Developmental Dysplasia Of The Hip In Adults Research Articles

Integrated Acetabular Prosthesis Versus Bone Grafting in Total Hip Arthroplasty for Crowe Type II and III Hip Dysplasia: A Retrospective Case-Control Study.

Many methods of acetabular reconstruction with total hip arthroplasty (THA) for Crowe type II and III adult developmental dysplasia of the hip (DDH) acetabular bone defect have been implemented clinically. However, there was no study comparing the results of integrated acetabular prosthesis (IAP) with bone grafting (BG). This study aims to investigate the efficacy of IAP and BG for acetabular reconstruction in Crowe type II and III DDH. The clinical data of 45 patients with unilateral Crowe type II and III DDH who underwent THA from January 2020 to January 2023 were retrospectively analyzed. The patients were divided into two groups: 25 patients using 3D-printed IAP (IAP group) and 20 patients using BG (BG group). The operation time and intraoperative blood loss were recorded. The clinical outcomes were assessed by Harris Hip Score (HHS) and full weight-bearing time. The radiological outcomes were evaluated by the radiological examination. Accordingly, intraoperative and postoperative complications were observed as well. The data between the two groups were compared by independent sample t-tests and the Mann-Whitney U rank sum test. There were no significant differences between the two groups in Harris Hip Score (HHS) (preoperative, 6 months postoperative, and the last follow-up), leg length discrepancy (LLD), cup inclination, cup anteversion, vertical center of rotation (V-COR), horizontal center of rotation (H-COR) (p > 0.05). The mean HHS in the IAP group was higher than in the BG group at 1 and 3 months postoperative (p < 0.001). The mean surgical time and blood loss in the IAP group were less than in the BG group (p < 0.001). The mean full weight-bearing time in the IAP group was shorter than in the BG group (p < 0.01). No complications were observed in either group during the follow-up period. IAP and BG have similar radiographic outcomes and long-term clinical efficacy in THA for Crowe type II and III DDH, but the IAP technique has higher surgical safety and facilitates the recovery of hip joint function, which is worthy of clinical promotion.

Current Surgical Techniques in the Treatment of Adult Developmental Dysplasia of the Hip.

The surgical protocols currently used for the treatment of developmental dysplasia of the hip (DDH) are varied, with sufficient differences in clinical outcomes that warrant a review of the role of practicing orthopedic surgeons. This paper aims to summarize the current novel techniques within the realm of surgical treatment for adult DDH, thus serving as a guide to surgeons looking to quickly familiarize themselves with available techniques. We performed computer systematic literature searches of the Embase and PubMed databases from 2010 to 2 April 2022. Study parameters as well as their respective patient reported outcomes (PROMs) were described in detail and compiled into diagrams. Two novel techniques were identified for the treatment of borderline or low-grade DDH. Six techniques which included modifications to the Bernese periacetabular osteotomy (PAO) were identified for the treatment of symptomatic DDH. Three techniques which include combinations of arthroscopy and osteotomy were identified for the treatment of DDH with concomitant hip pathologies such as cam deformities. Finally, six techniques, all of which are modifications to total hip arthroplasty (THA), were identified for the treatment of high-grade DDH. The techniques detailed in this review therefore equip surgeons with the necessary knowledge to improve outcomes in patients with varying degrees of DDH.

Application of artificial intelligence preoperative planning system in total hip arthroplasty for adult developmental dysplasia of the hip

By comparing with the traditional X-ray template measurement method, to explore the accuracy of artificial intelligence preoperative planning system (AI-HIP) to predict the type of prosthesis and guide the placement of prosthesis before total hip arthroplasty (THA) in adult patients with developmental dysplasia of the hip (DDH). Patients with DDH scheduled for initial THA between August 2020 and August 2022 were enrolled as study object, of which 28 cases (28 hips) met the selection criteria were enrolled in the study. Among them, there were 10 males and 18 females, aged from 34 to 77 years, with an average of 59.3 years. There were 12 cases of the left DDH and 16 cases of the right DDH. According to DDH classification, there were 10 cases of Crowe type Ⅰ, 8 cases of type Ⅱ, 5 cases of type Ⅲ, and 5 cases of type Ⅳ. According to Association Research Circulation Osseous (ARCO) staging of osteonecrosis of the femoral head, 13 cases were in stage Ⅲ and 15 cases in stage Ⅳ. The disease duration was 2.5-23.0 years (mean, 8.6 years). The limb length discrepancy (LLD) was 11.0 (8.0, 17.5) mm. Before operation, the prosthesis types of all patients were predicted by AI-HIP system and X-ray template measurement method, respectively. And the preoperative results were compared with the actual prosthesis type during operation in order to estimate the accuracy of the AI-HIP system. Then, the differences in the acetabular abduction angle, acetabular anteversion angle, femoral neck osteotomy position, tip-shoulder distance, and LLD were compared between preoperative planned measurements by AI-HIP system and actual measurement results after operation, in order to investigate the ability of AI-HIP system to evaluate the placement position of prosthesis. The types of acetabular and femoral prostheses predicted based on AI-HIP system before operation were consistent with the actual prostheses in 23 cases (82.1%) and 24 cases (85.7%), respectively. The types of acetabular and femoral prostheses predicted based on X-ray template measurement before operation were consistent with the actual prostheses in 16 cases (57.1%) and 17 cases (60.7%), respectively. There were significant differences between AI-HIP system and X-ray template measurement (P<0.05). There was no significant difference in acetabular abduction angle, acetabular anteversion angle, femoral neck osteotomy position, and tip-shoulder distance between AI-HIP system and actual measurement after operation (P>0.05). LLD after operation was significantly lower than that before operation (P<0.05). There was no significant difference between the LLD predicted based on AI-HIP system and the actual measurement after operation (P>0.05). Compared with the traditional X-ray template measurement method, the preoperative planning of AI-HIP system has better accuracy and repeatability in predicting the prosthesis type. It has a certain reference for the prosthesis placement of adult DDH.

