Diagnosis Of Hip Dysplasia Research Articles

Early hip laxity screening and later canine hip dysplasia development.

Background and Aim:Passive hip laxity (PHL) is considered the primary risk factor for canine hip dysplasia (HD) and is estimated, in stress hip radiographs, using the distraction index (DI). The study aimed to associate the early PHL using the hip Distractor of University of Trás-os-Montes and Alto Douro (DisUTAD) and the late HD grades.Materials and Methods:A total of 41 dogs (82 hips) were submitted to a follow-up study. First, between 4 and 12 months of age, dogs were radiographed using the DisUTAD hip distractor and were determined the DI for each hip joint. Then, after 12 months of age, dogs were reevaluated for HD using the conventional hip ventrodorsal projection and hips were evaluated for HD using the Fédération Cynologique Internationale (FCI) scoring system.Results:Hips of dogs’ in the second examination with FCI grades of A (n=28), B (n=11), C (n=22), and D and E (n=21) had an early DI of 0.32±0.1, 0.38±0.08, 0.50±0.12, and 0.64±0.11, respectively. Statistical analysis using the general linear model univariate, with the DI as dependent variable and the FCI grades, side and sex as fixed factors, and the post hoc Bonferroni correction test showed significant differences among FCI grades (p<0.05).Conclusion:These results show the association between early DI and the late FCI HD grades and the DisUTAD is recommended for the early canine HD diagnosis.

Automated diagnosis of hip dysplasia from 3D ultrasound using artificial intelligence: A two-center multi-year study

BackgroundThree-dimensional (3D) Ultrasonography of the hip introduces opportunities for automation by artificial intelligence (AI) to diagnose developmental dysplasia of the hip (DDH). We compared conventional clinical diagnosis and a commercial FDA-cleared AI algorithm in detecting and classifying hip dysplasia on 3DUS. PurposeTo validate the accuracy of AI in detection and classification of DDH from 3D US. Materials and methodsInfant hip 3D US obtained prospectively for clinical suspicion of DDH at two tertiary pediatric hospitals (in Edmonton, Canada and Melbourne, Australia) from January 2012 to December 2020 were analyzed retrospectively by an AI algorithm trained on other data from Edmonton and not previously exposed to Melbourne images. Results were compared to the clinical diagnosis made using concurrently obtained conventional two-dimensional (2D) US of the same hips. The AI algorithm automatically calculated two indices (alpha angle and femoral head coverage) without user input and classified hips as normal or dysplastic. Diagnostic accuracy of AI for human expert reference-standard diagnosis, and inter-rater reliability between AI and clinical diagnosis were assessed. Results2492 hips from 1563 patients were evaluated (1294 hips in Edmonton, 1198 in Melbourne; 1061 (68%) female patients, mean age 87 days, range 4–267 days). 2327/2492 hips were clinically classified as Normal or Borderline (initially Graf IIa but spontaneously normalizing at follow-up imaging), while 165 hips were clinically Dysplastic and treated. AI correctly categorized 90% (148/165) of Dysplastic hips and 86% (2006/2327) of the other hips overall, with sensitivity 0.90 for dysplasia. Only one case of severe dysplasia (Graf III) was missed by AI. Agreement between AI and clinical diagnosis was very high (kappa = 0.79). ConclusionAutomated artificial intelligence analysis of 3D ultrasound images correlated well to human expert clinical diagnosis of hip dysplasia from concurrent conventional 2D ultrasound of the same hips.

Investigation of the possible effectiveness of osteopathic correction in the complex treatment of children in the first year of life with hip dysplasia

