CE Angle Research Articles

Single-Center Experience of Surgical Treatment of Subjects with Late-Presenting Developmental Dysplasia of the Hip

Aim: This study aimed to delineate the single-center experience surrounding the long-term consequences of surgical reconstruction in subjects with late-presenting DDH (developmental dysplasia of the hip). Methods: We analyzed 23 hips of 21 subjects aged >6 years who underwent surgical interventions, such as pelvic osteotomy, open reduction, femoral shortening, and derotation, for developmental hip dysplasia. Results: After a median follow-up of 23.34 (8–120) months, there were no noteworthy alterations in the Harris score and anteversion. Nevertheless, significant improvements were observed in SHARP, CE angle, and depth and width index over the follow-up duration. Using Sever’s radiological criteria, 87.1% of subjects achieved excellent and good results. Assessment of femoral head avascular necrosis, based on Bucholz and Ogden’s classification, produced the subsequent findings: 52% of hips were Type I; 13% were Type II; 22% were Type III; and 13% were categorized as Type IV. Conclusion: Despite achieving favorable postoperative radiological outcomes, there's a noticeable decline in clinical success in these subjects, especially as their age increases. Additionally, they face an elevated risk of avascular necrosis. The juxtaposition of a 75% radiological success rate with a 50% clinical success rate accentuates this contrast. Crucially, the success rate of surgical corrections in late-presenting DDH is tied to the age of the patient, with the success rate decreasing as age progresses.

Modified triple pelvic osteotomy for residual acetabular dysplasia through double incisions: Technical note and review of short-term results.

To assess validity, safety, and efficacy of the modified triple pelvic osteotomy (TPO) approach for correction of residual acetabular dysplasia. This is a retrospective case series conducted on 15 hips in 15 patients from 2019 to 2023 with residual acetabular dysplasia treated by modified TPO as described by Tonnis with two modifications. The first modification is using a single medial incision for pubic and ischial cuts (the Vladimirov modification). The second modification is having the ischial cut closer to the acetabulum (Li modification) allowing free movement of the acetabular fragment for better femoral head coverage. The mean age at the time of surgery was 11.85years, (range 8-23). Cases presenting were 10 males (66.7%) and 5 females (33.3%). The mean follow-up period was 36.533 months (24-60 months). Our study revealed significant clinical and radiological improvement. The CE angle improved from a mean value of 10° (range 2-17) pre-operatively to 32.785° (range 18°-40°) post-operatively. The AI improved from a mean value of 32° pre-operatively to a mean value of 13.89° post-operatively. HHS increased from a preoperative mean value of 74.80° to a post-operative mean value of 90.67°. Also, there was a significant improvement in ROM (abduction and internal rotation). LLD improved from a mean value of 2.60cm preoperatively to a mean value of 0.37cm postoperatively. Delayed union was found in 3 cases. No cases of osteonecrosis or neurovascular complication were encountered in our study. The modified TPO technique using dual incisions can be considered safe and effective, providing adequate coverage of the femoral head in acetabular dysplasia with less surgical time, satisfactory functional outcomes, and minimal complications. IV.

Triple Innominate Osteotomy in Management of Residual Acetabular Dysplasia in Young Adolescent Patients (Systematic Review and Meta-Analysis)

Background: Aim of the Work The aim of this work is to provide cumulative data about the effic cy and safety of triple innominate osteotomy in management of residual acetabular dysplasia in young adolescent patients. Methods This review was done using standard methodology outlined in the Cochrane Handbook and reported the findings in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses Results We found that; the total number of patients in all the included studies was 631 patients; while their average follow up time was (7.2 ± 4.6 years); with longest follow up time of 14.5 years. The average age of all patients was (12.67 ± 3.7 years); with youngest mean age of 7.5 years. Regarding Pre-operative assessment, the average CE angle was (10.4 ± 7.2) degrees, and the average HHS score was (77.7 ± 17.69) degrees. Regarding Post-operative sequel, the overall complications rate was (184/631) (29.1%), and the overall AVN rate was (123/631) (19.5%). Regarding 1 ry efficacy outcome measures, Conclusion Acetabular dysplasia is among the anatomical abnormalities seen in developmental dyplasia of the hip (DDH). One of the goals of surgical treatment during childhood is to achieve optimal femoral head coverage by correcting this architectural flaw, thereby preventing osteoarthritis. Pelvic osteotomy is a treatment option in children and adolescents with residual acetabular dysplasia after developmental dyplasia of the hip.

