Hip Flexion Weakness following Transpsoas Interbody Fusion

Objective The present work evaluated the motor deficit resulting from the psoas muscle access through the extreme lateral interbody fusion (XLIF) approach. Methods This was a prospective, non-randomized, controlled, single-center study with 60 patients, with a mean age of 61.8 years old. All of the subjects underwent a lateral transpsoas retroperitoneal approach for lumbar interbody fusion with electroneuromyographic guidance and accessing 1 to 3 lumbar levels (mean level, 1.4; 63% cases in only 1 level; 68% cases included L4-L5). The isometric hip flexion strength in the sitting position was determined bilaterally with a handheld dynamometer (Lafayette Instrument, Lafayette, IN, USA). Themean value of three peak forcemeasurements (N) was calculated. Standardized isometric strength tests were performed before the procedure and at 10 days, 6 weeks, 3 months and 6 months postsurgery. Results Ipsilateral hip flexion was diminished (p < 0.001) at the early postoperative period, but reached preoperative values at 6 weeks (p > 0.12). The mean hip flexion measures before the procedure and at 10 days, 6 weeks, 3 months and 6 months after surgery were the following, respectively: 13 N; 9.7 N; 13.7 N; 14.4 N; and 16 N (ipsilateral); 13.3 N; 13.4 N; 15.3 N; 15.9 N; and 16.1 N (contralateral). Neither the level nor the number of treated levels had a clear association with thigh symptoms, but hip flexion weakness was the most common symptom. Conclusions Patients in the early postoperative period of transpsoas access presented hip flexion weakness. However, this weakness was transient, and electroneuromyography use is still imperative in transpsoas access. In addition, patients must be thoroughly educated about hip flexion weakness to prevent falls in the immediate postoperative period.

Osteochondral Lesion of the Bilateral Femoral Heads in a Young Athletic Patient

Osteochondral lesions of the femoral head are uncommon and few studies have reported their imaging findings. Since joints are at risk of early degeneration after osteochondral damage, timely recognition is important. Osteochondral lesions of femoral head may often be necessary to differentiate from avascular necrosis. Here, we report a case of osteochondral lesions on bilateral femoral heads. This lesion manifested as subchondral cysts in initial radiographs, which led to further evaluation by computed tomography arthrography and magnetic resonance imaging, which revealed overlying cartilage defects.

Coxa vara in conjunction with metaphyseal dysostosis

We describe a rare case of unilateral development of coxa vara secondary to metaphyseal dysostosis encountered in a 6-year-old boy. Family history and radiographic documentation revealed a 31-year-old father with a typical clinical history. Proximal femoral intertrochanteric valgus osteotomy and a revision cup [Allofit] have been performed for the child and his father respectively

The Correlations of the Radiological Parameters of Hip Dysplasia and Proximal Femoral Deformity in Clinically Normal Hips of a Korean Population

BACKGROUND: The aim of this study was to answer the following two questions: 1) Do the radiological parameters of dysplasia have significant correlations between themselves or with the parameters of the proximal femoral deformity and vice versa? 2) Do the physical parameters have a significant correlation with the radiological parameters of hip dysplasia and proximal femoral deformity? METHODS: Four hundred and twenty eight consecutive patients with no clinical evidence of hip osteoarthritis and who underwent pelvic radiography in the supine position for hip contusion or a routine health check were analyzed for the relationships between the center-edge (CE) angle, acetabular depth, acetabular angle, the head-neck ratio and the neck-shaft angle as well as the relationships of the above-mentioned variables with age, gender, body height and the body mass index. RESULTS: The CE angle, acetabular depth and acetabular angle showed a strong correlation with each other. The neck-shaft angle and the head-neck ratio showed no correlation with each other or with the CE angle, acetabular depth and acetabular angle. Age was positively associated with the CE angle, and inversely associated with the acetabular depth or acetabular angle. Male gender was significantly associated with the increased neck-shaft angle, and inversely associated with the head-neck ratio. CONCLUSIONS: The radiological parameters of hip dysplasia are all strongly, if not perfectly, inter-correlated. Age was associated with the radiological parameters of hip dysplasia whereas gender was associated with the radiological parameters of a proximal femoral deformity.