Meta-analysis of the Efficacy of the Anatomical Center and High Hip Center Techniques in the Treatment of Adult Developmental Dysplasia of the Hip.

Background In total hip arthroplasty for the treatment of adult developmental dysplasia of the hip, there is considerable controversy regarding the placement of the acetabular cup, anatomic center, and upward in acetabular reconstruction. This article explores the efficacy of the anatomical center technique and high hip center technique in the treatment of adult developmental dysplasia of the hip. Method By searching for articles in the Cochrane Library, PubMed, CNKI, and Wanfang databases, we collected the literature on the treatment of adult developmental dysplasia of the hip by anatomical center and high hip center technology and screened the literature according to the inclusion and exclusion criteria. The Cochrane risk of bias assessment tool was used to assess the risk of bias of randomized controlled trials, the quality of the literature in retrospective cohort studies was assessed using the Newcastle–Ottawa scale, and the RevMan 5.4 software was used to analyze the extracted outcome indicators. Results Nine studies were finally included, including one prospective cohort study, eight retrospective cohort studies, two high-quality studies, and six moderate-quality studies. The meta-analysis results showed that the reconstruction of the acetabulum in two positions was significantly different in terms of operation time (WMD = −37, 95% CI: -45.25-28.74, P < 0.00001), intraoperative blood loss (WMD = −91.88, 95% CI: -108.57-75.19, P < 0.00001), postoperative drainage volume (WMD = 80.55, 95% CI: -140.56-301.66, P = 0.48), time to ground (WMD = −0.68, 95% CI: -1.37-0.0, P = 0.05), Harris score (WMD = −0.04, 95% CI: -0.91-0.82, P = 0.92), lower limb length difference (WMD = 0.21, 95% CI: -0.22-0.64, P = 0.33), WOMAC score (WMD = −1.24, 95% CI: -4.89-2.41, P = 0.51), postoperative complications (RD = −0.02, 95% CI: -0.06-0.02, P = 0.44), Trendelenburg sign (RD = −0.02, 95% CI: -0.02-0.05,P = 0.31), limb lengthening (WMD = 0.85, 95% CI: 0.61-1.09, P < 0.00001), prosthesis wear (WMD = 0.01, 95% CI: 0-0.02, P = 0.17), and prosthesis loosening (RD = 0.01, 95% CI: -0.02-0.04, P = 0.45). Conclusions The high hip center technique can reduce operative time, intraoperative blood loss, and downtime. The anatomical center technique is superior to the high hip center technique in terms of limb lengthening. Compared with acetabular anatomical reconstruction, there was no significant difference in postoperative drainage, lower limb length difference, postoperative complications, Trendelenburg sign, and prosthesis survival or wear. For DDH patients who are not severely shortened in the lower limbs and have severe acetabular bone defects, joint surgeons can choose to reconstruct the acetabulum in the upper part to simplify the operation, reduce the trauma of the patient, and accelerate the recovery of the patient, and they can choose to adjust the length of the neck and the angle of the neck shaft to maintain the moment arm of the abductor muscle. A ceramic interface or a highly cross-linked polyethylene interface minimizes the effect of hip response forces. To further evaluate the efficacy of the anatomical center technique and the high hip center technique in the treatment of adult developmental dysplasia of the hip, more large-sample, high-quality, long-term follow-up randomized controlled trials are still needed for verification.

