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.

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.

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.

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.

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.

Resultados de la osteotomía tipo Salter como tratamiento definitivo en displasia del desarrollo de la cadera / Results of the Salter's osteotomy as a definitive treatment for the developmental dysplasia of the hip

Resumen: Objetivo: Evaluar los resultados de la reducción abierta asociada a una osteotomía tipo Salter a los nueve meses de edad como tratamiento en la displasia del desarrollo de la cadera. Material y métodos: Serie de casos con pacientes con diagnóstico de displasia del desarrollo de cadera unilateral en un período comprendido de Julio de 2004 a Diciembre de 2008 y seguimiento a los tres, seis y nueve meses del postquirúrgico. Resultados: 16 pacientes, 13 del sexo femenino (81%) y tres del sexo masculino (19%). Se les realizó reducción abierta con osteotomía tipo Salter a los nueve meses de edad (de ocho a 10 meses) en promedio. El lado afectado más frecuente fue en cadera izquierda en 75% y cadera derecha en 25%. A los nueve meses de evolución 15 pacientes presentaron un puntaje de McKay excelente y sólo un paciente mostró McKay bueno. Sólo un paciente fue valorado al año de la última cirugía con cadera estable, sin dolor y disminución del rango de movilidad tanto en flexión y abducción en relación con la cadera contralateral. Conclusión: La reducción abierta con una osteotomía de tipo Salter sin una tracción preoperatoria es un tratamiento efectivo en el corto plazo. Puede haber restricciones en la movilidad. Es importante el uso del aparato de yeso en forma pausada y en una posición de reducción segura.

Abstract: Objective: Evaluate the results of open reduction associated to a Salter osteotomy at nine months of age for treatment of the developmental Dysplasia of the Hip. Material and methods: Case- series of unilateral Developmental Dysplasia of the hip treated between July 2004- December 2008 with follow-up at 3, 6 and 9 months postop. Results: 16 patients, 13 females (81%) 3 males (19%). we did an open reduction and Salter's osteotomy at 9 months on average (8- 10 months); the most effected side were the left hip on 75%. at 9 months of follow up 15 patients had a McKay score excellent and 1 good. Only one patient was followed up at one year with no pain, full range of motion and stable. Conclusion: open reduction and salter osteotomy without preoperative traction is an effective treatment in the short-term; the range of motion could be affected. It is important that the spica cast were applied in a staged manner and in secured position.

Artroplastía de cadera con osteotomía de acortamiento femoral en la cadera displásica grado IV de Crowe / Total hip arthroplasty with shortening subtrochanteric osteotomy in Crowe type-IV developmental dysplasia

Introducción: La reconstrucción del centro de rotación anatómico es uno de los propósitos principales en la displasia del desarrollo de la cadera de grado IV de Crowe. La osteotomía de acortamiento subtrocantérica ha surgido como una alternativa para lograr esta reconstrucción. El objetivo de este trabajo es analizar los resultados clínicos y radiológicos, y las complicaciones con esta técnica quirúrgica. Materiales y Métodos: Se evaluaron 10 casos en 8 pacientes con displasia del desarrollo de la cadera de grado IV sometidos a osteotomía de acortamiento subtrocantérica. Todos eran mujeres (edad promedio 42 años; rango 36-55); 6 casos eran unilaterales y 2, bilaterales. La discrepancia de longitud de miembros inferiores preoperatoria era, en promedio, de 41 mm. El abordaje fue posterolateral. En 7 casos, se implantaron tallos no cementados modulares de fijación metafisaria y, en 3 casos, tallos cementados pulido espejo. Resultados: A los 38 meses de seguimiento promedio (rango 12-63), todas las osteotomías tenían consolidación radiológica. El centro de rotación posoperatorio descendió 42 mm en promedio (rango 35-52). La discrepancia de longitud promedio posoperatoria fue de 6 mm (rango 3-12). Las complicaciones fueron: un aflojamiento femoral aséptico, una subluxación por alteración de la anteversión femoral, una luxación, una infección aguda y una neuropraxia crural. Conclusiones: En estos pacientes con displasia del desarrollo de la cadera de grado IV de Crowe operados con la técnica de osteotomía de acortamiento subtrocantérica, observamos una alta tasa de consolidación, una implantación anatómica del centro de rotación y una compensación de la discrepancia en la longitud de los miembros. Nivel de evidencia: IV.