Introduction. Congenital dysplasia of the hip joints is one of the main among congenital diseases of the musculoskeletal system in children and requires a long period of treatment, including in a hospital settings. Standard methods of treatment contain the orthopedic and rehabilitation measures: the use of abduction splints, a complex of physiotherapy exercises, general massage, the use of various physiotherapeutic procedures. Osteopathic correction is not included in the standards of care for this category of patients. At the same time, these standard treatment methods do not always give a desired result, and sometimes even lead to the development of complications. All this facts determines the need to search for additional therapeutic techniques.The aim of the study is to research the possible effectiveness of osteopathic correction as part of the complex treatment of children in the first year of life with hip dysplasia.Materials and methods. The study included 34 children with a diagnosis of hip dysplasia (ICD code-10 — Q65.8). The patients were randomly divided into 2 equivalent groups: study and control. Participants in both groups received standard treatment; the participants of the main group additionally underwent osteopathic correction of the revealed somatic dysfunctions. Before and after the course of treatment, the patients' osteopathic status, the disease clinical manifestations, and the X-ray data of the hip joints were assessed.Results. The inclusion of osteopathic correction in the complex with standard treatment procedures for children of the first year of life with hip dysplasia is accompanied by a statistically significant decrease in the detection frequency of the somatic dysfunctions at the regional and local levels. The median duration of standard orthopedic treatment also decreases (p&lt;0,05).Conclusion. The obtained results demonstrate that the inclusion of osteopathic correction in the complex treatment of children in the first year of life with hip dysplasia shortens the treatment time for patients. It is recommended to continue research in this direction with a larger sample size.

Ultrasound as a diagnostic tool for femoral head containment disorders in children between one and 12 years of age

PurposeUltrasound has been used to diagnose hip dysplasia in neonates and to screen until the end of their first year. For older children, femoral head containment disorders such as developmental dysplasia of the hip, Legg-Calvé-Perthes disease or cerebral palsy are usually diagnosed with plain radiographs. The aim of the present study was to evaluate ultrasound in comparison with radiographic imaging in children up to age 12 years and to determine reference values for sonographic containment parameters.MethodsHip ultrasound and radiographic imaging were acquired on the same day and then compared. As a reference, normal acetabular angle and acetabulum head index were determined on radiographs. Lateral cartilage distance (LCD), lateral head distance (LHD) and femoral head extrusion angle (HA) were measured on ultrasound images.ResultsWe included 96 patients with 167 healthy hips in the study. A total of 55 patients were female and 41 male. The mean age was 5.2 years (sd 3.3; 1.0 to 11.9). LCDultrasound, LHDultrasound and HAultrasound correlated significantly with radiographic parameters. The following ultrasound values were calculated as limits for impending loss of containment: LCDultrasound ≥ 6.5 mm, LHDultrasound ≥ 3.3 mm and HAultrasound ≥ 27.6°.ConclusionUltrasound is a simple, radiation-free diagnostic tool to detect femoral head containment disorders, even in children older than one year. This study provides reference values for hip ultrasound in children up to 12 years.Level of evidenceIII

Editor's Spotlight/Take 5: What is the Interobserver Reliability of an Ultrasound-enhanced Physical Examination of the Hip in Infants? A Prospective Study on the Ease of Acquiring Skills to Diagnose Hip Dysplasia.

Editor's Spotlight/Take 5: What is the Interobserver Reliability of an Ultrasound-enhanced Physical Examination of the Hip in Infants? A Prospective Study on the Ease of Acquiring Skills to Diagnose Hip Dysplasia.

What is the Interobserver Reliability of an Ultrasound-enhanced Physical Examination of the Hip in Infants? A Prospective Study on the Ease of Acquiring Skills to Diagnose Hip Dysplasia.

Developmental dysplasia of the hip (DDH) is the most common disorder found in newborns. The consequences of DDH can be mitigated with early diagnosis and nonoperative treatment, but existing approaches do not address the current training deficit in making an early diagnosis. Can ultrasound be taught to and used reliably by different providers to identify DDH in neonates? This was a prospective observational study of a series of neonates referred for an evaluation of their hips. An experienced clinician trained three second examiners (a pediatric orthopaedic surgeon, an orthopaedic resident, and a pediatrician) in performing an ultrasound-enhanced physical examination. The 2-hour training process included video and clinical didactic sessions aimed to teach examiners to differentiate between stable and unstable hips in newborns using ultrasound. The experienced clinician was a pediatric orthopaedic surgeon who uses ultrasound regularly in clinical practice. Materials required for training include one ultrasound device. A total of 227 infants (454 hips) were examined by one of the three second examiners and the experienced clinician (gold standard) to assess reliability. Of the 454 hips reviewed, there were 18 dislocations, 24 unstable hips, and 63 dysplastic hips, and the remainder had normal findings. The cohort was composed of a series of patients younger than 6 months referred to a specialty pediatric orthopaedic practice. Ultrasound-enhanced physical examination of the hip was easily taught, and the results were reliable among different levels of providers. The intraclass correlation coefficient between the gold-standard examiner and the other examiners for all hips was 0.915 (p = 0.001). When adjusting for only the binary outcome of normal versus abnormal hips, the intraclass correlation coefficient was 0.97 (p = 0.001). Thus, the agreement between learners and the experienced examiner was very high after learners completed the course. After a 2-hour course, physicians were able to understand and reliably examine neonatal children using ultrasound to assess for DDH. The success of the didactic approach outlined in this study supports the need for ultrasound-enhanced examination training for the diagnosis of DDH in orthopaedic surgery and pediatric residency core curriculums. Training programs would best be supported through established residency programs. Expansion of training more residents in the use of ultrasound-enhanced physical examinations would require a study to determine its efficacy. This finding highlights the need for further research in implementing ultrasound-enhanced physical examinations on a broader scale. Level II, diagnostic study.

