OBJECTIVETo investigate the effects of periacetabular osteotomy (PAO) for developmental dysplasia of the hip in adolescent.

METHODSTwelve hips in 9 adolescent patients who underwent a Bernese periacetabular osteotomy for symptomatic or asymptomatic developmental dysplasia of the hip were analyzed. The average age of the patients at the time of surgery was 12.9 years(11-14 years). The Harris hip score and overall patient satisfaction with surgery were used to assess hip function and clinical results. Plain radiographs were used to assess the correction of the deformity and to observe progression of degenerative changes.

RESULTSThe average duration of clinical follow-up was 88.5 (60-136) months. The mean Harris hip score increased from 89 ± 6 preoperatively to 97 ± 3 at the time of the most recent follow-up (t = -6.754, P = 0.000). All patients (12 hips) had an excellent clinical result. The lateral center-edge angle of Wiberg increased from 4° ± 13° preoperatively to 36° ± 7° at the time of the most recent follow-up (t = -11.677, P = 0.000). The acetabular roof obliquity decreased from 28° ± 10° preoperatively to 2° ± 8° at the time of the most recent follow-up (t = 9.038, P = 0.000). The acetabular-head index increased from 54% ± 11% preoperatively to 89% ± 13% at the time of the most recent follow-up (t = -11.137, P = 0.000). The hip center was translated medially. Improvement of cystic degeneration of the acetabulum were found in 4 hips. Remodeling of aspherical uncongruence were found in 5 cases. Crossing sign were found in 2 hips postoperatively without symptoms of impingement.

CONCLUSIONSPAO can provide comprehensive deformity correction and improve hip function in treatment of developmental dysplasia of the hip in adolescence. Some of the patients have improvement of cystic degeneration and remodeling of the hip.

Acetabulum ; pathology ; Adolescent ; Child, Preschool ; Disease Progression ; Hip Dislocation ; surgery ; Hip Dislocation, Congenital ; Humans ; Osteotomy ; Postoperative Period

BACKGROUND: Cotyloplasty is a technique that involves making a perforation of the medial wall of a shallow acetabulum and then inserting an acetabular cup with the medial aspect of its dome beyond the Kohler line. The purpose of this study was to evaluate the results of cementless total hip arthroplasty (THA) using cotyloplasty with focusing on the amount of medial cup protrusion. METHODS: Sixteen hips with insufficient acetabulum in sixteen patients were treated by cementless THA using cotyloplasty. The average patient age was 47 years. The diagnoses included dysplastic hip (12) and infection sequelae (4). All the patients were followed up for at least 2 years. Clinically, the Harris hip scores were assessed and radiologically, the amount of cup protrusion, the hip center movement and cup fixation were evaluated. RESULTS: The average Harris hip score improved from 57 to 94 postoperatively. The average proportion of cup surface beyond the Kohler line was 44.1% and the hip centers were medialized by an average of 23 mm. Stable fixation of the acetabular cup was achieved in all the cases except one. In this one case, migration of the cup was detected 2 weeks postoperatively and a reoperation was performed. CONCLUSIONS: Using cotyloplasty, good coverage of the acetabular cup was obtained without a block bone graft, and the hip joint centers were medialized. However, the safety margin for the amount of protrusion should be established.
Acetabulum/*pathology/radiography/*surgery ; Adult ; Arthritis, Infectious/complications/pathology ; *Arthroplasty, Replacement, Hip ; Female ; Hip Dislocation, Congenital/pathology/surgery ; Hip Joint/radiography ; *Hip Prosthesis ; Humans ; Male ; Middle Aged

Adolescent ; Child ; Female ; Hip Dislocation, Congenital ; diagnostic imaging ; pathology ; surgery ; Humans ; Male ; Osteotomy ; methods ; Pelvic Bones ; surgery ; Radiography

BACKGROUND: Total hip arthroplasty (THA) for severe developmental dysplasia of the hip (DDH) is a technically demanding procedure for arthroplasty surgeons, and it is often difficult to reduce the hip joint without soft tissue release due to severe flexion contracture. We performed two-stage THAs in irreducible hips with expected lengthening of the affected limb after THA of over 2.5 cm or with flexion contractures of greater than 30 degrees in order to place the acetabular cup in the true acetabulum and to prevent neurologic deficits associated with acute elongation of the limb. The purpose of this study is to evaluate the outcomes of cementless THA in patients with severe DDH with a special focus on the results of two-stage THA. METHODS: Retrospective clinical and radiological evaluations were done on 17 patients with Crowe type III or IV developmental DDH treated by THA. There were 14 women and 3 men with a mean age of 52.3 years. Follow-ups averaged 52 months. Six cases were treated with two-stage THA followed by surgical hip liberalization and skeletal traction for 2 weeks. RESULTS: The mean Harris hip score improved from 40.9 to 89.1, and mean leg length discrepancy (LLD) in 13 unilateral cases was reduced from 2.95 to 0.8 cm. In the patients who underwent two-stage surgery, no nerve palsy was observed, and the single one-stage patient with incomplete peroneal nerve palsy recovered fully 4 weeks postoperatively. CONCLUSIONS: The short-term clinical and radiographic outcomes of primary cementless THA for patients with Crowe type III or IV DDH were encouraging. Two-stage THA followed by skeletal traction after soft tissue release could provide alternative solutions to the minimization of limb shortenings or LLD without neurologic deficits in highly selected patients.
Adult ; Aged ; Arthroplasty, Replacement, Hip/*instrumentation/*methods ; Female ; Femur/radiography/surgery ; Hip/radiography/surgery ; Hip Dislocation, Congenital/pathology/radiography/*surgery ; Hip Joint/pathology/radiography/surgery ; Hip Prosthesis ; Humans ; Ilium/radiography/surgery ; Male ; Middle Aged ; Orthopedic Fixation Devices ; Retrospective Studies ; Traction

