Analysis of the epidemiological profile of congenital hip deformities, 2011-2021 / Análise do perfil epidemiológico das deformidades congênitas de quadril, 2011-2021

ABSTRACT Objective: This study aimed to identify the relevance of hospitalizations for congenital hip deformities in Bahia. Methods: This is a retrospective epidemiological study in public databases. Descriptors in health sciences: "congenital hip dysplasia", "congenital hip dislocation", and "congenital dislocation hip". This is qualitative-quantitative research with the analysis of secondary data and cross-sectional typologies in the databases of the Ministry of Health - Health Information (TABNET), made available by the Department of Informatics of the Unified Health System (DATASUS). Results: Bahia was the third Brazilian state with the highest number of hospitalizations, registering 1481 cases. The municipalities in Bahia with the highest prevalence were Itanhém, Salvador, and Barreiras, with 912, 445, and 20 cases, respectively. Conclusions: The elevated number of congenital hip deformities reflects a public health problem, requiring investments in public policies.

RESUMO Objetivo: Identificar a relevância das internações por deformidades congênitas do quadril na Bahia. Métodos: Este é um estudo epidemiológico retrospectivo, feito em bases de dados públicas. Descritores em ciências da saúde: "displasia congênita de quadril", "Hip Dislocation Congenital" AND "Luxação congênita de quadril". Trata-se de uma pesquisa qualiquantitativa, com análise de dados secundários e tipologia transversal nas bases de dados do Ministério da Saúde — Informações de Saúde (TABNET), disponibilizados pelo Departamento de Informática do Sistema Único de Saúde (DATASUS). Resultados: A Bahia foi o terceiro estado brasileiro com maior número de internações, registrando 1.481 casos. Os municípios baianos com maiores prevalências foram Itanhém, Salvador e Barreiras, com 912, 445 e 20 casos, respectivamente. Conclusão: O elevado número de deformidades congênitas do quadril reflete um problema de saúde pública, necessitando de investimentos em políticas públicas.

Early detection and risk factors of congenital hip dislocation in Morocco

Background and Objective: Congenital dislocation of the hip is a malformation of the lower limbs that could be complicated by a disabling physical handicap with long-term psychological and social repercussions if detected late. This study aims to describe the screening for congenital hip dislocation and to investigate the association between the occurrence of this anomaly and possible risk factors in Morocco. Methods: The study was based on the exploitation of the records of children treated at the trauma and orthopedics department of the Mohammed VI University Hospital in Marrakech, Morocco. It concerned 160 cases with a 5-year follow-up from January 2016 to March 2021. Results: The results of the study showed that 56.7% of the affected children had a bilateral dislocation and 25.8% of the cases had a left-sided dislocation. The malformation occurred more frequently in females 69.2%. A familial disposition to the malformation was found in about 22% of the cases. The diagnosis was late (at walking age) in 61% of children following the onset of lameness with or without pain in 91% of children. In 41.87% of the hips, the reduction was surgical, with 28% failure dominated by acetabular dysplasia in 11%. Conclusion: The risk factors for congenital hip dislocation identified in our setting were dominated by sex, primiparity, consanguineous marriage, and the presence of a family history of dislocation. Communication of risk factors specific to our setting to healthcare personnel will allow them to guide the diagnosis and increase vigilance in the at-risk population for management that prevents the development of complications.

Restauración de la biomecánica en artroplastia total de cadera por luxación congénita alta / Restoration of Biomechanics in Total Hip Arthroplasty Due to High Congenital Dislocation

