Hip dysplasia Dotaz Zobrazit nápovědu
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.
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
INTRODUCTION: The aim of this study has been to present outcomes after cementless arthroplasty for developmental dysplasia Crowe type IV of the hip, with transverse subtrochanteric shortening osteotomy and using the S-ROM stem. METHODS: We evaluated radiographs, functional scores and complications in a consecutive series of 23 patients (28 hips) with high dislocation of the hip. The average age of patients at surgery was 49.9 (range 22-68) years. The operations were performed between 2007 and 2013. Patients were assessed retrospectively-clinically and radiographically during the year 2018. RESULTS: The mean follow-up period was 94 (range 60-134) months. The average Harris hip score improved from 39.9 to 84.0. The mean leg length discrepancy decreased from 5 cm preoperatively to 1.4 cm at the final follow-up. All acetabular components were implanted into the true acetabulum, and all prostheses were stable at the latest examination. No neurovascular damage was recorded. We have identified specific complications in seven hips (25%) in total: Intraoperative femoral fracture required fixation in four hips; three hips (10.7%) needed revision: Recurrent dislocation, with the need for cup reorientation, occurred in two hips (in one of them, this was followed by the subsequent need for resection of heterotopic ossification); there was one aseptic stem loosening with the need of one-stage revision. All the osteotomies healed within 8 months. CONCLUSION: Hip arthroplasty with transverse shortening femoral osteotomy, using S-ROM stem, is an acceptable, but not complication-free treatment method in patients with Crowe type IV developmental hip dysplasia, in the midterm.
- Klíčová slova
- Hip dysplasia, S-ROM stem, Shortening femoral osteotomy,
- MeSH
- dislokace kloubu etiologie chirurgie MeSH
- dospělí MeSH
- kyčelní kloub * diagnostické zobrazování patofyziologie chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- náhrada kyčelního kloubu * škodlivé účinky metody MeSH
- nestejná délka dolních končetin etiologie chirurgie MeSH
- osteotomie * škodlivé účinky metody MeSH
- pooperační komplikace * diagnóza patofyziologie chirurgie MeSH
- rentgendiagnostika metody MeSH
- reoperace * škodlivé účinky metody statistika a číselné údaje MeSH
- retrospektivní studie MeSH
- výsledky a postupy - zhodnocení (zdravotní péče) MeSH
- vývojová kyčelní dysplazie * diagnóza chirurgie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Various surgical treatments for osteoarthritis (OA) secondary to hip dysplasia have been reported in the literature. According to the position of the arthroplasty cup, generally they could be divided into two groups: the primary rotational center (PRC) group and the high hip center (HHC) group. Some surgeons prefer the HHC technique. Without doubt it is less demanding, but several concerns exist against the long-term stability. When restoring the PRC, since the dysplastic acetabulum is usually shallower and underdeveloped, bone grafts or other biosynthetic materials are usually needed for the ideal fixation. The source of grafts is quite wide. For example, they could be autologous (femoral head, iliac crest) or homologous (allografts), bulky or morselized. Medial wall protrusion technique, as well as other materials like oblong cup, porous titanium and tantalum augments, 3D printed implants could also be an option. Except these, reports are also divided into cemented and cementless techniques. Therefore, no technique is perfect and clinical results so far are quite variable. We think it's necessary to compare the pros and cons between each other. Key words:hip dysplasia, total hip replacement, cup position, secondary osteoarthritis.
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
- Názvy látek
- kostní cementy MeSH
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.
The objective of this study was to estimate the genetic parameters, genetic trends and breeding values using linear model (LM) and threshold model (TM) for the development of hip dysplasia (HD) in Labrador Retrievers in the Czech Republic (n = 3151). The right and left hip joints were evaluated separately using the Fédération Cynologique Internationale scoring system. Four linear and four TMs were tested for the correct estimation of genetic parameters. All the tested models utilized fixed effects of sex, assessor, year of birth, regression of age at evaluation, random direct genetic effects and the effect of the animals' permanent environments. The models differed in the inclusion of the following effects: fixed effects of regression of inbreeding coefficient, random maternal effect and random effect of the maternal permanent environment. Compared to the TM, the LM provided lower coefficients of direct (0.25-0.29 versus 0.26-0.35) and maternal heritability (0.01-0.02 versus 0.03-0.05), repeatability (0.76-0.77 versus 0.78-0.83) and of the correlation between direct and maternal effects (-0.55 to -0.21 versus -0.80 to -0.27). In the tested models, no statistical significance was found for fixed regression of inbreeding coefficients or for the random effect of the permanent maternal environment. In spite of the similarity of the LM and TM results, the TM is recommended as the more suitable model for estimating genetic parameters and subsequent breeding values for HD in Labrador Retrievers in the Czech Republic.
This paper evaluates the results of conservative treatment for developmental dysplasia of the hip after an average follow-up of 3 years in 69 patients and 99 hips: 31 bilateral, 23 left side, and 14 right. They were treated at the Al-Razi Hospital, Kuwait, between January 1995 and December 1996. There were 59 girls and 10 boys aged between 5 months and 24 months (average age 12 months). The treatment consisted of traction for 1 or 2 weeks, followed by manipulation in 36 hips and manipulation with adductor longus tenotomy in 45 hips and with adductor longus and psoas tenotomy in 18 hips. Avascular necrosis of the femoral head developed in 16 hips (16%): 14 hips on the affected side and 2 hips on the unaffected side. Persistent acetabular dysplasia was present in 13 hips, subluxation in 9 hips and dislocation in 13 hips. Open reduction was later required in 5 hips, open reduction and innominate osteotomy in 8 hips, and hip extracapsular innominate osteotomy in 1 hip. The results were evaluated according to the age groups with highest rate of complications after the age of 15 months. The treatment protocol was changed to limit conservative treatment until the age of 14 months.
- MeSH
- kojenec MeSH
- lidé MeSH
- manipulace ortopedická MeSH
- retrospektivní studie MeSH
- trakce MeSH
- vývojová kyčelní dysplazie komplikace chirurgie terapie MeSH
- Check Tag
- kojenec MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Kuvajt MeSH
- Klíčová slova
- ABNORMALITIES *, AGING *, HIP/abnormalities *,
- MeSH
- kyčel abnormality MeSH
- lidé MeSH
- rodiče * MeSH
- stárnutí * MeSH
- vrozené vady * MeSH
- vývojová kyčelní dysplazie * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Klíčová slova
- HIP/abnormalities *,
- MeSH
- kyčel abnormality MeSH
- lidé MeSH
- vývojová kyčelní dysplazie * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