Variations in developmental dysplasia of the hip – current concepts

Developmental dysplasia of the hip (DDH) is one of the most common congenital defects with an incidence of around 2 cases per 1000 births, affecting the development of the acetabulum and the femoral head. Etiopathogenesis remains unclear but certain risk factors have been associated with DDH including the female gender, postmaturity, primiparity, oligohydramnios and breech presentation. If left untreated, hip dysplasia is considered a main cause of early osteoarthritis. Reviewing the literature, the purpose of the current study is to present current evidence regarding the anatomical abnormalities of DDH during infancy, childhood and adulthood. Using the searching tools on the internet, a thorough search, evaluation and selection of recent published articles in reliable international electronic libraries was conducted regarding the anatomical variations in developmental dysplasia of the hip. The results, extracted from these manuscripts, were the basic source of the current study. It was found that hip anatomy is affected in many different ways which range from sole acetabular dysplasia and stability to subluxation and dislocation. Acetabular defects along with femoral head and soft tissue abnormalities are usually present, making surgery a very challenging process. Dominant symptoms in infancy involve length discrepancy and limited abduction while groin pain and abnormal gait appear later in life. In cases of early diagnosis, DDH can be treated efficiently. Therefore, careful examination of all infants should be performed using the Barlow and Ortolani tests along with ultrasound, when there is a high clinical suspicion. It would be advisable though to screen all infants in order to avoid delayed diagnosis. In later life, radiographs are considered the primary diagnostic tool, whereas a considerable advancement to treating adult DDH is the growing use of personalized (custom-made) implants.

Biomechanical effect of metal augment and bone graft on cup stability for acetabular reconstruction of total hip arthroplasty in hip dysplasia: a finite element analysis

BackgroundDifferent methods of acetabular reconstruction with total hip arthroplasty (THA) for Crowe II and III of adult developmental dysplasia of the hip (DDH) acetabular bone defect have been implemented clinically. However, the biomechanical effect of different augmented materials for acetabular reconstruction in THA on shell stability has never been discussed.MethodsIn the present study, autologous bone graft (BG)and metal (Ti6Al4V) augment (MA) were simulated with several acetabular bone defect models of DDH in THA. The contact pressure and micromotion between the shell and host bone were measured for evaluating the shell stability using a finite element method.ResultsThe peak contact stress between shell and host bone was higher in the MA situation (12.45 vs 8.71 MPa). And the load transfer path was different, for BG models, the high local contact stresses were found at the junction of bone graft and host bone while for MA models the concentrated contact stresses were at the surface of MA. The peak relative micromotion between shell and host bone was higher in the MA situation (12.61 vs 11.13 µm). However, the peak micromotion decreased in the contact interface of MA and cup compared to the BG models.ConclusionsThe higher micromotion was found in MA models, however, enough for bone ingrowth, and direct stronger fixation was achieved in the MA-cup interface. Thus, we recommended the MA can be used as an option, even for Crowe III, however, the decision should be made from clinical follow-up results.

Edema of the Ligamentum Teres as a Novel MRI Marker for Non-Traumatic Painful Hip Pathology: A Retrospective Observational Study.

BackgroundThe ligamentum teres has been recognized as an important stabilizer of the hip joint and can be affected by various hip pathologies. This study aims to introduce ligamentum teres edema as an MRI marker to diagnose the underlying cause of hip pathology, mainly femoral acetabular impingement (FAI) and adult developmental dysplasia of the hip (ADDH), in non-traumatic patients.MethodologyAdult patients presenting with non-traumatic hip pain of variable duration and ligamentum teres edema on MRI between 2014 and 2020 were included. A high-resolution standard MRI hip protocol was used for all patients in this series. MRI and plain radiographs were assessed. Ligamentum teres edema, alpha angle, center edge angle of Wiberg, and retroversion were assessed.ResultsIn total, 55 patients with 110 hip joints (males: 29 (52.7%), females: 26 (47.3%)) of different ethnicities were included in this study. Out of the 55 patients with ligamentum teres edema, one had only unilateral right-sided FAI, seven had only unilateral left-sided FAI, and 46 (94 hip joints) had either bilateral FAI or ADDH. Therefore, eight (14.5%) patients with unilateral FAI had the absence of the contralateral FAI or ADDH (6.5% false-positive) despite the presence of ligamentum teres edema bilaterally, and the rest of the patients with bilateral ligamentum teres edema (102 joints: 92.7% positive predictive value) had findings of either FAI or ADDH.ConclusionsLigamentum teres edema can be considered as an early MRI marker to diagnose the underlying pathology of symptomatic painful hip disorders, especially FAI.

Effects of femoral offset and mechanical axis of the lower extremity on hip after osteotomy for adult developmental dysplasia of the hip

