Congenital Dislocation Of The Hip Research Articles

Developmental dysplasia of the hip caused by homozygous TRIM33 pathogenic variant affecting downstream BMP pathway

BackgroundDevelopmental dysplasia of the hip (DDH), formerly termed congenital dislocation of the hip, is the most common congenital disease of the musculoskeletal system in newborns. While familial predilection to DDH...

Résultats à long terme de l’arthroplastie totale dans les luxations congénitales de la hanche. Étude rétrospective des résultats avec 10 à 20 ans de recul

Introduction: The impact of bone deformities, previous surgeries, and the surgical technique in total hip arthroplasty (THA) for congenital dislocation of the hip (CDH) at a long-term has not been clearly defined yet. In this single-centre observational study we sought to assess patients undergoing THA due to osteoarthritis secondary to severe CDH with low or high dislocation ten- to 20-years after surgery. To determine this purpose, we assessed: 1) THA-related complications and reoperations; 2) the clinical outcome, patients´ satisfaction and radiological results; and 3) the possible risk factors for reoperation with particular attention to the surgical technique and the influence of prior surgeries.Hypothesis: We hypothesized that an anatomical reconstruction of the hip would decrease the reoperations rates in patients undergoing THA with severe CDH.Methods: Seventy-five patients (85 hips) operated between 1999 and 2012 at our large tertiary hospital were analyzed. Fifty-six hips were diagnosed as low dislocation (group 1) and 29 hips as high dislocation (group 2). The existence of prior surgeries was frequent: group 1, pelvic osteotomies 6 hips, femoral osteotomies 7, tectoplasty (shelf) 6, resection arthroplasty 1 and lowering of the greater trochanter 1; group 2 included pelvic osteotomies 10 hips, femoral osteotomies 10, and a femoral lengthening 2. The number of additional procedures during THA was: group 1 (19/56 (34%)), acetabular roof bone autograft 8 hips, acetabular medial wall autograft 2, hardware removal 6, extended femoral osteotomy 2, and a femoral shortening 1; group 2 (20/29 (69%)), acetabular bone autograft 12 hips, medial autograft 1, hardware removal 1, extended femoral osteotomy 2, and a femoral shortening 4 hips The clinical and the radiological analysis were compared in both groups for a minimum follow-up of ten years. Cox regression models were used to detect risk factors for reoperation.Results: Nine patients (13.8%) required reoperation for the following reasons: cup loosening (5 hips), periprosthetic femoral fracture (3) and stem loosening (1); seven had prior surgeries. The 12-year survival rate for reoperation for any reason was 96.3% (95% Confidence Interval (CI) 91.2-100) in group 1 and 75.7% (95% CI, 65.8-90.8) in group 2 (p=0.003). Patients with high dislocation (p=0.02, Hazard Ratio (HR): 6.25, 95% CI, 1.26-30.9) and those with an acetabular component inclination placed out of the target zone between 35º and 50º (p=0.03, HR: 4,27, 95% CI, 1.13-16.1) had a higher risk of reoperation.Discussion: An optimal placement of the acetabular component decreased the reoperation rates in patients undergoing THA for severe CDH. Hips with high dislocation and the existence of prior surgery can affect THA implantation.Level of Evidence: III; retrospective; comparative

Clinico-radiological characteristics of two patients with geroderma osteodysplasticum caused by new nucleotide variants in the GORAB gene

Geroderma osteodysplasticum (OMIM #231070) is a rare autosomal recessive disorder characterized by congenital wrinkled skin on the dorsal surface of the limbs and abdomen; marked osteoporosis in childhood. Pathogenic variants of the nucleotide sequence in the GORAB gene, which encodes the GORAB protein located in the Golgi apparatus and plays a crucial role in vesicle transport in the Golgi complex, lead to the disease. This is the first report of 2 patients with this disease in Russia. A detailed description of the clinical-radiological and genetic characteristics of these patients with new nucleotide variants in the GORAB gene in a compound heterozygous state is presented: c.170C>G (p.Ser57Ter) and c.790G>C (p.Ala264Pro); c.295C>T (p.Gln99Ter) and heterozygous deletion on chromosome 1 (chr1:g.170531967–170539494del), affecting exons 1 and 2 of the gene. The main clinical manifestations of the syndrome were congenital wrinkled skin, sagging cheeks, hypoplasia of the cheekbones, prognathism, muscle hypotonia and joint hypermobility. Radiological signs included congenital bilateral dislocation of the hip, compression fractures of the vertebral bodies, and disruption of the continuity of the growth plate of the distal femur and proximal tibia, referred to as “insertion.” The rarity of the syndrome, as well as the similarity of clinical manifestations with a heterogeneous group of hereditary diseases accompanied by decreased skin elasticity, leads to a late correct diagnosis. This necessitates the description of the clinical-genetic characteristics of the disease, the study of the dynamics of the formation of its phenotypic manifestations, and the methods of molecular-genetic diagnostics.

