scholarly journals The Course and Anatomical Characteristics of Sciatic and Femoral Nerves in Unilateral Crowe Type IV Hip Dysplasia

2021 ◽  
Author(s):  
Ping Song ◽  
Xiangpeng Kong ◽  
Minzhi Yang ◽  
Wei Chai
Keyword(s):  
Femoral Nerve ◽  
Anterior Wall ◽  
Ischial Tuberosity ◽  
Developmental Dysplasia ◽  
Anatomical Characteristics ◽  
Female Patients ◽  
Type Iv ◽  
Bony Landmarks ◽  
Dysplasia Of The Hip ◽  
Control Study

Abstract Background This study aims to investigate the course and anatomical characteristics of sciatic and femoral nerves in unilateral Crowe type IV developmental dysplasia of the hip (DDH) patients. Methods We conducted a retrospective own-control study of patients with unilateral Crowe type IV DDH. Bilateral hips’ CTs of 21 female patients were reviewed in our institute from February 2018 to February 2020. The distances between nerves and bony landmarks were measured in different CT sections (anterior superior iliac spine, acetabular inner wall, teardrop, and ischial tuberosity) to analyze the anatomical position and course of sciatic and femoral nerves between bilateral hips. Results In the section of acetabular inner wall, the distance between femoral nerve and acetabular anterior wall in affected hip (13.20±3.59 mm) was significantly smaller than that in healthy hip (16.58±5.12mm) (p=0.000). In other sections, the distances between nerves and bony landmarks in affected hips were significantly larger than or equal to those in healthy hips. Conclusion In female patients with unilateral Crowe type IV DDH, the femoral nerve in affected hip runs closer to anterior acetabular wall than that in healthy hip.

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 Tübingen hip flexion splint for the treatment of developmental dysplasia of the hip in children younger than six months age: a meta-analysis

2021 ◽  
pp. 1-7
Author(s):  
Xinwang Zhi ◽  
Xietian Xiao ◽  
Yuwei Wan ◽  
Ping Wei ◽  
Federico Canavese ◽  
...  
Keyword(s):  
Success Rate ◽  
Femoral Nerve ◽  
Developmental Dysplasia ◽  
Cochrane Library ◽  
Close Monitoring ◽  
Type Ii ◽  
Level Of Evidence ◽  
Type Iv ◽  
Hip Flexion ◽  
Dysplasia Of The Hip

Purpose To investigate the success rate of the Tübingen hip flexion splint (THFS) for the treatment of developmental dysplasia of the hip (DDH), of different severity as per the Graf classification, among infants younger than six months of age. The type and incidence rate of complications associated with THFS treatment were also evaluated. Methods The following databases were searched using keywords and limited for age less than six months: PubMed, Embase, Web of Science, Cochrane Library, and SinoMed, between inception and July 2020. Articles were screened and extracted by two researchers, and the quality of the included literature was evaluated (methodological index for non-randomized studies criteria). R studio 1.3 was used for statistical analysis. The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results After screening, eight articles were included in the analysis, contributing 1211 hips (875 patients). The overall success rate of THFS treatment is 91% (95% confidence interval (CI) 0.82 to 0.95). The success rate by Graf type is as follows: type-II, 98% (95% CI 0.94 to 1.00); type-III, 96% (95% CI 0.88 to 1.00); and type-IV, 32% (95% CI 0.18 to 0.47). Complications (24/1211, 2%) included transient femoral nerve palsy (n = 1); avascular necrosis of the femoral head (n = 9) and residual acetabular dysplasia (n = 14). Conclusion THFS treatment is successful for Graf type-II and –III, but low for type-IV, with a low rate of complication. THFS may be an effective treatment option for DDH among infants less than six months of age. However, those with Graf type-IV require close monitoring. Level of Evidence: III

scholarly journals The Variation of the Pelvis in Unilateral Crowe Type IV Developmental Dysplasia of the Hip

2021 ◽  
Author(s):  
Yin‐qiao Du ◽  
Bohan Zhang ◽  
Jing‐yang Sun ◽  
Hai‐yang Ma ◽  
Jun‐min Shen ◽  
...  
Keyword(s):  
Developmental Dysplasia ◽  
Type Iv ◽  
Dysplasia Of The Hip

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 Sagittal spinal-pelvic alignment in patients with Crowe type IV developmental dysplasia of the hip

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Peng Ren ◽  
Xiangpeng Kong ◽  
Wei Chai ◽  
Yan Wang
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Vertical Axis ◽  
Developmental Dysplasia ◽  
Sacral Slope ◽  
Low Back ◽  
Sagittal Vertical Axis ◽  
Type Iv ◽  
The Impact ◽  
Dysplasia Of The Hip

