.83 ± 5.46 mm). Significantly fewer patients had a >5-mm decrease in FO on the unaffected side in the CFP stem group ( n = 1) than Tri-Lock stem group ( n = 10). Conclusion Both stems similarly improved hip function and reconstructed the leg length, but the CFP stem was superior to the Tri-Lock stem in reconstructing FO.

scholarly journals Calculation method to predict postoperative limb length in patients undergoing THA following developmental dysplasia of hips

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Renwen Guo ◽  
Jerry Yongqiang Chen ◽  
Guoqiang Zhang ◽  
Yonggang Zhou ◽  
Jiying Chen ◽  
...  
Keyword(s):  
Calculation Method ◽  
Intraclass Correlation ◽  
Limb Length Discrepancy ◽  
Developmental Dysplasia ◽  
Lower Limbs ◽  
Limb Length ◽  
Absolute Difference ◽  
Lesser Trochanter ◽  
Tibial Plafond ◽  
Two Parameters

Abstract Background Limb length discrepancy (LLD) is one of the main cause of dissatisfaction after total hip arthroplasty (THA). The teardrop-lesser trochanter method can accurately predict and analyze LLD for healthy people. However, for patients with preoperative LLD, no method for predicting postoperative LLD is currently available, and these patients are highly susceptible to more severe LLD after THA. Accordingly, this study proposed a calculation method to predict postoperative limb length for these patients. Methods Eighty patients who underwent THA between May 2016 and October 2018 due to unilateral developmental dysplasia of the hip (DDH) were evaluated. Relevant parameters were measured from radiographs of full-length lower limbs, e.g. the distance between the rotation center of the hip and the midpoint of the tibial plafond and the distance between the point which was marked at the same height as the lesser trochanter on the anatomical long axis of the femur and the midpoint of the tibial plafond. Then, a mathematical model was established by simplifying the structure from the hip to the ankle. The relationship between the placement position of the prosthesis and the LLD value was calculated by Law of Sines and Iterative Calculation. Results The preoperatively predicted LLD values and the postoperatively measured LLD values were compared, yielding a mean absolute difference of 3.7 (range, 0.1 to 8.6) mm. The intraclass correlation coefficient (ICC) of the two parameters exhibited strong reliability (ICC = 0.911, 95%CI, 0.795 to 0.955). The Bland-Altman plot also showed good conformity between the two parameters. Conclusions The proposed calculation method effectively predicted the postoperative LLD using preoperative parameters. Despite the complexity of the method, it can go a long way towards reducing the occurrence of severe postoperative LLD in DDH-THA.

scholarly journals Reverse Wedge Effect Following Intramedullary Nailing of a Basicervical Trochanteric Fracture Variant Combined with a Mechanically Compromised Greater Trochanter

2020 ◽  
Author(s):  
Yu Zhang ◽  
Jun Hu ◽  
Xiaodong Qin ◽  
Xiang Li ◽  
Guqi Hong
Keyword(s):  
Intramedullary Nailing ◽  
Trochanteric Fracture ◽  
Fracture Line ◽  
Greater Trochanter ◽  
Intraoperative Complication ◽  
Lesser Trochanter ◽  
Neck Shaft Angle ◽  
Mean Width ◽  
Secondary Displacement ◽  
The Mean