Osteoplastía femoroacetabular sin luxación coxofemoral en el síndrome de choque femoroacetabular: valoración de la calidad de vida / Femoroacetabular osteoplasty without coxofemoral dislocation in the femoroacetabular impingement syndrome: quality of life assessment

Introducción: El choque femoroacetabular es causa de lesiones del labrum y de coxartrosis en los pacientes jóvenes. Existe escasa evidencia sobre los resultados terapéuticos mediante la osteoplastia coxofemoral por vía anterior sin luxación. El objetivo de este trabajo fue analizar una serie de pacientes tratados con dicha técnica centrándose en los cambios en la calidad de vida. Materiales y métodos: En 22 pacientes con síndrome de tipo cam se realizaron 24 queilectomías y 9 plásticas labrales mediante exposición anterior “reducida”, capsulotomía anterior y osteoplastia insitu. Edad promedio: 44 años; seguimiento promedio: 24 meses. Se documentaron las complicaciones, la amplitud de movimiento y las imágenes radiológicas (Tõnnis). Se definieron los niveles de calidad de vida en pobre, aceptable, buena y muy buena, según el dolor, la escala WOMAC y la reinserción deportiva. Resultados: La amplitud de movimiento aumentó en todos los pacientes. Se comprobó progresión radiológica en 4 casos. Después de 18 meses, 14 permanecían asintomáticos, con calidad de vida muy buena y 3, con buena. Como única complicación se produjo paresia temporal del femorocutáneo en 3 pacientes. Conclusiones: El progreso de la cirugía reconstructiva supone la realización de procedimientos poco agresivos que disminuyan las complicaciones secundarias y permitan una pronta reinserción a las actividades diarias. Esta técnica permite acceder a los osteofitos cervicales y al labrum anterior, donde se localizan 70 por ciento de las lesiones.

Application of Ganz Surgical Hip Dislocation Approach in Pediatric Hip Diseases

BACKGROUND: Ganz surgical hip dislocation is useful in the management of severe hip diseases, providing an unobstructed view of the femoral head and acetabulum. We present our early experience with this approach in pediatric hip diseases. METHODS: Twenty-three hips of 21 patients with pediatric hip diseases treated using the Ganz surgical hip dislocation approach were the subjects of this study. The average age at the time of surgery was 15.7 years. There were 15 male and 6 female patients who were followed for an average of 15.1 months (range, 6 to 29 months). Diagnoses included hereditary multiple exostoses in 9 hips, slipped capital femoral epiphysis in 7, Legg-Calve-Perthes disease in 4, osteoid osteoma in 1, pigmented villonodular synovitis in 1, and neonatal septic hip sequelae in 1. Medical records were reviewed to record diagnoses, principal surgical procedures, operative time, blood loss, postoperative rehabilitation, changes in the range of hip joint motion, and complications. RESULTS: Femoral head-neck osteochondroplasty was performed in 17 patients, proximal femoral realignment osteotomy in 6, open reduction and subcapital osteotomy for slipped capital femoral epiphysis (SCFE) in 2, core decompression and bone grafting in 2, hip distraction arthroplasty in 2, and synovectomy in 2. Operative time averaged 168.6 minutes when only osteochondroplasty and/or synovectomy were performed. Hip flexion range improved from a preoperative mean of 84.7degrees to a mean of 115.0degrees at the latest follow-up visit. Early continuous passive motion and ambulation were stressed in rehabilitation. No avascular necrosis of the femoral head was noted up to the time of the latest follow-up visit, except for in one SCFE patient whose surgical intervention was delayed for medical reasons. CONCLUSIONS: Ganz surgical hip dislocation provides wide exposure of the femoral head and neck, which enables complete and precise evaluation of the femoral head and neck contour. Hence, the extensive impinging bump can be excised meticulously, and the circulation of the femoral head can be monitored during surgery. The Ganz procedure was useful in severe pediatric hip diseases and allowed for quick rehabilitation with fewer complications.