La osteoartritis secundaria a displasia o luxación congénita de cadera conlleva grandes dificultades para el cirujano que reconstruye la cadera. Los casos con escasa deformidad no difieren prácticamente de la reconstrucción primaria convencional. En el extremo opuesto están los casos con graves hipoplasias del acetábulo, escaso desarrollo femoral, luxación completa, discrepancia importante de las extremidades y gran cabalgamiento del trocánter mayor. Por las enormes dificultades que pueden representar para la cirugía, nos trazamos el objetivo de discutir nuestro caso, con las consideraciones y resultados del tratamiento elegido. Se presenta paciente femenina de 54 años de edad, con antecedentes de salud previa, que nos llegó a consulta con una grave deformidad congénita, acortamiento del miembro inferior derecho (6 cm) y limitación dolorosa de todos los movimientos de la cadera. Se constata una luxación congénita grado C de Hartofilakidis y IV de Crowe, que muestra como parte del tratamiento, la artroplastia total con injerto autólogo y reimplantación del cótilo en el acetábulo verdadero, para recuperar el centro de rotación del acetábulo y la osteotomía femoral de acortamiento para la implantación del vástago femoral. Se exponen los requerimientos, procederes técnicos y resultados alcanzados(AU)

Osteoarthritis secondary to congenital hip dysplasia or dislocation poses great difficulties for the surgeon reconstructing the hip. Cases with little deformity do not differ practically from conventional primary reconstruction. At the opposite end there are cases with severe acetabulum hypoplasia, poor femoral development, complete dislocation, significant limb discrepancy, and great thrust of the greater trochanter. Due to the enormous difficulties that they can represent for surgery, we set the objective of discussing our case, with the considerations and results of the chosen treatment. A 54-year-old female patient is reported, she has previous health history, and she came for consultation with severe congenital deformity, shortening of her right lower limb (6 cm) and painful limitation of all hip movements. Congenital dislocation grade C of Hartofilakidis and IV of Crowe was confirmed, which showed as part of the treatment, the total arthroplasty with autologous graft and reimplantation of the cup in the true acetabulum, to recover the center of rotation of the acetabulum and the shortening femoral osteotomy for implantation of the femoral stem. Requirements, technical procedures and results achieved are informed(AU)

Profile of Patients Diagnosed with Developmental Dysplasia of the Hip / Perfil dos pacientes diagnosticados com displasia do desenvolvimento do quadril

Abstract Objective To describe the profile of patients with developmental dysplasia of the hip (DDH) diagnosed by physical and ultrasound examination, with the implementation of a protocol for the treatment and follow-up of DDH. Methods A cross-sectional study with DDH patients born between January 2014 and December 2016, in the city of Pelotas, Southern Brazil. Ethnicity, gender, birth weight, fetal presentation, affected side of the hip, gestational age, maternal age and family history were considered. The data on the medical records were compared with the characteristics of the general population described on the Brazilian National Information System on Live Births (Sistema de Informação sobre Nascidos Vivos [SINASC]). Results A total of 33 DDH patients were identified, mostly female, with a four-fold higher probability of having the condition (p < 0.001); the left was the most affected side. No statistically significant association was found regarding the following factors: birth weight, gestational age, ethnicity, and maternal age. The newborns in breech presentation had a 15-fold higher probability of presenting DDH (p < 0.001). A total of 21 newborns required immediate treatment of the hips, since the ultrasound showed a Graf classification of IIb or higher, or the radiography showed dislocation in DDH patients older than 6 months of age. Conclusion Screening for DDH is essential in all newborns; physical examinations revealing alterations must be complemented with ultrasound imaging to avoid the delayed diagnosis of the condition.

Resumo Objetivo Descrever o perfil dos pacientes com displasia do desenvolvimento do quadril (DDQ), diagnosticados por meio de exame físico e ultrassonográfico, com a implantação do protocolo de atenção e rastreio de DDQ. Métodos Estudo transversal que incluiu os portadores de DDQ nascidos de janeiro de 2014 a dezembro de 2016, na cidade de Pelotas, Sul do Brasil, que considerou os fatores etnia, sexo, peso ao nascer, posição fetal, lado de ocorrência, idade gestacional, idade materna e histórico familiar. Os dados de prontuário foram comparados com as características da população geral por meio do Sistema de Informação sobre Nascidos Vivos (Sinasc). Resultados Foram identificados 33 portadores de DDQ, a maioria do sexo feminino, que mostrou uma probabilidade quatro vezes maior de apresentar a patologia (p < 0,001), e o lado mais acometido foi o esquerdo. Os recém-nascidos com apresentação pélvica tiveram uma probabilidade 15 vezes maior de ter DDQ (p < 0,001). Não foi encontrada associação estatisticamente significativa com os seguintes fatores avaliados: peso ao nascer, idade gestacional, etnia e idade materna. Um total de 21 recém-nascidos necessitaram de tratamento imediato do quadril; a ecografia demonstrou classificação IIb ou maior, pelo método de Graf, ou a radiografia mostrou luxação nos portadores de DDQ com mais de seis meses de idade. Conclusão O rastreio de DDQ é essencial em todos os recém-nascidos, e o exame físico, quando alterado, deve ser complementado com o ultrassonográfico para evitar o diagnóstico tardio da doença.