Introduction: The reconstruction of the anatomic center of rotation is one of the main purposes in Crowe type-IV developmental dysplasia of the hip. Subtrochanteric shortening osteotomy has emerged as an alternative to achieve this reconstruction. The aim of this paper is to analyze the clinical and radiological results, as well as the complications with this surgical technique. Methods: Ten cases were evaluated in 8 patients with Crowe type-IV developmental hip dysplasia who underwent subtrochanteric shortening osteotomy. All were female, 6 cases were unilateral and 2 bilateral. The average age was 42.2 years (range 36-55). Preoperative lower limb discrepancy was on average 41 mm. Posterolateral approach was used in all patients. Uncemented stems with modular metaphyseal fixation were implanted in 7 cases and polished cemented stems in 3 cases. Results: At an average follow-up of 38 months (range 12-63), all the cases showed radiological healed osteotomies. The postoperative center of rotation diminished an average of 42 mm (range 35-52 mm). Postoperative limb discrepancy was 6 mm (range 3-12 mm). Complications were: one aseptic femoral loosening, one subluxation due to excessive femoral anteversion, one dislocation, one acute infection and one acute femoral neuropraxia. Conclusions: In these patients with Crowe type-IV developmental dysplasia of the hip, subtrochanteric shortening osteotomy technique was associated with a high rate of consolidation, correction of the center of rotation, and limb lenght compensation. Level of evidence: IV.

Bilateral developmental dysplasia of the hip treated with open reduction and Salter osteotomy: analysis on the radiographic results / Displasia do desenvolvimento do quadril bilateral tratada com redução cruenta e osteotomia de Salter: análise dos resultados radiográficos

Objectives: To evaluate the radiographic results from patients with bilateral developmental dysplasia of the hip (DDH) who underwent surgical treatment by means of open reduction and Salter osteotomy, with or without associated femoral shortening as described by Ombrédanne. Methods: This was a retrospective descriptive study in which 21 patients with bilateral DDH (42 hips) were analyzed. They were treated at Hospital Infantil Joana de Gusmão (HIJG), with operations between August 1997 and October 2009. To evaluate the radiographic results, the acetabular index and the Wiberg center-edge angle were measured, and the Severin and Kalamchi–MacEwen classifications were used. Descriptive and parametric statistical analyses were used to evaluate the data. Results: We did not observe any statistically significant difference in analyzing the radio-graphic parameters, making comparisons regarding the side affected, the order of the procedures and whether femoral shortening was performed, although there was a significant difference between them from before to after the operation. Conclusion: Open reduction in association with iliac osteotomy as described by Salter presented significant improvements in the radiographic parameters analyzed, comparing the pre- and postoperative values. This improvement occurred independently of whether Ombrédanne femoral shortening was performed. The most prevalent complication in the study group was avascular necrosis of the femoral head...