Developmental dysplasia of the hip (DDH) is one of the most common congenital disorders in childhood. Its diverse pathological changes require different treatments and result in different outcomes. Although many studies have been conducted on DDH, some special pathology is still unrecognized. We here presented a rare case of a one-year and eleven-month old girl with DDH; a half-free intra-articular osteocartilaginous tissue was found in her right hip joint. X-ray, computer assisted tomography (CT) and magnetic resonance imaging (MRI) were performed to evaluate the pathological changes. MRI revealed some positive findings. The patient experienced open reduction and histopathological examination of the small tissue. Through gross anatomy it is a half-free intra-articular osteocartilaginous tissue, which can fully match a fossa observed at the femoral head. Histopathological examination found that the tissue was composed of collagenous fiber and cartilage-like tissue. Interestingly, we found the expression of type I collagen according to immunohistochemical analysis, which indicated that the cartilage-like tissue was formed due to laceration of the articular cartilage. This kind of disorder should be included as one of the pathologies of DDH. The most possible origin of this tissue is the femoral head which we speculate may have been fractured before.
Female ; Hip Dislocation, Congenital ; diagnostic imaging ; pathology ; surgery ; Humans ; Infant ; Magnetic Resonance Imaging ; Tomography, X-Ray Computed

PURPOSE: The purpose of this study was to evaluate the clinical and radiological results of total hip arthroplasty using a proximal modular femoral stem in patients who had secondary coxarthrosis associated with a dysplastic hip. MATERIALS AND METHODS: Forty-two patients (45 hips) with secondary coxarthrosis were evaluated after undergoing primary total hip arthroplasty using an S-ROM proximal modular femoral stem. The average follow-up was 80 months (range: 60 to 96 months). Clinical and radiological assessments were performed based on the Harris hip score and the radiological changes around the prosthesis. RESULTS: The average Harris hip score improved from 52.2 points to 88.5 points. All femoral stems showed stable fixation; there were 37 cases by bony ingrowth and 8 cases by stable fibrous ingrowth. Neither osteolysis nor progressive radiolucent lines around the femoral stem were found at the last follow-up. Forty-one hips (91.9%) revealed excellent or good clinical results at the most recent follow-up. CONCLUSION: For advanced secondary coxarthrosis, total hip arthroplasty with the use of the proximal modular femoral stem yielded good mid-term results with respect to the clinical and radiological criteria.
Adult ; Aged ; Arthroplasty, Replacement, Hip/adverse effects/*methods ; Female ; Femur/*pathology ; Hip Dislocation, Congenital/complications/pathology/*surgery ; *Hip Prosthesis ; Humans ; Joint Deformities, Acquired/complications/pathology/*surgery ; Male ; Middle Aged ; Osteoarthritis, Hip/etiology/surgery ; Postoperative Complications/pathology

BACKGROUND: Some dysplastic hips with favorable radiographic parameters fail to develop normally, suggesting that we should consider cartilaginous or soft tissue structures for further information regarding the condition of the hip. The purpose of this study was to provide a clear definition of concentric reduction in developmental dysplasia of the hip (DDH) based on magnetic resonance imaging (MRI), and to determine how radiographic and MR-based parameters could be used together to treat dysplastic hips. METHODS: We studied range of motion (ROM)-MRI of 25 patients with unilateral hip dysplasia (mean age at the time of MR imaging, 44.1 months). Each ROM-MRI consisted of a set of bilateral hip scans in the following positions: neutral; abduction; abduction- internal rotation; abduction-internal rotation-flexion; and adduction. Before MR scanning, the 25 patients received the following primary treatments: closed reduction (n = 15; at a mean age of 14.5 months); and open reduction (n = 10; at a mean age of 10.0 months). The following new parameters appear to be useful in treating DDH: 1) the labral angle, the angle the labrum makes with the acetabulum; 2) the uncorrected labral deformity (ULD), the "residual deformity" (deflection of the labrum) when the affected labrum is freed from pressure in abduction; and 3) the zone of compressive force (ZCF), the region of the acetabulum through which the body weight acts on the femoral head. RESULTS: A concentrically-reduced hip is one in which the labrum points downward in the neutral position, at the same angle as that of the normal side; and in which the ZCF is zone 3, the inner acetabular zone as defined herein. The ULD and the ZCF may be determined precisely as we have done, or the physician may simply observe the changes in the orientation of the labrum and compare the changes qualitatively to the unaffected side, and likewise for the medial joint space. CONCLUSIONS: Detailed analysis of the labrum as permitted by ROM-MRI, together with acetabular index and other parameters measured from radiographs, provides important information for physicians treating childhood hip dysplasia.
Child, Preschool ; Female ; Hip Dislocation, Congenital/*diagnosis/physiopathology/radiography/surgery ; Hip Joint/pathology/physiopathology/radiography ; Humans ; Infant ; *Magnetic Resonance Imaging ; Male ; Range of Motion, Articular

