PURPOSE OF THE STUDY Different techniques have been reported to reconstruct the defi cient acetabulum during total hip arthroplasty (THA). The purpose of this study was to compare the biomechanical features of the bulk bone graft (BBG) technique (Harris acetabular plasty) and the Roof Step Cut (RSC) technique using fi nite element analysis. MATERIAL AND METHODS Based on a female patient's dysplastic hip CT scan, 3D models were assembled according to the two techniques. For the Harris technique, an irregular BBG was sculpted from a solid sphere, while for the RSC technique, the graft was sculpted into a step-cut shape with a similar size. Each graft was fi xed with two compression screws at two different angles (0° and 45°). Four fi nite element models were used to compare the von Mises stress distribution and total deformation of the grafts and the screws. The pressure and sliding distances of the contacts between the bone graft, metal cup and acetabular host bone were also analyzed. RESULTS For both of the bone grafts and the screws, compared to the Harris models, the maximum stress of the RSC models was signifi cantly lower (16.56 MPa, 25.50 MPa vs 97.13 MPa, 112.72 MPa) and the total deformation was signifi cantly smaller (0.0096 mm, 0.0089 mm vs 0.022 mm, 0.018 mm). 45° inserted screws generated higher stress at the end of the screws and on the outside of the bone graft. In case of 0° inserted screws, the maximum value was mainly located in the middle of the screws, inside the screw channel as well as at the contact area between the graft and the host bone. At all analyzed contacts, the RSC technique shows signifi cantly lower pressure and sliding distances, irrelevant to the screw's insertion angle. In comparison, the model of BBG with 45° screws showed a signifi cant sliding effect and higher contact pressure. CONCLUSIONS Compared with the BBG technique, the step-shaped graft of the RSC technique could signifi cantly reduce the maximum stress and deformation of the graft and the screws, and decrease the pressure and sliding distance between the bone graft, metal cup and the acetabular host bone. The angle of screw placement affects the location of stress and deformation. Key words: developmental dysplasia of the hip, total hip arthroplasty, acetabular reconstruction, bone graft, fi nite element analysis.
Osteokartilaginózna exostóza alebo ostechondróm, je benígny kostný nádor lokalizovaný v okolí rastovej chrupavky. Je to najčastejšie sa vyskytujúci kostný tumor, tvorí 20–50 % všetkých benígnych kostných afekcií. Jeho radiografické zobrazenie je veľmi charakteristické – väčšinou sa jedná o stopkatý útvar zakončený chrupavčitou čiapočkou. Osteochondrómy môžu byť solitárne, alebo mnohopočetné – hovoríme o exostózovej chorobe. Jedná sa o histologicky benígnu afekciu, ktorá sa klinicky manifestuje bolesťou, rezistenciou a obmedzenou hybnosťou. „Malígna“ však môže byť svojou lokalizáciou. Histologická malignizácia buniek útvaru je vzácna, dochádza k nej len v 1 % prípadov. V práci publikujeme prípad 15-ročného chlapca s exostózou proximálneho femuru s výrazným ischiofemorálnym impingement syndrómom. Po histologizácii a parciálnej resekcii bol ošetrený prístupom SHD (Surgical Hip Dislocation), ktorý umožňuje pomocou luxácie kĺbu ošetriť postihnutý proximálny femur bez porušenia nutritívnych ciev. Po radikálnej resekcii je pacient v sledovaní 4 roky s klinicky aj roentgenologicky výborným výsledkom.
Osteocartilaginous exostosis, also called osteochondroma, is a benign bone tumor for most localized near the epiphyseal plate. It is the most common bone tumor, representing about 20–50 % of all benign bone tumors. Its radiological image is very typical – it is most often a pediculate formation with a cartilaginous cap. Osteochondromas can be solitary, cases of multiple occurrence are called hereditary multiple enchondromatosis (HME). Histologically it is categorized as a benign affection, clinically presenting with pain, a local palpable mass and restriction of movement. Histological malignization of the tumor is rare, reported in 1 % of cases. In the tumor can however be considered malignant in cases of adverse localization. In this article we present the case of a 15-year-old boy with an exostosis of the proximal femur with a prominent ischiofemoral impingement syndrome. After a biopsy and a partial resection, the tumor was treated via the surgical hip dislocation technique, which allows access to the femoral head without compromising its nutritional blood vessels. After a radical resection, the patient has been monitored for 4 years and his clinical and radiological condition is satisfactory.