Long-term results of total hip arthroplasty in severe congenital hip disease: A ten- to 20-year follow-up study

IntroductionThe impact of bone deformities, previous surgeries, and the surgical technique in total hip arthroplasty (THA) for congenital dislocation of the hip (CDH) at a long-term has not been clearly defined yet. In this single-centre observational study we sought to assess patients undergoing THA due to osteoarthritis secondary to severe CDH with low or high dislocation ten- to 20-years after surgery. To determine this purpose, we assessed: (1) THA-related complications and reoperations; (2) the clinical outcome, patients’ satisfaction and radiological results; and (3) the possible risk factors for reoperation with particular attention to the surgical technique and the influence of prior surgeries. HypothesisWe hypothesized that an anatomical reconstruction of the hip would decrease the reoperations rates in patients undergoing THA with severe CDH. MethodsSeventy-five patients (85 hips) operated between 1999 and 2012 at our large tertiary hospital were analyzed. Fifty-six hips were diagnosed as low dislocation (group 1) and 29 hips as high dislocation (group 2). The existence of prior surgeries was frequent: group 1, pelvic osteotomies 6 hips, femoral osteotomies 7, tectoplasty (shelf) 6, resection arthroplasty 1 and lowering of the greater trochanter 1; group 2 included pelvic osteotomies 10 hips, femoral osteotomies 10, and a femoral lengthening 2. The number of additional procedures during THA was: group 1 (19/56 [34%]), acetabular roof bone autograft 8 hips, acetabular medial wall autograft 2, hardware removal 6, extended femoral osteotomy 2, and a femoral shortening 1; group 2 (20/29 [69%]), acetabular bone autograft 12 hips, medial autograft 1, hardware removal 1, extended femoral osteotomy 2, and a femoral shortening 4 hips. The clinical and the radiological analysis were compared in both groups for a minimum follow-up of ten years. Cox regression models were used to detect risk factors for reoperation. ResultsNine patients (13.8%) required reoperation for the following reasons: cup loosening (5 hips), periprosthetic femoral fracture (3) and stem loosening (1); seven had prior surgeries. The 12-year survival rate for reoperation for any reason was 96.3% (95% confidence interval [CI] 91.2–100) in group 1 and 75.7% (95% CI, 65.8–90.8) in group 2 (p=0.003). Patients with high dislocation (p=0.02, hazard ratio [HR]: 6.25, 95% CI, 1.26–30.9) and those with an acetabular component inclination placed out of the target zone between 35° and 50° (p=0.03, HR: 4.27, 95% CI, 1.13–16.1) had a higher risk of reoperation. DiscussionAn optimal placement of the acetabular component decreased the reoperation rates in patients undergoing THA for severe CDH. Hips with high dislocation and the existence of prior surgery can affect THA implantation. Level of evidenceIII; retrospective; comparative.

Early detection and risk factors of congenital hip dislocation in Morocco.

