ABSTRACT
BACKGROUND: Femoroacetabular impingement (FAI) deformity has been associated with posterior hip instability in adult athletes. PURPOSE: To determine if FAI deformity is associated with posterior hip instability in adolescents, the femoral head-neck junction or acetabular structure in a cohort of adolescent patients who sustained a low-energy, sports-related posterior hip dislocation was compared with that in a group of healthy age- and sex-matched controls with no history of hip injury or pain. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: We identified 12 male patients (mean age, 13.9 years; range, 12-16 years) who sustained a sports-related posterior hip dislocation and underwent a computed tomography (CT) scan after closed reduction. For each patient, 3 age- and sex-matched healthy controls were identified. Femoral head-neck type was assessed by measurement of the alpha angle on the radially oriented CT images at the 12-, 1-, 2-, and 3-o'clock positions. Age, body mass index (BMI), alpha angle at each position, acetabular version, Tönnis angle, and lateral center-edge angle (LCEA) on the involved hip in the dislocation group were compared with those of the matched controls using a mixed-effects model. A logistic regression analysis using a generalized estimating equation was used to compare the percentage of subjects with cam-type FAI deformity (alpha angle >55°) in each group. RESULTS: The dislocation and control groups were similar in age distribution and BMI (P > .05). The mean alpha angles were statistically significantly higher in the dislocation group compared with the control group at the superior (46.3° ± 1.1° vs 42.7° ± 0.6°; P = .0213), superior-anterior (55.5° ± 1.9° vs 46.0° ± 1.3°; P = .0005), and anterior-superior (54.9° ± 1.5° vs 48.9° ± 1.0°; P = .0045) regions. Cam deformity was present in a larger proportion of patients in the dislocation group than in the control group (P < .0035). An alpha angle greater than 55° was present in 16.7% of the dislocation group and 0% of the control group at the 12-o'clock position (P = .1213), 41.7% versus 0% at the 1-o'clock position (P = .0034), 58% versus 6% at the 2-o'clock position (P = .0004), and 25% versus 2.8% at the 3-o'clock position (P = .0929). Acetabular anteversion was lower in the dislocation group (9.6° ± 1.4°) compared with the control group (15.1° ± 0.8°) (P = .0068). Mean acetabular LCEA was within a normal range in both groups. CONCLUSION: A significantly higher mean alpha angle from the superior to the anterior-superior regions of the femoral head-neck junction and lower acetabular version were found in adolescents who sustained low-energy, sports-related posterior hip dislocations.
Subject(s)
Athletic Injuries/epidemiology , Femoracetabular Impingement/epidemiology , Femur Head/pathology , Femur Neck/pathology , Hip Dislocation/epidemiology , Adolescent , Athletes/statistics & numerical data , Athletic Injuries/etiology , Athletic Injuries/pathology , Child , Cohort Studies , Cross-Sectional Studies , Femoracetabular Impingement/ethnology , Femoracetabular Impingement/pathology , Hip Dislocation/etiology , Hip Dislocation/pathology , Humans , Male , Tomography, X-Ray ComputedABSTRACT
OBJECTIVE: To evaluate the progression of the contralateral hip after unilateral reconstruction of hip dislocation in patients classified as GMFCS IV-V; and to identify potential prognostic factors for their evolution. METHODS: This was a retrospective study on 17 patients with spastic cerebral palsy, who were classified on the GMFCS scale (Gross Motor Functional Classification System) as degrees IV and V, and who underwent unilateral reconstruction surgery to treat hip dislocation (adductor release, femoral varus osteotomy and acetabuloplasty). The minimum postoperative follow-up was 30 months. The clinical parameters evaluated were sex, age at time of surgery, length of follow-up after surgery and range of abduction. The treatment parameters were use/nonuse of femoral shortening, application of botulinum toxin and any previous muscle releases. The radiographic parameters were Reimer's extrusion index (REI), acetabular angle (AA) and the continuity of Shenton's line. RESULTS: Among the 17 patients evaluated, eight presented dislocation (group I) and nine did not (group II). Group I comprised three males and five females; group II comprised one male and eight females. The mean age at the time of surgery among the group I patients was 62 months and the mean follow-up was 62 months. In group II, these were 98 and 83 months, respectively. There was a trend in which patients of greater age did not evolve with contralateral dislocation. Among the nine patients with the combination of REI < 30% and AA < 25°, only one presented dislocation during the follow-up. Contralateral subluxation occurred within the first two years after the surgery. CONCLUSION: Hips presenting REI < 30° and AA < 25° do not tend to evolve to subluxation and can be kept under observation. Preoperative clinical and radiographic measurements alone are not useful for indicating the natural evolution of non- operated hips. The critical period for subluxation is the first two years after surgery.