INTER-RATER RELIABILITY OF THE PRONE APPREHENSION RELOCATION TEST (PART)

Background:Hip dysplasia and related instability can cause pain, limit hip function, and ultimately result in osteoarthritis. The Prone Apprehension Relocation Test (PART) augments existing radiographic markers and clinical provocative maneuvers in diagnosing hip dysplasia. Reproducibility of the PART between examiners has not been previously studied.Hypothesis/Purpose:One measure of the potential clinical utility of the PART depends on the reproducibility of test results by evaluating providers including physicians, licensed athletic trainers, and physical therapists. The purpose of this study is to determine the inter-rater reliability of the PART between health care professionals.Methods:We retrospectively identified patients in our institution’s hip preservation registry who presented between September 2017 and June 2019 for evaluation of hip pain. Patients included in the study had the PART performed by two health care professionals who were blinded to the other’s results. Inter-rater reliability was assessed using the Cohen 𝜅, with a value of 𝜅 ≥ 0.75 considered excellent inter-rater reliability, between 0.75 and 0.40 moderate, and ≤ 0.40 poor.Results:96 patients (190 hips) were included, with 63 females and 35 males, average age 32 ± 12.1 years. 23 hips had a positive PART from both examiners. Inter-rater reliability was excellent between health care professionals for the PART when evaluating the right hip (𝜅 = 0.80), left hip (𝜅 = 0.82), and when combining the results for left and right (𝜅 = 0.81). A sub-analysis of patients who had a positive PART from both raters demonstrated that 19 of the 23 hips had a lateral center edge angle > 25°.Conclusion:Our study demonstrates that the PART is a reliable physical exam maneuver in the evaluation of hip pain.

Study on Canine Hip Dysplasia and its Diagnosis by Imaging and Molecular Genetics Technique

The present paper is a bibliographical research on canine hip dysplasia using imaging and molecular genetics techniques. Ever since the first description in 1935 made by Schnelle, canine hip dysplasia has remained one of the most diagnosed orthopedic conditions present in the dog breeds. The gold standard method of diagnosis of hip dysplasia is the radiological examination in hip-extended position. While the radiological examination focuses mainly on the individual for the diagnosis of this condition, methods of diagnosis of an entire population are sought, and these methods are represented by molecular genetics techniques. Naming the etiology of canine hip dysplasia and finding out the latest methods of genetically and radiologically diagnosis of canine hip dysplasia and the best alternatives of treatment for this disease. Canine hip dysplasia continues to be a major problem for owners, breeders and veterinarians. Currently, there are five standardized systems worldwide that deal with the grading of canine hip dysplasia. In addition to digital radiology, CT and ultrasonographic examination are feasible diagnosis methods. Even if the standard method of diagnosis remains the radiological examination in the present, the near future provides to be of the molecular genetic techniques.

Does Patient-specific Functional Pelvic Tilt Affect Joint Contact Pressure in Hip Dysplasia? A Finite-element Analysis Study.