Congenital dislocation of the hip is a malformation of the lower limbs that could be complicated by a disabling physical handicap with long-term psychological and social repercussions if detected late. This study aims to describe the screening for congenital hip dislocation and to investigate the association between the occurrence of this anomaly and possible risk factors in Morocco. The study was based on the exploitation of the records of children treated at the trauma and orthopedics department of the Mohammed VI University Hospital in Marrakech, Morocco. It concerned 160 cases with a 5-year follow-up from January 2016 to March 2021. The results of the study showed that 56.7% of the affected children had a bilateral dislocation and 25.8% of the cases had a left-sided dislocation. The malformation occurred more frequently in females 69.2%. A familial disposition to the malformation was found in about 22% of the cases. The diagnosis was late (at walking age) in 61% of children following the onset of lameness with or without pain in 91% of children. In 41.87% of the hips, the reduction was surgical, with 28% failure dominated by acetabular dysplasia in 11%. The risk factors for congenital hip dislocation identified in our setting were dominated by sex, primiparity, consanguineous marriage, and the presence of a family history of dislocation. Communication of risk factors specific to our setting to healthcare personnel will allow them to guide the diagnosis and increase vigilance in the at-risk population for management that prevents the development of complications.

E49 Behçet's disease associated with Warkany syndrome: a case report

Abstract Background Behçet's disease is a rare chronic, relapsing, multisystem vasculitis characterized by mucocutaneous lesions, articular, ocular, vascular, and central nervous system manifestations, of which pediatric forms may be syndromic. Warkany syndrome is a rare genetic anomaly defined by trisomy 8, characterized clinically by facial dysmorphia, mild intellectual disability, and skeletal anomalies. Aim We report the case of a 9-year-old boy diagnosed with Behçet's disease and whose examination revealed an associated Warkany syndrome. Observation the boy was from a non-consanguineous marriage, correctly vaccinated, with a history of congenital dislocation of the hip operated at the age of 3 years and obstruction of the lacrimal duct operated at the age of 6 years, who presented with chronic bilateral synechial pan uveitis, recurrent oral aphthosis (>3 times a year), multiple dysostosis with chronic diffuse arthralgias: hip, knees, shoulders. The clinical examination reveals a facial dysmorphia (elongated skull, high and prominent forehead, hypertelorism, sunken eyes, wide nose with anteverted nostrils, micrognathia with eversion of the lower lip, large ears with a thick rim), organomegaly (hepatosplenomegaly, large kidneys), a moderate intellectual deficit and deep palmar and plantar folds Auditory evoked potential finds bilateral deafness. Inflammatory workup was positive, HLAb51 typing was positive. MPS enzyme assay is normal. Genetic study: not done due to lack of means. Conclusion Behçet's disease in children can be associated with other genetic syndromes, it remains to be seen if it is a simple fortuitous association.

Hip survival after periacetabular osteotomy in patients with acetabular dysplasia, acetabular retroversion, congenital dislocation of the hip, or Legg-Calvé-Perthes disease: a cohort study on 1,501 hips

Previous studies on hip survival following periacetabular osteotomy (PAO) have reported isolated data for the treatment of 1 underlying condition, making comparison between patient groups difficult. We report the hip survival after PAO in patients with acetabular dysplasia (AD), acetabular retroversion (AR), congenital dislocation of the hip (CDH), and Legg-Calvé-Perthes disease (LCPD) with total hip arthroplasty (THA) as primary endpoint and secondarily the risk of subsequent hip-related operations other than THA. From 1997 to December 2021, 1,501 hips (1,203 patients) underwent PAO in a single center (Odense University Hospital). We identified conversions to THA and other subsequent hip-related operations through patient files and the Danish National Patient Registry (DNPR). 123 (8.2%) of the total cohort of 1,501 hips were converted to THA within the study period. The overall Kaplan-Meier hip survival rate was 71% (95% confidence interval [CI] 61-79) at 24 years with a mean follow-up of 7.6 years (range 0.02-25). The individual Kaplan-Meier hip survival rates at 15 years were 81% (CI 76-86) for AD, 94% (CI 91-96) for AR, 84% (CI 66-93) for CDH, and 66% (CI 49-79) for LCPD. In total, the overall risk of additional hip-related operations was 48% (of which 92% were screw removal). Encouragingly, 71% of hips were preserved 24 years after PAO. We found that AR patients had the highest (94%) PAO survivorship at 15 years compared with the other underlying hip conditions. Almost half of PAO patients may undergo later additional surgery, of which screw removal is the primary intervention. Overall long-term survival, risk factors for conversion to THA, and risk of additional surgery are relevant information for shared decision-making.

