Progress in diagnosis and hip arthroscopic treatment of borderline developmental dysplasia of hip with Cam-type femoroacetabular impingement / 中国修复重建外科杂志

OBJECTIVE@#To summarize the biomechanical characteristics, diagnosis, and hip arthroscopic treatment of borderline developmental dysplasia of hip (BDDH) with Cam-type femoroacetabular impingement (Cam FAI).@*METHODS@#The literature on BDDH with Cam FAI at home and abroad in recent years was extensively reviewed and analyzed.@*RESULTS@#In patients with BDDH and Cam FAI, the femoral neck anteversion angle and femoral neck shaft angle increase, the pelvis tilts, and the acetabulum rotates, resulting in instability of the hip joint. In order to maintain the stability of the hip joint, the direction of biomechanical action of the hip joint has changed, which further affects the anatomical structures such as the proximal femur and acetabular morphology. BDDH with Cam FAI can be diagnosed clinically by combining lateral center edge angle, anterior center edge angle, and acetabular index. BDDH with Cam FAI can be effectively treated through arthroscopic polishing of the edges of the acetabular proliferative bone, excision of Cam malformations, and minimally invasive repair of the glenoid lip and cartilage of the hip joint.@*CONCLUSION@#Currently, there is no unified standard for the diagnosis and treatment of BDDH with Cam FAI. Minimally invasive treatment of the hip under arthroscopy can achieve good early- and medium-term effectiveness, and has certain advantages in repairing and maintaining the integrity of the glenoid lip and suturing/compression joint capsule. However, the long-term effectiveness needs to be further followed up to determine. The timing of surgery, intraoperative bone edge depth polishing, and joint capsule suturing/compression techniques also need to be further explored.

Imaging measurement and analysis of related indexes of variation of femoral head rotation center / 中国骨伤

OBJECTIVE@#To provide guidance for hip replacement by analyzing the variation of femoral head rotation center in different hip diseases.@*METHODS@#A total of 5 459 patients were collected from March 2016 to June 2021, who took positive and proportional plain films of both hips for various reasons. The relative position between the rotation center of the femoral head and the apex of the greater trochanter was measured. The positive variation is more than 2 mm above the top of the great trochanter, and the negative variation is more than 2 mm below the top of the great trochanter. A total of 831 patients with variation of femoral head rotation center were collected and were divided into 4 groups according to different diseases, and the variation was counted respectively. There were 15 cases in the normal group involving 10 cases of positive variation and 5 cases of negative variation. There were 145 cases of avascular necrosis of femoral head involving 25 cases of positive variation and 120 cases of negative variation. There were 346 cases of congenital hip dysplasia involving 225 cases of positive variation(including 25 cases of typeⅠ, 70 cases of type Ⅱ, 115 cases of type Ⅲ and 15 cases of type Ⅳ), and 121 cases of negative variation(including 50 cases of crowe typeⅠ, 60 cases of typeⅡ, 10 cases of type Ⅲ and 1 case of type Ⅳ). There were 325 cases of hip osteoarthritis group involving 45 cases of positive variation and 280 cases of negative variation.@*RESULTS@#There was significant difference in variation of femoral head rotation center among the four groups(P<0.05). There was significant difference in variation of femoral head rotation center among different types of congenital hip dysplasia(P<0.05). There were significant differences in cervical trunk angle and eccentricity among different variations of femoral head rotation center(P<0.05).@*CONCLUSION@#The variation of femoral head rotation center is related to cervical trunk angle and eccentricity. The variation of femoral head rotation center is an important factor in hip diseases. The variation of femoral head rotation center is different in different hip diseases. Avascular necrosis of the femoral head and osteoarthritis of the hip were mostly negative variations. With the aggravation of congenital hip dysplasia, the variation of femoral head rotation center gradually changed from negative variation to positive variation.The variation of femoral head rotation center should be paid attention to in the preoperative planning of hip arthroplasty. It is of great significance to select the appropriate prosthesis and place the prosthesis accurately.

Developmental Dysplasia of the Hip - Part 1 / Displasia do desenvolvimento do quadril - Parte 1

Abstract Developmental dysplasia of the hip (DDH) is a condition characterized by changes in joint formation within the last months of intrauterine life or the first months after birth. Developmental dysplasia of the hip presentation ranges from femoroacetabular instability to several stages of dysplasia up to complete dislocation. Early diagnosis is essential for successful treatment. Clinical screening, including appropriate maneuvers, is critical in newborns and subsequent examinations during the growth of the child. Infants with suspected DDH must undergo an ultrasound screening, especially those with a breech presentation at delivery or a family history of the condition. A hip ultrasound within the first months, followed by pelvic radiograph at 4 or 6 months, determines the diagnosis and helps follow-up. Treatment consists of concentric reduction and hip maintenance and stabilization with joint remodeling. The initial choices are flexion/abduction orthoses; older children may require a spica cast after closed reduction, with or without tenotomy. An open reduction also can be indicated. After 18 months, the choices include pelvic osteotomies with capsuloplasty and, eventually, acetabular and femoral osteotomies. The follow-up of treated children must continue throughout their growth due to the potential risk of late dysplasia.

