scholarly journals Acetabular Dysplasia: a Modern View of the Problem (Literature Review)

2020 ◽  
pp. 92-100
Author(s):  
V.V. Filipchuk ◽  
V.L. Suvorov
Keyword(s):  
Articular Cartilage ◽  
Hip Dysplasia ◽  
Acetabular Dysplasia ◽  
Dynamic Condition ◽  
Hip Osteoarthritis ◽  
Previous Treatment ◽  
Developmental Dysplasia ◽  
Older Children ◽  
Reconstructive Procedures ◽  
Advantages And Disadvantages

Summary. Hip dysplasia is the most common orthopedic problem in the practice of pediatric orthopedists. A significant problem with hip dysplasia is the divergence of nomenclature units, which is related to different points of view on the pathophysiology of the process. Contemporary conception defines hip dysplasia as a dynamic condition – “developmental dysplasia of the hip (DDH)”, which (in the absence of treatment) worsens with age and leads to the development of early hip osteoarthritis and requires hip replacement in young people. The leading macromorphological substrate of DDH is acetabular dysplasia, which is a spatial and structural change of acetabulum. For the treatment of acetabular dysplasia, conservative or surgical treatment (depending on the age of the child and the presence of previous treatment) is used. The most problematic solution is the treatment tactics for walking-age children. This is due to two factors: 1) increased loading on certain parts of the articular cartilage of the acetabulum during gait, which leads to the progression of deformity of the acetabulum and to progression of pathology; 2) changes in morphology of the intra-articular and extra-articular structures. However, better results with fewer complications are achieved after surgery. Biomechanically justified for acetabular dysplasia are pelvic osteotomies, which are divided into reconstructive and “salvage” procedures (preference is given to reconstructive procedures, which allows saving the native articular cartilage of acetabulum). Each osteotomy has its own advantages and disadvantages. When comparing three pelvic osteotomies commonly used in children (Salter, Pemberton and Dega), it is found that better results are achieved in children younger than 4 years after Salter’s osteotomy, results in older children are better after Dega’s osteotomy, and there is a high risk of femoroacetabular impingement following Pemberton’s osteotomy in the future.

Relationship Between Hip Dysplasia, Pain, and Osteoarthritis in a Cohort of Patients with Hip Symptoms

2013 ◽  
Vol 40 (9) ◽  
pp. 1583-1589 ◽  
Author(s):  
Johanne Morvan ◽  
Ronan Bouttier ◽  
Bernard Mazieres ◽  
Evelyne Verrouil ◽  
Jacques Pouchot ◽  
...  
Keyword(s):  
Anterior Margin ◽  
Hip Dysplasia ◽  
Acetabular Dysplasia ◽  
Hip Osteoarthritis ◽  
Population Based ◽  
Hip Pain ◽  
Prevalence Survey ◽  
Center Edge ◽  
Study Participants ◽  
The Relationship

Objective.The relationship between acetabular dysplasia (HD) and hip osteoarthritis (OA) remains unclear, especially for mild forms of dysplasia. Our objectives were to estimate the prevalence of HD in a population-based sample with symptoms and to evaluate potential associations linking HD, hip OA, and hip pain.Methods.Individuals 40 to 75 years of age with symptoms in 1 or both hips were recruited during a multiregional prevalence survey. All study participants underwent examination and radiographs. Radiographs were evaluated using Kellgren-Lawrence staging (with stages ≥ 2 indicating hip OA) and HD measures [center-edge (CE) angle, acetabular inclination angle (HTE), acetabular depth (AD), and vertical center-anterior margin angle].Results.We studied both hips of 842 individuals (1684 hips), among whom 203 had hip OA. Compared to left hips, right hips had significantly smaller CE angles and significantly greater AD and HTE values (p ≤ 0.001). Overall, the prevalence of HD ranged from 7.6% to 22.2% of the hips depending on the measure used. The prevalence of HD was higher in individuals with hip OA, with significant differences for abnormal HTE (19.1% vs 11.4%; p < 0.0001) and abnormal CE (11.3% vs 7.5%; p = 0.04). By logistic regression, only abnormal HTE remained associated with OA. Same-side hip pain was not statistically more common in individuals with HD after stratification on OA status (p = 0.12).Conclusion.Our study confirms the relationship between OA and HD, particularly as defined based on the HTE angle.

Progress in analgesic development: How to assess its real merits?