The use of physical exercises in restoring the health of young children with congenital pathology of the hip joints in rehabilitation centers

The analysis of scientific literature shows that the leading place in the development of methods of restoring the health of young children with congenital pathology of the hip joints in rehabilitation centers is occupied by the use of physical exercises and massage, and the most progressive methods of rehabilitation today are the use of osteopathic techniques and kinesiotaping.
 The tasks of using physical exercises to restore the health of young children with congenital hip joint pathology in rehabilitation centers include: prevention and elimination of thigh muscle contracture; formation of hip joints, restoration of their shape, fixation of joints in the position of maximum correction; strengthening of the muscles that produce movement in the hip joints (flexion, extension, abduction, inward rotation); full development of active movements in hip joints; correction of the valgus position of the knee and ankle joints, which occurs during treatment with the use of tires.
 The most important task of using physical exercises is to relieve tension and strengthen the muscles of the hip joint, restore the range of motion as much as possible and organize the motor activity of the child for its full and harmonious physical development. Physical exercises, which are divided into general developmental and special, begin to be used from the beginning of a child's life as reflex exercises taking into account his psychomotor development. Special exercises contribute to the improvement of trophic processes in the hip joints, thigh muscles and buttocks. Taking into account the age of the child, passive (up to a year) and active exercises (from 1 to 3 years) are used. Kinesiotherapy in the rehabilitation of children with congenital dislocation of the hip is the main means of forming a healthy joint and the only means of supporting motor development. The use of physical exercises in water is characterized by a positive combination of physical therapy, aqua massage and relaxation. Hydrokinesitherapy for children is the most effective and affordable means of physical development and rehabilitation.

Orthosis Treatment for Patients with Congenital Hip Dislocation

Background: Congenital dislocation of the hip is currently a public health and socioeconomic problem. Delayed treatment impairs the functional prognosis of the affected hip and increases the need for surgical treatment. Aim: To evaluate the therapeutic results of the treatment by orthosis and the cost of the treatment. Material and Methods: This retroprospective descriptive study was carried out at the CHUAM of Antananarivo and the CRMM of Antsirabe on patients with congenital hip dislocation treated with braces; from January 2017 to August 2021. Results: Forty-eight cases were retained during this study. A female predominance was mentioned with a sex ratio of 0.45 and an average age of 7.8 ± 5.5 months at the beginning of the treatment. A left dislocation was observed in 27.1% of cases. Twenty-nine patients were treated with abduction pants. A recentered femoral head showing a good result was present in 37 patients. Five dislocations were observed at follow-up, and 5 residual subluxations. No cases of avascular necrosis of the femoral head have been reported. The total cost of orthosis treatment was on the average of 138.554,5 ± 51.678,8 Ariary. Conclusion: The age at the start of treatment and the duration of treatment influence the therapeutic outcome. The cost of orthosis treatment was affordable. If the treatment started earlier, the functional prognosis would be better.

Congenital dislocation of the hip – theories, etiological and predisposing factors (risk factors)

According to current statistics worldwide, congenital orthopedic pathologies rank second quantitatively after congenital diseases of the nervous system. Congenital dislocation of the hip is one of the most common and severe pathologies of the musculoskeletal system in children and adolescents. The theories of its development and etiological factors are not only of historical interest but also create prerequisites for determining the true cause of this complex process. The problem of predicting the development of hip dysplasia remains relevant. The practical significance lies in determining the etiological factor (predisposing or risk factors) of the disease onset or manifestation. Analysis of the literature suggests that hip dysplasia is based on a genetic substrate as an etiological factor. Predisposing factors only increase the risk of pathology manifestation. Further studies to determine the etiological factor will make it possible to formulate more specific recommendations for the management of patients with hip dysplasia and possibly expand the methods of prevention and conservative treatment.

S2k-Guideline Developmental Dysplasia of the Hip in the Neonate.