Camptodactyly, Arthropathy, Coxa vara, Pericarditis (CACP) Syndrome: A Case Report

The camptodactyly-arthropathy-coxa vara-pericarditis syndrome (CACP) is characterized by congenital or early-onset camptodactyly, childhood-onset noninflammatory arthropathy associated with synovial hyperplasia. Some patients have pro-gressive coxa vara deformity and/or noninflammatory pericardial effusion. CACP is inherited as an autosomal recessive mode and the disease gene is assigned to a 1.9-cM interval on human chromosome 1q25-31. We describe a 10-yr-old boy who has typical features of CACP without familial association.

Displasia del desarrollo de la cadera / Developmental dysplasia of the hip

Indroducción. La displasia del desarrollo de la cadera (DDC) es un padecimiento con incidencia variable en México, siendo el propósito de este trabajo determinarla e identificar los factores diagnósticos y de riesgo en nuestro medio para la DDC en la etapa de recién nacido. Material y métodos. Se revisaron 8,316 recién nacidos vivos no patológicos del Servicio de Gineco-Obstetricia del Hospital Civil de Guadalajara, seleccionándose los que tenían factores diangósticos y de riesgo para el sedarrollo normal de la cadera. Resultados. Se confirmaron 55 casos de DDC para una incidencia de 6.6 por 1000 recién nacidos vivos. Siendo los principales factores diagnósticos y de riesgo que deben hacer sospechar DDC: el sexo femenino (78 por ciento), limitación de la abducción (74 por ciento) y la maniobra de Ortolani-Barlow positiva (64 por ciento). El 27 por ciento de los recién nacidos con DDC tenían 3 factores diagnósticos y de riesgo y el 73 por ciento restante más de 4. Conclusión. En base a la incidencia de la DDC y estos factores, el pediatra, que es el primer contacto con recién nacidos, con 3 de éstos debe sospechar el diagnóstico y recurrir al ortopedista pediatra para su evaluación, tratamiento de ser necesrio y su seguimiento. Con 4 factores el diagnóstico se confirma. Esto ayudará a disminuir el número tan elevado en nuestro medio de pacientes que son diagnosticados en edad de la marcha, donde el tratamiento es más complicado y el pronóstico menos favorable

Evaluation of early results of reduction and pinning of acute SCFE

Fourteen patients with 17 Acute slips of S.C.F.E. were investigated clinically and radiologicallly. They were managed by gentle traction in internal rotation for 5-7 days, followed by percutaneous pinning. The results were satisfactory in 94. 1%. No case developed avasacular necrosis

Reflexiones sobre ecografía dinámica de caderas: qué, cómo y quién y cuándo? / Examination of the hip with real time ultrasound: what, how, who, when?

Se exponen algunos conceptos sobre la ecografía de caderas y su incersión en la rutina pediátrica diaria. Se discute la oportunidad de la elección del examen. si bien el estudio es beneficioso para el paciente, debe existir una correcta formación del médico o ecografista, quien debe realizar para su entrenamiento unas cien caderas. Parafraseando al creador del método dinámico, el Dr. Harcke, deben ser como las "horas de vuelo" necesarias. El Dr. Harcke y nosotros opinamos que la elección de realización es después del mes de vida

The Reaction of the Acetabular Articular Cartilage to Bipolar Hemiarthroplasty

An evaluation of the acetabular cartilage was performed grossly and histologically in a patient who had a bipolar hemiarthroploasty, which had served satisfactorily for 2 years until the femoral prosthetic head had been separated from the acetabular assembly due to creep deformation of the inner bearing polyethylene cup. This study indicates that the double-bearing bipolar prosthesis dose not necessarily have an advantage over the classical single-piece prosthesis in the prevention of acetabular cartilage wear.