To investigate the effects of femoral offset and mechanical axis of the lower extremity on hip after osteotomy for adult developmental dysplasia of the hip (DDH). A clinical data of 62 adult patients with DDH (62 hips), who underwent periacetabular osteotomy combined with femoral osteotomy between January 2016 and May 2019 and met selective criteria, was retrospectively analyzed. There were 6 males and 56 females. The age ranged from 18 to 38 years, with an average of 24.4 years. Body mass index ranged from 15.8 to 31.8 kg/m 2, with an average of 21.8 kg/m 2. There were 44 cases of Hartofilakidis typeⅠ and 18 cases of typeⅡ. According to the modified Tönnis osteoarthritis staging, 46 cases were stage 0 and 16 cases were stageⅠ. There were 13 cases with pelvic anteversion, 40 cases with normal pelvis, and 9 cases with pelvic retroversion. Intraoperative blood loss, length of hospital stay, and complications were recorded. Postoperative hip function was evaluated by Harris score and International Hip Outcome Tool (iHOT) score. The femoral offset, collo-diaphyseal angle, hip-knee-ankle angle (HKA), knee valus angle, CE (Wiberg central-edge angle), anterior CE angle, and acetabular index angle were measured and the osteotomy healing was observed on X-ray films. Patients were grouped according to postoperative femoral offset (≥48 mm or <48 mm) and HKA [varus group (HKA<177°), normal group (HKA 177°-183°), and valgus group (HKA>183°)]. Harris score and iHOT score were compared between groups. Intraoperative blood loss ranged from 200 to 1 550 mL, with an average of 476 mL. The length of hospital stay ranged from 8 to 21 days, with an average of 13.3 days. All incisions healed by first intention. All patients were followed up 2.0-4.5 years, with an average of 2.8 years. At 1 year after operation, the Harris score and iHOT score of the hip joint significantly increased when compared with those before operation ( P<0.05); there were significant differences in the femoral offset, collo-diaphyseal angle, HKA, knee valus angle, CE angle, anterior CE angle, and acetabular index angle between pre- and post-operation ( P>0.05). According to the modified Tönnis osteoarthritis staging, 38 cases were stage 0 and 24 cases were stageⅠ; and there was no significant difference between pre- and post-operation ( χ 2=2.362, P=0.124). There were 11 cases with pelvic anteversion, 38 cases with normal pelvis, and 13 cases with pelvic retroversion, showing no significant difference when compared with that before operation ( χ 2=0.954, P=0.623). The pubic branch osteotomy did not heal in 9 cases, proximal femur osteotomy did not heal in 2 cases, and inferior pubic ramus stress fracture occurred in 5 cases. There were significant differences ( P<0.05) in the Harris score and iHOT score between femoral offset≥48 mm group ( n=10) and femoral offset<48 mm group ( n=52). There was no significant difference ( P>0.05) in Harris score and iHOT score between varus group ( n=13), normal group ( n=40), and valgus group ( n=9). Periacetabular osteotomy combined with femoral osteotomy can improve the femoral offset and mechanical axis of the lower extremity of patients with DDH, and improve the functional score of the hip. However, excessive increase of femoral offset during femoral osteotomy is not desirable, resulting in low postoperative functional score.

Recent research progress of hip-preserving treatment for adolescents and adults with developmental dysplasia of the hip

To review the imaging evaluation, treatment progress, and controversy related to developmental dysplasia of the hip (DDH) in adolescents and adults. The domestic and abroad hot issues related to adolescents and adults with DDH in recent years, including new imaging techniques for assessing cartilage, controversies over the diagnosis and treatment of borderline DDH (BDDH), and the improvement and prospect of peracetabular osteotomy (PAO) were summarized and analyzed. DDH is one of the main factors leading to hip osteoarthritis. As the understanding of the pathological changes of DDH continues to deepen, the use of delayed gadolinium-enhanced MRI of cartilage can further evaluate the progress of osteoarthritis and predict the prognosis after hip preservation. There are still controversies about the diagnosis and treatment of BDDH. At the same time, PAO technology and concepts are still being improved. Cartilage injury and bony structure determine the choice of surgical methods and postoperative prognosis of hip preservation surgery. The hip preservation of adolescent and adult DDH patients will move towards the goal of individualization and accuracy.

Application of Mako robot-assisted total hip arthroplasty in developmental dysplasia of the hip

To evaluate the early effectiveness and summarize the initial application experiences of Mako robot-assisted total hip arthroplasty (THA) for developmental dysplasia of the hip (DDH) in adults. Between August 2018 and January 2020, 55 cases of DDH (75 hips) were treated with Mako robot-assisted THA. There were 10 males and 45 females with an average age of 51 years (range, 30-73 years). There were 35 cases of unilateral hip and 20 cases of bilateral hips. The DDH was classified as Crowe type Ⅰin 29 hips, type Ⅱ in 20 hips, type Ⅲ in 6 hips, and type Ⅳ in 20 hips. The modified Harris score was 54.8±16.0, the hip joint range of motion was 90° (80°, 100°), and the leg length discrepancy (LLD) was 22.0 (10.5, 47.0) mm. The preoperative surgical plan was made in the robot system based on the CT data. The reaming and installation of the acetabular cup were completed with the assistance of the robot system. The distance between the rotation center of the hip joint and the teardrop (horizontal distance, vertical distance), inclination angle, and anteversion angle were measured on the pelvic X-ray film to evaluate the position of the acetabular prosthesis. The above indicators were compared with preoperative planning to evaluate the accuracy of robotic-assisted surgery. The modified Harris score, the range of motion, and the LLD were used to evaluate the early effectiveness. The 75 hips of THAs were completed with the assistance of Mako robots. There was no significant difference in the acetabular inclination angle, the horizontal distance and the vertical distance of the rotation center between the preoperative planning and the postoperative measurement values ( P>0.05); the acetabular anteversion angle was significantly smaller than the postoperative measurement value ( t=-2.482, P=0.015). Four hips located beyond the Lewinnek safety zone, and 71 hips located within the Lewinnek safety zone. All patients followed up 6-24 months (mean, 13 months). All incisions healed by first intention. At last follow-up, the modified Harris score was 85.5±11.2, the hip joint range of motion was 120° (110°, 120°), and the LLD was 3.8 (2.0, 8.1) mm; all improved significantly compared with preoperative ones ( P<0.05). Except for one nerve injury case, there was no other complication. Mako robot-assisted THA is a safe and effective method for adult DDH, which can optimize the acetabular cup positioning, hip function, and leg length, but the long-term effectiveness needs to be confirmed by further studies.