Hip developmental disorders are the most common musculoskeletal disease in newborns in Central Europe. The definition of hip developmental disorder includes both dysplastic and dislocated joints. In a dysplastic joint, shearing forces induce a growing disorder in the acetabulum. If this growing disorder persists, the femoral head first displaces the acetabular cartilage cranially and finally the femoral head dislocates posteriorly into the gluteal fossa - progressively losing contact to the acetabulum. Therefore nowadays there is general support for the concept of a developmental instead of a congenital dislocation of the hip. From the first day of life, the different stages of hip developmental disorder be exactly classified by an ultrasound examination of the infant hip joint according to Graf. Therefore the Graf hip ultrasound examination has been an integral part of the paediatric guidelines in Germany since 1996. All newborns must receive Graf hip ultrasound screening examination, ideally at the age of 4-5 (maximal 8) weeks as part of the U3 screening examination. Newborns with historical or clinical risk factors must receive an ultrasound examination in the first week of life, additionally to the clinical examination of the hip joints of all newborns according to the second screening examination U2. In the case of pathological results, therapy should be initiated according to measured hip type within one week. Dislocated joints need reduction and as soon as the contact between the femoral head and the acetabulum has been restored, the head should be retained securely within the acetabulum. This phase of retention is followed by the maturation phase for dislocated joints, which is also sufficient therapy for dysplastic joints. In order to avoid femoral head necrosis as an early complication or as a new hip developmental disorder in the course of further growth, the femoral head during the retention phase and the maturation phase should be placed deeply into the socket. This can be achieved by retaining hip flexion of 100-110° with simultaneous hip abduction of 50° to a maximum of 60°.

Endoprosthetics of the hip joint in children of senior school age

The experience of hip arthroplasty in 22 children (23 joints) treated in the Department of Pediatric Bone Pathology and Adolescent Orthopedics of CITO is presented. The main group of operated were children with stage III coxarthrosis due to osteochondrodysplasia (10) and congenital dislocation of the hip (6). The duration of follow-up is from 1 to 23 years. A good result was obtained in 13 cases, satisfactory - in 7. Unsatisfactory results were associated with suppuration (1) and instability of the endoprosthesis (2). The authors see bilateral arthroplasty as a way to normalize the biomechanics of standing and walking in patients with osteochondrodysplasia.

Treatment of congenital dislocation of the hip in young children Jaeger (Surg. Gyn. A. Obst. V. 50, No. 4)

Jaeger (Surg. Gyn. A. Obst. V. 50, No. 4) gives 2 cases of successful treatment of congenital hip dislocation in young children. In contrast to the generally accepted late reduction, when the deformation of the glenoid cavity has already gone far, the author proposes to set it early.

Whole-exome sequencing reveals POLR3B variants associated with progeria-related Wiedemann-Rautenstrauch syndrome

BackgroundWiedemann-Rautenstrauch syndrome (WRS) is a rare autosomal recessive neonatal progeroid disorder characterized by prenatal and postnatal growth retardation, short stature, a progeroid appearance, hypotonia, and mental impairment.Case presentationA 6-year-old patient, who initially presented with multiple postnatal abnormalities, facial dysplasia, micrognathia, skull appearance, hallux valgus, and congenital dislocation of the hip, was recruited in this study. The patient was initially diagnosed with progeria. The mother of the patient had abnormal fetal development during her second pregnancy check-up, and the clinical phenotype of the fetus was similar to that of the patient. Whole-exome sequencing (WES) of the patient was performed, and POLR3B compound heterozygous variants—c.2191G > C:p.E731Q and c.3046G > A:p.V1016M—were identified in the patient. Using Sanger sequencing, we found that the phenotypes and genotypes were segregated within the pedigree. These two variants are novel and not found in the gnomAD and 1000 Genomes databases. The two mutation sites are highly conserved between humans and zebrafish.ConclusionsOur study not only identified a novel WRS-associated gene, POLR3B, but also broadened the mutational and phenotypic spectra of POLR3B. Furthermore, WES may be useful for identifying rare disease-related genetic variants.

