Anatomical Parameters Associated with the Shortening Decision in Crowe Type 4 Dysplastic Hip Osteoarthritis: A Case-Control Study.

Background: Muscle and bone morphometry may be potent indicators for predicting femoral subtrochanteric shortening osteotomy (FSSO). We aimed to investigate muscular and bony factors that may be predictive of FSSO. Methods: Patients with unilateral Crowe type 4 developmental dysplasia of the hip (DDH) who underwent unilateral total hip arthroplasty (THA) without (Group 1, 31 patients) and with FSSO (Group 2, 39 patients) were included. Sixty healthy hips (Group 3) were selected as the control group. Several muscular and bony parameters were measured on the operative (O) and non-operative (NO) hips on radiographs and computed tomography (CT) images. Results: The mean NO gluteus medius cross-sectional area (CSA) index (NO-GMed CI), NO tensor fasia lata (TFL) CI, NO iliopsoas (IP) CI, and NO gluteus maximus (GMax) CI for the control group were lower than those for both Crowe type IV DDH with and without FSSO. The mean NO gluteus minimus CI (NO-GMin CI) for the control group were higher than those for both Crowe type IV DDH with and without FSSO. There was significant difference between Groups 1 and 2 regarding axial position of neo-acetabulum (APNA) (- 0.03 ± 8.5 vs. 5.27 ± 6.33, p = 0.004), coronal position of neo-acetabulum (CPNA) (33.39 ± 10.65 vs. 53.70 ± 12.27, p = 0.000), operative leg length discrepancy (O-LLD) (14.18 ± 15.14 vs. 24.44 ± 15.80, p = 0.001), O-gluteus minimus (GMin) length (155.34 ± 157.73 vs. 106.79 ± 20, p = < 0.01), and O-GMin CI (57.28 ± 58.59 vs. 29.95 ± 12.13, p = < 0.01). The cutoff values determined by the receiving operating curve analyses were as follows: 13.7 mm, 2.5 mm, and 41.4 mm for O-LLD, APNA, and CPNA, respectively. Conclusion: FSSO is associated with APNA, CPNA, O-LLD, O-GMin length, and O-GMin CI. By using cutoff values of APNA, CPNA, and O-LLD, predicting FSSO preoperatively is possible. Owing to these parameters, it may be possible to lower the technically demanding level of surgery.

Location of Femoral Vessels Around the Acetabulum in Crowe Type 4 Dysplastic Hips.

BACKGROUND: There are anatomical differences in the femur and acetabulum on the dysplastic hips. Yet, although there are detailed researches on bony structure differences, studies regarding anatomical differences for the vascular structure are insufficient. The study aimed to determine the relationship between the femoral artery and vein with acetabulum in computed tomography evaluation of Crowe type 4 hips and to compare with normal hip femoral vein and artery anatomic position. METHODS: Forty patients with one side hip Crowe type 4 deformity and opposite side normal hip were found suitable for the study. Pelvis CT was previously applied to all patients for the planning of total hip arthroplasty surgery. Normal hip acetabulum and the true acetabulum of the dysplastic hip were marked with the Ranawat's triangle and were then divided into quarters with four axial slices of the acetabulum; as dome, proximal one-fourth, center, and distal three-fourths. The shortest distance from the femoral vessels to the pelvis was measured at these 4 axial slices at the dysplastic side and compared with the healthy side. RESULTS: The distance of the vein to the acetabulum is closer to the dysplastic side. At distal three-fourths of Ranawat's triangle axial images, both femoral artery and femoral vein are closer to acetabulum at the dysplastic side. CONCLUSION: The analysis of preoperative images in cases of Crowe type 4 hip shows that the femoral vessels are closer to the anterior wall of the dysplastic true acetabulum at the level of the center of the hip (vein, mean: 2.7 mm closer) and below the center of the hip (vein, mean: 3 mm; and artery, mean: 3.3 mm closer) when compared with the normal acetabulum. Anatomic relationships knowledge can be used intraoperatively to avoid iatrogenic vascular injury during Crowe type 4 dysplastic hip arthroplasty surgery.

The interposition of soft tissue between the cortical button and femoral lateral cortex significantly increases button migration but does not negatively affect knee stability and clinical outcome.