PURPOSE OF THE STUDY Hip dislocation is one of the major causes of disability in children with cerebral palsy (CP). Surgical treatment can be achieved using different techniques including proximal femoral varus derotation osteotomy (FVDRO), pelvic osteotomies, and open hip reduction (OHR). However, we claim that pathologies originating from extraarticular structures in the dislocated hip in CP can be reconstructed by extraarticular methods and OHR may not always be necessary. Therefore, this study aims to discuss the results of hip reconstruction with extraarticular intervention in patients with CP. MATERIAL AND METHODS In total, 141 hips (95 patients) were included in the study. All patients underwent FVDRO, either with or without a Dega osteotomy. Changes in the Acetabular Index (AI), Migration Index (MI), neck-shaft angle (NSA), and center-edge angle (CEA) were assessed on the preoperative, postoperative, and final follow-up anterior-posterior radiographs of the pelvis. RESULTS Median age was 8 years (range between 4-18 years). The average follow-up duration was 5 years (range between 2-9 years). Changes in AI, MI, NSA and CEA values were statistically significant for postop and follow-up periods when compared to preoperative values. Of the 141 operated hips, 8 (5.6%) hips required revision surgery due to redislocation/resubluxation detected at the follow-ups, and unilateral operation can be accepted as a risk factor for redislocation. CONCLUSIONS Our results demonstrate that reconstructive treatment consisting of FVDRO, medial capsulotomy (in the case of reduction difficulty) and transiliac osteotomy (in the case of acetabular dysplasia) provides satisfactory outcomes in hip dislocation in CP. Key words: hip displacement, cerebral palsy, hip reduction.
- MeSH
- acetabulum MeSH
- dítě MeSH
- kyčelní kloub chirurgie MeSH
- lidé MeSH
- luxace kyčle * diagnostické zobrazování etiologie chirurgie MeSH
- mladiství MeSH
- mozková obrna * komplikace chirurgie MeSH
- následné studie MeSH
- pánev MeSH
- předškolní dítě MeSH
- retrospektivní studie MeSH
- výsledek terapie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- předškolní dítě MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE OF THE STUDY In treatment algorithm of developmental dysplasia of the hip, posteromedial limited surgery is placed between closed reduction and medial open articular reduction. The aim of the present study was to assess the functional and radiologic results of this method. MATERIAL AND METHODS This retrospective study was performed in 37 Tönnis grade II and III dysplastic hips of 30 patients. The mean age of the patients at operation was 12.4 months. The mean follow-up time was 24.5 months. Posteromedial limited surgery was applied when sufficient stable concentric reduction was not achieved by closed technique. No pre-operative traction was applied. Postoperatively, human position hip spica cast was applied for 3 months. Outcomes were evaluated regarding modified McKay functional results, acetabular index and presences of residual acetabular dysplasia or avascular necrosis. RESULTS Thirty-six hips had satisfactory and one hip had poor functional result. The mean pre-operative acetabular index was 34.5 degrees. It improved to 27.7 and 23.1 degrees at the postoperative 6th month and the last control X-Rays. The change in acetabular index was statistically significant (p<0.05). At the last control, 3 hips had findings of residual acetabular dysplasia and 2 hips had avascular necrosis. CONCLUSIONS Posteromedial limited surgery for developmental dysplasia of the hip is indicated when closed reduction remains insufficient and medial open articular reduction remains unnecessarily invasive. This study, in line with the literature, provides evidences that this method might decrease the incidences of residual acetabular dysplasia and avascular necrosis of the femoral head. Key words: developmental dysplasia of the hip, posteromedial limited surgery, closed reduction, medial open reduction.