The effectiveness of preliminary traction in the treatment of congenital dislocation of the hip

BackgroundHistorical papers on the treatment of congenital dislocation of the hip suggest the use of preliminary traction to facilitate closed reduction or to decrease the risk of avascular necrosis (AVN) of the femoral head. In the 1980s, some authors questioned the role of preliminary traction and suspended its use, yielding satisfactory results. Since then, several studies called into question this method, and some authors have continued to recommend preliminary traction while other authors have discouraged its use.Materials and methodsWe reanalysed the full set of radiographs of 71 hips (52 patients) surgically treated by a medial approach after 4 weeks of preoperative longitudinal traction. The mean age at operation was 16 months. Before and after traction, the height of the dislocation was graded according to the Gage and Winter method. The hips were divided into two groups: group 1, in which the traction was effective, and group 2, in which the traction was not effective. These two groups were statistically analysed regarding the severity of the dislocation, the age of the patient at surgery and the incidence of AVN.ResultsPreliminary traction was effective in 48 hips (68%, group 1), while it was not effective in the remaining 23 (32%, group 2). The effectiveness of preliminary traction was statistically related to the height of the dislocation and to the age of the patient at surgery, with traction being less effective in more severe dislocations and in older children. The incidence of AVN was statistically lower in group 1 than in group 2.ConclusionsIn our study population, despite not having a control group, preliminary traction—when effective—seemed to reduce the incidence of AVN in patients surgically treated for congenital dislocation of the hip. The effectiveness of the traction was influenced by the severity of the dislocation and the age of the patient; it worked better for less severe dislocations and in younger children. To reduce hospital costs, traction should be applied at home.Level of evidence3.

МЕДИКО-ГЕОГРАФИЧЕСКИЕ ФАКТОРЫ ЗДОРОВЬЯ НАСЕЛЕНИЯ СЕВЕРНОЙ ОСЕТИИ

Introduction. Medico-geographical researches are now becoming particularly relevant, since geographic methods with their inherent complexity, diversity, vision of the territory, the identification of medical geographic factors and the application of cartographic methods can explain the basis of those processes and phenomena that occur on the territory of our country and its regions in terms of the morbidity of the population and find ways to optimize the health system. Methods. Medical geography studies the impact of natural, socio-economic and environmental factors on the health of the population, examines the geography of the spread of diseases and identifies the territorial organization of health. Particular attention is paid to the complexity of research; The identification of interaction, mutual development and mutual influence of geographic factors affecting the health of the population in a particular region, as well as the application of GIS technologies and cartographic methods. Results (discussion). The natural conditions of North Os-setia (excluding the highlands) are generally favorable for the population living. Their diversity (despite the limited territory) leads to significant differences in the level and structure of the population morbidity. Within the republic there are five medical-geographical zones, each of which has its own natural-focal diseases. So, for example, rabies, echinococcosis, trichinosis, intestinal infection, leptospirosis, tularemia are characteristic for the steppe zone (the north of the republic); For the forest zone – ascaridosis, endemic goiter, dental caries, echinococcosis, rabies, trichinosis, leptospirosis. Congenital dislocation of the hip is common in the mountainous zone. And girls get this disease five times more often than boys. In addition, almost all of the republic is characterized by a shortage of fluoride, iodine and some other elements. Conclusions. The study of the geographical factors of the morbidity of the population is of great practical importance since it allows developing measures aimed at preventing many diseases.

Congenital Hip Dislocation with a Genu Recurvatum in Togo: A Case Report

Introduction: CHD is a condition, which is frequent in pediatrics in the Caucasian population, remains rare in the Black population, and exceptional in sub-Saharan Africa. The Patient: We report this first Togolese case of bilateral congenital dislocation of the hip associated with genu recurvatum observed in a newborn received on the second day of life. The Primary Diagnoses, Interventions, and Outcomes: The pediatric examination had noted extension of lower limbs. The thighs were in adduction with a stiff bilateral genu recurvatum. The abduction of the thighs on the pelvis was considerably limited. The Barlow and Ortolani maneuvers showed a protrusion. There was also a camptodactyly of the thumbs and a cleft palate. The rest of the examination was normal. Ultrasound of the hip showed a bilateral congenital dislocation of the hip with an estimated acetabular fundus of 7 mm on both the right and left sides. Ultrasound and radiography of the knees were normal. Conclusion: Clinical examination at birth is the key step in diagnosis of congenital hip dislocation. In situations where diagnosis is difficult, ultrasound is of capital importance. Treatment is in the majority of cases orthopedic.