Minimally invasive surgery supercapsular percutaneously-assisted total hip (SuperPath) arthroplasty.

The benefits of minimally invasive surgical techniques in total hip arthroplasty (THA) are well known, but concerns about applying SuperPATH in patients with secondary OA of acetabular dysplasia do not have been reported. We aim to evaluate whether SuperPATH is applicable to secondary OA, furthermore, to quantify the recovery of lower extremity function. 30 patients with secondary OA admitted for THA applying SuperPATH were investigated. Clinical Japanese Orthopaedic Association (JOA) Score and radiographical evaluation were performed. Following was examined pre- and early post-operatively; pain level, blood tests, TUG and 10-M walking time for lower limb recovery. Preoperative radiographic measurements revealed an average Sharp angle of 46.2 ± 2.8 degrees and CE angle of 19.4 ± 7.3 degrees. 29 THAs had Crowe Type I and 1 THA had Crowe Type II. JOA score improved from 48.8 preoperatively to 91.5 at 2 months postoperatively. The perioperative pain assessment (VAS) averaged 7.0±1.5 preoperatively, 4.6±2.6 on the first postoperative day, then decreased gradually to 1.2±1.4 at 2 weeks. Blood data showed that creatine kinase, myoglobin, and CRP were significantly elevated on the day after surgery, but they normalized at 2 weeks postoperatively. Both TUG and 10M walking time showed slightly higher values at 1 week postoperatively compared to preoperatively but recovered to the same level as preoperatively at 2 weeks after surgery. Our data suggests that SuperPATH approach to THA for dysplastic OA was applicable to mildly dysplastic OA and achieved an early recovery of lower limb function.

Morphometric assessment of the hip joint in children aged 2-13 years.

Our study aimed to evaluate the hip joints of healthy children aged 2-13 years morphometrically through radiographic images. Demographic characteristics of 300 healthy children in our study include an average age of 6.4 years old based on the 2-to-13-year-old bracket and sex classified to 133 girls and 167 boys. A total of 600 normal hips from these children were digitally measured based on Acetabular Index, ACM angle, MZ distance, Sharp angle, CE angle, Femoral Head Coverage Ratio, Cranial, and medial joint space (MJS). *p < 0.05; **p < 0.01 indicated a statistically significant difference. It was found that Acetabular Index, ACM angle, MZ distance, Sharp angle, Cranial, and MJSs decreased with age; Acetabular Depth value and CE angle increased with age; the CE angle differed between the sides (right-left) in the young teens period and in boys; and the cranial joint space (CJS) differed between the sides in girls. In addition, girls had higher values than boys in terms of Acetabular Index, ACM angle, Sharp angle, MZ distance, and Femoral Head Coverage Ratio; CE angle and MJS were higher in girls; and Acetabular Depth Value and CJS did not differ significantly between sexes. Obtaining the normal values will guide in the diagnosis and treatment of many clinical conditions including DDH and Legg-Calve-Perthes disease. It can also be used to compare the hips between healthy children and those diagnosed with Cerebral Palsy.

Quantitative assessment of hip morphology to enhance the identification of hip dysplasia in German Shepherd Dogs

To develop quantitative measures that, when combined with the Fédération Cynologique Internationale (FCI) score, would potentially enhance the accuracy of the scoring process. 153 client-owned purebred German Shepherd Dogs with normal and near normal (71 dogs) and dysplastic coxofemoral joint (82 dogs). Center edge (CE) angle, Norberg angle (NA), indexes of dorsal acetabular femoral head (AFH) coverage width and area, acetabular index angle, and inclination angle were determined. We also investigated the correlation between selected variables. Coxofemoral joints were classified into normal, near normal, and mildly, moderately, and severely dysplastic joints based on the morphometric criteria previously established by the conventional FCI scoring. Variables were compared among the 5 groups using ANOVA. Linear relationships were determined using Spearman correlation coefficients. All radiographic measurements differed significantly (P < .0001) among the 5 assigned groups (normal, near normal, mildly dysplastic, moderately dysplastic, and severely dysplastic hip joints). NA was the only measure that differed significantly (P ≤ .03) between the 5 assigned groups. Positive correlations were identified between Norberg and CE angles (rs = 0.93), between width and area indexes of dorsal AFH coverage (rs = 0.92), and between the measurement techniques utilized to assess lateral versus dorsal AFH coverage (rs ≥ 0.65). Evaluation of lateral and dorsal AFH coverage may help to refine the scoring system used to select German Shepherd Dogs for breeding. German Shepherd Dogs with NA < 103°, CE angle < 20.8°, dorsal AFH coverage width index ≤ 49%, and/or dorsal AFH coverage area index ≤ 51% should be considered to have mild, moderate, or severe hip dysplasia and are therefore not good candidates for breeding. Borderline values between near normal and mildly dysplastic joints should be reevaluated.