Influences of thermal insulation at different temperatures on inflammatory response and postoperative rehabilitation in children undergoing congenital dislocation hip surgery / 中华护理杂志

Objective To observe influences of thermal insulation at different temperatures on changes of vital signs,and inflammatory factors in children with congenital dislocation of the hip joint during surgery and postoperative rehabilitation.Methods Totally 39 cases of children undergoing congenital dislocation hip surgery under general anesthesia were selected and randomly divided into 32℃,38℃ and 43℃ groups.Children patients in three groups were given forced air heating at 32℃,38℃ and 43℃,respectively.The body temperature and other vital signs of each group were recorded immediately after anesthesia induction and intubation (T0),during surgical biopsy (T1),at 1h after operation(T2),2 h after operation(T3) and at the end of operation(T4).The venous blood was taken at T0 and T4 to determine the serum TGF-β activation,TNF-α,IL-1β and IL-10.Results Compared with T0,the temperature of three groups increased at T1-4 (P＜0.05),and 38℃ group had the most reliable temperature maintenance.Compared with 32℃ and 43℃ groups,serum TNF-α and IL-1β significantly decreased and TGF-β and IL-10 significantly increased in 38℃ group at T4(P＜0.05).Children in 43℃ group developed more cases of fever compared with other two groups,and the difference was significant (P＜0.05).Conclusion Temperatures setting at 32℃,38℃ and 43℃ can guarantee stable vital signs during surgery,and address hypothermia before surgery and during anesthesia induction.Applying 38℃ gas heating can maintain normal intra-operative body temperature and effectively inhibit inflammatory response.

Cementless Total Hip Arthroplasty Involving Trochanteric Osteotomy without Subtrochanteric Shortening for High Hip Dislocation

BACKGROUND: Total hip arthroplasty with subtrochanteric shortening osteotomy is widely performed for high hip dislocation. However, suboptimal leg length discrepancy correction and nonunion of the osteotomy site remain concerns. Although total hip arthroplasty using trochanteric osteotomy without subtrochanteric osteotomy was introduced, cemented implants have been more commonly used than contemporary cementless implants in this procedure. We evaluated the long-term results of cementless total hip arthroplasty with trochanteric osteotomy without subtrochanteric osteotomy for high hip dislocation. METHODS: From 1990 to 2002, 27 cementless total hip arthroplasties using trochanteric osteotomy without subtrochanteric osteotomy were performed in 26 patients with Crowe III or IV high hip dislocation and a mean age of 36.4 ± 12.9 years. Seven ceramic-on-ceramic, 8 ceramic-on-polyethylene, 10 metal-on-polyethylene, and 2 metal-on-metal bearings were inserted. Mean follow-up was 15.1 ± 3.7 years. We retrospectively reviewed medical records and radiographic data and evaluated the clinical and radiological results including the Harris hip score, implant survival, correction of leg length discrepancy, and occurrence of complications. RESULTS: The mean Harris hip score and leg length discrepancy improved significantly from 73.3 to 94.9 points and from 4.3 cm to 1.0 cm, respectively. With revision for loosening set as the end point, implant survival rates at 10 and 15 years postoperatively were 96.0% and 90.9% for stems and 74.1% and 52.3% for cups. In 8 of 10 hips with the metal-on-polyethylene bearing and 4 of 8 hips with the ceramic-on-polyethylene bearing, revision surgery was performed for aseptic loosening. However, no revision was performed in hips with the ceramic-on-ceramic bearing or the metal-on-metal bearing. Implant survival was significantly different by the type of bearing surface. Two permanent neurologic complications occurred in patients with a limb lengthening over 3.5 cm. CONCLUSIONS: With proper selection of the bearing surface coupled with adjustment of lengthening, cementless total hip arthroplasty using trochanteric osteotomy without subtrochanteric osteotomy might be a favorable treatment option for high hip dislocation.

