scholarly journals Contact Pressure Distribution of the Hip Joint During Closed Reduction of Developmental Dysplasia of the Hip

2020 ◽  
Author(s):  
Zhiqiang Zhang ◽  
Hai Li ◽  
Dashan Sui ◽  
Haiyi Qin ◽  
Ziming Zhang
Keyword(s):  
Finite Element ◽  
Femoral Head ◽  
Avascular Necrosis ◽  
Contact Pressure ◽  
Closed Reduction ◽  
Treatment Success ◽  
Developmental Dysplasia ◽  
Abduction Angle ◽  
Lateral Part ◽  
Dysplasia Of The Hip

Abstract Background: Developmental dysplasia of the hip (DDH) is the most common deformity of the lower extremity in children, and the etiology remains unclear. The biomechanical change during closed reduction (CR) focused on cartilage contact pressure (CCP) has not been studied. Thereby, we try to provide insight into biomechanical factors potentially responsible for CR treatment success and complications by using finite element analysis (FEA) for the first time.Methods: Finite element models of one patient with DDH were established based on the data of MRI scan on which cartilage contact pressure was measured. During CR, CCP between the femoral head and acetabulum in different abduction and flexion angles were tested to estimate the efficacy and potential risk factors of avascular necrosis (AVN) following CR.Results: A 3D reconstruction by the FEA method was performed on a sixteen-month-old girl with DDH on the right side. The acetabulum of the involved side showed a long, narrow, and "plate-shaped" deformity, whereas the femoral head was smaller and irregular compared with the contralateral side. With increased abduction angle, the stress of the posterior acetabulum increased significantly, and the stress on the lateral part of the femoral head increased as well. The changes of CCP in the superior acetabulum were not apparent during CR. There were no detectable differences in terms of pressure on the femoral head.Conclusions: Severe dislocation (IHDI grade III and IV) in children showed a high mismatch between the femoral head and acetabulum. Increased abduction angle corresponded with high contact pressure, which might relate to avascular necrosis, whereas increased flexion angle was not. Enhanced pressure on the lateral part of the femoral head might increase the risk of AVN.

scholarly journals Contact pressure distribution of the hip joint during closed reduction of developmental dysplasia of the hip: a patient-specific finite element analysis

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Zhiqiang Zhang ◽  
Dashan Sui ◽  
Haiyi Qin ◽  
Hai Li ◽  
Ziming Zhang
Keyword(s):  
Finite Element Analysis ◽  
Finite Element ◽  
Femoral Head ◽  
Contact Pressure ◽  
Closed Reduction ◽  
Developmental Dysplasia ◽  
Abduction Angle ◽  
Lateral Part ◽  
Element Analysis ◽  
Dysplasia Of The Hip

Abstract Background Developmental dysplasia of the hip (DDH) is the most common deformity of the lower extremity in children. The biomechanical change during closed reduction (CR) focused on cartilage contact pressure (CCP) has not been studied. Thereby, we try to provide insight into biomechanical factors potentially responsible for the success of CR treatment sand complications by using finite element analysis (FEA) for the first time. Methods Finite element models of one patient with DDH were established based on the data of MRI scan on which cartilage contact pressure was measured. During CR, CCP between the femoral head and acetabulum in different abduction and flexion angles were tested to estimate the efficacy and potential risk factors of avascular necrosis (AVN) following CR. Results A 3D reconstruction by the FEA method was performed on a 16 months of age girl with DDH on the right side. The acetabulum of the involved side showed a long, narrow, and “flat-shaped” deformity, whereas the femoral head was smaller and irregular compared with the contralateral side. With increased abduction angle, the stress of the posterior acetabulum increased significantly, and the stress on the lateral part of the femoral head increased as well. The changes of CCP in the superior acetabulum were not apparent during CR. There were no detectable differences in terms of pressure on the femoral head. Conclusions Severe dislocation (IHDI grade III and IV) in children showed a high mismatch between the femoral head and acetabulum. Increased abduction angle corresponded with high contact pressure, which might relate to AVN, whereas increased flexion angle was not. Enhanced pressure on the lateral part of the femoral head might increase the risk of AVN.

scholarly journals Contact pressure distribution of the hip joint during closed reduction of developmental dysplasia of the hip: A Patient-Specific Finite Element Analysis

2020 ◽  
Author(s):  
Zhiqiang Zhang ◽  
Hai Li ◽  
Dashan Sui ◽  
Haiyi Qin ◽  
Ziming Zhang
Keyword(s):  
Finite Element Analysis ◽  
Finite Element ◽  
Femoral Head ◽  
Contact Pressure ◽  
Closed Reduction ◽  
Developmental Dysplasia ◽  
Abduction Angle ◽  
Lateral Part ◽  
Element Analysis ◽  
Dysplasia Of The Hip