Although individual and postural variations in the physiologic pelvic tilt affect the acetabular orientation and coverage in patients with hip dysplasia, their effect on the mechanical environment in the hip has not been fully understood. Individual-specific, finite-element analyses that account for physiologic pelvic tilt may provide valuable insight into the contact mechanics of dysplastic hips, which can lead to further understanding of the pathogenesis and improved treatment of this patient population. We used finite-element analysis to ask whether there are differences between patients with hip dysplasia and patients without dysplasia in terms of (1) physiologic pelvic tilt, (2) the pelvic position and joint contact pressure, and (3) the morphologic factors associated with joint contact pressure. Between 2016 and 2019, 82 patients underwent pelvic osteotomy to treat hip dysplasia. Seventy patients with hip dysplasia (lateral center-edge angle ≥ 0° and < 20° on supine AP pelvic radiographs) were included. Patients with advanced osteoarthritis, femoral head deformity, prior hip or supine surgery, or poor-quality imaging were excluded. Thirty-two patients (32 hips) were eligible to this finite-element analysis study. For control groups, we reviewed 33 female volunteers without a history of hip disease. Individuals with frank or borderline hip dysplasia (lateral center-edge angle < 25°) or poor-quality imaging were excluded. Sixteen individuals (16 hips) were eligible as controls. Two board-certified orthopaedic surgeons measured sagittal pelvic tilt (the angle between the anterior pelvic plane and vertical axis: anterior pelvic plane [APP] angle) and acetabular version and coverage using pelvic radiographs and CT images. Intra- and interobserver reliabilities, evaluated using the kappa value and intraclass correlation coefficient, were good or excellent. We developed individual-specific, finite-element models using pelvic CT images, and performed nonlinear contact analysis to calculate the joint contact pressure on the acetabular cartilage during the single-leg stance with respect to three pelvic positions: standardized (anterior pelvic plane), supine, and standing. We compared physiologic pelvic tilt between patients with and without dysplasia using a t-test or the Wilcoxon rank sum test. A paired t-test or the Wilcoxon signed rank test with a Bonferroni correction was used to compare joint contact pressure between the three pelvic positions. We correlated joint contact pressure with morphologic parameters and pelvic tilt using the Pearson or the Spearman correlation coefficients. The APP angle in the supine and standing positions varied widely among individuals. It was greater in patients with hip dysplasia than in patients in the control group when in the standing position (3° ± 6° versus -2° ± 8°; mean difference 5° [95% CI 1° to 9°]; p = 0.02) but did not differ between the two groups when supine (8° ± 5° versus 5° ± 7°; mean difference 3° [95% CI 0° to 7°]; p = 0.06). The mean pelvic tilt was 6° ± 5° posteriorly when shifting from the supine to the standing position in patients with hip dysplasia. The median (range) maximum contact pressure was higher in dysplastic hips than in control individuals (in standing position; 7.3 megapascals [MPa] [4.1 to 14] versus 3.5 MPa [2.2 to 4.4]; difference of medians 3.8 MPa; p < 0.001). The median maximum contact pressure in the standing pelvic position was greater than that in the supine position in patients with hip dysplasia (7.3 MPa [4.1to 14] versus 5.8 MPa [3.5 to 12]; difference of medians 1.5 MPa; p < 0.001). Although the median maximum joint contact pressure in the standardized pelvic position did not differ from that in the standing position (7.4 MPa [4.3 to 15] versus 7.3 MPa [4.1 to 14]; difference of medians -0.1 MPa; p > 0.99), the difference in the maximum contact pressure varied from -3.3 MPa to 2.9 MPa, reflecting the wide range of APP angles (mean 3° ± 6° [-11° to 14°]) when standing. The maximum joint contact pressure in the standing position was negatively correlated with the standing APP angle (r = -0.46; p = 0.008) in patients with hip dysplasia. Based on our findings that individual and postural variations in the physiologic pelvic tilt affect joint contact pressure in the hip, future studies on the pathogenesis of hip dysplasia and joint preservation surgery should not only include the supine or standard pelvic position, but also they need to incorporate the effect of the patient-specific pelvic tilt in the standing position on the biomechanical environment of the hip. We recommend assessing postural change in sagittal pelvic tilt when diagnosing hip dysplasia and planning preservation hip surgery because assessment in a supine or standard pelvic position may overlook alterations in the hip's contact mechanics in the weightbearing positions. Further studies are needed to elucidate the effect of patient-specific functional pelvic tilt on the degeneration process of dysplastic hips, the acetabular reorientation maneuver, and the clinical result of joint preservation surgery.

Incidence of Hip Dysplasia Diagnosis in Young Patients With Hip Pain: A Geographic Population Cohort Analysis.