2021 ◽  
Vol 16 ◽  
Author(s):  
Igor Kissin
Keyword(s):  
Drug Evaluation ◽  
Previous Treatment ◽  
Widespread Application ◽  
Drug Candidates ◽  
Advantages And Disadvantages ◽  
Inflammatory Drugs ◽  
Pain Analgesics ◽  
Approved Drugs ◽  
Multifactorial Approach ◽  
Opioid Receptor Agonists

Background: Assessing analgesic drugs developed over preceding 50 years demonstrated that very intensive efforts directed at diverse molecular pain targets produced thousands of PubMed articles and the introduction of more than 50 new analgesics. Nevertheless, these analgesics did not have a sufficiently broad spectrum of action and level of effectiveness to demonstrably affect the use of opioids or nonsteroidal anti-inflammatory drugs for the treatment of pain. Analgesics in current are only modestly effective in chronic pain (at least with respect to neuropathic pain), and the widespread application of mu opioid receptor agonists for this purpose culminated in the global "opioid crisis”. The introduction of every new drug is regarded as an important success, at least initially. Assessing the merit of a new analgesic is extremely complicated. Objective: The aim of this article is to describe an approach that combines very different categories of drug evaluation – multifactorial approach to assessment of new analgesics. It is based on conclusiveness of clinical trials, novelty of a drug’s molecular target, a drug’s commercial appeal, and the interest in a drug reflected by scientometric indices. Results: This approach was applied to analgesics developed in 1982-2016. It shows that although several new agents have completely novel mechanisms of action, all newly approved drugs, and drug candidates, demonstrated the same persistent problems: relatively low therapeutic advantage over previous treatment and narrow spectrum of use in different types of pain, compared to opioids or NSAIDs. Conclusion: The use of the suggested multifactorial approach to drug assessment may provide a better view of the whole spectrum of analgesics advantages and disadvantages.

Posterior Cruciate Ligament Femoral Insertion Site Characteristics: Importance for Reconstructive Procedures

2002 ◽  
Vol 30 (5) ◽  
pp. 643-651 ◽  
Author(s):  
Etienne A. Mejia ◽  
Frank R. Noyes ◽  
Edward S. Grood
Keyword(s):  
Articular Cartilage ◽  
Posterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Insertion Site ◽  
Femoral Shaft ◽  
Surgical Reconstruction ◽  
Anatomic Study ◽  
Reconstructive Procedures ◽  
Femoral Attachment ◽  
Site Characteristics

Background: Previous descriptions of the insertion site of the posterior cruciate ligament are inadequate. Hypothesis: More than one reference system is required to adequately represent the anatomy of the femoral attachment. Study Design: Descriptive anatomic study. Methods: Twelve cadaveric specimens were evaluated by using two measurement methods relative to the femoral articular cartilage margin and two methods relative to the intercondylar femoral roof. Results: Reference lines perpendicular to the articular cartilage best defined the 12- and 1-o'clock positions, and those perpendicular to the articular cartilage or parallel to the femoral shaft best defined the 2-, 3-, and 4-o'clock positions. The angle of the proximal attachment to the roof was 88° ± 5.5°. The posterior cruciate ligament was a continuum of fibers rather than two distinct bundles, and its attachment showed variability in shape and thickness, extending past the midline in the notch (11:21 ± 15 minutes to 4:12 ± 20 minutes, right knee). Conclusions: More than one measurement system is required to accurately describe the femoral origin of the posterior cruciate ligament. Clinical Relevance: Accurate assessment of the anatomy is crucial for successful surgical reconstruction of the posterior cruciate ligament femoral attachment.

scholarly journals Residual hip dysplasia: is there a place for hip shelf operation?

2018 ◽  
Vol 12 (4) ◽  
pp. 358-363 ◽  
Author(s):  
T. Terjesen
Keyword(s):  
Periacetabular Osteotomy ◽  
Developmental Dysplasia ◽  
Hip Pain ◽  
Older Children ◽  
Long Term Effects ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Shelf Procedure ◽  
Shelf Operation

Purpose After modern acetabular osteotomies were introduced, hip shelf operations have become much less commonly used. The aims of this study were to assess the short-term and long-term outcome of a modified Spitzy shelf procedure and to compare the results with those of periacetabular osteotomy (PAO). Methods In all, 44 patients (55 hips) with developmental dysplasia of the hip and residual dysplasia had a modified Spitzy shelf operation. Mean age at surgery was 13.2 years (8 to 22). Indication for surgery was a centre-edge angle < 20° with or without hip pain. Outcome was evaluated using duration of painless period and survival analysis with conversion to total hip arthroplasty (THA) as endpoints. Results Preoperative hip pain was present in 46% of the hips and was more common in patients ≥ 12 years at surgery (p < 0.001). One year postoperatively, 93% of the hips were painless. Analysis of pain in hips with more than ten years follow-up showed a mean postoperative painless period of 20.0 years (0 to 49). In all, 44 hips (80%) had undergone THA at a mean patient age of 50.5 years (37 to 63). Mean survival of the shelf procedure (time from operation to THA) was 39.3 years (21 to 55). Conclusions The Spitzy operation had good short and long-term effects on hip pain and a 30-year survival (no THA) of 72% of the hips. These results compare favourably with those of PAO and indicate that there is still a place for the shelf procedure in older children and young adults.

scholarly journals Should We Continue to Screen for Developmental Dysplasia of the Hip in Clubfoot? Our Experience and Review of the Literature