The Impact of Hip Dysplasia on CAM Impingement.

Predisposing factors for CAM-type femoroacetabular impingement (FAI) include acetabular protrusion and retroversion; however, nothing is known regarding development in dysplastic hips. The purpose of this study was to determine the correlation between CAM-type FAI and developmental dysplastic hips diagnosed using X-ray and rotational computed tomography. In this retrospective study, 52 symptomatic hips were included, with a mean age of 28.8 ± 7.6 years. The inclusion criteria consisted of consecutive patients who suffered from symptomatic dysplastic or borderline dysplastic hips and underwent a clinical examination, conventional radiographs and rotational computed tomography. Demographics, standard measurements and the rotational alignments were recorded and analyzed between the CAM and nonCAM groups. Among the 52 patients, 19 presented with CAM impingement, whereas, in 33 patients, no signs of CAM impingement were noticed. For demographics, no significant differences between the two groups were identified. On conventional radiography, the acetabular hip index as well as the CE angle for the development of CAM impingement were significantly different compared to the nonCAM group with a CE angle of 21.0° ± 5.4° vs. 23.7° ± 5.8° (p = 0.050) and an acetabular hip index of 25.6 ± 5.7 vs. 21.9 ± 7.3 (p = 0.031), respectively. Furthermore, a crossing over sign was observed to be more common in the nonCAM group, which is contradictory to the current literature. For rotational alignment, no significant differences were observed. In dysplastic hips, the CAM-type FAI correlated to a lower CE angle and a higher acetabular hip index. In contrast to the current literature, no significant correlations to the torsional alignment or to crossing over signs were observed.

Modified Pemberton Pelvic Osteotomy Through Inner Ilium Approach for Treatment of Developmental Dysplasia of the Hip in Children.

Pemberton osteotomy is a widely used operation in developmental dysplasia of the hip (DDH). The traditional pelvic osteotomy was through outside of the ilium. However, in this study, we performed the pelvic osteotomy through the inner ilium approach. We retrospectively analyzed 79 patients diagnosed with DDH with open surgery in our hospital from March 2016 to May 2018. There were 39 patients who underwent outside ilium Pemberton osteotomy (PO) and 40 patients who underwent inner "L shaped" ilium Pemberton osteotomy (ILSO). Acetabular index (AI), center-edge angle of Wiberg (CE angle), Severin grading scoring system, postoperative avascular necrosis (AVN) by Kalamchi and McEwen classification, and McKay grading scoring system were used for evaluation. There was no significant difference between the PO group and ILSO group on AI (p = 0.476), CE angles (p = 0.225), avascular necrosis (Kalamchi and McEwen, p = 0.854), and hip function (McKay's, p = 0.444) on the final follow-up. There were significant differences in X-ray radiation (p < 0.001), blood loss (p = 0.011) and surgery time (p < 0.001). Inner side ilium is a viable approach for Pemberton osteotomy of DDH in children with less X-ray radiation, and less blood loss and shorter surgery time. III. The online version contains supplementary material available at 10.1007/s43465-022-00676-7.