Abstract Background: Developmental dysplasia of the hip (DDH) is the most common deformity of the lower extremity in children. The biomechanical change during closed reduction (CR) focused on cartilage contact pressure (CCP) has not been studied. Thereby, we try to provide insight into biomechanical factors potentially responsible for the success of CR treatment sand complications by using finite element analysis (FEA) for the first time.Methods: Finite element models of one patient with DDH were established based on the data of MRI scan on which cartilage contact pressure was measured. During CR, CCP between the femoral head and acetabulum in different abduction and flexion angles were tested to estimate the efficacy and potential risk factors of avascular necrosis (AVN) following CR.Results: A 3D reconstruction by the FEA method was performed on a sixteen months of age girl with DDH on the right side. The acetabulum of the involved side showed a long, narrow, and "flat-shaped" deformity, whereas the femoral head was smaller and irregular compared with the contralateral side. With increased abduction angle, the stress of the posterior acetabulum increased significantly, and the stress on the lateral part of the femoral head increased as well. The changes of CCP in the superior acetabulum were not apparent during CR. There were no detectable differences in terms of pressure on the femoral head.Conclusions: Severe dislocation (IHDI grade III and IV) in children showed a high mismatch between the femoral head and acetabulum. Increased abduction angle corresponded with high contact pressure, which might relate to AVN, whereas increased flexion angle was not. Enhanced pressure on the lateral part of the femoral head might increase the risk of AVN.

scholarly journals Contact pressure distribution of the hip joint during closed reduction of developmental dysplasia of the hip: A Patient-Specific Finite Element Analysis

2020 ◽  
Author(s):  
Zhiqiang Zhang ◽  
Hai Li ◽  
Dashan Sui ◽  
Haiyi Qin ◽  
Ziming Zhang
Keyword(s):  
Finite Element Analysis ◽  
Finite Element ◽  
Femoral Head ◽  
Contact Pressure ◽  
Closed Reduction ◽  
Developmental Dysplasia ◽  
Abduction Angle ◽  
Lateral Part ◽  
Element Analysis ◽  
Dysplasia Of The Hip

Abstract Background Developmental dysplasia of the hip (DDH) is the most common deformity of the lower extremity in children, and the etiology remains unclear. The biomechanical change during closed reduction (CR) focused on cartilage contact pressure (CCP) has not been studied. Thereby, we try to provide insight into biomechanical factors potentially responsible for CR treatment success and complications by using finite element analysis (FEA) for the first time. Methods Finite element models of one patient with DDH were established based on the data of MRI scan on which cartilage contact pressure was measured. During CR, CCP between the femoral head and acetabulum in different abduction and flexion angles were tested to estimate the efficacy and potential risk factors of avascular necrosis (AVN) following CR. Results A 3D reconstruction by the FEA method was performed on a sixteen-month-old girl with DDH on the right side. The acetabulum of the involved side showed a long, narrow, and "plate-shaped" deformity, whereas the femoral head was smaller and irregular compared with the contralateral side. With increased abduction angle, the stress of the posterior acetabulum increased significantly, and the stress on the lateral part of the femoral head increased as well. The changes of CCP in the superior acetabulum were not apparent during CR. There were no detectable differences in terms of pressure on the femoral head. Conclusions Severe dislocation (IHDI grade III and IV) in children showed a high mismatch between the femoral head and acetabulum. Increased abduction angle corresponded with high contact pressure, which might relate to avascular necrosis, whereas increased flexion angle was not. Enhanced pressure on the lateral part of the femoral head might increase the risk of AVN.

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

Hip Joint Contact Pressure Distribution During Pavlik Harness Treatment of an Infant Hip: A Patient-Specific Finite Element Model

2018 ◽  
Vol 140 (7) ◽  
Author(s):  
Behzad Vafaeian ◽  
Samer Adeeb ◽  
Marwan El-Rich ◽  
Dornoosh Zonoobi ◽  
Abhilash R. Hareendranathan ◽  
...  
Keyword(s):  
Finite Element ◽  
Femoral Head ◽  
Contact Pressure ◽  
Treatment Success ◽  
Element Model ◽  
Developmental Dysplasia ◽  
Patient Specific ◽  
Pavlik Harness ◽  
Excessive Pressure ◽  
Joint Contact Pressure

Developmental dysplasia of the hip (DDH) in infants under 6 months of age is typically treated by the Pavlik harness (PH). During successful PH treatment, a subluxed/dislocated hip is spontaneously reduced into the acetabulum, and DDH undergoes self-correction. PH treatment may fail due to avascular necrosis (AVN) of the femoral head. An improved understanding of mechanical factors accounting for the success/failure of PH treatment may arise from investigating articular cartilage contact pressure (CCP) within a hip during treatment. In this study, CCP in a cartilaginous infant hip was investigated through patient-specific finite element (FE) modeling. We simulated CCP of the hip equilibrated at 90 deg flexion at abduction angles of 40 deg, 60 deg, and 80 deg. We found that CCP was predominantly distributed on the anterior and posterior acetabulum, leaving the superior acetabulum (mainly superolateral) unloaded. From a mechanobiological perspective, hypothesizing that excessive pressure inhibits growth, our results qualitatively predicted increased obliquity and deepening of the acetabulum under such CCP distribution. This is the desired and observed therapeutic effect in successful PH treatment. The results also demonstrated increase in CCP as abduction increased. In particular, the simulation predicted large magnitude and concentrated CCP on the posterior wall of the acetabulum and the adjacent lateral femoral head at extreme abduction (80 deg). This CCP on lateral femoral head may reduce blood flow in femoral head vessels and contribute to AVN. Hence, this study provides insight into biomechanical factors potentially responsible for PH treatment success and complications.