Background:Hip dysplasia is a common source of hip pain and a known cause of early osteoarthritis of the hip.Purpose:To (1) define the population-based incidence of hip dysplasia diagnosis in young patients presenting with hip pain in a large geographically defined cohort, (2) analyze trends regarding presentation and diagnosis of hip dysplasia, and (3) report the rate and type of surgical interventions used to treat this population.Study Design:Cross-sectional study; Level of evidence, 3.Methods:A geographic epidemiological database was queried to identify patients aged 14 to 50 years with hip pain between the years 2000 and 2016. Patient medical records were analyzed, and demographic, imaging, clinical, and treatment history were recorded. Incidence trends were examined by use of linear regression with confidence intervals for age and calendar year.Results:Overall, 1893 patients were included. Of these, 156 patients (196 hips) had a diagnosis of hip dysplasia. The incidence of hip dysplasia diagnosis in patients who reported hip pain was 12.7 per 100,000 person-years. Patients with dysplasia had a mean age of 26.7 ± 9.8 years, while the highest age-adjusted incidence occurred at age 14 to 18 years in both male and female patients. Female patients had double the age-adjusted incidence of male patients (cases per 100,000 person-years: 16.8 [95% CI, 13.9-19.7] vs 8.7 [95% CI, 6.6-10.8]; P < .01). Of the patients who underwent magnetic resonance imaging, 77% had imaging consistent with labral pathology. Patients were treated with physical therapy (67%), intra-articular steroid injection (29%), hip arthroscopy (10%), and periacetabular osteotomy (9%). The use of hip arthroscopy significantly increased over time (P < .01), whereas the use of steroid injection and periacetabular osteotomy did not (P < .28 and P < .08, respectively).Conclusion:The incidence of hip dysplasia diagnosis in patients presenting with hip pain was 12.7 per 100,000 person-years. Female patients had twice the age-adjusted incidence of male patients, and the highest age-adjusted incidence occurred in the age range of 14 to 18 years in both sexes. The use of hip arthroscopy to treat patients with hip dysplasia significantly increased over time.

Hallazgos artroscópicos de la cadera en pacientes con indicación de osteotomía periacetabular

BackgroundDysplasia of the hip in development (DHD) produces anatomical changes that cause premature arthrosis. Within the surgical procedures indicated, Ganz periacetabular osteotomy has been described. It is designed to improve the architecture of the hip that, by itself, does not improve the damage to the articular cartilage, as well as possible lessions of the labrum. The objective was to describe the arthroscopic findings found in hips with dysplasia and indication of Ganz periacetabular osteotomy. MethodCase series type observational retrospective study based on the review of surgical descriptions and videos of all cases with diagnosis of hip dysplasia and indication of Ganz periacetabular osteotomy where arthroscopy of the hip was performed prior to the osteotomy. ResultsHip arthroscopy showed intra-articular compromise of 76.9% of the cases studied (10 of 13). Six cases had compromise of the articular cartilage in the 2, 3 and 4 geographic zones. In addition, compromise of the chondrolabral joint was observed in 6 cases and damage at the labrum level was detected in 5 cases. In regard to the femoral head-neck offset, it was found to be reduced in 5 cases. In one of the cases periacetabular osteotomy was contraindicated due to the level of compromise of the articular cartilage. ConclusionsDHD is a clinical condition that is very frequently predisposed to damage of the articular structures; they can be treated with arthroscopy with the aim of avoiding persistence of sypmtoms after a periacetabluar osteotomy or even contraindicating it.Level of Evidence: IV.

Methods of diagnosis of hip dysplasia in dogs

To diagnose hip dysplasia, you can use a test system, the essence of which is to create a subhabitation in the hip joint of the dog, laid on the side, while there is a click in the joint, which means that the test is positive, while the pressure on the knee joint of the hip joint does not happen. The most common method of diagnosing dysplasia worldwide is X-ray, in which the age of the dogs studied should be more than a year, and large and giant breeds are studied in the range of one to one and a half years, with the animal laid on the back so that the X-ray image shows the pelvis with the wings of the iliac bone and femurs, including the knee joints, therefore, it is also necessary to use sedation, which allows you to comply with all the requirements for styling. The resulting X-rays are assessed according to the main Xray characteristics of the hip joint, taking measurements on six parameters presented in the text of this article, and determining the type of dysplasia. Computed tomography and magnetic resonance imaging can reveal the instability of the pathology in the hip joint and improve understanding of the disease process.

