Reliability and sensitivity of radiographic measures of hip dysplasia in childhood Charcot-Marie-Tooth disease

Background: Hip dysplasia is a lack of femoral head coverage and disruption of hip and acetabular alignment and congruency, with severity ranging from mild subluxation in nascent at-risk hips to complete dislocation. Presentation of hip dysplasia in neuromuscular conditions can be sub-clinical or associated with a limp with or without hip pain, abductor and flexor weakness and reduced hip range of motion. Untreated hip dysplasia leads to early onset osteoarthritis requiring hip arthroplasty in early adulthood. Hip dysplasia occurs in 6–20% of children with Charcot-Marie-Tooth disease, however little is known about the reliability and sensitivity of detection on plain film pelvic radiographs. Methods: 14 common measures of hip dysplasia on anteroposterior pelvis radiographs were independently assessed by 2 orthopaedic specialists in 30 ambulant children with Charcot-Marie-Tooth disease. Hip health was also categorised based on clinical impression to assess the sensitivity of radiographic measures to identify hip dysplasia status. Results: 8 measures (acetabular index, head width, lateral centre-edge angle, lateral uncoverage, medial joint width, migration percentage, neck shaft angle, triradiate status) exhibited ‘excellent’ reliability between clinical evaluators. 5 of the 30 patients (17%) were identified as having nascent hip dysplasia. Reliable radiographic measures that significantly distinguished between nascent hip dysplasia and healthy hips were acetabular index, lateral centre edge angle, medial joint width and migration percentage. Conclusions: We have identified a subset of reliable and sensitive radiographic hip measures in children with Charcot-Marie-Tooth disease to prioritise during hip screening to mitigate the deleterious effects of hip dysplasia, pain and disability in adulthood.

Correlation of postoperative magnetic resonance image measurements with persisting acetabular dysplasia in open reduction of developmental hip dysplasia

Objectives: The aim of this study was to evaluate correlation of post-reduction magnetic resonance imaging (MRI)-based parameters with residual acetabular dysplasia in developmental dysplasia of the hip (DDH) patients who underwent open reduction. Patients and methods: A total of 62 hips of 54 children (5 males, 57 females; mean age: 8.5±3.5 months; range, 0 to 24 months) with a diagnosis of DDH who underwent open reduction between January 2012 and January 2017 were retrospectively analyzed. The acetabular head index (AHI), head coverage index (HCI), sphericity, bony acetabular index (BAI), cartilage acetabular index (CAI), anterior acetabular index (AAI), posterior acetabular index (PAI), abduction angle (AA), and acetabular medial wall thickness were measured by MRI. The correlation between MRI measurements and residual acetabular dysplasia was evaluated. Results: The mean follow-up was 23.7±10.1 (range, 12 to 56) months. The mean age at the final examination was 47.6±10.4 months. The age at the time of operation (r=0.250, p=0.049), medial wall thickness (r=0.304, p=0.016), AAI (r=0.729, p<0.001), PAI (r=0.590, p<0.001), and early postoperative AI (r=0.900, p<0.001) at the third postoperative month were positively correlated with the last follow-up AI. The AHI (r=-0.512, p<0.001), sphericity (r=-0,661, p<0.001), and HCI (r=-0.554, p< 0.001) were negatively correlated with the last follow-up AI. Conclusion: Post-reduction MRI parameters can be used to evaluate correlation with persistent acetabular dysplasia in DDH patients.

Is Follow-up Needed for Infants with Graf Type I Hip at Screening?

Background: The purpose was to determine if follow-up of infants with Graf Type I hip at screening is required. Methods: Overall, 526 hips in 263 infants (61 males and 202 females) born between April 2015 and March 2018 who underwent primary screening for hip dislocation and presented to our department for secondary hip dislocation examination were included. Among these, 250 (59 males and 191 females) infants had bilateral Graf Type I hips for a total of 500 hips. Ultrasound results and physical examination at the initial visit and after 3 months were compared. X-rays were taken at the age of 1 year, and the proportion of infants with an acetabular index of 30° or greater was evaluated. Results: There were 0 hips that deteriorated from Graf Type I to II or higher among the infants. There were also 25 infants with abduction limitations in flexion at the initial visit, which was still present in 3 out of 23 infants 3 months later. There were 49 infants with asymmetry of the femoral or inguinal skin creases at the initial visit, which was still present in 9 out of 48 infants 3 months later. At the age of 1 year, an acetabular index of 30° or greater was observed in 35 out of 402 hips (8.7%).Conclusion: Ultrasounds at 3 months later were not required in any of the infants with Graf Type I hip at initial diagnosis. Some infants were diagnosed with acetabular dysplasia at the age of 1 year.