Behandlungsoptionen bei femoroazetabulärem Impingement-Syndrom und Koxarthrose

Femoroacetabular impingement syndrome (FAIS) is aprearthritic deformity. Many patients with FAIS show signs of osteoarthritis at the time of initial presentation. Ideally, surgical correction of FAIS should stop the progression of osteoarthritis. However, biological changes in the joint, inflammatory processes, and patient-specific factors, which are not influenced by surgery, show arole in the progression of joint degeneration. Thus, it is not surprising that the results of joint-preserving surgery in FAIS and osteoarthritis Tönnis grade2 and higher are bad, and patients often need to undergo total hip replacement (THR).Even in patients with initial osteoarthritis (Tönnis grade1) the results of joint-preserving surgery are significantly worse in comparison to in patients without osteoarthritis. As this pathology occurs mainly in young patients, efforts should be made to avoid THR, as the risk of loosening and revision surgery is increased. Analysis of risk factors that lead to worse outcome in joint-preserving surgery can be helpful. Age > 45years, adiposity, high alpha angle, CE angle < 25° and female sex are risk factors that lead to worse outcome in patients with risk factors and osteoarthritis Tönnis grade1, the success rate of joint-preserving surgery after 5years is below 50%. Therefore, we recommend non-surgical treatment. Promising is the use of mesenchymal progenitor cells (MPCs), even if their routine use has not been established. If conservative therapy is not successful, THR is indicated. With the use of modern bearings, a survival rate of THR of more than 90% after 15years is reported in patients < 50years. Patient satisfaction after THR is higher than after joint-preserving surgery.The combination of treatment modalities like joint-preserving surgery in combination with the application of MPCs to both correct the mechanical conflict and also influence progression of osteoarthritis is promising the from abiological point of view.

Radiographic Outcomes of Ganz versus Modified Triple Osteotomies in Femoral Head Medialization and Coverage in Acetabular Dysplasia.

Variable techniques in periacetabular osteotomy have been formulated for the treatment of acetabular dysplasia. However, few studies have compared the radiographic outcomes between different osteotomy types. This study compared modified triple innominate (MTI) osteotomy and Ganz osteotomy with respect to radiographic outcomes. Patients receiving MTI osteotomies and Ganz osteotomies at any time between 2006 and 2018 in a tertiary medical centre were recruited. Only patients with unilateral osteotomies were recruited to eliminate potential influence from the contralateral hip following periacetabular osteotomy. Patients having hip-joint dislocation, receiving simultaneous proximal femoral osteotomy, or having fewer than 2 years of follow-up were excluded. The radiographic parameters of preoperative and postoperative anteroposterior radiographs of the pelvis were measured, and Sharp’s angle (SA), the lateral centre-edge angle (CE angle), the femoral head extrusion index (FHEI), and the centre-head distance discrepancy (CHDD) were included for comparison. Among 55 participants, 23 received MTI osteotomies and 32 received Ganz osteotomies. The mean age at which patients underwent surgery was 21.9 years in the Ganz osteotomy group and 21.1 years in the MTI group. The mean follow-up length was 2.5 years. The preoperative radiographic parameters between groups differed only slightly and nonsignificantly. Both groups exhibited significantly improved SA, LCEA, and FHEI after surgery. The Ganz osteotomy group exhibited more favourable postoperative FHEI (13.5 vs. 24.3, p < 0.0001), CHDD (3.7 vs. 11.5, p < 0.0001), Sharp angle (45.0 vs. 41.8, p = 0.0489) and CE angles (28.3 vs. 21.1, p = 0.029) compared with the MTI osteotomy group. Notably, CHDD became better and worse following Ganz and MTI osteotomies, respectively; this suggests that the femoral head is pushed laterally in modified triple osteotomy. With respect to femoral head coverage and the medialization of the femoral head, Ganz osteotomy exhibits more favourable corrections in postoperative radiographic parameters than does MTI osteotomy.

Clinical And Radiological Results Of Ludloff Medial Open Reduction Technique In Patients Wıth Developmental Hip Dysplasia

Aim: The aim of this study was to evaluate the clinical and radiological results of Ludloff medial open reduction surgery in patients with the developmental of hip dysplasia, younger than 18 months old.Methods: The radiological and clinical results of 35 patients (49 hips), younger than 18 months of age treated with Ludloff medial approach due to DDH between the years 2013 and 2020 were retrospectively evaluated. Preoperative, final control acetabular index angles and medial apertures were measured according to the McCay criteria, Tönnis classification, Kalamchi-MacEwen classification, IHDI classification and Severin classification were analysed.Results: At the last control, the youngest age was 27 months, the oldest was 88 months and the mean age was 43.90 ± 14.17 months. The follow-up period was performed at a minimum age of 12 months, a maximum age of 72 months, and the mean follow-up period was 24.81 ± 17.17 months. According to the Tönnis classification, 40 hips were Tönnis classification type 1 (81.63%), 4 hips were Type 2 (8.16%), 3 hips were Type 3 (6.12%) and 2 hips were Type 4 (4.08%) in the follow-up visit. According to McCay clinical evaluation criteria, 38 hips (79.59%) were grade 1 which equates to excellent results. Grade 0 (no necrosis) was detected in 38 (77.55%) of 49 hips according to the Kalamchi and MacEwen AVN clinical evaluation criteria. According to the Severin classification, type 1 results were observed in 32 (65.31%) of 49 hips, type 2 in 9 hips (18.37%), type 3 in 1 hip (2.04%) and type 4 in 7 hips (14.29%). The mean CE angle was found to be 18.56 ± 9.93. Additional surgical intervention was required in 8 hips of 6 patients.Conclusion: Clinically and radiologically satisfactory results were obtained in DDH patients with Ludloff medial open reduction technique, below the age of 18 months.