Resumo O termo displasia do desenvolvimento quadril (DDQ) refere-se à condição na qual a articulação sofre alterações na sua formação durante os últimos meses da vida intrauterina ou nos primeiros meses após o nascimento. No espectro de apresentação, varia desde a instabilidade femuroacetabular, passando por estádios de displasia até a completa luxação. O diagnóstico precoce é fundamental para o sucesso do tratamento. A triagem através do exame clínico incluindo manobras apropriadas é imprescindível nos recém-nascidos e nas avaliações subsequentes durante o crescimento da criança. O rastreamento ultrassonográfico é indicado nos bebês sob suspeita clínica e muito mais recomendável naqueles que tiveram apresentação pélvica para o parto ou que tenham antecedentes familiares. A ultrassonografia do quadril nos primeiros meses seguida da radiografia da bacia após o 4° ou 6° mês de vida são os exames que determinam o diagnóstico e auxiliam o seguimento. O tratamento está baseado na obtenção de uma redução concêntrica e na manutenção e estabilização do quadril, propiciando a remodelação articular. Inicialmente, as órteses de flexão/abdução são a escolha; em crianças maiores pode ser necessário o uso de gesso após redução incruenta com ou sem tenotomia; redução aberta pode ser indicada e após os 18 meses as osteotomias pélvicas associadas a capsuloplastia e eventuais osteotomias acetabular e femoral. Crianças tratadas devem ser acompanhadas durante todo o seu crescimento pelo eventual risco de displasias tardias.

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.

Descripción de pacientes con displasia del desarrollo de cadera en Hospital Clínico Herminda Martin, Chillán, entre los años 2020-2021 / Description of patients with developmental dysplasia of the hip at the Hospital Clínico Herminda Martin, Chillán, between the years 2020-2021

Introducción: La displasia del desarrollo de la cadera (DDC), una patología multifactorial más prevalente en el sexo femenino, afecta a lactantes, y el diagnóstico y tratamiento oportuno permiten evitar consecuencias posteriores, morbimortalidad significativa y una carga en salud importante. Objetivo: Conocer la realidad local en relación con el diagnóstico y tratamiento de la DDC, describiendo demográficamente a los pacientes evaluados por médicos especialistas, específicamente traumatólogos infantiles del Hospital Clínico Herminda Martin (HCHM) en Chillán. Materiales y métodos: Se llevó a cabo un estudio descriptivo transversal de una cohorte de pacientes evaluados mediante radiografías en el HCHM por sospecha de DDC, entre junio de 2020 y julio de 2021. Se recopilaron variables como sexo, tipo de compromiso del desarrollo de la cadera y tratamiento utilizado. Resultados: De 146 pacientes evaluados, el 83.6% correspondían al sexo femenino, mientras que el 16.4% eran del sexo masculino. En cuanto a los tratamientos ortopédicos, el 82.7% fueron mujeres y el 17.2% hombres, siendo las correas de Pavlik el tratamiento más utilizado. Solo 7 pacientes requirieron tratamiento quirúrgico. Discusión: Los resultados obtenidos se respaldan en la evidencia internacional, reflejando realidades similares a la situación local. La relevancia de este estudio radica en la falta de una base de datos nacional o local actualizada sobre la patología, sumado a la ventaja de informar acerca de los tratamientos disponibles y la adherencia a ellos. Esto permite reflejar el comportamiento de la población local durante los años 2020-2021. Las limitaciones incluyen el seguimiento, debido a restricciones por la pandemia y la falta de datos previos.

Introduction: Developmental dysplasia of the hip (DDH), a multifactorial pathology more prevalent in females, affects infants, where timely diagnosis and treatment avoid subsequent consequences, significant morbidity, and mortality, as well as the health burden it generates. Objective: To understand the local reality regarding the diagnosis and treatment of DDH by describing the demographic characteristics of patients evaluated by medical specialists, specifically child traumatologists from the Hospital Clínico Herminda Martin (HCHM) in Chillán. Materials and Methods: A cross-sectional descriptive study was conducted on a cohort of patients evaluated through radiographs at HCHM due to suspected DDH between June 2020 and July 2021. Variables collected included sex, type of hip development compromise, and treatment used. Results: Out of 146 patients, 83.6% were female and 16.4% were male. In terms of orthopedic treatments, 82.7% were females, and 17.2% were males, with Pavlik straps being the most used orthopedic treatment. Only 7 patients underwent surgical treatment. Discussion: The obtained results align with international evidence, reflecting realities similar to the local situation. The study's significance lies in the absence of an updated national or local database on the pathology. Additionally, it provides insights into available treatments and patient adherence, offering a snapshot of the local population's behavior during 2020-2021. Limitations include patient follow-up challenges due to pandemic restrictions and the lack of pre-existing data.