Objetivos: Avaliar os resultados radiográficos de pacientes portadores de displasia do desenvolvimento do quadril (DDQ) bilateral, submetidos ao tratamento cirúrgico por meio da redução cruenta e osteotomia de Salter associada ou não ao encurtamento femoral descrito por Ombrédanne. Métodos: Trata-se de estudo descritivo retrospectivo com análise de 21 pacientes com DDQ bilateral (42 quadris), tratados no Hospital Infantil Joana de Gusmão (HIJG) e operados entre agosto de 1997 e outubro de 2009. Para avaliação dos resultados radiográficos, foram medidos o índice acetabular e o ângulo center-edge (CÊ) de Wiberg e usadas as classificações de Severin e de Kalamchi e MacEwen. Análises estatísticas descritivas e paramétricas foram usadas para avaliação dos dados. Resultados: Não observamos diferença estatisticamente significante na análise dos parâmetros radiográficos comparando-os quanto ao lado acometido, à ordem dos procedimentos e à feitura de encurtamento femoral ou não, embora exista diferença significativa entre eles nos períodos pré e pós-operatório. Conclusão: Redução cruenta associada à osteotomia do ilíaco descrita por Salter apresentou melhoria significativa dos parâmetros radiográficos analisados na comparação dos valores pré e pós-operatórios. Essa melhoria ocorreu independentemente da feitura ou não do encurtamento femoral de Ombrédanne. A complicação mais prevalente no grupo estudado foi a necrose avascular da cabeça femoral...

Anesthesia for a patient with Fanconi anemia for developmental dislocation of the hip: a case report / Anestesia em paciente com anemia de Fanconi e displasia do desenvolvimento do quadril: relato de caso / Anestesia en paciente con anemia de Fanconi y displasia del desarrollo de la cadera: caso clínico

Fanconi anemia is a rare autosomal recessive inherited bone marrow failure syndrome with congenital and hematological abnormalities. Literature regarding the anesthetic management in these patients is limited. A management of a developmental dislocation of the hip was described in a patient with fanconi anemia. Because of the heterogeneous nature, a patient with fanconi anemia should be established thorough preoperative evaluation in order to diagnose on clinical features. In conclusion, we preferred caudal anesthesia in this patient with fanconi anemia without thrombocytopenia, because of avoiding from N2O, reducing amount of anesthetic, existing microcephaly, hypothyroidism and elevated liver enzymes, providing postoperative analgesia, and reducing amount of analgesic used postoperatively.

A anemia de Fanconi é uma síndrome hereditária autossômica recessiva rara, caracterizada por deficiência da medula óssea e anomalias congênitas e hematológicas. A literatura sobre o manejo anestésico dos pacientes é limitada. O manejo de uma displasia do desenvolvimento do quadril foi descrito em um paciente com anemia de Fanconi. Por causa da natureza heterogênea, um paciente com anemia de Fanconi deve ser submetido à avaliação pré-operatória para diagnosticar as características clínicas. Em conclusão, o bloqueio caudal foi a nossa escolha para esse paciente com anemia de Fanconi, sem trombocitopenia, para evitar o N2O, reduzir a quantidade de anestésico, a microcefalia existente, o hipotireoidismo e o aumento das enzimas hepáticas, proporcionar analgesia pós-operatória e reduzir a quantidade de analgésico usada no pós-operatório.

La anemia de Fanconi es un síndrome hereditario autosómico recesivo raro, caracterizado por deficiencia de la médula ósea y por anomalías congénitas y hematológicas. La literatura sobre el manejo anestésico de esos pacientes es limitada. El manejo de una displasia del desarrollo de la cadera fue descrito en un paciente con anemia de Fanconi. Debido a la naturaleza heterogénea, un paciente con anemia de Fanconi debe ser sometido a la evaluación preoperatoria para diagnosticar las características clínicas. En conclusión, el bloqueo caudal fue nuestra elección para ese paciente con anemia de Fanconi sin trombocitopenia para evitar el N2O, reducir la cantidad de anestésico, microcefalia existente, hipotiroidismo y aumento de las enzimas hepáticas, proporcionar analgesia postoperatoria y reducir la cantidad de analgésico usado en el postoperatorio.

