Hip In Children Research Articles

Epidemiology and injury morphology of traumatic hip dislocations in children and adolescents in Germany: a multi-centre study.

Traumatic hip dislocations are very rare in childhood and adolescence. The aim of this multi-centre study is to analyse the current epidemiology and injury morphology of a large number of traumatic hip dislocations in children. This can provide a better understanding of childhood hip dislocations and contribute to the development of a therapeutic approach in order to prevent long-term impacts. This retrospective, anonymised multi-centre study included patients, aged up to 17years, with acute traumatic hip dislocations and open growth plates. The patients came from 16 German hospitals. Exclusion criteria included insufficient data, a positive history of hip dysplasia, or an association with syndromal, neurological or connective tissue diseases predisposing to hip dislocation. An analysis was carried out on the patients' anthropometric data and scans (X-ray, MRI, CT), which were collected between 1979 and 2021. Gender, age at the time of dislocation, associated fractures, mechanism of injury, initial treatment including time between dislocation and reduction, method of reduction, treatment algorithm following reduction and all documented complications and concomitant injuries were evaluated. Seventy-six patients met the inclusion criteria. There were two age peaks at 4-8years and 11-15years. There was an increased incidence of girls in the under-eight age group, who had mild trauma, and in the group of over-eights there were more boys, who had moderate and severe trauma. Dorsal dislocation occurred in 89.9% of cases. Mono-injuries dominated across all age groups. Concomitant injuries rarely occurred before the age of eight; however, they increased with increasing ossification of the acetabulum and appeared as avulsion injuries in 32% of 11-15-year-olds. Of the 76 patients, 4 underwent a spontaneous, 67 a closed and 5 a primary open reduction. A reduction was performed within 6h on 84% of the children; however, in around 10% of cases a reduction was not performed until after 24h. Concomitant injuries needing intervention were identified in 34 children following reduction. Complications included nerve irritation in the form of sensitivity disorders (n = 6) as well as avascular necrosis (AVN) of the femoral head in 15.8% of the patients (n = 12). Traumatic hip dislocations are rare in childhood and adolescence and have high complication rates. The most severe complication, femoral head necrosis, occurred in 16% of cases. Minor injuries, especially in younger children, are enough to cause a dislocation. Posterior dislocation was more frequent and primarily occurred as a mono-injury; however, concomitant injuries must be considered with increasing age. Children continue to experience delayed reductions. The length of time until reduction, age and the severity of the concomitant injury play a role in the development of femoral head necrosis; however, this topic requires additional investigation.

The Impact of Pelvic Osteotomies on Birth Canal Anatomy and Cesarean Section Rates: A Systematic Review

Background: Various pelvic osteotomies can be performed to improve femoral head coverage for patients with hip dysplasia and other childhood hip disorders with the goal of delaying or preventing osteoarthritis. During preoperative discussions, female patients and their parents often ask about the influence of these osteotomies on future pregnancy. The literature on this topic is varied with no consensus on the appropriateness of elective cesarean section (C-section) for such patients. Therefore, this study sought to review and summarize the literature regarding the impact of different pelvic osteotomies on birth canal anatomy and C-section rates.Methods: All studies assessing the impact of pelvic osteotomies on birth canal anatomy or pregnancy outcomes for patients were identified through a systematic search of four online databases (PubMed, Embase, CINAHL, and Cochrane Library). PRISMA guidelines were then used to evaluate all identified studies for appropriateness, leading to the final inclusion of 17 articles evaluating five general types of pelvic osteotomies.Results: The Salter, double, and triple osteotomies were found to decrease the size of the pelvic outlet in modelbased and radiographic studies. The Chiari osteotomy decreased the dimensions of the pelvic inlet/mid-pelvis and was associated with higher reported C-section rates. The Bernese periacetabular osteotomy was not associated with any changes in pelvic diameters, with reported increased rates of C-section noted to result from obstetrician preference. For osteotomies performed prior to skeletal maturity, resulting pelvic deformities largely remodeled with growth.Discussion: Pelvic osteotomies can alter normal pelvic parameters and may influence the ability for vaginal delivery. Obstetricians may recommend C-section for patients undergoing non-PAO osteotomies depending on skeletal maturity status at the time of their osteotomy and other obstetric-related factors such as fetal size and natural pelvic relaxation. The literature on this subject, however, remains limited.Levels of Evidence: Level IVKey Concepts•Pelvic osteotomies for residual hip dysplasia or other childhood hip disorders alter normal pelvic parameters that may preclude the possibility of vaginal birth, particularly when performed after skeletal maturity.•The Chiari osteotomy primarily alters the dimensions of the pelvic inlet and mid-pelvis, while the Salter, double, and triple osteotomies decrease the size of the pelvic outlet.•The Bernese periacetabular osteotomy does not influence bony birth canal anatomy.•Pelvic deformities resulting from pelvic osteotomies performed before skeletal maturity often remodel with growth.•Obstetricians may recommend cesarean section after pelvic osteotomy, particularly when performed bilaterally, dependent on obstetric-specific factors.