Influences of thermal insulation at different temperatures on inflammatory response and postoperative rehabilitation in children undergoing congenital dislocation hip surgery / 中华护理杂志

Objective To observe influences of thermal insulation at different temperatures on changes of vital signs,and inflammatory factors in children with congenital dislocation of the hip joint during surgery and postoperative rehabilitation.Methods Totally 39 cases of children undergoing congenital dislocation hip surgery under general anesthesia were selected and randomly divided into 32℃,38℃ and 43℃ groups.Children patients in three groups were given forced air heating at 32℃,38℃ and 43℃,respectively.The body temperature and other vital signs of each group were recorded immediately after anesthesia induction and intubation (T0),during surgical biopsy (T1),at 1h after operation(T2),2 h after operation(T3) and at the end of operation(T4).The venous blood was taken at T0 and T4 to determine the serum TGF-β activation,TNF-α,IL-1β and IL-10.Results Compared with T0,the temperature of three groups increased at T1-4 (P＜0.05),and 38℃ group had the most reliable temperature maintenance.Compared with 32℃ and 43℃ groups,serum TNF-α and IL-1β significantly decreased and TGF-β and IL-10 significantly increased in 38℃ group at T4(P＜0.05).Children in 43℃ group developed more cases of fever compared with other two groups,and the difference was significant (P＜0.05).Conclusion Temperatures setting at 32℃,38℃ and 43℃ can guarantee stable vital signs during surgery,and address hypothermia before surgery and during anesthesia induction.Applying 38℃ gas heating can maintain normal intra-operative body temperature and effectively inhibit inflammatory response.

Comparison of recent years’ incidences of congenital hip dislocation and developmental dysplasia of the hip among children / Монголын Анагаах Ухаан