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. .

validity of preoperative templating in cementless total hip arthroplasty: a pilot study

Preoperative templating plays an important role in orthopaedic surgery for achieving a successful outcome in THA. This includes not only selecting the type and size of implant, but also deciding on the alignment, position, and orientation of these implants, relying on anatomically defined landmarks. The first goal of this study was to evaluate the validity of preoperative templating technique in terms of determining the final implant size and position. The second goal was to investigate the interobserver and Intraobserver reliability of template readings on conventional radiographs. In Aljumhorei hospital, Mosul city a case series; pilot study has been carried for twenty-eight patients had preoperative templating for total hip arthroplasty between 21/10/2009 to 16/5/2012 was carried by the operating surgeon. Preoperative templating by same two orthopedic surgeons carried for 12 patients from the total. Preoperative templating for Seventeen patientsout of the total were studied with the same operating surgeon after 2 years of experiences. 29% compatibility for shell between preoperative templating with intraoperative for the operator, P_ 0.023. While for stem 39%P_ 0.257. Second surgeon 58% compatibility with P_0.564, Stem differences represent 33% [P_ 0.248]. Differences with two years experiences for the operating surgeon indicate 35% compatibility both for shell and the stem with non-significant differences. Preoperative templating appeared to be more accurate for femoral stem measurements than the acetabular templating in determining the accurate sizes. Two years experienced added no more in templating measurements. There were significant differences for interobserver measurements.

Osteotomía de Chiari: resultados clínicos y radiológicos a largo plazo / Chiari osteotomy: long-term clinical and radiological results

Introducción: la displasia de cadera es una causa muy frecuente de artrosis en personas jóvenes. En 1953 el Profesor Karl Chiari describió una osteotomía supracetabular con medialización de la cadera para proveer una mayor cobertura cefálica y aumenta la congruencia articular. Esta osteotomía puede proporcionar una solución en estos pacientes, prolongando y mejorando la función de la cadera. Materiales y Métodos: entre enero de 1973 y diciembre del 2000 se realizaron 45 osteotomías de Chiari en nuestro servicio. Evaluamos retrospectivamente 34 osteotomías en 29 pacientes. Hombres 7, mujeres 22. 33,S años (rango 6 a 59). Seguimiento 15,4 años (rango 8 a 25). Se utilizó score de Barret y score de Harris para la evaluación clínica. Valoración radiológica: ángulo de Wiberg (CEA, centre-edge-angle), índice acetabular (IA), cobertura cefálica(CC), grado de artrosis, ángulo de osteotomía, medialización de la cadera y la clasificación de Severin para evaluar congruencia articular prequirúrgica y posquirúrgica. Se evaluó tiempo de sobrevida de osteotomía y necesidad de artroplastia. Resultados: al último control 11/34 caderas requirieron una artroplastia en promedio 15,9 años luego la osteotomía (rango 4-20). Cuatro caderas fueron excluidas de la valoración funcional por ser en pacientes con parálisis cerebral que no deambulan y 2 por ser en un paciente que falleció. Para las otras 17 caderas el score de Harris promedio de 83,9 puntos, resultados excelentes y buenos en 10/17. El score de Barret mostró 12/17 caderas con excelentes y buenos resultados. No tenían dolor o dolor leve para las actividades de la vida diaria 13/17 pacientes. La osteotomía mejoró el CEA en un promedio 33.8, lA promedio 15.3. La CC mejoró de 60.1 por ciento prequirúrgico a un promedio de 94.4 por ciento. El grado de artrosis evolucionó en 14 pacientes mientras que en 7 se mantuvo igual. Conclusión: la osteotomía de Chiari es un procedimiento efectivo para mejorar y prolongar la función de la articulación de la cadera, a largo plazo, en pacientes jóvenes con displasia sintomática. La artrosis prequirúrgica es un factor pronóstico.