BACKGROUND: Femoral posterior hip dislocation with associated femoral head fractures (Pipkin fractures) are rare high-energy injuries. Published treatment modalities involve conservative treatment, head fragment resection, open reduction and internal fixation, and total hip replacement. The experience with mini-invasive screw osteosynthesis of these fractures is the main focus of our study. METHODS: Seven Pipkin fractures (five Pipkin II and two Pipkin I) in six patients were treated by closed reduction of hip dislocation, followed by minimal invasive lag screw osteosynthesis. Cancellous screw(s) were inserted from the incision on the lateral hip through the femoral neck to the reduced fracture fragment. In all patients, postoperative CT was performed to check the quality of surgery. Active physiotherapy with immediate toe-touch weight bearing was the routine postoperative protocol. In all patients, radiological and clinical results were evaluated with the Thompson Epstein, Merle d'Aubigne and Postel score, and Harris hip score. RESULTS: All fractures united, and all femoral heads survived. Infectious complications were not observed, and no secondary surgery was needed. After an average follow-up of 18.4 months, the average Merle d'Aubigne and Postel score was 17.7 points, while the mean Harris hip score reached 98.1 points. The majority of patients achieved an excellent Thompson-Epstein clinical and radiological outcome. All patients returned to their original occupation. CONCLUSIONS: Mini-invasive screw osteosynthesis can be used for the treatment of Pipkin type I-II femoral head fractures. Successful reduction of hip dislocation and head fracture is necessary for using this technique. Long-term follow-up is necessary to confirm this technique.
- MeSH
- fraktury femuru * komplikace chirurgie MeSH
- fraktury kyčle * diagnostické zobrazování chirurgie komplikace MeSH
- hlavice femuru diagnostické zobrazování chirurgie zranění MeSH
- kostní šrouby škodlivé účinky MeSH
- lidé MeSH
- luxace kyčle * komplikace chirurgie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE OF THE STUDY The literature is conflicting as to whether the high hip center (HHC) reconstruction in total hip arthroplasty (THA) is an ideal option for patients with severe developmental dysplasia of the hip (DDH). This study aimed to compare the mid-term functional and radiographic outcomes of THA using HHC versus anatomical hip center (AHC) technique in Crowe types II and III DDH. Our hypothesis was that there may be no differences in terms of functional and radiographic outcomes between patients who underwent THA using HHC or AHC. MATERIAL AND METHODS Fifty-seven patients who underwent a primary THA due to Crowe type-II or type-III DDH were retrospectively reviewed and included. Patients were divided into two groups as per the hip center reconstruction: Group A (AHC technique) and group H (HHC technique). A cementless cup was inserted in 25 hips (19 female, 6 male; mean age = 51 years, age range = 28-67)) at near-AHC in group A and 32 hips (22 female, 10 male; mean age = 53 years, age range = 29-68) at HHC position in group H. To assess clinical status, the Harris Hip Score (HHS) was used at the final follow-up. In radiographical assessment, component loosening and osseointegration of the acetabular cup were examined on follow-up radiographs. Complications were also recorded. RESULTS The mean follow-up was 41 months (range, 25-84) in group A and 40 months (range, 24-86) in group H. The mean HHS was 83 (range, 74-91) in group A and 83.6 (range, 73-94) in group H (p = 0.741). Osteolysis was determined in three patients from each group. The other 51 cups demonstrated a minimum of one radiographic sign of osseointegration. Although the overall complication rate was higher in group A (64%) than in group H (46%), this difference reached no statistical significance (p = 0.11). CONCLUSIONS The HHC technique using cementless acetabular fixation seems to be a valuable alternative option to AHC technique in cases of Crowe types II and III DDH. Key words: High hip center; anatomical hip center; center of rotation; total hip arthroplasty; dysplastic hip; developmental dysplasia of the hip; Crowe type II; Crowe Type III.