BACKGROUND: In clinical practice, soft tissue interposition may occur during femoral graft fixation. Soft tissue interposition between the lateral femoral cortex and the cortical button may affect graft tension and related longitudinal graft motion in the tunnel. We aimed to investigate the effect of soft tissue interposition on button migration and clinical outcomes in anatomical single-bundle anterior cruciate ligament reconstruction. METHODS: Eighty-four patients aged 18-40 years, who underwent anatomical single-bundle anterior cruciate ligament reconstruction with quadruple hamstring autograft were included. Patients were divided into two groups as Group 1 (n = 32) with soft tissue interposition between the cortical button and cortex, and Group 2 (n = 52) without soft tissue interposition. At the one-year follow-up visit, the anteroposterior knee stability of the patients was evaluated using the Lachman test and KT-2000 arthrometer, and rotational stability was assessed with the pivot shift test. The Lysholm knee score was used to evaluate the functional outcome of the patients. Relationship between tissue interposition and clinical outcome, and button migration was examined. RESULTS: Button migration was observed in 12 patients in Group 1 (37.5%) and two patients (3.84%) in Group 2 (p < 0.001). However, no significant difference was observed between patients with and without tissue interposition or those with and without button migration regarding knee stability parameters and clinical outcome (p < 0.05). CONCLUSIONS: Postoperative tissue interposition is found to be associated with cortical button migration during the follow-up. However, it does not affect the clinical outcome.

Increased femoral anteversion related to infratrochanteric femoral torsion is associated with ACL rupture.

PURPOSE: To determine the association between femoral torsion and anterior cruciate ligament (ACL) rupture and determine the level of torsion using magnetic resonance imaging (MRI). METHODS: The medical records of patients who were diagnosed with ACL injury were reviewed retrospectively. This descriptive epidemiological study included 2344 patients. MRI scans were examined and patients with femur and knee MRI scans obtained at the same time were identified (ACL-deficient group). Twenty-eight of them had femur and knee MRI scans because of an incidental benign lesion in the distal femur. Patients who were diagnosed with enchondroma were followed up by MRI evaluation of the femur and were randomly selected as controls. Supratrochanteric torsion (STT), infratrochanteric torsion (ITT), and femoral anteversion (FA) were measured by orthopedic surgeons with at least 5 years of experience. RESULTS: Age, sex, and side properties were similar in both groups. The mean FA values were 19.4 ± 3.0 degrees and 11.9 ± 2.0 degrees in the ACL-deficient and control groups, respectively (p < 0.001). STT was similar in the ACL-deficient and control groups [mean: 38.2 ± 4.3 and 37.7 ± 3.3, respectively, (n.s.)]. ITT was increased in the ACL-deficient group compared with the control group (mean - 18.8 ± 4.3 and - 25.8 ± 3.8, respectively; p < 0.001). CONCLUSIONS: According to our results, increased FA was associated with ACL rupture. Further, the torsional abnormality was developed from the ITT. We concluded that each ACL-deficient patient should be assessed by a clinician for torsional abnormality using physical examination. LEVEL OF EVIDENCE: III.

Changes in Hip, Knee, and Ankle Coronal Alignments After Total Hip Arthroplasty With Transverse Femoral Shortening Osteotomy for Unilateral Crowe Type IV Developmental Dysplasia of the Hip.

BACKGROUND: To investigate changes in lower extremity coronal alignment in patients with unilateral Crowe type IV developmental dysplasia of the hip who underwent total hip arthroplasty with transverse femoral shortening osteotomy. METHODS: We reviewed the preoperative and 1-year postoperative full-length lower extremity radiographs of 25 patients. Femoral offset (FO), mechanical hip-knee-ankle angle, anatomical axis, mechanical axis deviation (MAD), mechanical lateral proximal femoral angle, anatomical medial proximal femoral angle, mechanical lateral distal femoral angle, anatomical lateral distal femoral angle, knee joint line congruency angle, mechanical medial proximal tibial angle, mechanical lateral distal tibial angle, ankle joint line orientation angle, tibial plafond talus angle, extremity length, and pelvic obliquity were measured on both the operative and nonoperative sides. RESULTS: Postoperatively, there were significant changes in FO (P = .001), hip-knee-ankle angle (P = .004), MAD (P = .016), mechanical lateral proximal femoral angle (P = .001), anatomical medial proximal femoral angle (P = .012), mechanical lateral distal femoral angle (P = .043), and ankle joint line orientation angle (P = .012) on the operative side. Only MAD (P = .035) changed significantly on the nonoperative side. CONCLUSION: Modification of FO and reconstruction of hip joint anatomy led to neutralization of knee and ankle valgus alignment. Effects on the nonoperative side were minimal.