Tratamento cirúrgico de displasia de desenvolvimento do quadril de apresentação tardia depois da idade da marcha / Surgical treatment of the late - presenting developmental dislocation of the hip after walking age

OBJETIVO: Os casos de displasia de desenvolvimento do quadril (DDQ) ainda ocorrem depois da idade da marcha devido ao diagnóstico tardio ou ausente e à falha do tratamento conservador. A escolha do tratamento da DDQ depois da idade da marcha continua controversa e uma das opções é a redução a céu aberto combinada com osteotomia do inominado.MÉTODOS: Vinte pacientes com 26 quadris com DDQ tratados cirurgicamente foram avaliados de 2005 a 2008, usando-se a osteotomia do inominado pela técnica de Salter depois de redução e capsulorrafia a céu aberto. A idade dos pacientes no momento da cirurgia variou de 12 a 18 meses (média de idade 14,7 meses). De 15 pacientes do sexo feminino e cinco do masculino, seis tiveram luxação bilateral e dos restantes, nove tiveram luxação do quadril esquerdo e cinco, do direito.RESULTADOS: Os resultados foram avaliados de acordo com os critérios modificados de McKay e dos critérios radiológico de Severin, depois de acompanhamento médio de 46,7 meses. Oitenta e nove por cento dos quadris foram classificados como excelentes ou bons pelos critérios de McKay. Não houve resultados ruins. De acordo com os critérios de Severin, 77% eram do tipo I e II, enquanto 23% eram do tipo III e IV; nenhum quadril foi classificado nos tipos V ou VI. Houve um caso (3,8%) de reluxação, mas a cirurgia de revisão resultou em redução estável, concêntrica e permanente. Não há relato de casos de infecções, fratura do enxerto e lesão vacular ou nervosa.CONCLUSÃO: A redução a céu aberto combinada com a osteotomia de Salter não afeta o quadril com relação à remodelação em crianças entre 12 e 18 meses de idade. Nível de Evidência IV, Série de Casos.

OBJECTIVE: Cases of developmental dislocation of the hip (DDH) still occur after walking age because of late or missed diagnosis and failed conservative treatment. The choice of treatment for DDH after walking age continues to be controversial, and one of the options is open reduction combined with innominate osteotomy.METHODS: Twenty patients with 26 surgically treated hips with DDH, were evaluated from 2005 to 2008, using innominate osteotomy by Salter's technique after open reduction and capsulorraphy. The age of patients, fifteen females and five males, at time of surgery ranged from 12 to 18 months (mean age 14.7 months). Six patients had bilateral dislocation and in the remaining, nine had their left hip dislocated and five had their right hip dislocated.RESULTS: The results were evaluated according to modified McKay criteria and to Severin radiological criteria, after a mean follow-up of 46.7 months. Eighty – nine percent of hips were rated as excellent or good by McKay criteria. There were no poor results. According to Severin criteria, 77% were type I and II while 23% showed type III and IV, no hips were rated as Severin's group V or VI. There was one case (3.8%) of re-dislocation, but revision surgery resulted in stable, concentric, and permanent reduction. No cases of infection, graft fracture and vascular or nervous injury were reported.CONCLUSION: Open reduction combined with Salter osteotomy does not hurt the hip with regard to acetabular remodeling for children between 12 and 18 months of age. Level of Evidence IV, Case Series.

Avaliação clínica e radiológica após procedimento de Salter e Ombrédanne na displasia de desenvolvimento do quadril / Clinical and radiological evaluation on developmental hip dysplasia after salter and Ombrédanne procedure

OBJETIVO: Avaliar o resultado clínico e radiológico em médio prazo do tratamento cirúrgico da displasia do desenvolvimento do quadril através da osteotomia do osso inominado de Salter e o encurtamento femoral de Ombrédanne. MÉTODOS: Foram avaliados 14 pacientes, 18 quadris (sete quadris do lado direito e 11 do lado esquerdo), todos tratados cirurgicamente entre 1998 e 2008 pela técnica proposta. Foi realizada avaliação clínica e radiológica pelos critérios de Dutoit e Severin, respectivamente. RESULTADOS: Nos sete quadris do lado direito o índice pré-operatório médio foi de 43,3º (40º a 50º), sendo corrigido cirurgicamente, em média, para 31,57º (24º a 42º), enquanto os 11 quadris do lado esquerdo tinham média pré-operatória de 42,1º (36º a 56º) evoluindo para 30,36º (20º a 44º), sendo que as avaliações dos índices acetabulares pré e pós-operatórios apresentaram significância estatística com P < 0,05. Na avaliação clínica foram encontrados sete quadris ótimos (38,9 por cento), oito bons (44,4 por cento), três regulares (16,7 por cento) e nenhum ruim (0 por cento). Agrupando quadris com avaliação boa e ótima como satisfatórios e os com avaliação ruim e regular como insatisfatórios, obtiveram-se resultados favoráveis em 83,3 por cento dos casos. Não se obteve significância estatística entre a ocorrência de complicações e a idade do paciente, no momento da cirurgia, e o índice acetabular pré-operatório (p > 0,05). Como complicações, ocorreram uma subluxação, uma osteonecrose e uma osteonecrose associada à subluxação. CONCLUSÃO: O procedimento combinado de Salter e Ombrédanne é uma opção viável para o tratamento da displasia de desenvolvimento do quadril após o início da marcha.

