Role of magnetic resonance imaging in assessment of acetabular and femoral version in developmental dysplasia of the hip.

Objective: To evaluate the role of magnetic resonance imaging (MRI) in the assessment of femoral and acetabular version in developmental dysplasia of the hip (DDH). Materials and Methods: This was a cross-sectional study of 20 consecutive patients with DDH (27 dysplastic hips) who were examined with MRI. In dysplastic and normal hips (DDH and comparison groups, respectively), we evaluated the following parameters: osseous acetabular anteversion (OAA); cartilaginous acetabular anteversion (CAA); femoral anteversion; osseous Mckibbin index (OMI); cartilaginous Mckibbin index (CMI); and the thickness of the anterior and posterior acetabular cartilage. Results: The OAA was significantly greater in the dysplastic hips. The CAA, femoral anteversion, OMI, and CMI did not differ significantly between the normal and dysplastic hips. In the DDH and comparison groups, the OAA was significantly lower than the CAA, the OMI was significantly lower than the CMI, and the posterior acetabular cartilage was significantly thicker than the anterior cartilage. Conclusion: Our findings confirm that MRI is a valuable tool for the assessment of femoral and acetabular version in DDH. Preoperative MRI evaluation has great potential to improve the planning of pelvic and femoral osteotomies.

Objetivo: Avaliar o papel da ressonância magnética (RM) na avaliação da versão femoral e acetabular na displasia do desenvolvimento do quadril (DDQ). Materiais e Métodos: Estudo transversal de 20 pacientes consecutivos com DDQ (27 quadris displásicos) que foram examinados com RM. Nos quadris displásicos e normais (grupos DDQ e comparação, respectivamente), avaliamos os seguintes parâmetros: anteversão acetabular óssea (AAO), anteversão acetabular cartilaginosa (AAC), anteversão femoral, índice de Mckibbin ósseo (IMO), índice de Mckibbin cartilaginoso (IMC) e espessura da cartilagem acetabular anterior e posterior. Resultados: A AAO foi significativamente maior nos quadris displásicos. A AAC, anteversão femoral, IMO e IMC não diferiram significativamente entre os quadris normais e displásicos. Nos grupos DDQ e comparação, a AAO foi significativamente menor que a AAC, o IMO foi significativamente menor que o IMC, e a cartilagem acetabular posterior foi significativamente mais espessa que a anterior. Conclusão: Nossos achados confirmam que a RM é uma ferramenta valiosa para a avaliação da versão femoral e acetabular na DDQ. A avaliação pré-operatória por RM tem grande potencial para melhorar o planejamento das osteotomias pélvicas e femorais.

Role of magnetic resonance imaging in assessment of acetabular and femoral version in developmental dysplasia of the hip / Papel da ressonância magnética na avaliação da versão acetabular e femoral na displasia do desenvolvimento do quadril

Abstract Objective: To evaluate the role of magnetic resonance imaging (MRI) in the assessment of femoral and acetabular version in developmental dysplasia of the hip (DDH). Materials and Methods: This was a cross-sectional study of 20 consecutive patients with DDH (27 dysplastic hips) who were examined with MRI. In dysplastic and normal hips (DDH and comparison groups, respectively), we evaluated the following parameters: osseous acetabular anteversion (OAA); cartilaginous acetabular anteversion (CAA); femoral anteversion; osseous Mckibbin index (OMI); cartilaginous Mckibbin index (CMI); and the thickness of the anterior and posterior acetabular cartilage. Results: The OAA was significantly greater in the dysplastic hips. The CAA, femoral anteversion, OMI, and CMI did not differ significantly between the normal and dysplastic hips. In the DDH and comparison groups, the OAA was significantly lower than the CAA, the OMI was significantly lower than the CMI, and the posterior acetabular cartilage was significantly thicker than the anterior cartilage. Conclusion: Our findings confirm that MRI is a valuable tool for the assessment of femoral and acetabular version in DDH. Preoperative MRI evaluation has great potential to improve the planning of pelvic and femoral osteotomies.

Resumo Objetivo: Avaliar o papel da ressonância magnética (RM) na avaliação da versão femoral e acetabular na displasia do desenvolvimento do quadril (DDQ). Materiais e Métodos: Estudo transversal de 20 pacientes consecutivos com DDQ (27 quadris displásicos) que foram examinados com RM. Nos quadris displásicos e normais (grupos DDQ e comparação, respectivamente), avaliamos os seguintes parâmetros: anteversão acetabular óssea (AAO), anteversão acetabular cartilaginosa (AAC), anteversão femoral, índice de Mckibbin ósseo (IMO), índice de Mckibbin cartilaginoso (IMC) e espessura da cartilagem acetabular anterior e posterior. Resultados: A AAO foi significativamente maior nos quadris displásicos. A AAC, anteversão femoral, IMO e IMC não diferiram significativamente entre os quadris normais e displásicos. Nos grupos DDQ e comparação, a AAO foi significativamente menor que a AAC, o IMO foi significativamente menor que o IMC, e a cartilagem acetabular posterior foi significativamente mais espessa que a anterior. Conclusão: Nossos achados confirmam que a RM é uma ferramenta valiosa para a avaliação da versão femoral e acetabular na DDQ. A avaliação pré-operatória por RM tem grande potencial para melhorar o planejamento das osteotomias pélvicas e femorais.

Relation of interleukin-6 in rheumatoid arthritis patients to systemic bone loss and structural bone damage.

IL-6 plays a key role in local and systemic manifestation of RA. IL-6 is not only a pro-inflammatory cytokine, but also interacts in complex ways with the cells involved in bone remodeling. In RA, IL-6 may indirectly promote osteoclastogenesis by increasing the release of RANK-L by osteoblasts, and it diminishes the proliferation of osteoblasts at late differentiation stages. The aims of this work were to evaluate the level of serum IL-6 and to correlate it with the activity, severity, early development of osteoporosis, and early structural bone damage in RA patients. The following parameters were investigated in 40 RA patients and 20 healthy controls: IL-6 level, BMI, ESR, CRP, CBCs, serum ionized calcium, blood urea, serum creatinine, AST, ALT, anti-CCP, and RF. Bone mineral density was measured by dual-energy X-ray absorptiometry at lumbar spines and femoral neck. Drug history was taken stressing on steroid therapy. Data were processed and analyzed using computer-based program. IL-6 was significantly positively correlated with HAQ1, PTGA, grade of pain, ESR, platelet count, blood urea, AST level, and anti-CCP level; IL-6 showed an inverse significant correlation with T-score. IL-6 was positively correlated with TGC, DAS-28 score, and RF level. No correlation was found between T-score and morning stiffness duration, BMI, CRP, RBC, serum creatinine, and ALT. There was an inverse significant correlation between T-score and HAQ1, SJC, pain grade, DAS-28 score, PTGA, ESR, RF, anti-CCP, and IL-6. Patients with RA on steroid therapy had significantly higher TJC, SJC, and DAS-28 score, anti-CCP, and IL-6 than patients with RA not on steroid therapy. Patients with RA on steroid therapy had significantly lower T-score and lower serum ionized calcium than patients with RA not on steroid therapy. IL-6 has an important role in increasing osteoclastic activity and subsequent bone resorption in the patients with RA. Blocking IL-6 by using IL-6 inhibitors and anti-RANK-L therapy may be effective in inhibiting the inflammatory process and preventing the bone complications of RA disease.