Comparison of the modified Smith-Petersen (S-P) and ilioinguinal (I-I) approaches for periacetabular osteotomy in adult developmental dysplasia of the hip: a retrospective study

BackgroundAdult developmental dysplasia of the hip is an untreated congenital hip dysplasia that results in adult hip pain. One of the usual and effective methods for the treatment of this condition is periacetabular osteotomy. However, which approach is better between the modified S-P and the I-I approaches is still unclear and controversial.Method and materialsWe retrospectively assessed our experience with the modified S-P and the I-I approaches by inquiring and evaluating intraoperative blood loss, postoperative radiographic material, postoperative function of the hip, and related complications from July 2014 to January 2019.ResultsA total of 61 patients with adult developmental dysplasia of the hip were enrolled, and 33 patients were divided into a modified S-P group and 28 patients were divided into I-I group. The operation time and blood loss of group I-I were higher than that of group modified S-P. Other clinical and radiographic indexes showed no statistical significance between group the modified S-P and I-I groups.ConclusionThere is no significant difference in the improvement of the function of the hip at the post-operation stage, but group I-I may require more operation time and blood loss at the intra-operation stage.

The Variation of the Pelvis in Unilateral Crowe Type IV Developmental Dysplasia of the Hip.

ObjectiveTo investigate variation of the pelvis in unilateral Crowe type IV developmental dysplasia of the hip (DDH) and analyze the reliability of pelvic landmarks.MethodsWe retrospectively received preoperative anteroposterior pelvic radiographs for 89 adult patients with unilateral Crowe type IV DDH at our institution between September 2008 and May 2019. Forty‐eight patients without a false acetabulum was type IVA and 41 with a false acetabulum was type IVB. The heights of the ilium, acetabulum, and ischium areas in affected and unaffected sides were measured. The ratios of the three areas in entire pelvis are calculated. The discrepancies of bilateral iliac crest, inferior sacroiliac articulation, teardrop, and ischial tuberosity on the bisector of the pelvis were also measured.ResultsThe mean heights of the ilium, acetabulum, ischium areas in the affected side were 74.4, 88.6, and 37.0 mm, respectively, in type IVA group and 77.7, 83.5, and 37.8 mm, respectively, in type IVB group. The heights in the unaffected side were 82.1, 84.6, and 43.8 mm, respectively, in type IVA group and 84.6, 82.0, and 44.0 mm, respectively, in type IVB group. The ratios of the ilium, acetabulum, ischium areas in affected side of Crowe type IVA group were 0.37, 0.44, and 0.19, respectively, and the ratios in unaffected side were 0.39, 0.40, and 0.21, respectively. The ratios in affected side of Crowe type IVB group were 0.39, 0.42, and 0.19, respectively, and the ratios in unaffected side were 0.40, 0.39, and 0.21, respectively. The discrepancies of bilateral iliac crest, inferior sacroiliac articulation, teardrop, and ischial tuberosity on the line of the bisector of the pelvis in Crowe type IVA group were 5.6, 5.2, 2.0, and 7.1 mm, respectively. Those in Crowe type IVB group were 8.1, 3.5, 3.5, and 4.9 mm, respectively.ConclusionsPelvic asymmetry was a common occurrence in unilateral Crowe type IV DDH in adults. Furthermore, it should be reliable to use teardrop as pelvic landmark to balance leg length discrepancy in preoperative planning.

Hypermobility Assessment in 1,004 Adult Patients Presenting with Hip Pain: Correlation with Diagnoses and Demographics.