OBJECTIVE: To evaluate the clinical and radiological medium-term results from surgical treatment of developmental hip dysplasia through Salter innominate bone osteotomy and Ombrédanne femoral shortening. METHODS: Fourteen patients were evaluated, with surgical treatment on 18 hips (seven right-side hips and eleven left-side hips) using the proposal technique, performed between 1998 and 2008. The Dutoit and Severin criteria were used respectively for clinical and radiographic evaluations. RESULTS: The average preoperative index for the seven right-side hips was 43.3º (40º to 50º), and this was corrected through surgery to an average of 31.57º (24º to 42º). The average preoperative index for the eleven left-side hips was 42.1º (36º to 56º), and this was corrected through surgery to an average of 30.36º (20º to 44º). There was a statistically significant difference between the preoperative and postoperative acetabular indexes, with P < 0.05. The clinical evaluation showed that there were seven excellent hips (38.9 percent), eight good ones (44.4 percent), three fair hips (16.7 percent) and no poor ones (0 percent). By grouping the hips rated good and excellent as satisfactory and those rated poor and fair as unsatisfactory, 83.3 percent of the results were seen to be favorable. There were no statistically significant correlations between occurrences of complications and patient age at the time of surgery or between complications and the preoperative acetabular index (p > 0.05). The complications observed consisted of one case each of subluxation, osteonecrosis and osteonecrosis together with subluxation. CONCLUSION: The combined procedure of Salter and Ombrédanne is a viable option for treating developmental hip dysplasia after patients have started to walk.

Hipercrescimento femoral no tratamento cirúrgico do quadril displásico inveterado / Femoral overgrowth following surgical treatment of long-established dysplasia of the hip

OBJETIVO: Medir radiograficamente através de escanometria o hipercrescimento femoral em pacientes portadores de Displasia do Desenvolvimento do Quadril inveterada tratados cirurgicamente com encurtamento femoral, redução cruenta e acetabuloplastia. MÉTODOS: Avaliamos 30 crianças (33 quadris) submetidas à redução cruenta pela técnica de Scaglietti e Calandriello, ostectomia para encurtamento femoral e acetabuloplastia de Salter. Haviam 29 do sexo feminino e 1 do sexo masculino, com idade média de 4 anos e 5 meses na ocasião da cirurgia. De acordo com a classificação de Zionts e MacEwen, 23 (69,6 por cento) quadris foram classificados como tipo III, 5 (15,2 por cento) como tipo I e 5 (15,2 por cento) como tipo II. O encurtamento femoral médio foi 45,12mm (variando de 30,00mm a 80,00mm). O tempo de seguimento médio foi de 10 anos e 2 meses. A discrepância femoral média mensurada nos escanogramas foi 13,48mm (variando de 0,00mm a 60,00mm) após acompanhamento mínimo de 2 anos e 3 meses. RESULTADOS: Todos os pacientes evoluíram com hipercrescimento sendo que em 18 (54,6 por cento) casos a anisomelia observada foi <30mm, 11 (33,3 por cento) alcançaram igualdade de comprimento e 4 (12,1 por cento) discrepância >30mm. CONCLUSÃO: Observamos diminuição significante na diferença entre os comprimentos femorais após tratamento cirúrgico comparando com as medidas obtidas durante o seguimento ambulatorial.