BackgroundChildren’s congenital hip dislocation is ranked first, accounting for 49,4% among other skeletal anomalieswhich cause to physical disability.There is a tendency that the number of newborn with the congenitalhip dislocation is going to be increased in recent years, 5000:1 were in 1976 and 1000:1,3% in 1998.Bilateral dysplasia accounts for 50-62% of the total incidences. In unilateral cases,left hip seems to beinvolved 2 times more than the right,and the sex ratio is 2,5:1. Some cultures who swaddle their infantstightly with their legs straightened have a far greater incidence of developmental dysplasia of the hip. Aresearch indicated that discouraging this traditional swaddling method has reduced the prevalence ofdevelopmental dysplasia of the hip and congenital hip dislocationby 6 times in America. It is noted thatthis methodhas also been implemented in Japan and Turkey.Aim.This research aimed to study about the prevalence of congenital hip dislocation, developmental dysplasiaof the hip and other anomalies among the children who were underwent treatment at Pediatric Traumaand Orthopedic Department of National Trauma and OrthopedicResearch Centre of Mongolia in 2013-2015 and children served by outpatient visit in the clinics in 2011-2015.The following objectives were defined in the scope of the research. Herein:1. Evaluate and determine the percentage and prevalence of congenital hip dislocation anddevelopmental dysplasia of the hip among the children who undergo treatment in Pediatric Traumaand Orthopedic Departmentof National Trauma Orthopedic Research Center of Mongolia.2. Evaluate and determine the percentage and prevalence of congenital hip dislocation, developmentaldysplasia of the hip and other anomalies among children who are being served by outpatient visit inClinics of National Trauma and Orthopedic Research Center of Mongolia.Materialis and MethodThis research were studied the prevalence of congenital hip dislocation, developmental dysplasia of thehip and other anomalies among the children who were underwent treatment at Pediatric Trauma andOrthopedic Department of National Trauma and OrthopedicResearch Centre of Mongolia in 2013-2015and children served by outpatient visit in the clinics in 2011-2015.ResultTotal of 40559 inpatients underwent treatment in National Trauma andOrthopedic Research of Mongolia;of which 12217 were inpatient in Pediatric Trauma and Orthopedic Department, aged 0-19;of which1351 has been registered with birth defects of hip; of which 248 has been diagnosed with developmentaldysplasia hip, 869 with congenital hip dislocation. Sex ratio of cases of congenital hip dislocationinmales to female is around 1:4.Total of 633 (13,8%) examinations were performed in the clinics in 2011;704 (15,3%) in 2012;962 (20,9%)in 2013;1013 (22%) in 2014;1287 (28%) in 2015 respectively. It shows an increase in the number ofexaminations year by year.Total of 4142 (90,1%) cases were diagnosed with congenital hip dislocation and developmental dysplasiain both hips; left hip has been dislocated 2 times more than the right, 162 (3,5%) with congenitaldislocation of right hip; 292 (6.4%) with congenital dislocation of left hip.ConclusionTo conclude, the analysis above shows that the prevalence of developmental dysplasia of the hip andcongenital hip dislocation is still high in Mongolia. Therefore, number of diagnosis with congenital hipdislocation has rapidly increased in the recent 2 years.

Avaliação clínica e radiológica em médio prazo dos pacientes portadores de displasia do desenvolvimento do quadril submetidos a redução aberta, capsuloplastia e osteotomia de Salter / Clinical and radiographic medium-term evaluation on patients with developmental dysplasia of the hip, who were submitted to open reduction, capsuloplasty and Salter osteotomy

Objetivo: avaliar o resultado clínico e radiológico do tratamento cirúrgico da displasia do desenvolvimento do quadril em médio prazo, por meio da redução aberta, da capsuloplastia e da osteotomia de Salter et al. Métodos: foram avaliados 13 pacientes, 13 quadris, entre 2004 e 2011, tratados cirurgicamente pela técnica proposta. Uma avaliação clínica e radiológica foi feita pelos critérios de Dutoit et al. e Severin et al., respectivamente. Resultados: nos 13 quadris acometidos o índice acetabular pré-operatório variou de 27° a 50° (média de 36) e, após correção cirúrgica, para 18,5° em média, com variação de 10° a 28°, de modo que as avaliações dos índices acetabulares pré e pós-operatórios apresentaram redução com significância estatística (p < 0,05). Quanto à avaliação clínica pós-operatória, foram encontrados: nove quadris ótimos (69,2%), três bons (23,1%), nenhum regular (0%) e um ruim (7,7%). Na avaliação radiológica, foram encontrados seis quadris ótimos (46,1%), três bons (23,1%), nenhum regular (0%) e quatro ruins (30,8%). Portanto, obtiveram-se resultados favoráveis em 92,3%, pois agrupam-se quadris com avaliação ótima e boa como satisfatórios e os com avaliação regular e ruim como insatisfatórios. Atente-se que não houve significância entre a ocorrência de complicações, a idade do paciente, o momento da cirurgia e o índice acetabular pré-operatório (p > 0,05). Como complicações ocorridas, têm se três subluxações isoladas e uma subluxação associada à necrose avascular da cabeça femoral. Conclusão: a redução aberta, ...