The strength of the association between hypermobility and developmental dysplasia of the hip (DDH) in adults is unknown. We sought to analyze this relationship in a prospective, blinded, institutional review board-approved, observational study. The hypothesis was that the prevalence of generalized joint hypermobility (GJH) would be significantly higher in patients with hip dysplasia than in those with other hip diagnoses on the basis of clinical observations of joint laxity. One thousand and four consecutive new patients (390 males and 614 females) seen over a 4-year period were evaluated for hypermobility of the hip using 2 criteria: the Beighton 9-point physical examination criteria and the Hakim-Grahame 5-item history questionnaire. Diagnosis, age, sex, and race were tested as predictors of hypermobility. Patient-reported outcome scores from the International Hip Outcome Tool (iHOT-12) and the modified Harris hip score (mHHS) were also assessed. DDH was the primary diagnosis in 33.2% of the patient population. Patients who had dysplasia without osteoarthritis (OA) had a significantly elevated prevalence of GJH (77.9%) compared with those with nondysplastic hips (32.8%; p < 0.0001) or with patients who had dysplasia and OA (35.7%; p < 0.0001) according to either method. The odds ratio (OR) for patients with DDH versus those with other diagnoses was 7.1 (95% confidence interval [CI]: 5.1 to 10.0). The prevalence of hypermobility was significantly greater in females than in males (OR = 4.2 [95% CI: 3.2 to 5.5]; p < 0.0001). The prevalence of GJH was inversely proportional to age. There was a significantly reduced prevalence of GJH observed in Hispanic patients (p < 0.05) compared with other races. GJH was not a predictor of patient-reported outcome scores (p = 0.51 for iHOT-12 and p = 0.44 for mHHS). To our knowledge, this study is the first to establish a strong association between hypermobility and DDH in adults, confirming the hypothesis. We recommend utilizing both the Beighton and Hakim-Grahame scoring systems together as routine components of the history and physical examination for patients with hip dysplasia. Further research is warranted to explore the genetic basis and potential causal relationships between soft-tissue laxity and skeletal dysplasia, as well as improvements in assessment tools. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Surgery simulation teaching based on real reconstruction aid versus traditional surgical live teaching in the acquisition of an adult total hip arthroplasty surgical technique for developmental dysplasia of the hip: a randomized comparative study

BackgroundA simulation and model (SM) teaching aid using 3D printing was developed to improve a training course for total hip arthroplasty of adult developmental dysplasia of the hip (adult DDH-THA). We named this new method Surgery Simulation Teaching based on a Real Reconstruction Aid (RRA-SST). A prospective randomized comparison was performed with the traditional surgical live teaching method to evaluate the training effectiveness of RRA-SST for adult DDH-THA.MethodsTwenty-six trainees, who were already practicing but were not experienced, participated in the study. We randomly divided the trainees into two groups: Group A (n = 13) received RRA-SST and group B (n = 13) received traditional surgical live teaching. A surgery simulation test and a questionnaire were used for evaluation. Next, each group received training with the other teaching method, and then the test and questionnaire were used again for evaluation.ResultsAfter the first test, the RRA-SST method was shown to produce better results than the traditional surgical live teaching method. After the second test, the results showed the training effect in both groups reached the same level, which was level as Group A RRA-SST results. Analysis of the questionnaire results showed that the training effect of RRA-SST was higher than that of traditional surgical live teaching, from multiple perspectives.ConclusionsThe use of RRA-SST improved participant performance according to simulation assessment. RRA-SST can be helpful for trainees who are already practicing but not experienced when developing proficiency in adult DDH-THA surgical techniques.

3D Printing Navigation Template Used in Total Hip Arthroplasty for Developmental Dysplasia of the Hip.

The purpose of our study was to explore the feasibility of 3D printing navigation template used in total hip arthroplasty (THA) for adult developmental dysplasia of the hip (DDH). 25 patients who received THA for DDH from February 2014 to May 2018 were randomized into the control or intervention group. Of these patients, 12 received THAs assisted with 3D printing navigation templates, 13 THAs underwent THAs without navigation templates. The mean follow-up was 1.6 (range, 1.2-3.8) years. Clinical scores and radiographic results were evaluated for two groups. Operating time, intra- and postoperative hemorrhage and Harris Hip Score (HHS) at 6 months postoperatively in the 3D printing group were better than those for patients in the conventional hip replacement group, while infection and implant loosening were 0 in the two groups. There were no significant differences in anteversion angle, abduction angle and the distance from rotation center to the ischial tuberosity line in 3D printing group as compared to the normal side. The abduction angle and the distance from rotation center to the ischial tuberosity line were significantly different between the two sides in the traditional group. Application of the 3D printing template for THA with DDH can facilitate the surgical procedure and create an ideal artificial acetabulum placement.

Image Quiz: Treatment of Adult Developmental Dysplasia of the Hip

JBJS Journal of Orthopaedics for Physician Assistants: July-September 2020 - Volume 8 - Issue 3 - p e19.00040 doi: 10.2106/JBJS.JOPA.19.00040

How to restore rotation center in total hip arthroplasty for developmental dysplasia of the hip by recognizing the pathomorphology of acetabulum and Harris fossa?