Comparison of Pemberton Osteotomy and Kalamchi Modification of Salter Osteotomy in the Treatment of Developmental Dysplasia of the Hip

Background: Several pelvic osteotomy techniques are introduced for the treatment of Developmental Dysplasia of the Hip (DDH). However, there is no agreement on the optimal pelvic osteotomy in DDH. Thus, this study aimed to compare the outcomes of Pemberton Osteotomy (PO) and the Kalamchi Modification of Salter Osteotomy (KMSO). Objectives: Comparison of pemberton osteotomy and kalamchi modification of salter osteotomy in the treatment of developmental dysplasia of the hip. Methods: In a retrospective study, radiographic and clinical outcomes as well as surgical complications were compared between the patients who underwent unilateral DDH surgery using either KMSO or PO. The radiographic measures included the assessment of the acetabular index and the Shenton line. The clinical results of the osteotomies were evaluated by McKay’s criteria modified by Berkeley et al. Also, Kalamchi and MacEwen’s classification was used for the assessment of avascular necrosis. Results: The characteristic features of the patients, such as age and follow-up time, were statistically comparable between the two study groups. One year after the surgery, the Shenton line was intact in 55 patients (84.6%) of the KMSO group and 40 patients (88.9%) of the PO group (P=0.52). The Mean±SD value of the acetabular index was 21.1±5.1 and 20.7±3.9 in the KMSO and PO groups, respectively (P=0.13). Besides, the McKay’s clinical criteria were respectively excellent, good, and fair in 44, 16, and 5 patients (67.7%, 24.6%, and 7.7%, respectively) of the KMSO group, and 31, 12, and 2 patients (70%, 26.6%, and 4.4%, respectively) of the PO group (P=0.4). Moreover, the number of postoperative avascular necrosis did not significantly differ between the two study groups. Conclusion: The PO and KMSO techniques are equally safe and effective osteotomies in the treatment of DDH and can be used interchangeably.

No association between femoral or acetabular angles and patient-reported outcomes in patients with femoroacetabular impingement syndrome—results from the HAFAI cohort

Patients with femoroacetabular impingement syndrome (FAIS) are diagnosed using imaging, but detailed description especially the acetabular shape is lacking and may help give more insight to the pathogenesis of FAIS. Furthermore, associations between patient-reported outcomes (PROs) and the radiological angles might highlight which radiological angles affect outcomes experienced by the patients. Hence, the aims of this study were (i) to describe computer tomography (CT) acquired angles in patients with FAIS and (ii) to investigate the association between radiological angles and the Copenhagen Hip and Groin Outcome Score (HAGOS) in patients with FAIS. Patients scheduled for primary hip arthroscopic surgery for FAIS were included. Based on CT, following angles were measured before and 1 year after surgery; femoral anteversion, alpha, lateral centre edge, acetabular index, anterior sector, posterior sector and acetabular anteversion. All patients completed the HAGOS. Sixty patients (63% females) aged 36 ± 9 were included. One year after surgery, significant alterations in the alpha angle and the acetabular index angle were found. Neither baseline PROs nor changes in PROs were associated with the radiological angles or changes in angles. Since neither changes in CT angles nor baseline scores were associated with HAGOS, the improvements felt by patients must origin from somewhere else. These findings further underlines that morphological changes seen at imaging should not be treated arthroscopically without a patient history of symptoms and clinical findings.

THE EPIDEMIOLOGY OF DEVELOPMENTAL DYSPLASIA OF THE HIP IN MALES

ABSTRACT Developmental Dysplasia of the Hip (DDH) is one of the most common orthopedic hip diseases of the pediatric population. There is a predominance in females and patients with known risk factors. Objective: To evaluate the characteristics of DDH in a reference center and compare them with the literature. Methods: This is a cross-sectional observational study based on the review of medical records and radiographs from which epidemiological data such as laterality, age at diagnosis, acetabular index, radiographic classification and others were collected. Results: A total of 297 medical records were found between May 1974 and June 2009. Of those, 147 patients (216 affected hips) were eligible for the survey. Most of the patients came from the state of São Paulo (91.1%), were born in autumn/winter (66.7%), reported as Caucasians (76.9%), with bilateral involvement (46.9%) and mean age at diagnosis of 22.8 months. Conclusion: The most frequent type of DDH was high dislocation (28.7%), and the acetabular index progressively increased with the age. The International Hip Dysplasia Institute classification was found to be more reproducible than Tönnis classification. Delayed diagnosis was associated with the absence of risk factors and with bilaterality. Level of Evidence III, Retrospective comparative study.