Research status of acetabular reconstruction in Crowe type Ⅱ and Ⅲ developmental dysplasia of the hip / 中国骨伤

Developmental dysplasia of the hip (DDH) is a major cause of hip arthritis and ultimately total hip arthroplasty. Due to the dysplastic acetabulum, how to place the acetabular cup becomes a challenge in acetabular reconstruction for such patients. Especially in the acetabula classified as Crowe typeⅡand type Ⅲ, the dislocation of the femoral head causes bone defects above the true acetabulum, which will affect the stability of the acetabular cup when the acetabular reconstruction is performed at the true acetabulum. Many acetabular reconstruction methods such as bone grafting, the use of small acetabular cups, socket medialization technique, and high hip center technique are used to increase the host bone coverage of the cup. However, each method has its own shortcomings that can not be ignored so that there is no unified conclusion on the acetabular reconstruction methods for Crowe typeⅡand type Ⅲ hip dysplasia. This article summarized and evaluated various reconstruction methods in combination with the acetabular morphology of DDH, and put forward the research direction in the future.

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)

Recomendaciones en la pesquisa y diagnóstico de la displasia del desarrollo de las caderas / Screening and diagnostic recommendations in the developmental dysplasia of the hip

La displasia del desarrollo de la cadera (DDC) es una anomalía de la articulación coxofemoral caracterizada por una laxitud o posicionamiento anormal de la cabeza femoral con respecto al acetábulo. Es la patología ósea perinatal más frecuente, e incluye alteraciones que van desde el aplanamiento o la displasia acetabular hasta una luxación completa de la cabeza femoral fuera de la articulación, que puede comprometer el desarrollo y la estabilidad articular. Nuestro objetivo es transmitir una sistemática de estudio en la valoración de la cadera del recién nacido, haciendo énfasis en un examen físico correcto como pilar fundamental en la detección de la DDC, y orientar al pediatra en la selección adecuada del método diagnóstico complementario acorde a edad del paciente, con el fin de optimizar la detección y reducir el número de caderas luxadas en etapas tempranas y tardías, y así disminuir la incidencia de patologías asociadas desarrolladas a partir de este trastorno

Developmental dysplasia of the hip (DDH) is a hip joint anomaly that is characterized by a laxity or abnormal positioning of the femoral head with respect to the acetabulum. It is the most common perinatal pathology of the skeleton and includes a spectrum of alterations ranging from flattening or acetabular dysplasia, to a complete dislocation of the femoral head outside the joint that can compromise joint development and stability. The purpose of this presentation is to transmit a systematic study in the evaluation of the newborn's hip, emphasizing a correct physical examination as primordial in the detection of DDH. Also, guide the pediatriciain the proper selection of the complementary diagnostic method to be used according to the age of the patient, in order to optimize detection and reduce the number of dislocated hips in early and late stages as well as the incidence of related pathologies.

Osteotomía periacetabular de Ganz para el tratamiento de la displasia del desarrollo de la cadera: experiencia inicial y resultados de los primeros 44 casos / Ganz periacetabular osteotomy for the treatment of developmental dysplasia of the hip. Initial experience and results from the first 44 cases

Objetivo: Describir la técnica quirúrgica, las indicaciones y los resultados iniciales de la osteotomía periacetabular bernesa para tratar la displasia del desarrollo de la cadera. Materiales y métodos: Entre mayo de 2011 y mayo de 2020, se realizaron 44 osteotomías periacetabulares bernesas en 44 pacientes (35 mujeres, edad promedio 30 años [rango 23-38]). Todos tenían diagnóstico de displasia de cadera sintomática. El ángulo centro-borde promedio fue de 17° (rango 9°-20°) y el índice acetabular promedio, de 18° (rango 15°-20°). En 22 casos, se evaluaron y repararon los hallazgos intrarticulares por artroscopia en el mismo acto quirúrgico. Se evaluaron la corrección obtenida, la consolidación de la osteotomía y los resultados funcionales al final del seguimiento. Resultados: En 22 pacientes, se detectó hipertrofia y rotura del labrum acetabular asociadas a displasia de cadera. Diez pacientes tenían quistes paralabrales. El ángulo centro-borde promedio posoperatorio fue de 32° (rango 27°-35°) y el índice acetabular, de 6° (rango 4°-9°). El tiempo quirúrgico para la osteotomía periacetabular bernesa fue de 130 min, cuando se sumó un procedimiento artroscópico, el tiempo fue de 148 minutos. Conclusiones: La osteotomía periacetabular bernesa es técnicamente demandante, pero logra resultados predecibles en pacientes con integridad del cartílago articular y deformidades corregibles. La artroscopia antes de la osteotomía permite evaluar las condiciones del cartílago, diagnosticar y tratar lesiones intrarticulares asociadas con esta enfermedad y decidir si es necesaria la corrección del déficit de cobertura. Nivel de Evidencia: IV

Objective: To describe the surgical technique, indications, and initial results of the Bernese periacetabular osteotomy (PAO) for the treatment of developmental dysplasia of the hip. Materials and methods: Between May 2011 and May 2020, 44 PAOs were performed in 44 patients (35 women) with an average age of 30 years (23-38). All patients had a diagnosis of symptomatic hip dysplasia. The average center-edge angle was 17° (9° to 20°) and the average acetabular index was 18° (15° to 20°). In 22 cases, the intra-articular findings were evaluated and repaired by arthroscopy in the same surgical stage. The correction obtained, the consolidation of the osteotomy, and the functional outcomes at the end of the follow-up were evaluated. Results: Hypertrophy and rupture of the acetabular labrum associated with hip dysplasia were evidenced in 22 patients. Paralabral cysts were found in 10 patients in the series. The average postoperative center-edge angle was 32° (27° to 35°) and the acetabular index was 6° (4° to 9°). The surgical time for PAO was 130 minutes; in patients where an arthroscopic procedure was added, the time was 148 minutes. Conclusions: PAO is technically demanding, but has predictable outcomes in patients with articular cartilage integrity and correctable deformities. Arthroscopy before osteotomy allows assessing cartilage conditions, diagnosing and treating intra-articular lesions associated with this pathology, and deciding on the need to correct the soft tissue deficit. Level of Evidence: IV