OBJECTIVE: To measure femoral overgrowth using radiographic scanning in patients with long-established Developmental Dysplasia of the Hip treated with femoral shaft shortening, open reduction and acetabuloplasty. METHODS: We studied 30 children (33 hips) submitted to surgical treatment including femoral shaft shortening, open reduction according to Scaglietti & Calandriello's procedure and Salter acetabuloplasty without preliminary traction. There were 29 females and 1 male, with mean age = 4 years and 5 months at the time of operation. According to Zionts & MacEwen's classification, 23 hips were classified as type III (69.6 percent), 5 (15.2 percent) as type I and 5 (15.2 percent) as type II. The average femoral shortening was 45.12 mm (range: 30.00 mm to 80.00 mm). The mean follow-up time was 10 years and 2 months (range: 2 years and 3 months to 18 years) and we noticed a mean femoral discrepancy of 13.48mm (range: 0.00 mm to 60.00 mm) using plain scanning images. RESULTS: All patients evolved to femoral overgrowth; in 18 cases (54.6 percent), the leg length discrepancy found was <30 mm, 11 (33.3 percent) showed no LLD, and 4 (12.1 percent) presented with a discrepancy >30mm. Conclusion: We noticed a significantly decreased discrepancy of femurs after surgical treatment when compared to the measurements obtained during outpatient follow-up.

Clinical and radiological aspects of closed reduction in developmental dysplasia of the hip treated in the first six months

To evaluate the success rate and subsequent restoration of normal acetabular angle [AC], and associated growth changes secondary to avascular necrosis of the proximal femur in cases of developmental dysplasia of the hip [DDH] treated during the first six months of life. Retrospective study from 1998 to 2006. Department of Pediatric Orthopedics, Altona Children Hospital, Hamburg, Germany. Twenty six patients with twenty nine dysplastic hips were evaluated regarding grade of hip dysplasia. The success rate of closed reduction, postoperative restoration of normal acetabular coverage [AC angle] and associated complication were noted. Closed reduction of DDH with intraoperative arthrogram followed by spica cast. Success rate of closed reduction and restoration of normal acetabular index. Closed reduction could be achieved in twenty two hips [76%]. Out of those twenty two hips fifteen [68%] developed normal acetabular index, six [27%] showed persistent acetabular dysplasia and one [5%] had border -line measurement. Closed reduction was not successful in seven hips. Those seven hips were treated by open reduction and capsulorrhaphy. Closed reduction of DDH in the first six months of life was achieved in [76%] of dislocated hips, and did not show any significant growth changes in the proximal femur. The early changes in the ossific nucleus of capital femoral epiphysis [CFE] alone were found to be of very little value in predicting the nature of development of the hip

Osteotomía femoral proximal percutánea con fijador externo / Proximal femoral osteotomy percutaneous external fixator

Con los adelantos de los métodos en fijación externa, es posible corregir las deformidades del desarrollo o adquiridas en las caderas, empleando principios geométricos y biomecánicos en las osteotomías intertrocantéricas y subtrocantéricas con correcciones de deformidades angulares en todos los planos (frontal, sagital, oblicuo), de traslación y rotación, así como corrección de diferencias de longitud y combinaciones de traslación-angulación. Se describen los resultados de 32 caderas en 20 niños, con tiempo promedio de seguimiento: 6,85 meses (3-12meses). Las osteotomías alcanzaron el ángulo planeado pre-operatorio y sanaron (93,75%) sin no-uniones, mal-uniones, ni fracasos del dispositivo o necrosis avascular. Las complicaciones ocurrieron en 2 pacientes (6,25%) en el manejo postoperatorio. Los resultados actuales nos muestran una corrección fácil (varus/valgus, fl exo/extensión y rotación), disminución en relación de tiempos quirúrgicos y sangrado intraoperatorio, menor morbimortalidad, tiempos anestésicos cortos, cirugías ambulatorias, menores costos quirúrgicos y de los dispositivos utilizados, sin costos de hospitalización, ausencias de reintervenciones para correcciones o extracción de materiales de osteosíntesis.