scholarly journals Effect of abduction on avascular necrosis of the femoral epiphysis in patients with late-detected developmental dysplasia of the hip treated by closed reduction: a MRI study of 59 hips

2019 ◽  
Vol 13 (5) ◽  
pp. 438-444 ◽  
Author(s):  
Y. H. Liu ◽  
H. W. Xu ◽  
Y. Q. Li ◽  
K. Hong ◽  
J. C. Li ◽  
...  
Keyword(s):  
Avascular Necrosis ◽  
Hip Joint ◽  
Closed Reduction ◽  
Developmental Dysplasia ◽  
Abduction Angle ◽  
Normal Side ◽  
Hip Abduction ◽  
The Mean ◽  
Dysplasia Of The Hip

Purpose The purpose of this study was to explore whether increasing the hip abduction angle would increase the incidence of avascular necrosis (AVN) in patients with late- detected developmental dysplasia of the hip (DDH) treated by closed reduction (CR) and spica cast immobilization. Methods A total of 55 patients (59 hips) with late-detected DDH underwent MRI after CR. Hip abduction angle and hip joint distance were measured on postoperative MRI transverse sections. The acetabular index and centre-edge angle were measured on plain radiographs at the last follow-up. The presence of AVN according to Kalamchi and McEwen’s classification was assessed. We retrospectively analyzed the associations among abduction angles, hip joint distances, radiographic parameters, AVN and final outcomes, exploring the relationship between hip joint abduction angle and AVN rate. Results The mean age at the time of CR was 14.4 months SD 5.5 (6 to 28), and the mean follow-up was 26.2 months SD 8.1 (12.4 to 41.7). The mean hip abduction angle was 70.2° SD 7.2° (53° to 85°) on the dislocated side and 63.7° SD 8.8° (40° to 82°) on the normal side; the mean hip joint distance was 5.1 mm SD 1.9 (1.3 to 9.1) on the dislocated side and 2.2 mm SD 0.6 on the normal side (1.3 to 3.3). Eight of 59 hips (13.6%) developed AVN. Neither the amount of abduction nor hip joint distance increased the AVN rate (p = 0.97 and p = 0.65, respectively) or the dislocation rate (p = 0.38 and p = 0.14, respectively). Conclusion Abduction angle up to 70.2° following CR did not increase the AVN rate in children aged six to 28 months with late-detected DDH treated by CR. Level of evidence III.

scholarly journals Does the size 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?

2020 ◽  
Vol 14 (3) ◽  
pp. 175-183
Author(s):  
JianPing Wu ◽  
Zhe Yuan ◽  
JingChun Li ◽  
MingWei Zhu ◽  
Federico Canavese ◽  
...  
Keyword(s):  
Femoral Head ◽  
Avascular Necrosis ◽  
Closed Reduction ◽  
Contralateral Side ◽  
Developmental Dysplasia ◽  
Negative Association ◽  
Spearman Correlation ◽  
Level Of Evidence ◽  
Nucleus Increase ◽  
Dysplasia Of The Hip

Purpose The purpose of this study was to identify if any correlation between size of the proximal femoral epiphysis and avascular necrosis (AVN) exists. Methods We retrospectively reviewed 111 patients with developmental dysplasia of the hip treated by closed reduction (124 hips). The diameter and height of both femoral head and ossific nucleus were assessed on preoperative MRI. Results The diameter and the height of the femoral head as well as of the ossific nucleus of the contralateral side were significantly greater than the dislocated side. AVN occurred in 21 (16.9%) out of 124 hips. The rate of AVN gradually decreased with age: 30.0% at six to 12 months, 18.2% at 12 to 18 months and 3.7% at 18 to 24 months. Spearman correlation analysis showed that age is negatively correlated with the incidence of AVN (r = -0.274; p = 0.002) and the diameter of the femoral head has a significantly negative association with the incidence of AVN (r = -0.287; p = 0.001). No significant association was observed between the incidence of AVN and height of the femoral head or size of the ossific nucleus. Hips with AVN were significantly smaller than hips without AVN. Conclusions The size of both the femoral head and the ossific nucleus increase with age although the dislocated femoral head is smaller compared with the contralateral side. The diameter of the femoral head and not the size of the ossific nucleus negatively correlate with the risk of AVN, with a bigger femoral head showing lower risk of AVN. Level of evidence III

Is Kalamchi and MacEwen Group I avascular necrosis of the femoral head harmless in developmental dysplasia of the hip?

2010 ◽  
Vol 20 (2) ◽  
pp. 156-162 ◽  
Author(s):  
Haluk Ağuş ◽  
Hakan Ömeroğlu ◽  
Ali Biçimoğlu ◽  
Yücel Tümer
Keyword(s):  
Femoral Head ◽  
Avascular Necrosis ◽  
Developmental Dysplasia ◽  
Group I ◽  
Dysplasia Of The Hip
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