Evaluation of hip joint laxity in crab-eating foxes (Cerdocyon thous)

ABSTRACT: Like canids, crab-eating foxes may probably be predisposed to similar orthopedic diseases of domestic dogs, such as hip dysplasia. However, for the adequate hip dysplasia diagnosis in wild animals, the normality characteristics of each species must be determined. This study aimed to estimate radiographic and computed tomographic (CT) values of hip joint laxity in healthy crab-eating foxes. Fifteen intact crab-eating foxes, eight males and seven females, ages 1 to 5 and mean body mass of 6.66kg were used. Norberg angle (NA) was calculated from ventrodorsal hip-extended radiographs. To calculate the dorsolateral subluxation (DLS) score, the center distance (CD) index, the lateral center edge angle (LCEA), and the dorsal acetabular rim angle (DARA), measurements obtained from transverse CT images were used. No statistically significant differences were observed between the right and left sides in the radiographic and tomographic parameters. The mean NA was 107.57°. The mean DLS score, the CD index, the LCEA, and the DARA were 60.79%, 0.16, 98.25° and 13.47°, respectively. The data obtained are helpful in characterizing mean values of the hip joint in healthy crab-eating foxes, and can contribute to the knowledge of the species.

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.

Radiographic and clinical characteristics associated with a positive PART (Prone Apprehension Relocation Test): a new provocative exam to elicit hip instability.

Hip instability due to mild dysplasia can be a diagnostic challenge. The physical exam is an important adjunct to radiographic evaluation for the clinical diagnosis of hip instability. Herein, we describe a new maneuver to replicate hip instability pain, called the PART (Prone Apprehension Relocation Test). We retrospectively identified patients in our institution’s hip preservation registry who presented for evaluation of hip pain. We divided patients into ‘positive’ or ‘negative’ PART and analyzed associated clinical and radiographic findings. Ninety patients (159 hips) were included, 83 female and 7 male, average age 27.3 ± 9.1 years. Thirty-four hips (21.4%) had a positive PART. There were no significant differences in hip range of motion, lateral center edge angle, or in acetabular depth. There was, however, a significant difference in acetabular version at 3 o’clock between the two test groups (18.5 ± 6.9° in negative, 21.2 ± 4.9° in positive, P = 0.045). There was no association between PART and previously described anterior apprehension testing. Historical methods of diagnosing hip dysplasia may not adequately identify patients with clinical hip instability. We describe a new provocative exam, the PART, which may be helpful in replicating hip instability symptoms in patients with anterior acetabular undercoverage. PART positive patients had significantly more acetabular anteversion at the 3 o’clock position, which is measured on computed tomography and is not visible on standard anteroposterior (AP) pelvis or false profile radiographs. We believe that the PART is a valuable supplement to clinical examination and radiographic measurements to identify patients with symptomatic hip instability.

How to judge pelvic malposition when assessing acetabular index in children? Three simple parameters can determine acceptability

BackgroundThe acetabular index (AI) is the most commonly used parameter for diagnosing hip dysplasia. Pelvic malposition can result in misinterpretation of AI measurement especially in younger children. We aimed to investigate the correlation between pelvic orientation and acetabular index (AI) by using digital reconstructed radiographs (DRRs) and identify reliable parameters predictive of pelvic orientation on plain radiographs.MethodsWe retrospectively identified 33 children (52 hips) who received dual source CT examinations. Virtual pelvic models were reconstructed after scanning. After orientating in the standard neutral position, the models were rotated and tilted around corresponding axes. DRRs were generated at every 3° during the process. The acetabular index, the horizontal diameter (Dh) and vertical diameter (Dv) of bilateral obturator foramina, the vertical distance (h) between upper border of pubic symphysis, and Hilgenreiner’s line were measured on each DRR by two independent observers. Rotation index (Rr = right Dh/left Dh), tilt index (Rt = h/Dv), intra-observer error, and inter-observer error of AI were calculated.ResultsFor tilt and rotation up to 12.0°, AI increased with anterior tilt and decreased with posterior tilt. And for rotation, it increased on the side toward which the pelvis rotated and decreased on the opposite side. AI varied dramatically if angulation exceeded 6.0°. Malposition below this limit demonstrated the intra- and inter-observer errors were ± 2.0° and ± 3.0° respectively and caused no significant effect on AI measurement.ConclusionsFor children up to age 6 years, an acceptable pelvic plain radiograph can be determined when Rt is approximately between 0.9 and 1.4 and Rr between 0.7 and 1.5. For the first time, we have identified parameters derived from a group of subjects which can predict this degree of malposition. The parameters obturator diameters (Dh), obturator height (Dv), and distance (h) between symphysis and Hilgengreiner’s line can be feasibly measured on X-ray and employed in clinical practice to assess the acceptability of the pediatric pelvic radiograph prior to measurement of the AI.