A Deep-Learning Aided Diagnostic System in Assessing Developmental Dysplasia of the Hip on Pediatric Pelvic Radiographs.

BackgroundDevelopmental dysplasia of the hip (DDH) is a common orthopedic disease in children. In clinical surgery, it is essential to quickly and accurately locate the exact position of the lesion, and there are still some controversies relating to DDH status. We adopt artificial intelligence (AI) to solve the above problems.MethodsIn this paper, automatic DDH measurements and classifications were achieved using a three-stage pipeline. In the first stage, we used Mask-RCNN to detect the local features of the image and segment the bony pelvis, including the ilium, pubis, ischium, and femoral heads. For the second stage, local image patches focused on semantically related areas for DDH landmarks were extracted by high-resolution network (HRNet). In the third stage, some radiographic results are obtained. In the above process, we used 1,265 patient x-ray samples as the training set and 133 samples from two other medical institutions as the verification set. The results of AI were compared with three orthopedic surgeons for reliability and time consumption.ResultsAI-aided diagnostic system's Tönnis and International Hip Dysplasia Institute (IHDI) classification accuracies for both hips ranged from 0.86 to 0.95. The measurements of numerical indices showed that there was no statistically significant difference between surgeons and AI. Tönnis and IHDI indicators were similar across the AI system, intermediate surgeon, and junior surgeon. Among some objective interpretation indicators, such as acetabular index and CE angle, there were good stability and consistency among the four observers. Intraclass consistency of acetabular index and CE angle among surgeons was 0.79–0.98, while AI was 1.00. The measurement time required by AI was significantly less than that of the doctors.ConclusionThe AI-aided diagnosis system can quickly and automatically measure important parameters and improve the quality of clinical diagnosis and screening referral process with a convenient and efficient way.

Model construction and application for automated measurement of CE angle on pelvis orthograph based on MASK-R-CNN algorithm

Developmental dysplasia of the hip (DDH) is a common orthopedic disease. A simple and cost-effective scientific tool for assisting the early diagnosis of DDH is urgently needed. This study proposed a new artificial intelligence (AI) model for automated measure of the CE angle to aid the diagnosis of DDH by modifying the Mask R-CNN algorithm.13228 anteroposterior pelvic x-ray images were collected from the PACS system of the second Hospital of Jilin University, of which 104 images were randomly selected as test data. The rest of x-ray images were labelled and preprocessed for model development. The new AI model was the constructed based modified Mask R-CNN model to detect key points for CE angle measurement. The performance of AI model on measuring CE angle was verified by comparing with three attending orthopaedic doctors. The mean CE angles on left and right pelvis measured by the AI model was 29.46 ± 6.98°and 27.92 ± 6.56°, respectively, while the mean CE angle measured by the three doctors was 29.85 ± 6.92°and 27.75 ± 6.45°, respectively. AI model displayed a higly consistency with the doctors in measuring CE angles. Besides, AI model showed a much high efficiency in term of measuring time-consumption. In this study, we successfully constructed a new effective model for measuring CE angle by identifying key points, which provided a new intelligent measurement tool for orthopedic image measurement and evaluation.

The Evaluation Indicators of X-ray Radiographs for Femoroacetabular Impingement Syndrome