Periacetabular osteotomy with concomitant hip arthroscopy: a case series with 24 months minimum follow-up

PURPOSE To describe patient-reported outcomes, radiological results, and revision to total hip replacement in patients with hip dysplasia that underwent periacetabular osteotomy as isolated treatment or concomitant with hip arthroscopy. METHODS Case series study. Between 2014 and 2017, patients were included if they complained of hip pain and had a lateral center-edge angle ≤ of 20°. Exclusion criteria included an in-maturate skeleton, age of 40 or older, previous hip surgery, concomitant connective tissue related disease, and Tönnis osteoarthritis grade ≥ 1. All patients were studied before surgery with an anteroposterior pelvis radiograph, false-profile radiograph, and magnetic resonance imaging. Magnetic resonance imaging was used to assess intraarticular lesions, and if a labral or chondral injury was found, concomitant hip arthroscopy was performed. The non-parametric median test for paired data was used to compare radiological measures (anterior and lateral center-edge angle, Tönnis angle, and extrusion index) after and before surgery. Survival analysis was performed using revision to total hip arthroplasty as a failure. Kaplan Meier curve was estimated. The data were processed using Stata. RESULTS A total of 15 consecutive patients were included; 14 (93%) were female patients. The median follow-up was 3.5 years (range, 2 to 8 years). The median age was 20 (range 13 to 32). Lateral center-edge angle, Tönnis angle, and extrusion index correction achieved statistical significance. Seven patients (47%) underwent concomitant hip arthroscopy; three of them (47%) were bilateral (10 hips). The labrum was repaired in six cases (60%). Three patients (15%) required revision with hip arthroplasty, and no hip arthroscopy-related complications are reported in this series. CONCLUSION To perform a hip arthroscopy concomitant with periacetabular osteotomy did not affect the acetabular correction. Nowadays, due to a lack of conclusive evidence, a case by case decision seems more appropriate to design a comprehensive treatment.

Displasia epifisaria de Meyer. Presentación de un caso / Meyer epiphyseal dysplasia. Case presentation

RESUMEN Se presentó el caso de una niña con el diagnóstico de displasia de Meyer. Consiste en una alteración en el desarrollo de la cadera en el niño dado por irregularidad y retraso en la osificación del núcleo de la epífisis femoral, aunque muchos ortopedistas la consideran como una variante fisiológica normal. Radiológicamente se manifiesta como un patrón granular múltiple de osificación y clínicamente si bien puede ser sintomática en algunos casos, lo más frecuente es que sea asintomática. Se enfatizó en la importancia de considerar a la displasia de Meyer como posibilidad diagnóstica ante alteraciones en la osificación de la epífisis femoral. Se señaló a la displasia congénita de la cadera y la enfermedad de Perthes como principales entidades a tener en cuenta al hacer el diagnóstico diferencial. Se analizó la evolución clínico-radiológica de la paciente a partir de los datos recogidos en la historia clínica. Se concluyó enfatizando que la displasia de Meyer debe tenerse presente como posibilidad diagnóstica ante casos similares, realizar una cuidadosa valoración de cada paciente y tener en cuenta a la displasia congénita de la cadera y la enfermedad de Perthes como diagnóstico diferencial atendiendo a la edad del paciente (AU).

ABSTRACT The authors present the case of a female child diagnosed with Meyers dysplasia. It is an alteration of the hip development in children, given the ossification irregularity and retardation of the femoral epiphysis nucleus, although several orthopedists consider it a normal physiological variant. Radiologically, it shows like a multiple granular pattern of ossification, and clinically it could be symptomatic in several cases, but more frequently it is asymptomatic. It was emphasized the importance of considering Meyer dysplasia as a diagnostic possibility in the presence of alterations in the femoral epiphysis ossification. The authors indicated hip congenital dysplasia and Perthes disease as main entities to take into account when making the differential diagnosis. They also analyzed clinic-radiological evolution of the patient on the basis of the data collected in the clinical record. They concluded emphasizing that Meyer dysplasia must be taken into consideration as a diagnostic possibility in similar cases, each patient should be carefully assessed and that hip congenital dysplasia and Perthes disease have to be considered as differential diagnosis given the age of the patient (AU).