Prevalence of Hip Dysplasia and Associated Conditions in Children Treated for Idiopathic Early-onset Scoliosis-Don't Just Look at the Spine.

Hip dysplasia, congenital muscular torticollis, plagiocephaly, and metatarsus adductus are known to be associated. The etiology of infantile idiopathic scoliosis and its association with the aforementioned conditions is unknown. This study reviews a series of infantile scoliosis patients to address this gap. The medical records of all patients treated with casting for early-onset scoliosis (EOS) from 2001 to 2016 were retrospectively reviewed. Inclusion criteria were a diagnosis of idiopathic EOS and age below 4 years at the time of the first cast. Demographic information, comorbid conditions, and radiographic measurements including Cobb angle and acetabular index (AI) were collected. The first acceptable anteroposterior pelvis radiograph for each patient was measured. An AI≥30 degrees was defined as hip dysplasia. A measurement between 25 and 30 degrees was defined as a "hip at risk." Between 2001 and 2016, 142 patients were treated with casting. Eighty-one patients met the inclusion criteria. The mean age at the first cast was 19.3 (±7.5) months and the mean Cobb angle was 53.6 (±18.8) degrees. There was no significant correlation between Cobb angle and AI. Nine patients met radiographic criteria for hip dysplasia (11.1%), only 4 of whom had been previously diagnosed. Thirty-six patients (44.4%) met the criteria of having at least 1 hip "at risk" of hip dysplasia. Ten patients (12.3%) had been diagnosed with torticollis and 13 patients (16.0%) with plagiocephaly. Three patients (3.7%) had been diagnosed with metatarsus adductus or clubfoot. In total, 30.9% of patients (25/81) had at least one of the above comorbid conditions. In a large group of children treated for idiopathic EOS, we found a high prevalence of commonly associated conditions-hip dysplasia, torticollis, plagiocephaly, metatarsus adductus, and clubfoot. In 6.2% of our sample, a diagnosis of hip dysplasia was not made in a timely manner despite routine radiographic spine follow-up. With increasing subspecialization within pediatric orthopaedics, surgeons need to maintain vigilance in assessing the entire child. Level IV.

THE MAIN MISTAKES IN SONOGRAPHIC EXAMINATION OF HIP JOINTS IN INFANTS UNDER ONE YEAR OF AGE

Developmental dysplasia of hip (DDH) remains one of the most common and severe congenital pathologies in infants. The best results of DDH treatment are observed in early-infancy up to 3 months. A sonographic examination was long recognized as a “golden standard” of early diagnosis of hip dysplasia, but some practitioners still do not trust this method through a certain number of pseudo-positive and pseudo-negative diagnoses. The aim: To carry out the quality analysis of sonographic examination of hip joints in infants under one year of age, to identify the main mistakes during the diagnosis and the causes of their occurrence; determine the dependence of the number of errors on the age of the examined child; suggest a method for assessing the quality of the received sonograms during the survey to reduce the number of false results. The sonographic images of the hip joints of 782 infants (1564 sonograms in total) aged 0.1–12 months were analyzed, who had been examined in Ortoclinic on the basis of Ternopil Town Clinical Hospital of Emergency Medical Care from 2016 to 2019. The ultrasound examination was performed according to a standard R. Graf technique.The comprehensive evaluation of each sonogram included the following parameters: a clear visualization of all the anatomical structures of the hip joint, the correctness of mutual spatial arrangement of the joint elements, the correct sonographic marking. 498 low-grade sonograms (31,84 %) were identified, which make impossible to objectively assess the degree of development of the joint. The basic causes of errors were found out – incorrect examination and incorrect estimation of the image. The use of special patterns was suggested, which helps to check the quality of the received image at once during the examination and to adjust it according to the standards.