Objective: To explore the evaluation indicators of X-ray radiographs for femoroacetabular impingement (FAI) syndrome, and to propose therapeutic plans for FAI syndrome by using X-ray radiographs. Methods: From June 2016 to May 2018, patients who were diagnosed as FAI syndrome by hip joint anteroposterior radiographs in Second Yinzhou District Hospital were selected as research objects. After screening, the surgical treatment group included 52 cases, totally. Another 30 healthy adults who received X-ray radiography were included as the control group. Each included patient underwent minimally invasive surgery under hip arthroscopy. The efficacy indicators were evaluated, and the data were statistically analyzed. Results: By analyzing the basic data of the subjects, it was found that there was no significant difference in gender and body mass index between the healthy people and FAI patients (P &gt; 0.05), but the VAS and Harris scores of 7d, 30d, 90d, and 180d after surgery were significantly higher than those before the operation, and with the prolongation of the treatment time, the scores increased continuously, the difference had statistical significance (P &lt; 0.05). By analyzing patients' knee joint mobility, it was found that after therapy, the flexion, pronation, abduction, and extension of knee joint at 30d, 90d, and 180d were distinctly increased compared with those before therapy. Also, the difference had statistical significance (P &lt; 0.05) with the treatment time increasing; the X-ray films of hip joint of the subjects were observed, and it was found that there were healthy people, clamp type FAI, and cam type FAI three typical kinds. There were significant differences in the angle, eccentricity, depth of acetabulum, coverage rate of acetabulum, and CE angle among cam type patients, clamp type patients, and healthy people (P &lt; 0.05). Conclusion: The research in this study found that when using the X-ray radiographs to determine the FAI syndrome, the differences between the classification of FAI symptoms and the healthy adults were obvious. In addition, the knee joint gradually recovered significantly in the range of movement (RM) after treatments, thereby providing experimental basis for diagnosing and treating the FAI syndrome in the later clinical stage.

Hip arthroscopy technique

Arthroscopy of the central and peripheral compartment is an obligatory part of hip arthroscopy to evaluate, confirm or find pathologies and their treatment. Loose bodies, lesions of the labrum and ligamentum capitis femoris, cartilage damage, femoroacetabular impingement, synovial diseases, initial osteoarthritis, femoral head necrosis (ARCO stage1-2) and adhesions. Local infections, bone tumors near the joint, extensive peri-articular ossification, severe arthrofibrosis with peri-articular involvement, advanced osteoarthritis, protrusio acetabuli, advanced femoral head necrosis (from ARCO stage3-4 extended), recent fracture of the acetabulum and extensive joint capsule tears. Precise positioning of the patient on afracture table is essential to avoid complications. Central and peripheral compartment arthroscopy requires at least2, in some cases more than 3portals. Arthroscopy of the central compartment is carried out under traction by an anterolateral (AL) and anterior portal(A). Aposterolateral (PL) portal and distal ventrolateral portal (DVL) may also be required. For peripheral compartment arthroscopy, ananterolateral (AL) and anterior (A), alternatively/additively aproximal ventrolateral portal (PVL) and/or and distal ventrolateral (DVL) portal are established in 45° flexion and no traction of the hip joint. Mobilization with full weight bearing from the day of the operation, crutches are optional. After stimulating cartilage surgery or autologous chondrocyte transplantation, partial weight bearing of 10 kg on crutches is indicated until the end of postoperative week6. Physiotherapy with full range of motion allowed, except for labrum refixation, should take place from postoperative day1. From 01/2010-12/2019, 2815 hip arthroscopies were performed; average patient age 43 (12-81) years. All procedures include adiagnostic arthroscopy of the hip. Two to 5portals were used. Average operation time was 70 (18-48) min. In 26cases (0.9%), arthroscopy of the central compartment at ahigh CE angle was not possible or not performed, even after previous arthroscopy of the peripheral compartment with capsule release. Intraoperative or directly postoperative problems and complications were rare, e.g., damage to the skin/genitals due to contact pressure (0.7%), instrument breakage (0.5%), transient lesions of the pudendus nerve (<1.5%).

Femoroasetabular Sıkışma ve Femur Boyun Kırıklarının İçten Tespiti Arasındaki İlişki

Objective: Congenital deformities, slipped capital femoral epiphysis and Legg-Calve-Perthes disease have been suggested as possible causes for femoroacetabular impingement (FAI). The aim of our study is to describe the radiographic signs of FAI after femoral neck fractures and to compare these data with those of the contralateral hip. Method: Our institutional medical records database was retrospectively searched for patients 18-50 years old with a history of femoral neck fractures (OTA 31-B) between 2010-2019. Fifty-two patients were identified. After exclusion criteria, we detected 37 fractures in 37 patients. The mean age of 29 male and 8 female patients was 32,7 (range 18-48) years. The antero-posterior and cross- table lateral views of bilateral hip joints for all 37 patients were reviewed preoperatively and at final follow-up. The mean follow-up period was 48 months (range 6-98 months). In addition, postoperative CT-scans of these patients were also reviewed. Results: According to OTA classification subtypes, 2 subcapital (31B1), 25 transcervical (31B2) and 10 basicervical (31B3) fractures were detected. The mean alpha angle on lateral X-ray of the operated side was statistically significantly higher than the unaffected side. The mean alpha angle on CT was higher on the operated side than the unaffected side. In addition, the acetabular version angle on CT was higher on the unaffected side while acetabular depth on CT was higher on the operated side. The lateral CE angle on the AP X-ray was not different on the unaffected side compared to the operated side. Conclusion: Symptoms of impingement can be seen in patients undergoing internal fixation after femoral neck fracture, and a decrease in acetabular version and an increase in acetabular depth may be predisposing to femoral neck fracture.