PurposeTo restore rotation center exactly in total hip arthroplasty (THA) is technically challenging for patients with end-stage osteoarthritis due to developmental dysplasia of the hip (DDH). The technical difficulty is attributable to the complex acetabular changes. In this study, we investigated the pathomorphology of acetabulum and Harris fossa of Crowe types I to IV and discussed the method of restoring rotation center of the hip.MethodsThis study retrospectively reviewed 56 patients (59 hips) who underwent cementless THA due to end-stage osteoarthritis of DDH. The pathomorphology of acetabulum and Harris fossa was observed during operations. Using the preoperative and postoperative pelvic radiographs, the vertical and the horizontal distances of hip rotation center were measured in order to evaluate the effects of restoring rotation center of the hip.ResultsAdult DDH acetabulum could be classified into four basic pathological types which include the shallow cup shape, the dish shape, the shell shape, and the triangular shape. Adult DDH Harris fossa could be classified into four pathological types, including the crack shape, the closed shape, the triangle shape, and the shallow shape, in accordance with the osteophyte coverage. The vertical and horizontal distances of hip rotation center on the pelvic radiographs before and after operations were as follows: the preoperative vertical distance of hip rotation center was (39.96 ± 5.65) mm, and the postoperative one was (13.83 ± 2.66) mm; the preoperative horizontal distance of hip rotation center was (42.15 ± 6.42) mm, and the postoperative one was (28.12 ± 4.56) mm.ConclusionsThe acetabulum and Harris fossa can display different pathological types on account of different degrees of dislocation and osteophyte hyperplasia in the end-stage osteoarthritis of adult DDH. The hip rotation center can be accurately restored by locating the acetabular center with Harris fossa and acetabular notch as the marks.

The application of 3D printed customized porous tantalum acetabular patch for adult DDH hip reconstruction

Objective To explore the feasibility, safety and efficacy of customized porous tantalum acetabular patch made by three-dimensional (3D) printing technique in treating adult developmental dysplasia of the hip (DDH). Methods Eight adult patients with CroweⅠtype DDH (2 men and 6 women, with a mean age of 43.75±7.81 years, range 33-58 years) who were treated with 3D printed customized porous tantalum acetabular patch hip reconstruction from January 2017 to September 2017 were included. The 3D printing technique was used for reconstructing and designing the optimal acetabular patch for the personalized hip joint of each patient. The acetabular patch was subjected to porous processing and finite element analysis until the biomechanical requirements were met. The 3D printing of porous tantalum acetabular patch and post-processing was subsequently performed. The acetabular patch was implanted through the anterior approach of the hip joint. The operative duration, intraoperative blood loss and complications were recorded. All the included patients were followed up at 1.5, 3 and 6 months postoperatively. Pain was assessed using the visual analog scale (VAS), and the hip joint function was evaluated using the Harris score and gait analysis. The patients underwent anterior-posterior radiography and 3D computed tomography of the hip joint aiming to observe the position of the acetabular patch and osteoarthritis progression. Results The mean operative duration was 1.13±0.23 h, and the mean blood loss was 114.17±41.22 ml. All patients were followed up for 6 to 12 months, with an average of 8.2 months. The mean lateral central-edge angle and anterior central-edge angle ranged from 9.83°±5.34° preoperatively to 32.67°±2.53° postoperatively and from 3.83°±2.79° preoperatively to 21.67°±1.87° postoperatively, respectively. The rate of acetabular coverage increased from 57.33%±7.97% preoperatively to 87.33%±4.56% postoperatively. The VAS and Harris scores ranged from 2.92±0.79 preoperatively to 0.83±0.72 postoperatively and from 69.67±4.62 preoperatively to 84.25±4.14 postoperatively with statistically significant difference, respectively. The results of gait analysis showed that the step speed, stride, the range of motion of hip and knee were better than that preoperatively. The images suggested a close contact between the tantalum acetabular patch and the iliac bone without loosening and progress of osteoarthritis in hip joint. Conclusion 3D printed customized porous tantalum acetabular patch could reconstruct the defect of acetabular, increase the coverage, and delay the progress of osteoarthritis of the hip joint. This method could reduce the difficulty of hip reconstruction, and the patients could obtain better joint function at the early stage. Key words: Bone diseases, development; Imaging, three-dimensional; Tantalum; Porosity

Three dimensional reconstruction and measurement of the proximal femur in adult developmental dysplasia of the hip