OBJECTIVETo observe the distribution law and study the factors related to the femoral neck anteversion angle among the patients with developmental dysplasia of the hip of Hartofilakidis type I.

METHODSAmong the patients with hip dysplasia of Hartofilakidis type I who was admitted to Department of Orthopaedic Surgery, the First Affiliated Hospital of People's Liberation Army General Hospital from June 2010 to June 2013, a total of 340 hips (25 male and 161 female) were included in the study. The average age was 28.3 years, ranging from 13.5 to 49.9 years. The observation index included: femoral neck anteversion angle, lateral center-edge angle, acetabular index angle, lateral displacement of the femoral head, superior displacement of the femoral head, continuity of Shenton's line and Calve's line. The correlation between different factors was analyzed, and the factor closest to femoral neck anteversion angle was analyzed further by regression analysis.

RESULTSAmong the patients of developmental dysplasia of the hip of Hartofilakidis type I, the femoral neck anteversion angle increased, with an average of 28°±13°. Correlation and regression analysis showed significant negative correlation with treatment age (r=-0.158, P=0.003; t=-6.892, P=0.000); positive correlation with gender (r=0.332, P=0.000; t=-4.376, P=0.000); significant positive correlation with lateral displacement of the femoral head (r=0.092, P=0.000; t=3.766, P=0.000); significant negative correlation with central-edge angle (r=-0.122, P=0.024; t=2.031, P=0.043). The femoral neck anteversion angle showed correlation with acetabular index angle, continuity of Calve's line and superior displacement of the femoral head in correlation analysis, not in regression analysis, however, it did not show correlation with side and continuity of Shenton's line.

CONCLUSIONAmong the patients of developmental dysplasia of the hip of Hartofilakidis type I, the increasing of the femoral neck anteversion angle may not only lead to early onset and therefore early treatment of pain in the hip joint but also the lateral displacement of the femoral head that requires immediate medical attention.

Acetabulum ; Adolescent ; Adult ; Female ; Femur Head ; Femur Neck ; pathology ; Hip Dislocation, Congenital ; pathology ; surgery ; Hip Joint ; Humans ; Hyperplasia ; Male ; Middle Aged ; Orthopedic Procedures ; Orthopedics ; Regression Analysis ; Tomography, X-Ray Computed ; Young Adult

BACKGROUNDTreating developmental dysplasia of the hip is often challenging. The difficulties include not only the hip surgery itself but also the treatment of the associated lower-limb valgus deformity. However, there have been very few studies on such deformity in patients with developmental hip dysplasia. In this study, we investigated the prevalence and severity of lower-limb valgus deformity, along with the relationship between the severity of valgus deformity and mechanical alterations of the hip or the ipsilateral knee.

METHODSTwo hundred and six affected lower limbs of 116 adult patients with untreated developmental dysplasia of the hip were included in the study, grouped according to the severity of hip dysplasia. Each study participant's radiographs were measured to quantitatively evaluate the mechanical axis deviation of the lower limb, and further to evaluate the prevalence and severity of the lower-limb valgus deformity. Some mechanical alterations of the hip and the ipsilateral knee were also measured on the radiographs.

RESULTSOf the affected lower limbs, 14.1% had valgus deformities. Study participants with Crowe type III hip dysplasia had the most severe deformity and the highest prevalence of deformity. Severity of valgus deformity had a strong positive correlation with the lateral migration of the femoral head but not with the superior migration. A decreased lateral distal femoral angle contributed to the lower-limb valgus deformity, and the lateral distal femoral angle had a strong negative correlation with the severity of valgus deformity.

CONCLUSIONSHip dysplasia is commonly associated with lower-limb valgus deformity, and the severity of the lower-limb valgus deformity is mostly affected by lateral migration but not superior migration of the femoral head. The valgus deformity may originate mainly in the distal femur, in addition to the hip joint itself. These findings can be taken into account when planning to treat the patients with hip dysplasia.

Adolescent ; Adult ; Aged ; Female ; Femur Head ; diagnostic imaging ; pathology ; surgery ; Hallux Valgus ; diagnostic imaging ; pathology ; surgery ; Hip Dislocation, Congenital ; diagnostic imaging ; pathology ; surgery ; Hip Joint ; diagnostic imaging ; pathology ; surgery ; Humans ; Joint Deformities, Acquired ; diagnostic imaging ; pathology ; surgery ; Male ; Middle Aged ; Radiography ; Young Adult