A Semi-automatic Diagnosis of Hip Dysplasia on X-Ray Films.

Background: Diagnosis of hip joint plays an important role in early screening of hip diseases such as coxarthritis, heterotopic ossification, osteonecrosis of the femoral head, etc. Early detection of hip dysplasia on X-ray films may probably conduce to early treatment of patients, which can help to cure patients or relieve their pain as much as possible. There has been no method or tool for automatic diagnosis of hip dysplasia till now.Results: A semi-automatic method for diagnosis of hip dysplasia is proposed. Considering the complexity of medical imaging, the contour of acetabulum, femoral head, and the upper side of thigh-bone are manually marked. Feature points are extracted according to marked contours. Traditional knowledge-driven diagnostic criteria is abandoned. Instead, a data-driven diagnostic model for hip dysplasia is presented. Angles including CE, sharp, and Tonnis angle which are commonly measured in clinical diagnosis, are automatically obtained. Samples, each of which consists of these three angle values, are used for clustering according to their densities in a descending order. A three-dimensional normal distribution derived from the cluster is built and regarded as the parametric model for diagnosis of hip dysplasia. Experiments on 143 X-ray films including 286 samples (i.e., 143 left and 143 right hip joints) demonstrate the effectiveness of our method. According to the method, a computer-aided diagnosis tool is developed for the convenience of clinicians, which can be downloaded at http://www.bio-nefu.com/HIPindex/. The data used to support the findings of this study are available from the corresponding authors upon request.Conclusions: This data-driven method provides a more objective measurement of the angles. Besides, it provides a new criterion for diagnosis of hip dysplasia other than doctors' experience deriving from knowledge-driven clinical manual, which actually corresponds to very different way for clinical diagnosis of hip dysplasia.

To evaluate the treatment modality by CE angle of Wiberg in various hip joint pathologies

Objective: To evaluate the treatment modality by CE angle of Wiberg in various Hip joint pathologies. Method: This is a non-Randomised Prospective, observational study carried out at Department of Orthopaedics, Index medical college hospital and research centre, Indore (M.P.) during the period of 15 months from January 2018 to March 2019. Ethical clearance taken by Ethical Committee. In this study 35 hips of 28 patients who fulfilled our inclusion criteria were included. In our study patients with hip pathologies with age more than 5 years of both genders, hip pathologies like CAM and/or Pincer type of Femoroacetabular impingement, Acetabular retroversion, Perthes like deformity, Osteoarthritis Hip, Avascular necrosis of femoral head, Developmental dysplasia of hip, Patients who are doubtful for hip preservation or salvage procedure, who were willing to provide their voluntary written informed consent were included. Patients with congenital hip pathologies were exclude. In this study, we assessed the CE angle of Wiberg, in various aspheric hip conditions and formulate a protocol for further management of these Hip pathologies. Result: In this prospective study total 28 patients (35 Hips) of various hip pathologies 21 males (25 hips) 75% and 7 females (10 hips) 25% with age range of 5 years - 65 years with mean age of 41.32 ± 18.50 years out of which males were from 5 - 65 years with mean age 40.86 ± 20.44 and females were in the age range of 23 - 52 years with mean age 42.71 ± 12.04. Out of 28 patients 9 (32.14%) were FAI, 8 (28.57%) were OA hip, 8 (28.57%) were Avascular necrosis of Femoral head and 3 case (10.71%) is of Perthes' disease. In FAI cases 4(44.44%) patients were of Pincer type, 5(55.55%) were of Combined type with no any case of isolated CAM form. All were unilateral involvement with average CE angle of 32.67 ° ± 11.67 °. In Pincer type mean CE angle was 36.25 ° ± 7.5 ° while in combined form the mean CE angle was 29.8 ° ± 14.4 °. Out of 4 patients of Pincer FAI, 3 patients of Pincer type had CE angle between 25 - 40 ° which comes under normal range of CE angle so all were planned for non-operative management. Conclusions: We have found that all the hip pathologies reported to us had spectrum of variations in CE angle depending on the severity of disease. Variation was maximum seen in Osteoarthritis and Femoroacetabular impingement, in the cases of FAI maximum were of Pincer type.