2021 ◽  
Vol 7 (2) ◽  
Keyword(s):  
Clinical Examination ◽  
Hip Dysplasia ◽  
Screening Programme ◽  
Developmental Dysplasia ◽  
The Other ◽  
Idiopathic Clubfoot ◽  
Ultrasound Screening ◽  
Review Of The Literature ◽  
Targeted Ultrasound ◽  
Dysplasia Of The Hip

Objective: The association between clubfoot and developmental dysplasia of the hip (DDH) remains uncertain, with only a few studies linking both. However, clubfoot is considered as a risk factor for DDH. The aim of this study was to determine the incidence of DDH and evaluate the need for routine hip imaging in our population of children with clubfoot. Methods: Retrospective analysis of all patients treated for clubfoot in our center between 2010 and 2019. We included patients with hip imaging for DDH in the first 12 months of life. Results: There were 108 children with clubfoot who underwent DDH screening. 92 had idiopathic clubfoot and 16 had syndromic clubfoot. Of the patients with idiopathic clubfoot, 2 (2.2%) had DDH; one had a clinically unstable hip and the other patient underwent hip screening on account of the clubfoot alone. Among patients with syndromic clubfoot, 3 (18.8%) had developmental dysplasia of the hip. Two of them had an abnormal hip examination while the other had normal hip clinical examination but other established risk factors for DDH. Conclusion: A targeted ultrasound or radiological screening programme for DDH in idiopathic clubfoot diagnosed hip dysplasia in only 1 child that would have otherwise been missed by clinical examination alone. We conclude that hip imaging is not warranted in children with idiopathic clubfoot and regular clinical screening may suffice. In syndromic clubfoot, due to the higher incidence of DDH, we recommend specific ultrasound screening even in the presence of a normal hip examination. Keywords: Clubfoot, Screening, Developmental dysplasia of the hip.

Radiographic hip osteoarthritis and acetabular dysplasia in Turkish men and women

2004 ◽  
Vol 25 (6) ◽  
pp. 419-422 ◽  
Author(s):  
Berna Goker ◽  
Alper Sancak ◽  
Semınur Haznedaroglu
Keyword(s):  
Acetabular Dysplasia ◽  
Hip Osteoarthritis ◽  
Men And Women

Residual Acetabular Dysplasia in Congenital hip dysplasia

2021 ◽  
pp. 103172
Author(s):  
Benoît de Courtivron ◽  
Kevin Brulefert ◽  
Adrien Portet ◽  
Thierry Odent
Keyword(s):  
Hip Dysplasia ◽  
Acetabular Dysplasia ◽  
Congenital Hip Dysplasia

PENICILLIN THERAPY OF LATE CONGENITAL SYPHILIS

PEDIATRICS ◽  
1948 ◽  
Vol 1 (5) ◽  
pp. 601-616
Author(s):  
RALPH V. PLATOU ◽  
JOHN T. KOMETANI
Keyword(s):  
Body Weight ◽  
Congenital Syphilis ◽  
Single Agent ◽  
Previous Treatment ◽  
Spinal Fluid ◽  
Older Children ◽  
Total Dosage ◽  
Intramuscular Injections ◽  
Interstitial Keratitis ◽  
Penicillin Therapy

Though no valid comparisons can be made until more patients have been treated and followed for a longer time, it seems to us that penicillin used alone is at least as effective as any other single agent for the treatment of late congenital syphilis. To what extent treatment or time alone contribute to improvements cannot yet be stated. Most of the clinical and serologic indications of healing developed rather slowly; in only a few patients with the most superficial lesions were there objective signs of improvement during therapy. The treatment schedules we employed are similar to those previously recommended for infants. At present we advise a total dosage comprising at least 100,000 units commercial penicillin per kilogram body weight, divided into 100 equal intramuscular injections and given at two to three hour intervals around the clock for eight or more days. Therapeutic reactions, entirely febrile in nature, have all been transient and benign. There were no deaths. We believe that the simplicity, safety and convenience of these plans make them preferable to the more costly, hazardous, and time-consuming older methods; further-more, they effectively curtail the appallingly high delinquency rates formerly prevailing. Results were significantly better for children treated under six years of age than they were for older children, and also for those who had normal spinal fluid before treatment; they were suggestively but not significantly better among those for whom the larger dosage schedules were used. Outcome was significantly worse in those who had received previous treatment of any sort. There were just three relapse—two defined only serologically, and one by a questionable recurrence of interstitial keratitis. About a quarter of those with latent congenital syphilis have become seronegative. The poorest results ensued for patients with clinical neurosyphilis; two children from this group continued to exhibit definite deterioration. For interstitial keratitis, results were most gratifying in two patients treated within a month of onset. Seventy-two per cent of all patients with late congenital syphilis so far treated with penicillin and followed for more than two months are clinically well and have negative serologic reactions or progressively declining titers.

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