Less Than Half of Pediatricians Educate Parents of Newborns on the Risks and Benefits of Swaddling

Background: Little is known about what counseling parents receive regarding safe swaddling practices and what training pediatricians are receiving. The purpose of this study is to determine what education parents of newborns are receiving on swaddling, and what training pediatricians are receiving. Methods: Parents of patients aged 0-12 months who presented to clinic for any evaluation without a diagnosis of hip dysplasia were administered an anonymous online survey. Parents were asked about their experiences …

Does Acetabular Coverage Vary Between the Supine and Standing Positions in Patients with Hip Dysplasia?

Although variation in physiologic pelvic tilt may affect acetabular version and coverage, postural change in pelvic tilt in patients with hip dysplasia who are candidates for hip preservation surgery has not been well characterized, and its clinical importance is unknown. The aim of this study was to determine (1) postural changes in sagittal pelvic tilt between the supine and standing positions; (2) postural changes in the acetabular orientation and coverage of the femoral head between the supine and standing positions; and (3) patient demographic and morphologic factors associated with sagittal pelvic tilt. Between 2009 and 2016, 102 patients underwent pelvic osteotomy to treat hip dysplasia. All patients had supine and standing AP pelvic radiographs and pelvic CT images taken during their preoperative examination. Ninety-five patients with hip dysplasia (lateral center-edge angle < 20°) younger than 60 years old were included. Patients with advanced osteoarthritis, other hip disease, prior hip or spine surgery, femoral head deformity, or inadequate imaging were excluded. Sixty-five patients (64%) were eligible for participation in this retrospective study. Two board-certified orthopaedic surgeons (TT and MF) investigated sagittal pelvic tilt, spinopelvic parameters, and acetabular version and coverage using pelvic radiographs and CT images. Intra- and interobserver reliabilities, evaluated using the intraclass correlation coefficient (0.90 to 0.98, 0.93 to 0.99, and 0.87 to 0.96, respectively), were excellent. Demographic data (age, gender, and BMI) were collected by medical record review. Sagittal pelvic tilt was quantified as the angle formed by the anterior pelvic plane and a z-axis (anterior pelvic plane angle). Using a 2D-3D matching technique, we measured the change in sagittal pelvic tilt, acetabular version, and three-dimensional coverage between the supine and standing positions. We correlated sagittal pelvic tilt with demographic and CT measurement parameters using Pearson's or Spearman's correlation coefficients. Although functional pelvic tilt varied widely among individuals, the pelvis of patients with hip dysplasia tilted posteriorly from the supine to the standing position (mean APP angle 8° ± 6° versus 2° ± 7°; mean difference -6°; 95% CI, -7° to -5°; range -17° to 4.1°; p < 0.001; paired t-test).The pelvis tilted more than 5° posteriorly from the supine to the standing position in 39 patients (60%), and the change was greater than 10° in 12 (18%). In the latter subgroup of patients, the mean acetabular anteversion angle increased (22° ± 5° versus 27° ±5°; mean difference 5°; 95% CI, 4°-6°; p < 0.001) and the mean anterosuperior acetabular sector angle notably deceased from the supine to the standing position (91° ± 11° versus 77° ± 14°; mean difference -14°; 95% CI, -17° to -11°; p < 0.001; paired t-test). Postural change in pelvic tilt was not associated with any of the studied demographic or morphologic parameters, including patient age, gender, BMI, and acetabular version and coverage. On average, the pelvis tilted posteriorly from the supine to the standing position in patients with hip dysplasia, resulting in increased acetabular version and decreased anterosuperior acetabular coverage in the standing position. Thus, assessment with a supine AP pelvic radiograph may overlook changes in acetabular version and coverage in weightbearing positions. We recommend assessing postural change in sagittal pelvic tilt when diagnosing hip dysplasia and planning hip preservation surgery. Further studies are needed to determine how postural changes in sagittal pelvic tilt affect the biomechanical environment of the hip and the clinical results of acetabular reorientation osteotomy. Level IV, diagnostic study.