- MeSH
- dospělí MeSH
- kyčelní protézy * MeSH
- lidé středního věku MeSH
- lidé MeSH
- náhrada kyčelního kloubu * metody MeSH
- následné studie MeSH
- retrospektivní studie MeSH
- senioři MeSH
- výsledek terapie MeSH
- vývojová dysplazie kyčelního kloubu * chirurgie MeSH
- vývojová kyčelní dysplazie * diagnostické zobrazování chirurgie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE OF THE STUDY Cementless stems in highly dysplastic hips are considered to increase the risk of femoral fracture and associated morbidity. Several authors speculated to use prophylactic cabling in this patient group to prevent intraoperative fractures. This study aims to reveal objective results regarding the perioperative complications in a large and consecutive patient group with respect to use of prophylactic cabling. MATERIAL AND METHODS A retrospective comparative study was planned. A total of 122 consecutive patients with dysplastic hips of Crowe type 3 or 4, operated on with total hip arthroplasty (THA) and shortening osteotomy using a rectangular femoral stem were included. Patients were stratified according to use of a diaphyseal prophylactic cerclage cable. Perioperative complications were recorded. Clinical outcome was measured in terms of Harris Hip Score and Visual Analog Scale (VAS) for pain. All results were compared between the groups. RESULTS The mean follow-up time was 27 months. Two (2%) versus five (14%) patients had a fracture at the diaphyseal level in cabled versus non-cabled groups. Difference between groups was statistically significant (p=0.01). Relative risk of fracture in case of a non-cabling was 5.8 (p=0.03). Eleven (9%) patients had a non-displaced fracture at the metaphyseal level. No significant differences were detected with respect to preoperative clinical outcome scores or change in these scores between groups. CONCLUSIONS Femoral diaphyseal fracture rates are low when cementless, rectangular stems are used in dysplastic high riding hips. Prophylactic cerclage cabling further decreases the fracture risk and eases treatment in case of a fracture without causing additional complications and therefore is recommended. Key words: intraoperative fracture, periprosthetic fracture, total hip arthroplasty, cerclage cabling, developmental hip dysplasia, transverse shortening osteotomy.
- MeSH
- fraktury femuru * etiologie prevence a kontrola chirurgie MeSH
- kostní cementy MeSH
- lidé MeSH
- náhrada kyčelního kloubu * škodlivé účinky metody MeSH
- periprotetické fraktury * etiologie prevence a kontrola chirurgie MeSH
- retrospektivní studie MeSH
- vývojová dysplazie kyčelního kloubu * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- coxa vara diagnostické zobrazování diagnóza patologie MeSH
- dítě MeSH
- kyčelní kloub * abnormality diagnostické zobrazování patologie MeSH
- lidé MeSH
- nádory kostí diagnóza komplikace patologie MeSH
- Perthesova nemoc diagnostické zobrazování diagnóza MeSH
- rentgendiagnostika metody MeSH
- vývojová dysplazie kyčelního kloubu diagnóza etiologie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- Publikační typ
- přehledy MeSH
PURPOSE OF THE STUDY The aim of the present study was to determine the potential effects of single nucleotide polymorphisms (SNPs) of TGFB1 and IL-6 on the development and severity of the disease in patients with DDH and investigate the relationship of these two gene polymorphisms. MATERIAL AND METHODS This case control study was conducted on 105 patients diagnosed with DDH and 119 healthy control subjects of any age. The DDH patients were classified according to the Hartofilakidis and IHDI classifications for adult and pediatric patients, respectively. Genomic DNA was isolated from peripheral blood samples using the Salting-out method. TGFB1 gene p.Pro10Leu (c.29C>T) (rs1800470) and IL-6 572G>C (rs1800796) polymorphisms were analyzed using Sanger DNA sequencing. RESULTS There was no statistically significant relationship of TGFB1 and IL-6 SNPs for DDH. When the rs1800470 and rs1800796 polymorphisms were compared according to family history, the homozygous mutation rate of TGFB1 gene was found to be significantly higher in patients with a positive family history than in patients with a negative family history. No significant relationship was found between rs1800796 polymorphisms and family history. TGFB1 homozygous mutation rate was determined to be statistically higher in the positive family history group than control group. No similar relationship was found between the negative family history group and the control group. No statistically significant relationship was determined between rs1800470 and rs1800796 and the severity of DDH. CONCLUSIONS rs1800796 and rs1800470 polymorphisms do not appear to be major responsible genetic factors for DDH. However, the determination of a correlation between a positive family history and homozygous mutation rate of the TGFB1 gene indicates that this gene may have a greater effect on DDH development. Key words: developmental dysplasia of the hip, interleukin-6, transforming growth factor beta 1, case control study.
- MeSH
- dítě MeSH
- dospělí MeSH
- frekvence genu MeSH
- interleukin-6 * genetika MeSH
- jednonukleotidový polymorfismus MeSH
- lidé MeSH
- studie případů a kontrol MeSH
- transformující růstový faktor beta1 genetika MeSH
- vývojová dysplazie kyčelního kloubu * MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