Abstract Background The impact of high dislocated dysplastic hips on spinal-pelvic alignment has not been well described. This study aims to evaluate compensatory spinal radiographic changes and presence of back pain in patients with Crowe type IV developmental dysplasia of the hip (DDH). Methods An observational study was conducted from July 2016 to December 2017, and 49 consecutive patients with Crowe IV DDH were enrolled. Forty-nine sex- and age-matched asymptomatic healthy adults were recruited as the controls. The sacral slope (SS), lumbar lordosis (LL), spino-sacral angle (SSA), C7 tilt (C7T), and sagittal vertical axis (SVA [C7]) were measured on lateral whole spine radiographs. The presence of low back pain and visual analogue scale (VAS) scores were recorded. Results The patients with Crowe IV DDH showed significantly greater SS (47.5 ± 7.5° vs. 40.4 ± 6.7°, p < 0.05), LL (− 63.7 ± 9.2° vs. − 53.3 ± 11.5°, P < 0.05), SSA (141.8° ± 7.2° vs. 130.6 ± 7.9°, p < 0.05), C7T (93.9 ± 3.6° vs. 91.1 ± 3.7°, P < 0.05), and lower SVA(C7) (− 16 mm[− 95–45] vs. 6.4 mm[− 52–47], p < 0.05) compared to the controls. The patients with bilateral Crowe IV DDH also exhibited larger SS, LL, SSA, and C7T and a smaller SVA (C7) than those with unilateral Crowe IV DDH. Sixty-three percent of the patients with Crowe IV DDH reported low back pain. Conclusion The patients with Crowe IV DDH exhibited abnormal spinal-pelvic alignment characterized by anterior pelvic tilt, lumbar hyperlordosis, and a backward-leaning trunk. Bilateral Crowe IV DDH had a greater impact on spinal-pelvic alignment than unilateral Crowe IV DDH.

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

The ‘clicky hip’

2018 ◽  
Vol 100-B (9) ◽  
pp. 1249-1252 ◽  
Author(s):  
S. Humphry ◽  
D. Thompson ◽  
N. Price ◽  
P. R. Williams
Keyword(s):  
Service Provision ◽  
Closed Reduction ◽  
Developmental Dysplasia ◽  
Ultrasound Screening ◽  
Ultrasound Scan ◽  
Type Iv ◽  
Referral Practices ◽  
Adductor Tenotomy ◽  
The Mean ◽  
Dysplasia Of The Hip

Aims The significance of the ‘clicky hip’ in neonatal and infant examination remains controversial with recent conflicting papers reigniting the debate. We aimed to quantify rates of developmental dysplasia of the hip (DDH) in babies referred with ‘clicky hips’ to our dedicated DDH clinic. Patients and Methods A three-year prospective cohort study was undertaken between 2014 and 2016 assessing the diagnosis and treatment outcomes of all children referred specifically with ‘clicky hips’ as the primary reason for referral to our dedicated DDH clinic. Depending on their age, they were all imaged with either ultrasound scan or radiographs. Results There were 69 ‘clicky hip’ referrals over the three-year period. This represented 26.9% of the total 257 referrals received in that time. The mean age at presentation was 13.6 weeks (1 to 84). A total of 19 children (28%) referred as ‘clicky hips’ were noted to have hip abnormalities on ultrasound scan, including 15 with Graf Type II hips (7 bilateral), one Graf Type III hip, and three Graf Type IV hips. Of these, ten children were treated with a Pavlik harness, with two requiring subsequent closed reduction in theatre; one child was treated primarily with a closed reduction and adductor tenotomy. In total, 11 (15.9%) of the 69 ‘clicky hip’ referrals required intervention with either harness or surgery. Conclusion Our study provides further evidence that the ‘clicky hip’ referral can represent an underlying diagnosis of DDH and should, in our opinion, always lead to further clinical and radiological assessment. In the absence of universal ultrasound screening, we would encourage individual units to carefully assess their own outcomes and protocols for ‘clicky hip’ referrals and tailor ongoing service provision to local populations and local referral practices. Cite this article: Bone Joint J 2018;100-B:1249–52.

Preliminary application of 3D-printed individualised guiding templates for total hip arthroplasty in Crowe type IV developmental dysplasia of the hip

2020 ◽  
pp. 112070002094800
Author(s):  
Qiang Tu ◽  
Huan-wen Ding ◽  
Hu Chen ◽  
Jian-jian Shen ◽  
Qiu-ju Miao ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Surgical Planning ◽  
Developmental Dysplasia ◽  
Femoral Osteotomy ◽  
Lower Limbs ◽  
Total Hip ◽  
Type Iv ◽  
3D Printed ◽  
Dysplasia Of The Hip

Objective: To evaluate the feasibility and accuracy of three-dimensional (3D)-printed individualised guiding templates in total hip arthroplasty (THA) for the treatment of developmental dysplasia of the hip (DDH). Methods: 12 hips in 12 patients with Crowe type IV DDH were treated with THA. A 3D digital model of the pelvis and lower limbs was reconstructed using the computed tomography data of the patients. Preoperative surgical simulations were performed to determine the most suitable surgical planning, including femoral osteotomy and prosthesis placement. Based on the ideal surgical planning, individualised guiding templates were designed by software, manufactured using a 3D printer, and used in acetabulum reconstruction and femoral osteotomy during surgery. Results: 12 patients were followed up for an average of 72.42 months (range 38–135 months). During surgery, the guiding template for each case was matched to the bony markers of the acetabulum and proximal femur. Preoperative and follow-up Harris hip scores were 34.2 ± 3.7 and 85.2 ± 4.2; leg length discrepancy, 51.5 ± 6.5 mm and 10.2 ± 1.5 mm; and visual analogue scale scores, 6.2 ± 0.8 and 1.3 ± 0.3, respectively, with statistical difference. Shortened deformity and claudication of the affected limb were obviously improved after surgery. However, 1 patient had artificial hip dislocation 2 weeks after surgery, and another patient had sciatic nerve traction injury, both of whom recovered after physical treatment. Conclusions: Preoperative surgical simulation and 3D-printed individualised guiding templates can fulfil surgeon-specific requirements for the treatment of Crowe type IV DDH. Accurate THA can be achieved using 3D-printed individualised templates, which provide a new personalised surgical plan for the precise positioning and orientation of acetabular reconstruction and femoral osteotomy.

Sign in / Sign up

Export Citation Format

Share Document