Abstract Background: To introduce an unreported intraoperative complication in intramedullary nailing (IN) of an anatomically reduced trochanteric fracture variant characterized by a basicervical fracture line and coronally disrupted greater trochanter (GT). Materials and Methods: A total of 414 trochanteric fractures (TF) treated with intramedullary nails from 2013 to 2017 were included in this study. After analysis of intraoperative fluoroscopy data, 33 cases, including 21 females and 12 males, with a mean age of 72.5 years (33 to 96 years) were identified for internal rotation of the cephalocervical fragment and inferior opening at the basicervical fracture line caused by nailing a satisfactorily reduced TF. The morphological features of this group of patients were analyzed on computed tomography (CT) scan. On radiograph, the magnitude of the displacement and final femoral neck-shaft angle (NSA) were measured.Results: CT analysis demonstrated that the basicervical fracture line and the posterolateral fragment (PLF) detached from the GT were the two dominant features of this cohort. They were classified according to the number of main fragments: a 3-fragmentary subgroup containing three consistent fragments (cephalocervical fragment, PLF and distal femoral shaft) and a 4-fragmentary subgroup embracing one additional fragment (lesser trochanter). The four subtypes were as follows: the 3-fragmentary S indicating a small PLF (6 cases), the 3-fragmentary M presenting a moderate PLF (3 cases), the 3-fragmentary L standing for the PLF involving whole lesser trochanter (LT) (4 cases) and the 4-fragmentary GL incorporating separated PLF and LT fragments (20 cases). Geological analysis demonstrated that the majority of the basicervical fracture lines (81.8%) just crossed the center of the piriformis fossa, while the others marginally involved the medial wall of the GT. Postoperatively, the mean width of the inferior opening at the basicervical region was 9.2±4.6 mm. The mean NSA was 135.2±7.8 degrees. The comparison between the 3- and 4-fragmentary subgroups revealed no significant differences in magnitude of displacement and NSA.Conclusion: This unreported intraoperative complication predominantly occurred in the intramedullary nailed basicervical trochanteric fracture variant combined with a PLF from the GT. The magnitude of the secondary displacement was substantial and resulted in a relative valgus reduction. This secondary displacement was caused by an impingement of the reamer with the superolateral cortex of the cephalocervical fragment and should be addressed during the operation. Level of Evidence: Therapy IV

scholarly journals Conventional Cementless Total Hip Arthroplasty for Hip Osteoarthritis after Distal Trochanteric Transfer: A Report of Two Cases

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Hirohito Hirata ◽  
Motoki Sonohata ◽  
Akira Hashimoto ◽  
Sakumo Kii ◽  
Takema Nakashima ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Hip Osteoarthritis ◽  
Gluteus Medius ◽  
Developmental Dysplasia ◽  
Leg Length ◽  
Greater Trochanter ◽  
Total Hip ◽  
Cementless Components ◽  
Dysplasia Of The Hip

Distal trochanteric transfer (DTT) has been widely performed to treat developmental dysplasia of the hip or Perthes disease. Total hip arthroplasty (THA) following DTT in patients with hip osteoarthritis is one of the most challenging procedures for hip surgeons, because great care must be taken regarding anatomical abnormalities of the greater trochanter and the soft tissue attached to the greater trochanter. To the best of our knowledge, there are no reports on THA after DTT. We herein report two cases of patients who underwent THA post DTT using cementless components. After THA, both patients developed abduction temporary contraction because of leg length extension and gluteus medius hypertension. However, in both cases, the contraction was reversible within two months and the final clinical result was good. Therefore, THA can be considered an effective and safe choice for treating osteoarthritis after DTT.

RELATED FACTORS TO RELAPSE IN DEPRESSED PATIENTS AFTER COGNITIVE BEHAVIOURAL THERAPY DURING ONE YEAR PROSPECTIVE FOLLOW-UP

2011 ◽  
pp. 13-19
Author(s):  
Nhu Minh Hang Tran ◽  
Huu Cat Nguyen ◽  
Dang Doanh Nguyen ◽  
Van Luong Ngo ◽  
Vu Hoang Nguyen ◽  
...  
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Relapse Rate ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Control Group ◽  
Controlled Clinical Trial ◽  
Related Factors ◽  
Depressed Patients ◽  
One Year

Objectives: To determine factors impact on the relapse in depressed patients treated with Cognitive Behavioral Therapy (CBT) during one year follow-up. Materials and Methods: 80 depressed patients divided into two groups, group 1: included 40 patients treated with CBT; group 2: 40 patients on amitriptyline. Non-randomized controlled clinical trial, opened, longiditual and prospective research. Results and Conclusions: relapse rate after CBT during 1 year follow-up is 10% (compared to 25% in control group), related factors to relapse rate in depression after CBT are age and education. Shared predictors between 2 groups are severity and recurrence of depression. Key words: Depression, relapse, Cognitive Behavioral Therapy (CBT)

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