Facteurs de risque associés à un mauvais résultat fonctionnel chez les enfants traités chirurgicalement d’une luxation congénitale de hanche découverte tardivement

BackgroundOpen reduction with or without pelvic and femoral osteotomy is the accepted treatment option for children older than 18 months with developmental dislocation of the hip (DDH). However, few studies have investigated hip function in children with late DDH treated by open reduction. Therefore, we performed a retrospective study investigating the risk factors potentially associated with unsatisfactory hip function. HypothesisWe hypothesized that some risk factors can be associated with unsatisfactory hip function in patients with late DDH treated by open reduction. Patients and methodsWe retrospectively reviewed the clinical and radiographic data of 79 children (98 hips, mean age 39.7±18.6 months; range, 19–95.3) with late-detected DDH treated by open reduction. Acetabular index (AI), Tönnis grade, Center Edge Angle (CEA), avascular necrosis of the femoral epiphysis (AVN), and Severin radiographic grade were evaluated on radiographs. Hip function was rated according to modified Outcome Evaluation Standard for Congenital Dislocation of the Hip with a maximum score of 15. According to type of surgery, patients were divided into four groups: open reduction alone (Group A), open reduction in conjunction with pelvic osteotomy (Group B), and open reduction in conjunction with femoral osteotomy and Pemberton/Salter (Group C) or Bernese-type triple pelvic osteotomy (Group D). Analysis of variance (ANOVA), t-test, chi-square test, and multivariate regression analysis were used to evaluate the independent risk factors of unsatisfactory hip function. ResultsThe mean hip function score was 10.8±2.8 (4.5–15); 61 hips (62.2%) had satisfactory function (23 [23.5%] excellent and 38 [38.8%] good), while 37 hips (37.8%) had unsatisfactory function (16 [16.3%] fair and 21 [21.4%] poor). Spearman correlation analysis indicated that age at surgery was negatively correlated with function score (r=−0.326, p=0.001). The age of patients with satisfactory hip function (34.5±14.2 months; range, 19.4–74.8) was significantly lower than those with unsatisfactory function (43.7±21 months; range, 20.6–95.3) (p=0.011). The hip function score in Group A (14.2±0.8; range, 12.8–15) was significantly higher than in the other three groups (p<0.001). Hip function score in patients with type III or IV AVN was significantly lower than those without AVN, or with type II AVN (p=0.001). Multivariate regression analysis confirmed age at surgery, type of surgery and AVN were negatively correlated with hip function score. Logistic regression analysis and chi-square test confirmed age and type of surgery, and AVN were independent risk factors of unsatisfactory hip function. Multivariate regression analysis found ability to squat and amount of hip flexion and abduction, significantly decreased with age at surgery; while presence of limping, amount of hip flexion, abduction, adduction and external rotation significantly decreased with type of surgery. DiscussionAge at surgery, type of surgery and severe AVN are independent risk factors for unsatisfactory hip function in patients with late-detected DDH treated by open reduction. The ability to squat, the amount of hip flexion and abduction are the main functional parameters affected by age and surgery. Level of evidenceIV, case series.

Risk factors associated with unsatisfactory hip function in children with late-diagnosed developmental dislocation of the hip treated by open reduction