Application of 3D printing guide plate in total hip arthroplasty for developmental dysplasia of the hip / 中国骨伤

OBJECTIVE@#To explore the value of 3D-printed navigation template using in total hip arthroplasty(THA)for developmental dysplasia of the hip (DDH).@*METHODS@#Twenty five patients with DDH underwent total hip arthroplasty from February 2016 to May 2018 were analyzed retrospectively, including 4 males and 21 females, aged from 40 to 75 years old. Among them, 5 cases were Crowe typeⅡ, 14 cases were Crowe type Ⅲ and 6 cases were Crowe type Ⅳ. Twelve cases of them underwent THA with the 3D printing navigation plate, another 13 cases underwent the same operation but without the aid of navigation templates. All patients were treated by the same operators. The operating time, intra- and post-operative hemorrhage and Harris Hip Score(HHS) at six months postoperativelywere compared, anteversion angle, abduction angle and the distance from rotation center to the ischial tuberosity connection between ipsilateral and contralateral sides were also compared.@*RESULTS@#All of the patients were followed up for 12 to 26 months. The operation time, intra- and post-operative hemorrhage and Harris score in the 3D printing group were better than those in the conventional hip replacement group(@*CONCLUSION@#The 3D-printed operation navigation template technique is an individualized, accurate and promisingtechnique for THA with DDH.

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.

Diferentes índices radiográfcos versus Índice Acetabular en la decisión de colocación de Arnés de Pavlik en pacientes con diagnóstico de Displasia de Cadera / Different X-ray indices versus Acetabular Index on Pavlik Harness Placement Decision in Patients Diagnosed with Hip Dysplasia

Existen diferentes índices y clasifcaciones radiográfcas para el diagnóstico de Displasia del Desarrollo de la Cadera, este estudio comparó la utilidad de diferentes parámetros radiográfcos en pacientes con índices acetabulares elevados a fn de determinar si se benefciarán o no de un tratamiento ortopédico. Pacientes y Métodos: Estudio de cohorte retrospectivo. Pacientes de 3 a 7 meses, atendidos en la consulta externa de Traumatología y Ortopedia pediátrica del Hospital Vozandes Quito en el período enero a diciembre de 2017 fueron incluidos en el estudio. Signos de inestabilidad de la cadera al examen físico, mediciones radiográfcas: índice acetabular, porcentaje de migración de cabeza femoral, índice de Smith, clasifcación de Tonnis por cuadrantes, formación de la ceja acetabular radiográfca se obtuvieron del prontuario médico de cada paciente. Resultados: Se evaluaron 104 pacientes, la mediana de la edad al momento del diagnóstico fue 4,63 meses, el 52% eran del sexo masculino y la media del índice acetabular fue de 37,9˚. Los pacientes fueron subdivididos en 2 grupos de acuerdo con el tratamiento ortopédico instaurado: con arnés de Pavlik (38,5%) y sin arnés (61,5%). Al comparar pacientes sin y con arnés obtuvimos un OR de 1,07 y un valor p = 0.69. Pacientes con una escala de Tonnis grado I tuvieron 96% de probabilidad de desarrollar una cadera normal en relación con el grado II de Tonnis (60%), con un OR de 21,3 y p = 0,69. Conclusión: Existe un grupo de pacientes con un índice acetabular elevado y caderas estables al examen físico que no se benefciarían de un tratamiento ortopédico. Dentro de todos los parámetros evaluados observamos que la ceja acetabular radiográfca normal y la escala de Tonnis grado I fueron parámetros predictores de una buena respuesta a los 2 meses. El índice de Smith y el porcentaje de Reimers no tiene valor pronóstico en pacientes con sospecha de displasia de cadera

There are different x-ray indices and classifcations for the diagnosis of Hip Developmental Dysplasia, this study compared the usefulness of different x-ray parameters in patients with high acetabular indices to determine whether or not would beneft from orthopedic treatment. Patients and Methods: Retrospective cohort study. Patients aged 3 to 7 months, attended in the external consultation of Traumatology and Pediatric Orthopedics of the Hospital Vozandes Quito in the period January to December 2017 were included in the study. Signs of hip instability to physical examination, radiographic measurements: acetabular index, percentage of femoral head migration, Smith index, Tonnis classifcation by quadrants, formation of the radiographic acetabular eyebrow were obtained from the medical record of each patient. Results: 104 patients were evaluated, the median age at the time of diagnosis was 4.63 months, 52% were male and the mean acetabular index was 37.9 degrees. Patients were subdivided into 2 groups according to the orthopedic treatment instituted: with Pavlik harness (38.5%) and without a harness (61.5%). When comparing patients without and with harness we got an OR of 1.07 and a value of p-0.69. Patients with a Grade I Tonnis scale had a 96% chance of developing a normal hip relative to Tonnis Grade II (60%), with an OR of 21.3 and p-0.69. Conclusions: There is a group of patients with a high acetabular index and hips stable to the physical examination who would not beneft from orthopedic treatment, within all the parameters evaluated we observe that the normal radiographic acetabular eyebrow and the Tonnis scale grade I were predictor parameters of a good response at 2 months. Smith's index and reimers percentage have no prognostic value in patients with suspected hip dysplasia

Avaliação ortopédica e ultrassonográfica da estabilidade dos quadris de recém-nascidos encaminhados por pediatras, com suspeita de Displasia Típica do Desenvolvimento / Orthopedic and ultrasound assessment of hip stability of newborns referred by pediatricians with suspected Developmental Dysplasia