One-stage treatment of hip dislocation with cerebral palsy via soft tissue release, hip reduction and osteotomy

Objective To investigate the methods and outcomes of surgical treatment for hip dislocation with cerebral palsy (CP) via soft tissue release, hip reduction and osteotomy. Methods Nineteen CP patients (male: 9, female: 10; total 23 hips) with hip dislocation underwent reconstructive surgery between April 2010 and December 2016. The average age was 12.5±2.4 years. There were 17 diplegic, 1 hemiplegic and 1 quadriplegic patient. Gross motor function classification system distribution were type I in 2 patients, type II in 10 patients, type III in 5 patients, type IV in 2 patients. Combine one-stage surgical procedures included soft tissue release, close or open reduction of hip joint and femoral varus shortening or de-rotational osteotomy and pelvic osteotomy. During the follow-up period, the clinical symptom and radiological parameters including Sharp angle and acetabular index were recorded. Results The average follow-up duration was 2.1 years (1-4.5 years). The radiological parameters were evaluated at one year postoperatively. The migration percentage corrected to 6%±8% from 68%±21% with statistically significant different (t=12.760, P<0.001). The mean Sharp angle was 42°±8.9°, which was statistically significant reduced compared with the pre-operative value 59°±6.1° (t=9.058, P<0.001). In 15 patients with triradiate cartilage open, the acetabular index also improved from 34°±8.7° pre-operatively to 18°±10° with statistical significance (t=5.598, P<0.001). Total of 15 patients had gained hip stability and improved functional status. Hip pain, which happened in 11 patients preoperatively, all had relieved after operation. Four patients had dissatisfied results and re-subluxation happened in 3 hips. All of them had CE angle <20° immediately after operation (average, 17°±2.6°), which was significantly different compared with average CE angle 32°± 8.0° in non-recurrence hips (t=3.143, P=0.005). One patient, who underwent proximal hamstring release, had decline of function status and contralateral hip dislocation. Conclusion Dislocation hips in CP patients can be effectively treated with one stage soft tissue release, hip reduction and femoral and pelvic osteotomy. The selection of osteotomy method is based on the age and pathological changes of patients. Key words: Cerebral palsy; Hip dislocation; Osteotomy

The relationship between radiographic findings and patient-reported outcomes in adult hip dysplasia patients: A hospital cross-sectional study

IntroductionThis study aimed to clarify the relationship of individual radiographic parameters and features with the patient-reported outcome measurements (PROMs) of patients with developmental dysplasia of the hip (DDH) in a hospital-referred cross-sectional analysis. MethodsThis cross-sectional study included 108 Japanese DDH patients (female, n = 88; male, n = 20; mean age, 43.4 years). We recorded the CE angle, angle of Sharp, ARO, ADR, AHI, crossover sign, pistol grip deformity, and femoral head-neck ratio, which were measured on the AP view, and the α-angle, which was measured on the Lauenstein view. We also recorded cyst formation and osteophytes on either view. We used the Japanese Orthopaedic Association hip disease evaluation questionnaire (JHEQ) to assess the PROMs. The PROMs of patients with and without cysts or osteophytes and those of patients with or without cam or pincer deformity were compared. The relationships between specific PROMs and radiographic features were evaluated with a linear regression analysis and independent associations between PROMs and radiographic features were assessed with a multiple regression analysis using various independent variables. ResultsThe JHEQ movement and mental values in patients with cyst formation were significantly lower in comparison to those in patients without cyst formation. The JHEQ subscale values did not differ according to the presence or absence of osteophytes, cam deformity or pincer deformity. The CE angle was found to be associated with the JHEQ movement score in the linear regression analysis. To identify radiographic features that were independently associated with each of the JHEQ subscale scores, we performed a multiple regression analysis with age, body mass index, sex and the number of affected hip joints (bilateral or unilateral) included as independent variables. The CE angle was found to be independently associated with JHEQ movement. ConclusionThe CE angle was independently associated with the JHEQ movement value.