Surgical treatment of dysplastic hip instability in children

Introduction: The Femoro-Epiphyseal Acetabular Roof (FEAR) index has recently been proposed as a useful tool in identifying hips with instability in the setting of borderline acetabular dysplasia. Beck et al. were the first to describe this parameter and demonstrated a FEAR index as the angle between a line connecting the most medial and lateral part of the sourcil and a line connecting the most medial and lateral part of the straight central third of the physeal scar. Purpose: The purposes of the current study were 1) external validation of intra-observer and inter-observer reliability and 2) to determine the correlation/association of FEAR with a clinical diagnosis of instability. Methods: The current study was a retrospective review of patients diagnosed with borderline acetabular dysplasia by a single surgeon. The study period included January 2008-April 2017 and identified patients with LCEA 20°-25°, via prospectively collected radiographic measurements in a hip preservation database. Inclusion criteria were treatment with either hip arthroscopy or PAO, LCEA of 20°-25°, and 14-40 years of age. Patients were excluded if they had a Tӧnnis grade ≥2, prior ipsilateral hip surgery, residual deformities from SCFE or Perthes. Demographics and radiographic measurements were recorded. Two individuals read all radiographs after obtaining an intra observer reliability of 97% and inter observer reliability of 88%. Sensitivity and specificity were calculated for FEAR predicting instability. A t-test was used to assess correlation of LCEA, acetabular inclination (AI), and ACEA with FEAR. Results: A total of 186 patients were included, FEAR was unable to be assessed in 5% of hips because of inability to visualize the proximal femoral physeal scar. Of the remaining 176 hips, 18% of hips had a FEAR index >5°. FEAR positive mean was 7.6°±2.8° (range=5.1°-17.5°) and FEAR negative mean was –6.9°±6.4° (range=-29.4°-3.7°). Results of FEAR predicting instability was sensitivity=33% (23/70), specificity=92% (98/106), PPV=74% (23/31), and NPV=67% (98/145). The mean AI was significantly high in FEAR(+) hips (AI mean=11.2° and FEAR(-) AI mean=9.5°; p=0.005). No difference in LCEA or ACEA was seen relative to the presence of FEAR. Discussion: In the current study, a positive FEAR index was generally indicative of the presence of clinical instability. However, the FEAR index was poorly sensitive to hip instability with 67% hips diagnosed with instability having a negative FEAR index.

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Dysplastic Hip Joint Configuration After Bernese Periacetabular Osteotomy

10.21203/rs.3.rs-366929/v1 ◽

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

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Surgical Treatment of Hip Instability in Patients With Lower Lumbar Level Myelomeningocele: Is Muscle Transfer Required?

Clinical Orthopaedics and Related Research ◽

10.1007/s11999-015-4316-8 ◽

2015 ◽

Vol 473 (10) ◽

pp. 3254-3260 ◽

Cited By ~ 2

Author(s):

Timur Yildirim ◽

Sarper Gursu ◽

İlhan Avni Bayhan ◽

Hakan Sofu ◽

Aysegul Bursali

Keyword(s):

Surgical Treatment ◽

Muscle Transfer ◽

Hip Instability ◽

Lumbar Level ◽

Lower Lumbar

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Development of techniques for greater trochanter fragment fixation during surgical treatment of the dysplastic coxarthrosis

Pediatric Traumatology Orthopaedics and Reconstructive Surgery ◽

10.17816/ptors6459-69 ◽

2018 ◽

Vol 6 (4) ◽

pp. 59-69

Author(s):

Igor A. Voronkevich ◽

Dmitrii G. Parfeev ◽

Alexandr I. Avdeev

Keyword(s):

Surgical Treatment ◽

Total Hip Arthroplasty ◽

Hip Joint ◽

Hip Arthroplasty ◽

Pain Syndrome ◽

Locking Plates ◽

Greater Trochanter ◽

Advanced Technique ◽

Total Hip ◽

Dysplastic Hip

Isolated fractures of the greater trochanter based on the sources of specialized literature on the subject are extremely rare. However, methods for fixing the greater trochanter are actively developed in connection with the use of various versions of trochanteric osteotomies in the surgical treatment of the dysplastic hip joint. In this article, the anatomical features of the proximal femur, development of the ideas of reattachment of the greater trochanter in the course of total hip arthroplasty, as well as the current state of the problem, were examined. Until recently, patches were used that were fixed to the thigh using the aid of wires for osteosynthesis of a large trochanter. In 2009, studies initially reported on the use of locking plates for osteosynthesis of the trochanter in total hip arthroplasty. Currently, greater trochanter fixation by locking plates shows the best results as previous fixation devices. However, patients sometimes experience greater trochanter pain syndrome after fixation fragment by plates. The analysis of the published works confirmed the relevance of the search for a new more advanced technique and a device for the reattachment of the greater trochanter to the femur in the surgical treatment of the dysplastic hip joint.

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Human Stapes Crura: Normal Ultrastructure. Scanning Electron Microscopic Findings

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100116267 ◽

1975 ◽

Vol 33 ◽

pp. 528-529

Author(s):

M.D. Graham

Keyword(s):

Electron Microscope ◽

Surgical Treatment ◽

Scanning Electron Microscope ◽

Osmic Acid ◽

Human Cadaver ◽

Electron Microscopic ◽

Scanning Electron Microscopic ◽

Normal Human ◽

Microscopic Findings ◽

Scanning Electron

The recent development of the scanning electron microscope has added great impetus to the study of ultrastructural details of normal human ossicles. A thorough description of the ultrastructure of the human ossicles is required in order to determine changes associated with disease processes following medical or surgical treatment.Human stapes crura were obtained at the time of surgery for clinical otosclerosis and from human cadaver material. The specimens to be examined by the scanning electron microscope were fixed immediately in the operating room in a cold phosphate buffered 2% gluteraldehyde solution, washed with Ringers, post fixed in cold 1% osmic acid and dehydrated in graded alcohol. Specimens were transferred from alcohol to a series of increasing concentrations of ethyl alcohol and amyl acetate. The tissue was then critical point dried, secured to aluminum stubs and coated with gold, approximately 150A thick on a rotating stage in a vacuum evaporator. The specimens were then studied with the Kent-Cambridge S4-10 Scanning Electron Microscope at an accelerating voltage of 20KV.

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