RESUMO Objetivo: avaliar recém-nascidos com suspeita de instabilidade do quadril, encaminhados por pediatras a um serviço ortopédico terciário. Métodos: recém-nascidos de uma maternidade pública universitária, com suspeita de instabilidade ou fatores de risco para displasia do quadril, eram encaminhados ao Departamento de Ortopedia e Anestesiologia, Ribeirão Preto/SP, onde eram avaliados clinicamente e através de exames ultrassonográficos dos quadris. Constatada a displasia, iniciava-se o tratamento, e em casos em que havia apenas imaturidade do quadril e exame clínico normal, procedia-se à observação e re-exame clinico e ultrassonográfico com dois ou três meses de vida. Resultados: foram examinados 448 recém-nascidos, com predominância feminina e média de idade na primeira avaliação de 27 dias. A principal causa do encaminhamento foi apresentação pélvica. Em 8% havia sinal de Ortolani positivo e em 12,5% estalido no quadril. No exame ortopédico, 405 (90,5%) pacientes eram normais, 8,5% apresentavam estalido no quadril e 1,1% apresentavam teste de Ortolani positivo. À ultrassonografia, 368 (89,5%) apresentavam imaturidade, 26 (6,3%) tinham displasia moderada e em 17 (4,1%) pacientes os quadris eram francamente displásicos. Todos os casos com sinal de Ortolani positivo apresentavam quadro ultrassonográfico de displasia. Conclusão: houve excesso de diagnóstico de instabilidade do quadril na avaliação do pediatra, o que, no entanto, permitiu ao paciente uma segunda avaliação, em ambiente mais especializado e com mais recursos tecnológicos.

ABSTRACT Objective: to evaluate newborns with suspected hip instability, referred by pediatricians to a tertiary orthopedic service. Methods: newborns from a public university maternity hospital, with suspected instability or risk factors for hip dysplasia, were referred to the Department of Orthopedics and Anesthesiology, Ribeirão Preto/SP, where we evaluated them clinically and through ultrasound examinations of the hips. Once we found dysplasia, we initiated treatment, and in cases in which there was only hip immaturity and normal clinical examination, we performed clinical and ultrasound observation and review at two or three months of age. Results: we examined 448 newborns, with female predominance and average age at first evaluation of 27 days. The main cause of referral was pelvic presentation at delivery. In 8% there was a positive Ortolani sign and in 12.5%,. At orthopedic examination, 405 (90.5%) patients were normal, 8.5% had hip click and 1.1% had positive Ortolani test. At ultrasound, 368 (89.5%) had immaturity, 26 (6.3%) had moderate dysplasia and in 17 (4.1%) patients the hips were frankly dysplastic. All cases with positive Ortolani sign showed dysplasia at ultrasound. Conclusion: there was an excess diagnosis of hip instability in the pediatrician evaluation, which, however, allowed the patient a second assessment, in a more specialized environment and with more technological resources.

Developmental dysplasia of the hip: why are we still operating on them? A plea for institutional newborn clinical screening

INTRODUCTION@#Developmental dysplasia of the hip (DDH) is a common orthopaedic condition at birth. Non-surgical management with the Pavlik harness can effectively treat DDH in the newborn by providing an early clinical diagnosis, but open surgeries continue to be performed. We aimed to elucidate the reasons for this.@*METHODS@#A retrospective review was performed of all open surgeries related to DDH from 2006 to 2016. Patients were either born at our institution (Group 1) or outside of it (Group 2). All Group 1 newborns were routinely screened for DDH at birth.@*RESULTS@#27 patients (Group 1: n = 5, Group 2: n = 22) presented at age 25 ± 19 months. Left-sided DDH (n = 21, 77.8%) and female infants (n = 22, 81.5%) were more common. The mean age at surgery was 40 ± 31 months. The most commonly performed procedure was soft tissue release open reduction with acetabuloplasty (n = 20, 74.1%). Gender, site, median age at presentation and at surgery, and prevalence of risk factors were similar for both groups. Both groups were mostly made up of late presenters (> 3 months; p = 0.34). A few patients had undergone prior treatment (p = 0.64). Newborn screening was the only significantly different variable between the groups (p < 0.01).@*CONCLUSION@#Lack of institutionalised newborn clinical screening appears to be the root cause of late presentation of DDH leading to open surgery for its management. We recommend quality institutionalised newborn clinical screening to reduce the number of late presentations.

Two different kinds of total hip arthroplasty for unilateral Crowe IV developmental dysplasia of the hip in adults / 中国骨伤

