The lateral edge and sourcil acetabular indices for surgical decision-making in developmental dysplasia of the hip.

PURPOSE: The acetabular index (AI) is a radiographic measure that guides surgical decision-making in developmental dysplasia of the hip (DDH). Two AI measurement methods are described; to the lateral edge of the acetabulum (AI-L) and to the lateral edge of the sourcil (AI-S). The purpose of this study was to determine the level of agreement between AI-L and AI-S on the diagnosis and degree of acetabular dysplasia in DDH. METHODS: A total of 35 patients treated for DDH with Pavlik harness were identified. The AI-L and AI-S were measured on radiographs (70 hips) at two and five years of age. AI-L and AI-S were then transformed relative to published normative data (tAI-L and tAI-S). Bland-Altman plots, linear regression and heat mapping were used to evaluate the agreement between tAI-L and tAI-S. RESULTS: There was poor agreement between tAI-S and tAI-L on the Bland-Altman plots with wide limits of agreement and no proportional bias. The two AI measurements were in agreement as to the presence and severity of dysplasia in only 63% of hips at two years of age and 81% at five years of age, leaving the remaining hips classified as various combinations of normal, mildly and severely dysplastic. CONCLUSION: AI-L and AI-S have poor agreement on the presence or degree of acetabular dysplasia in DDH and cannot be used interchangeably. Clinicians are cautioned to prudently evaluate both measures of AI in surgical decision-making. LEVEL OF EVIDENCE: I.

Vitamin D, calcium and albumin bloodserum levels in Belgian orthopedic patients - is systematic screening justified?

In the setting of fracture care, orthopedic surgeons are primarily focused on treating the fracture itself, but more and more attention is being paid to prevention of such fractures and identifying risk factors associated with worse postoperative prognoses. In our study we collected postoperative vitamin D, calcium and albumin bloodserum levels from 163 patients who were admitted with a femur fracture and from 233 patients who were admitted for an elective hip arthroplasty during the period of 365 days. Results : 84.21% of the fracture population had a vitamin D deficiency (< 20 ng/mL) as well as 77.30% of the elective hip arthroplasty population. There were no significant seasonal differences in the fracture population. 80.27% of the fracture population had an albumin deficiency (< 29 g/L) compared to 38.75% of the reference population. There were no significant statistical differences in vitamin D and albumin bloodserum levels between the under 75 years old age group and the over 75 years old age group. We can make the tentative assumption that systematic screening for all hip fracture patients and all elective hip arthroplasty patients admitted to our orthopedic ward - independent of their age, season or pathology - is justified and we advise other hospitals to implement this as well.

Cup oversizing as a risk factor for postoperative groin pain in Total Hip Arthroplasty : a retrospective analysis of 437 hips.

The majority of patients are pain free after total hip replacement, but some experience anterior hip pain due to iliopsoas impingement. There is evidence that a prominent or malpositioned cup may cause iliopsoas tendonitis. The purpose of this study was to determine whether oversizing the cup is a risk factor for postoperative groin pain. We retrospectively investigated 437 total hip replacements in which the femoral head diameter had been measured for other research purposes. Data regarding the cup size and positioning was collected from implant identification labels and pelvis x-rays. Clinical data were recovered from the medical files. Native femoral head size, cup size, anteversion, inclination and DS (difference between native femoral head size and cup size) and type of pain (anterior hip pain or non-anterior hip pain) were analyzed and correlations were sought. There was a strong and significant correlation between native femoral head size and cup size. Mean DS was 5.5 mm in the no pain group, 6.9 mm in the anterior hip pain group and 5.9 mm in the non-anterior hip pain group. The difference in mean DS was significant (P=0.046) in patients experiencing anterior hip pain vs. those with no pain or non-anterior hip pain. As patients with anterior hip pain had a significant larger DS of 6.9 mm, it seems that a cup size of more than 6 mm above the native femoral head size should be avoided. We therefore recommend a systematic intraoperative head size measurement prior to definite cup choice.

Ilizarov bone transport as a treatment of congenital pseudarthrosis of the tibia: a long-term follow-up study.

PURPOSE: Most studies on congenital pseudarthrosis of the tibia (CPT) report on the short-term union rate and refracture rate but do not take into account the long-term outcome. This review includes patients treated with an Ilizarov bone transport, who all reached skeletal maturity. It describes long-term results and highlights any prognostic factors that could predict the final outcome. METHODS: The records of patients with CPT treated with an Ilizarov bone transport in our institution were retrospectively evaluated. RESULTS: A total of 12 consecutive patients were studied. The mean follow-up was 24.5 years (range 6-39 years). Primary consolidation was seen in ten patients (83 %). Half of these patients had a refracture. At final follow-up, eight patients experienced union and four remained un-united, of whom one had an amputation. CONCLUSIONS: The present data confirm a good primary healing rate. However, tibial union at final follow-up was only seen in 67 %, indicating that refracture is the main issue. United bone is often of inferior biological and mechanical quality, so lifetime protection with intramedullary devices, braces or a combination of both is recommended.

Radiographic analysis of a bone plug in 275 primary cemented total hip arthroplasties.

Various designs of cement restrictors for total hip arthroplasty have shown a variability in resistance to intramedullary pressure and migration. The performance of a conical bone plug was studied in 275 cemented total hip arthroplasties with a followup between 5 and 19 years. In a radiographic analysis the relation between the plug position and the cement mantle quality was investigated. The results were compared to the performance of other cement restrictors as reported in the literature. Good to excellent cement mantles were observed in 80% of the femurs. A significant correlation between the stability of the plug and the quality of the cement mantle was found. Forty-nine percent of the plugs were within 1 to 3 centimetres of the Exeter stem hollow centraliser. We also demonstrated that bone plugs performed almost always better than polyethylene or gelatine restrictors reported in other studies.