OBJETIVO: Avaliar a evolução do quadril contralateral após a reconstrução unilateral de luxação de quadril em pacientes classificados como GMFCS IV-V e identificar possíveis fatores prognósticos da evolução. MÉTODOS: Estudo retrospectivo de 17 pacientes portadores de paralisia cerebral espástica, classificados pela escala GMFCS (Gross Motor Functional Classification System) em graus IV e V, submetidos a cirurgia de reconstrução unilateral de luxação de quadril (liberação de adutores, osteotomia varizante femoral e acetabuloplastia). O seguimento pós-operatório mínimo foi de 30 meses. Foram avaliados parâmetros clínicos (sexo, idade na ocasião do procedimento cirúrgico, tempo de seguimento após a cirurgia e amplitude de abdução), de tratamento (a feitura ou não de encurtamento femoral, aplicação de toxina botulínica e se houve procedimentos musculares prévios) e radiográficos (índice de extrusão de Reimers [IR], ângulo acetabular [AC] e continuidade do arco de Shenton [AS]). RESULTADOS: Dos 17 pacientes avaliados, oito deslocaram (grupo I) e nove não (grupo II). O grupo I contava com três pacientes do sexo masculino e cinco do feminino; grupo II apresentou um paciente do sexo masculino e oito do feminino. A média de idade no momento da cirurgia dos pacientes do grupo I foi de 62 meses e o tempo de seguimento médio foi de 62 meses. No grupo II foram de 98 e 83 meses, respectivamente. Houve tendência dos pacientes operados com maior idade não evoluírem com luxação contralateral. Dos nove pacientes que apresentavam a combinação de IR < 30% e AC < 25°, apenas um apresentou luxação no seguimento. A subluxação contralateral ocorre nos dois primeiros anos de pós-operatório. CONCLUSÃO: Quadris que apresentam um IR < 30° e AC < 25° não tendem a evoluir para subluxação e podem ser mantidos em observação. Medidas clínicas e radiográficas isoladas no pré-operatório não foram úteis para indicar a evolução natural do quadril não operado. O período crítico para subluxação são os dois primeiros anos do pós-operatório.
ABSTRACT
OBJECTIVE:To evaluate the progression of the contralateral hip after unilateral reconstruction of hip dislocation in patients classified as GMFCS IV-V; and to identify potential prognostic factors for their evolution.METHODS:This was a retrospective study on 17 patients with spastic cerebral palsy, who were classified on the GMFCS scale (Gross Motor Functional Classification System) as degrees IV and V, and who underwent unilateral reconstruction surgery to treat hip dislocation (adductor release, femoral varus osteotomy and acetabuloplasty). The minimum postoperative follow-up was 30 months. The clinical parameters evaluated were sex, age at time of surgery, length of follow-up after surgery and range of abduction. The treatment parameters were use/nonuse of femoral shortening, application of botulinum toxin and any previous muscle releases. The radiographic parameters were Reimer's extrusion index (REI), acetabular angle (AA) and the continuity of Shenton's line...
OBJETIVO:Avaliar a evolução do quadril contralateral após a reconstrução unilateral de luxação de quadril em pacientes classificados como GMFCS IV-V e identificar possíveis fatores prognósticos da evolução.MÉTODOS:Estudo retrospectivo de 17 pacientes portadores de paralisia cerebral espástica, classificados pela escala GMFCS (Gross Motor Functional Classification System) em graus IV e V, submetidos a cirurgia de reconstrução unilateral de luxação de quadril (liberação de adutores, osteotomia varizante femoral e acetabuloplastia). O seguimento pós-operatório mínimo foi de 30 meses. Foram avaliados parâmetros clínicos (sexo, idade na ocasião do procedimento cirúrgico, tempo de seguimento após a cirurgia e amplitude de abdução), de tratamento (a feitura ou não de encurtamento femoral, aplicação de toxina botulínica e se houve procedimentos musculares prévios) e radiográficos (índice de extrusão de Reimers [IR], ângulo acetabular [AC] e continuidade do arco de Shenton [AS])...