OBJECTIVE@#To compare the clinical effects of total hip arthroplasty(THA) with non-osteotomy and subtrochanteric osteotomy in the treatment of Crowe type IV hip dysplasia (DDH) in adults.@*METHODS@#Data of 35 Crowe type IV DDH patients who underwent THA were analyzed retrospectively, the patients were divided into two groups:15 cases of non-osteotomy and 20 cases of subtrochanteric osteotomy. There was no significant difference in age, gender, body mass index between two groups (>0.05). The operative time, bleeding volume, hospitalization duration, Harris hip score and the limb length discrepancy (LLD) were evaluated.@*RESULTS@#All of the patients were followed up for 12 to 48 months, no prosthesis loosening or infection occurred by the end of follow-up. In non-osteotomy group, 1 case had occurred by sciatic nerve injury and 1 case developed cutaneous branch injury of the femoral nerve, both of which were spontaneously recovered completely without treatment after 3 months. One case of dislocation occurred in subtrochanteric osteotomy group, after closed reduction, dislocation did not recur; three cases had proximal femoral crack fractures and received steel plate fixation; no reoperation was needed. There was significant difference in operation duration, bleeding volume, and hospitalization days between two groups(0.05). The postoperative discrepancy of bilateral lower limbs had significant difference(<0.05).@*CONCLUSIONS@#THA with no femoral shortening osteotomy can achieve good clinical results in patients with unilateral Crowe IV developmental dysplasia of hip. Comparing with subtrochanteric osteotomy, the procedure of no femoral shortening osteotomy is easier technically. For unilateral high dislocation DDH patients with limb lengthening <=4 cm and good tissue conditions, THA without femoral osteotomy may be considered.

Medición radiográfica del ángulo acetabular para el diagnóstico temprano de la displasia del desarrollo de la cadera / Radiographic measurement of the acetabular angle for early diagnosis of hip development dysplasia

Resumen: Antecedentes: Para evitar secuelas en la displasia del desarrollo de la cadera el tratamiento debe ser temprano; el ángulo acetabular corresponde a la inclinación del techo del acetábulo. Stanisavljevic indica que para medir adecuadamente el ángulo acetabular se deben colocar las caderas en abducción. Pregunta: ¿cuál es la magnitud de la diferencia de la medición radiográfica del ángulo acetabular entre las proyecciones anteroposterior de pelvis en posición neutra y con abducción de caderas? Métodos: Se tomaron 916 mediciones radiográficas comparando las de posición neutra contra las de abducción de caderas, de pacientes atendidos en consulta externa entre el 1 de Abril de 2010 y el 31 de Marzo de 2013. Resultados: Se realizaron pruebas t para medias de dos muestras emparejadas y se obtuvo una diferencia hipotética de las medias de 0.0000 y el coeficiente de correlación de Pearson para cadera derecha fue 0.74427531 y para la izquierda 0.73779866. Usando una Tabla propuesta de normalidad del ángulo acetabular según edad, se obtuvo el área bajo la curva en una distribución tgl457 = 0.650 con p = 0.516. El índice acetabular en posición neutra y con abducción de caderas es similar con alta significancia estadística, según el análisis de correlación de Pearson. Con base en la curva ROC, el índice acetabular en posición de rana tiene una alta sensibilidad y especificidad. Por tanto, la medición del índice acetabular en posición con abducción de caderas, tiene alta confiabilidad de lograr un diagnóstico correcto.

Abstract: Background: In order to avoid sequelae in the development dysplasia of the hip the treatment should be early; The acetabular angle corresponds to the inclination of the roof of the acetabulum. Stanisvljevic indicates that to properly measure the acetabular angle, the hips should be placed in abduction. Question: What is the magnitude of the difference in radiographic measurement of the acetabular angle between the anteroposterior projections of pelvis in neutral position and with abduction of hips? Methods: 916 radiographic measurements were taken by contrasting the neutral position against those of hip abduction, of patients in our clinic attended between April 1, 2010 and March 31, 2013. Results: T tests were performed for means of two matched samples and a hypothetical difference of the mean of 0.0000 was obtained and the Pearson correlation coefficient for right hip was 0.74427531 and for the left 0.73779866. Using a proposed Table of normality of the Acetabular angle according to age, the area was obtained under the curve in a distribution Tgl457 = 0.650 with P = 0.516. The index acetabular in neutral position and with abduction of hips is similar with high statistical significance, according to the analysis of correlation of Pearson. Based on the ROC curve, the acetabular index in frog position has a high sensitivity and specificity. Discussion: Therefore, the measurement of the acetabular index in position with hip abduction, has high reliability to achieve a correct diagnosis.

High congenital hip dislocation in adults - arthroplasty and functional results / Luxações congênitas altas da anca no adulto - Artroplastia e resultados funcionais

ABSTRACT Objective: Retrospective case-control study on the authors' experience regarding arthroplasty in high congenital dislocations of the hip in adults. Methods: Sample with 11 high congenital hip dislocations (Hartofilakidis type C) that occurred in seven patients, who were submitted to hip arthroplasty by the same surgeon and with the same surgical technique. Mean follow-up period was 4.32 ± 2.67 years (minimum one year) and all patients were evaluated by the same examiner. Results: All the arthroplasties had cementless fixation, with application of screwed acetabular cups, conical femoral stems, and a metal-polyethylene articular pars. In every patient, shortening femoral osteotomies were performed at subtrochanteric or supracondylar locations. The mean Harris Hip Score at the last evaluation was 88.55 ± 4.50 (range 81-94). The mean time with high dislocation of the hip (42.91 ± 14.59 years, range 19-68) showed a significant inverse correlation with Harris Hip Score (r = 0.80; p = 0.003). All patients reported important relief of pain complaints and are capable of ambulation without any external support. In the unilateral dislocations, leg length discrepancies were fully corrected; in the bilateral cases, isometric limbs were achieved in all patients. All osteotomies consolidated, with a mean interval of 3.27 ± 0.47 months. There were complications in 18.18% of the sample: one iatrogenic intraoperative fracture of the greater trochanter and a transitory sciatic neurapraxia. Conclusion: Despite being a demanding surgery with a reportedly high complication rate, total hip arthroplasty in high congenital dislocations, when properly indicated and technically correctly performed, allows an improvement in function and quality of life.