BackgroundOpen reduction with or without pelvic and femoral osteotomy is the accepted treatment option for children older than 18 months with developmental dislocation of the hip (DDH). However, few studies have investigated hip function in children with late DDH treated by open reduction. Therefore, we performed a retrospective study investigating the risk factors potentially associated with unsatisfactory hip function. HypothesisWe hypothesized that some risk factors can be associated with unsatisfactory hip function in patients with late DDH treated by open reduction. Patients and methodsWe retrospectively reviewed the clinical and radiographic data of 79 children (98 hips, mean age 39.7±18.6 months; range, 19–95.3) with late-detected DDH treated by open reduction. Acetabular index (AI), Tönnis grade, Center Edge Angle (CEA), avascular necrosis of the femoral epiphysis (AVN), and Severin radiographic grade were evaluated on radiographs. Hip function was rated according to modified Outcome Evaluation Standard for Congenital Dislocation of the Hip with a maximum score of 15. According to type of surgery, patients were divided into four groups: open reduction alone (Group A), open reduction in conjunction with pelvic osteotomy (Group B), and open reduction in conjunction with femoral osteotomy and Pemberton/Salter (Group C) or Bernese-type triple pelvic osteotomy (Group D). Analysis of variance (ANOVA), t-test, chi-square test, and multivariate regression analysis were used to evaluate the independent risk factors of unsatisfactory hip function. ResultsThe mean hip function score was 10.8±2.8 (4.5–15); 61 hips (62.2%) had satisfactory function (23 [23.5%] excellent and 38 [38.8%] good), while 37 hips (37.8%) had unsatisfactory function (16 [16.3%] fair and 21 [21.4%] poor). Spearman correlation analysis indicated that age at surgery was negatively correlated with function score (r=−0.326, p=0.001). The age of patients with satisfactory hip function (34.5±14.2 months; range, 19.4−74.8) was significantly lower than those with unsatisfactory function (43.7±21 months; range, 20.6–95.3) (p=0.011). The hip function score in Group A (14.2±0.8; range, 12.8–15) was significantly higher than in the other three groups (p<0.001). Hip function score in patients with type III or IV AVN was significantly lower than those without AVN, or with type II AVN (p=0.001). Multivariate regression analysis confirmed age at surgery, type of surgery and AVN were negatively correlated with hip function score. Logistic regression analysis and chi-square test confirmed age and type of surgery, and AVN were independent risk factors of unsatisfactory hip function. Multivariate regression analysis found ability to squat and amount of hip flexion and abduction, significantly decreased with age at surgery; while presence of limping, amount of hip flexion, abduction, adduction and external rotation significantly decreased with type of surgery. DiscussionAge at surgery, type of surgery and severe AVN are independent risk factors for unsatisfactory hip function in patients with late-detected DDH treated by open reduction. The ability to squat, the amount of hip flexion and abduction are the main functional parameters affected by age and surgery. Level of evidenceIV, case series.

Long-term treatment results of congenital hip disease in adolescents

Backgrоund. An analysis of modern literature reveals that presently, there are no algorithms for determining the correct method of surgical treatment for adolescents with high congenital hip dislocation; few publications are devoted to the treatment of adolescents with this pathology. Children are treated by podiatrists until the age of 18 before transferring to adult specialists. There remain debatable issues of total hip replacement in adolescents because there are time limits for hip preservation. The search for improved treatment methods for adolescents with this pathology by preserving their own bone structures continues to be relevant.&#x0D; Aim. To evaluate the long-term results of the treatment of adolescents with complete congenital hip dislocation after intertrochanteric osteotomy using the authors technique.&#x0D; Materials and methods. From 19902006, in the Republican Orthopedic and Traumatological Center of the Republic of Dagestan and the clinic of the Department of Traumatology and Orthopedics of the Dagestan State Medical University, 37 patients with high congenital dislocation of the hip underwent 49 operations using the method developed by the authors. The surgeries were performed by a single orthopedist and were presented as an angulatory lengthening by transtrochantiс osteotomy of the femur by fixation with a fingered plate. All patients underwent clinical, radiographical, biomechanical, and statistical evaluation before and after surgery using the Harris and VAS scales. The results of the study were processed using the Student, Pearson, and Kolmogorov coefficients and confidence intervals.&#x0D; Results. Over a long-term treatment period of up to 10 years, the average Harris score increased from 44.2 (95% CI 38.747.9) to 80.5 (95% CI 77.185.3). After the 10-year follow-up period (1015 years after surgery), the scores gradually dropped to 72.4 (95% CI 70.178.3). Unsatisfactory treatment results were found in 13.5% of cases and were mainly associated with an unsuccessful choice of support point under the pelvis and the preservation of uncompensated shortening of the limb. The alignment of the created degree of angulation of the hip in terms of adolescent age groups was not established. Differences in treatment results (depending on the inter-operation time for the bilateral dislocation of the hip) were not established. At follow-up periods of 1015 years after surgery, total hip replacement was performed in 21 joints (56.7%).&#x0D; Conclusions. The proposed method of surgical treatment of congenital hip dislocation in adolescents improves the staticdynamic capabilities of the hip joint and remains effective over the following 15 years of life. The duration of inpatient treatment is reduced and does not interfere with subsequent total hip arthroplasty.