Objective: to evaluate the clinical and radiographic medium-term results from surgical treatment of developmental dysplasia through open reduction, Salter et al.'s osteotomy and capsuloplasty. Methods: 13 patients were evaluated, 13 hips treated surgically by the proposed technique between 2004 and 2011. A clinical and radiographic evaluation was conducted by Dutoit et al. and Severin et al. criteria, respectively. Results: the acetabular preoperative index for the 13 surgically treated hips ranged from 27° to 50° (average of 36), and after surgical correction to 18.5° (10-28°), so that the evaluations of preoperative and postoperative acetabular indexes showed up significant statistic reduction (p < 0.05). Regarding the postoperative clinical evaluation, it was found: nine excellent hips Developmental (69.2%), three good ones (23.1%), no fair hips (0%) and a poor one (7.7%). In radiographic evaluation, it was found: six excellent hips (46.1%), three good ones (23.1%), no fair hips (0%) and four poor ones (30.8%). Therefore, favorable results were obtained (92.3%), with grouped hips with excellent and good ratings as satisfactory and with fair and bad ratings as unsatisfactory. It is also important to notice that there was no significance among occurrence of complications, the patient's age, the time of surgery and the preoperative acetabular index (p > 0.05). As complications occurred, it was found that three subluxations and a subluxation associated with avascular necrosis of the femoral head. Conclusion: open reduction, Salter et al.'s osteotomy and capsuloplasty are seen to be a viable option for the treatment of developmental dysplasia of the hip, according to clinical and radiological medium-term evaluations. .

Cementless Total Hip Arthroplasty with Subtrochanteric Transverse Shortening Osteotomy in Patients with High Hip Dislocation / 대한고관절학회지

PURPOSE: The purpose of this study was to evaluate the clinical and radiographic results of cementless total hip arthroplasty (THA) with subtrochanteric transverse shortening osteotomy in patients with high hip dislocation. MATERIALS AND METHODS: Eighteen patients with high hip dislocation who underwent cementless THA combined with a subtrochanteric transverse shortening osteotomy, plate or cable fixation and bone graft on the osteotomy site between 2001 and 2012 were evaluated in this study. The mean duration of follow-up was 5.2 (2-8.3) years. We evaluated Harris hip score, limping, limb length discrepancy as a clinical parameter and osteolysis, loosening and union of the osteotomy site as a radiographic parameter. RESULTS: Harris hip scores at the final follow-up showed improvement of limping and limb length discrepancy in all cases. And, with the exception of two cases of infection, there were no loosening and osteolysis. All cases showed union of the osteotomy site. There were two cases of infection and one case of dislocation as a complication. Infection occurred in two patients who underwent reoperation and one patient developed sciatic nerve palsy. CONCLUSION: Cementless THA with subtrochanteric transverse shortening osteotomy showed relatively satisfactory clinical and radiologic results. However, the incidence of complications, such as infection, is relatively high, therefore, careful attention is needed.

Total hip arthroplasty for severe congenital dislocation of adult hip mellitus / 中国矫形外科杂志

[Objective]To discuss the methods and results of total hip arthroplasty for the adult hip of severe congenital dislocation.[Method]Thirteen patients with unilateral Crowe type-Ⅳ dislocation underwent total hip replacement.All patients were distracted for two weeks preoperatively,and in the operation procedure,the acetabulat rotation center and abductor function were reconstructed on the basis of soft tissue release.The evaluations after surgery included the leg-length and Harris scores.[Result]According to the follow-up with an average of 18 months,the Harris hip score averaged 90 points.The leg-length extended 3.1 cm on average.One patient appeared sciatic nerve palsy.[Conclusion]Total hip arthroplasty could effectively treat server congenital dislocation of adult hip by the methods of tissue release,reconstruction of acetabular,proper selection of prosthetic and protection of nerve.

Congenital hip dislocation in the high risk group - X ray- diagnosis and epidemiology

A cross-sectional study of 204 hip radiographs of high risk CDH (Congenital Dislocation of the Hip) group newborn, using: (1) The Tonnis critenrion of acetabular index upper limit 35 degrees. (2) The position of femoral metaphyseal "beak" with Perkins and Hilgenreiner's lines, showed: 21 CDH/204 risk newborn or 10.24% with 7.35% Dislocatable Hip, 2.93% Complete Dislocation; Female = 9.5:1; Left side: Right side=3:2.