RESUMO Objetivo: Estudo retrospectivo sobre a experiência dos autores no uso de artroplastias para o tratamento de luxações congênitas altas da anca. Métodos: Amostra com 11 luxações congênitas altas da anca (Hartofilakidis tipo C) verificadas em sete pacientes, que foram submetidos a artroplastia da anca pelo mesmo cirurgião com a mesma técnica cirúrgica. O tempo de seguimento médio foi de 4,32 ± 2,67 anos (mínimo um ano) e todos os pacientes foram avaliados pelo mesmo médico. Resultados: Todas as próteses tiveram fixação não cimentada, usaram-se cúpulas acetabulares aparafusadas, hastes femorais cônicas e par articular metal-polietileno. Em todos os pacientes foram efetuadas osteotomias de encurtamento femoral no nível subtrocantérico ou supracondiliano. O Harris Hip Score médio no momento da última avaliação clínica foi de 88,55 ± 4,50 (intervalo 81-94). O tempo de duração da luxação alta da anca (42,91 ± 14,59 anos, intervalo 19-68) demonstrou uma correlação inversa significativa com o Harris Hip Score (r = 0,80; p = 0,003). Todos os pacientes relataram alívio importante das queixas álgicas e todos são capazes de deambular sem qualquer apoio exterior. Nas luxações unilaterais, conseguiu-se correção completa da dismetria e nas bilaterais, membros isométricos em todos os pacientes. Todas as osteotomias consolidaram em tempo médio de 3,27 ± 0,47 meses. Verificaram-se complicações em 18,18% da amostra: uma fratura iatrogênica intraoperatória do grande trocânter e uma neuropráxia transitória do ciático. Conclusão: Apesar de ser uma cirurgia exigente e com elevado índice de complicações relatado, a artroplastia da anca na luxação congênita alta, quando devidamente indicada e tecnicamente bem executada, permite melhorar a funcionalidade e qualidade de vida dos pacientes.

Utilidad de la artrografía en la decisión terapéutica en niños con displasia del desarrollo de cadera de tres meses a tres años de edad / Usefulness of the arthrogram in the decision therapy in children with developmental dysplasia of the hip from 3 months to 3 years of age

Resumen: Objetivo: Evaluar la utilidad de la artrografía como herramienta en la decisión terapéutica de pacientes con displasia del desarrollo de cadera (DDC). Material y métodos: 19 niños con diagnóstico de DDC habitual de edad entre tres meses y tres años, sin antecedentes quirúrgicos, Tonis II o III y expediente radiográfico completo. Para cada caso se registró la decisión terapéutica radiográfica y artrográfica por tres observadores independientemente, en el análisis estadístico el estándar fue la cirugía realizada necesaria para lograr una reducción concéntrica y cobertura acetabular adecuada. Resultados: 20 casos, 19 pacientes, de los cuales 18 fueron unilateral y uno bilateral. Fueron 17 niñas (89%) y dos niños (11%). Edad promedio: un año tres meses (de cuatro meses a dos años 11 meses), 11 Tonis II (55%) y nueve Tonis III (45%). El coeficiente de correlación intraclase (CCI) en relación con la decisión terapéutica radiográfica fue de 0.8933 y para la artrografía fue de 0.7205. El CCI de la decisión terapéutica radiográfica en relación con el estándar fue de 0.7933 y para la artrográfica fue de 0.6219. Se confirmó que en los 20 casos revisados la utilidad de la artrografía (CCI 0.6219) es menor que la de las radiografías (CCI 0.7933). La utilidad de la artrografía fue mayor en los pacientes con Tonis II con una edad entre nueve meses y dos años.

Abstract: Objective: To evaluate the utility of arthrography as a tool in therapeutic decision in developmental dysplasia of hip (DDH). Material and methods: 19 children with true DDH with age between three months and three years, without previous surgical treatment, with Tonis II or III, and complete X-rays. For each case; therapeutic decision was registered for X-rays and arthrography by three independent observers, we took like standard, surgery in each patient necessary to obtain a concentric reduction and good acetabular coverage. Results: 20 cases, 19 patients. 18 unilateral, 1 bilateral. They were 17 girls (89%) and 2 children (11%). Average Age: 1 year 3 months (4 months to 2 years 11 months). 11 Tonis II (55%) and 9 Tonis III (45%). The intraclass coefficient of correlation (ICC) in relation to the decision therapeutic radiographic was of 0.8933 and for the arthrography of 0.7205. And ICC of the decision therapeutic radiographic in connection with the standard was of 0.7933 and for the arthrography it was of 0.6219. We confirm that in our 20 cases, the utility of the arthrography (ICC 0.6219), is smaller to the X-rays (ICC 0.7933). The utility of the arthrography was bigger in the patients with Tonis II, and an age between nine months and two years.