To investigate characteristics and the differences of the anatomical parameters of the proximal femur of the developmental dysplasia of the hip (DDH). A total of 38 patients(47 hips) diagnosed as DDH with CT scan data and the pelvis radiograph from January 2012 to December 2014 in China-Japan Union Hospital of Jilin University were retrospectively analyzed. All the hips were divided into 3 groups according to Crowe classification method. Thirty normal hips were selected as controls who admitted at the same time. CT data of the patients were imported into Mimics 17.0. The three-dimensional models of the proximal femur were then reconstructed, and the following parameters were measured: neck-shaft angle, neck length, offset, height of the centre of femoral head, height of the isthmus, height of greater trochanter, the medullary canal diameter of isthmus (Di), the medullary canal diameter 10 mm above the apex of the lesser trochanter (DT+ 10), the medullary canal diameter 20 mm below the apex of the lesser trochanter (DT-20), and then DT+ 10/Di, DT-20/Di and DT+ 10/DT-20 were calculated.Variance discrepancy analysis was used to compare the difference among the four groups, and LSD method was used to compare the difference between either two groups. The parameters of neck-shaft angle of DDH with Crowe I, Crowe II-III, Crowe IV and the control group were (131.8°±7.1°), (131.7°±6.5°), (122.8°±11.4°) and (131.8°±5.9°), respectively; the parameters of neck-shaft angle of DDH with Crowe IV was smaller than that of DDH with Crowe I, Crowe II-III and control group (all P<0.05). The parameters of the neck length of DDH with Crowe IV ((44.6±6.6) mm) was smaller than that of DDH with Crowe I ((48.6±6.7) mm), Crowe II-III ((50.4±4.7) mm) (all P<0.05). There is no statistic difference in the offset among the groups (F=2.392, P>0.05). The parameters of the height of greater trochanter of DDH with Crowe IV ((12.1±6.1) mm) was bigger than that of DDH with Crowe I ((8.9±7.2) mm), Crowe II-III ((7.5±3.3) mm) and control group ((6.1±3.9) mm) (all P<0.05). The parameters of the height of the centre of femoral head of DDH with Crowe I, Crowe II-III, Crowe IV were (39.6±6.5) mm, (39.1±4.2) mm, (38.8±8.6) mm, which were smaller than that of the control group ((46.5±6.2) mm) (all P<0.05). The parameters of Di of DDH with Crowe I, Crowe II-III, Crowe IV and the control group were (9.9±2.2) mm, (8.3±1.8) mm, (8.7±1.7) mm and (10.1±1.4) mm; the parameters of Di of DDH with Crowe II-III and Crowe IV were smaller than that of the control group (all P<0.05). The parameters of DT+ 10 ((17.2±5.3) mm) and DT-20 ((12.2±3.0) mm) of DDH with Crowe IV were smaller than that of DDH with Crowe I ((25.2±3.4) mm, (17.1±2.3) mm) and Crowe II-III ((21.9±4.2) mm, (16.3±3.2) mm) (all P<0.05). The parameter of the height of the isthmus of DDH with Crowe IV ((94.1±19.7) mm) was smaller than that of DDH with Crowe I ((106.2±13.8) mm), Crowe II-III ((108.8±10.5) mm) and control group ((116.5±10.6) mm), respectively (P=0.010, 0.008, 0.000). The parameters of DT+ 10/Di (2.0±0.4) and DT-20/Di (1.4±0.2) of DDH with Crowe IV were smaller than that of DDH with Crowe I (2.6±0.5, 1.8±0.3), Crowe II-III (2.7±0.60, 1.9±0.3) (all P<0.05). Comparing to DDH with Crowe I-III and control group, DDH with Crowe IV has a dramatic change in the intramedullary and extramedullary parameters. The isthmus and the great trochanter are higher and there is apparent narrowing of the medullary canal around the level of the lesser trochanter.

Long-term clinical and radiological outcomes in a series of 26 cases of symptomatic adult developmental dysplasia of the hip managed with bernese periacetabular osteotomy

ObjectiveDevelopmental hip dysplasia is a frequent cause of coxofemoral pain in young adults. Bernese periacetabular osteotomy emerges as a possible option for the management of pain relief and functional limitation, in order to delay the need for arthroplasty in these patients. Material and methodsA descriptive retrospective study was conducted on 26 selected patients with symptomatic developmental hip dysplasia treated with bernese periacetabular osteotomy between 1996 and 2009 (94% women). Mean age at time of surgery was 39.8 years (15–49 years), with a mean follow-up of 10 years. Osteoarthritis (OA Tönnis scale), acetabular index and Wiberg angle were evaluated by radiology and functionality was valued by using the de Merle D’Aubigné-Postel scale. ResultsThe mean hospitalisation time was 10 days. At 10 years, the mean radiography value of acetabular index was 9.03° and 38.3° for Wiberg angle (17° and 27° correction, respectively, above the mean pre-operative values). Joint lock was referred to by 43% of patients and 53% to non-evidence based limb failure. Mean functional value was 14.30 (Good). At 5 years of follow-up, 20% advanced at least by one grade in OA Tönnis scale compared to their pre-operative status, increasing to 55% at 10 years. At 10 years after surgery, 83% patients did not need arthroplasty and 85% showed high satisfaction level. ConclusionsBernese periacetabular osteotomy is a useful alternative in young adults with symptomatic developmental hip dysplasia that can improve pain relief, femoral head coverage, and slow down coxofemoral osteoarthrosis progression in order to delay arthroplasty.