Abstract
Long-term follow-up studies on children with surgically treated developmental dysplasia of the hip (DDH) have shown that not only the affected side progresses to premature osteoarthritis, but the unaffected side may also suffer from insidious hip dysplasia or osteonecrosis. The current gait analysis study identified the loading and unloading rates of the ground reaction forces (GRF) and lower limb joint axial forces during gait, and their correlations with the hip morphology in twenty juvenile patients with surgically treated unilateral DDH during toddlerhood. In a gait laboratory, each subject walked at preferred speed on a 10-m walkway while the kinematics and the GRF were measured. Loading and unloading rates of the vertical GRF and the joint axial forces were obtained as the maximum instantaneous slope of these force curves. Radiographic measurements of the hips were taken, and the correlations between the morphological parameters and the loading and unloading rates were obtained. The patients showed greater-than-normal peak loading rates of the joint axial forces, and the loading rates on both the affected and unaffected sides were strongly correlated to the acetabular index on the unaffected side, which was also significantly correlated with the peak unloading rates on the affected side. These results suggest that apart from regular follow-up of the affected hip, routine assessment of the morphological changes and/or increased loading rates on the unaffected hip is also important for early identification of any signs of insidious hip dysplasia and risk of premature degeneration of the cartilage.
Highlights
Developmental dysplasia of the hip (DDH) is one of the most common pediatric hip disorder needing surgical intervention (Feeley et al, 2014)
Previous long-term follow-up studies on children treated for developmental dysplasia of the hip (DDH) with surgical reduction showed that the affected side would progress to premature osteoarthritis (OA), but that the unaffected side would suffer from insidious hip dysplasia or osteonecrosis (Song et al, 2008; Terjesen, 2014)
These results suggest that apart from the regular follow-up of the morphological changes of the affected hip in current clinical practice, monitoring the loading rates and morphological changes of the unaffected hip after DDH reduction surgery is important for early identification of any signs of insidious hip dysplasia and risk of premature degeneration of the cartilage
Summary
Developmental dysplasia of the hip (DDH) is one of the most common pediatric hip disorder needing surgical intervention (Feeley et al, 2014). Previous long-term follow-up studies on children treated for DDH with surgical reduction showed that the affected side would progress to premature osteoarthritis (OA), but that the unaffected side would suffer from insidious hip dysplasia or osteonecrosis (Song et al, 2008; Terjesen, 2014). These problems are often a result of the residual hip morphological changes, and of the magnitudes and loading rates of the forces transmitted at the joint even after surgery.
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