Tratamento da displasia do desenvolvimento do quadril pela técnica de Salter isolada ou associada à osteotomia do fêmur / Treatment of hip developmental dysplasia by isolated Salter's technique or associated to femoral osteotomy

Os resultados do tratamento da displasia do desenvolvimento do quadril (DDQ) por meio da redução aberta e osteotomia do ilíaco pela técnica de Salter foram analisados em 93 pacientes (103 quadris) com idade entre 18 meses e cinco anos. Em 59 quadris (57,28 por cento) foram associadas subseqüentemente osteotomia de rotação e varização do fêmur. A técnica de Salter foi precedida por período de tração percutânea em 84 quadris (81,55 por cento). Os quadris foram divididos em dois grupos: grupo A (44 quadris), tratados pela técnica de Salter, e grupo B (59 quadris), em que, além da técnica de Salter, foram adicionadas, subseqüentemente, osteotomia de rotação e varização do fêmur. Os resultados foram bons em 33 quadris (75,00 por cento) do grupo A e em 38 (64,40 por cento) do grupo B. Com relação à faixa etária, no grupo A houve 89,28 por cento de bons resultados nos pacientes operados entre 18 e 30 meses, em comparação com 50,00 por cento nos operados entre 31 e 60 meses de idade. No grupo B, houve 65,00 por cento de bons resultados nos operados entre 18 e 30 meses e 63,15 por cento nos com idade entre 31 e 60 meses. A análise comparativa entre os grupos sem e com osteotomia femoral revelou que, na faixa etária de 18 a 30 meses, 89,28 por cento tiveram bons resultados sem osteotomia femoral associada, ao passo que, naqueles em que foi adicionada osteotomia do fêmur, os resultados bons baixaram para 65,00 por cento. Nos pacientes operados entre 31 e 60 meses não foi observada diferença nos resultados entre os grupos sem e com osteotomia femoral. O grau de displasia, medido pelo índice acetabular (IA) pré-operatório, o grau de melhora do IA, obtido pela osteotomia do ilíaco, o uso de tração pré-operatória e o tipo de luxação não tiveram influência nos resultados de nenhum dos grupos. Melhores resultados foram obtidos nos quadris que não haviam sido submetidos a tratamento prévio.

Tratamento cirúrgico de luxação congênita do quadril pós marcha: redução aberta e osteotomia de Salter / Surgical Treatment of the congenital dislocation of the hip after walking age: open reduction and Salter´s osteotomy

The congenital dislocation of the hip, after the function of weight bearing begins or walking phase requires surgical treatment, and one of the options is the open reduction combined to innominate osteotomy (Salter). In this study, the results of 18 patients, 22 surgically treated hips with congenital dislocation, were evaluated from 1989 and 1995, using innominate osteotomy, by Salter's technique after open reduction. The age of the patients at the time of surgery ranged from 12 to 30 months (age after march), mean age of 19 months. Fifteen were female and 3 were male, 4 patients had bilateral dislocation and in the remaining, 8 had their left hip dislocated and 6 had their right hip dislocated. The results were evaluated according to Dutoit et al.(3) clinical criteria and to Severin(12) radiological criteria, after a mean follow-up of 48 months. Eighteen percent of excellent clinical results (4); 54 percent of good results (12); 14 percent of regular results (3) and 14 percent of bad results(3) were obtained. As to the radiologic criteria, 36 percent of the hips were classified as excellent (8); 45 percent as good (10); 5 percent regular (1) and 14 percent bad (3). There were 3 cases of re-dislocation which were treated by a different surgical technique. No cases of infection, graft fracture and vascular or nervous injury were reported.