The choice of pelvic osteotomy technique in young children with hip dysplasia

BACKGROUND: The choice of pelvic osteotomy in young children with late diagnosis of hip dysplasia most often depends on the experience and preferences of the surgeon, and the diagnosis of the degree of violation of the ratios is based on the generally accepted classification of hip dysplasia without considering possible variants of the deformation of the acetabulum. We hypothesized that the choice of the pelvic osteotomy technique in the surgical treatment of children with hip dysplasia of varying severity should be based on the variant of acetabulum deformation and the corrective capabilities of pelvic osteotomy.
 AIM: This study aimed to compare and analyze the results of the surgical treatment of children with hip dysplasia of varying severity and to evaluate the effectiveness of the proposed differentiated approach to the choice of the pelvic osteotomy technique.
 MATERIALS AND METHODS: The study included 150 patients (150 hip joints) aged 24 years (3.1 0.45) with grade IIIV hip dysplasia, according to the supplemented classification of Tnnis. Depending on the verified variant of acetabulum deformity and taking into account the corrective capabilities of various osteotomies, we divided the patients into three groups. All patients underwent conventional clinical and X-ray examinations. During radiometry, the following indicators were evaluated: acetabular index (AI), Wiberg angle, neckshaft angle (NSA), anteversion angle of the proximal femur, degree of bone coverage, acetabulum depth (AD) and pelvic height, length of the acetabular arch (LAA), and presence or absence of a bone oriel (BO).
 RESULTS: In the comparative analysis of the radiographic anatomical condition of the hip joint in children with hip dysplasia of varying severity, the differentiated use of the modified Salter pelvic osteotomy without autograft and pericapsular acetabuloplasty according to Pemberton and Pembersal surgery led to adequate correction of various variants of congenital acetabular deformity with approximately normal anatomy of the acetabulum and not lead to significant deformation of the hemipelvis, such as elongation.
 CONCLUSIONS: The results of the surgical treatment of young children with hip dysplasia of varying severity according to the proposed differentiated approach to the choice of the pelvic osteotomy technique, which is based on the variant of acetabulum deformation, indicate the achievement of adequate correction of congenital deformity of the acetabular component of the joint with the restoration of its anatomical structure and avoidance of secondary deformation of the hemipelvis. The effectiveness of the proposed approach to the choice of pelvic osteotomy technique in the treatment of young children with hip dysplasia of varying severity is confirmed by the changes in AI, Wiberg angle, AD, and PH, whose values became close to the individual norm (p 0.05), and reduction of possible secondary deformities.

Konačan ishod u lečenju Leg-Kalve-Pertesove bolesti koristeći kombinaciju ilizarovog metoda i tunelizacije - prikaz slučaja

Introduction: Legg-Calve-Perthes disease (LCPD) is a common childhood hip disease, affecting approximately 0.8 in 100,000 children. It usually affects children between 4 and 8 years old, and boys are more affected than girls. One hip is initially affected, but bilateral localization is present in 9-15 of the cases. The primary treatment in LCPD focuses on containing the femoral head in the acetabulum, thus preventing mollification and fragmentation. The most common surgical treatment method consists of either femoral or pelvic osteotomy or a combination of both. This paper aims to present a minimally invasive alternative method for treating LCPD. Case report: We are presenting a case report of a 19-year-old with a lengthy history of illness. His treatment started at the age of 5, and this is an update on his condition 14 years after the surgery. Conclusion: Hip arthrodiastasis using the Ilizarov circular frame combined with femoral head and neck tunneling is a minimally invasive surgical procedure. From a technical standpoint, this is a relatively demanding procedure that results in shorter in-patient treatment, reduced risk of complications, and cost compared to pelvic and femoral osteotomy.

Acetabular, Femoral, and Combined Anteversion in a Province in South Korea: Computed Tomography-Based Study.

The purpose of this study was to investigate the femoral, acetabular, and combined anteversion of the hip joint in South Koreans using computed tomography (CT). We measured anteversion using CT venograms taken from 2016 to 2020. Of the total 1,073 patients, 952 patients were included in the study except for those with pelvic fractures, previous femoral fractures, childhood hip joint disease, osteoarthritis, or hip dysplasia (lateral center-edge angle, < 20), foreigners, and hip and knee replacement patients. Measurements were taken twice by two orthopedic surgeons. The femoral anteversion in women was 10.64° ± 10.26° (≤ 49 years), 15.75° ± 9.40° (50-59 years), 10.81° ± 9.14° (60-69 years), 12.38° ± 8.55° (70-79 years), and 11.23° ± 8.44° (≥ 80 years). The femoral anteversion in men was 12.02° ± 11.38° (≤ 49 years), 10.62° ± 9.11° (50-59 years), 6.09° ± 9.95° (60-69 years), 6.57° ± 9.51° (70-79 years), and 5.53° ± 9.29° (≥ 80 years). The acetabular anteversion in women was 17.65° ± 6.58° (≤ 49 years), 19.24° ± 6.42° (50-59 years), 20.30° ± 6.25° (60-69 years), 22.38° ± 7.36° (70-79 years), and 23.34° ± 6.98° (≥ 80 years). The acetabular anteversion in men was 15.21° ± 8.14° (≤ 49 years), 17.68° ± 6.00° (50-59 years), 17.54° ± 5.93° (60-69 years), 18.68° ± 6.62° (70-79 years), and 18.19° ± 6.94° (≥ 80 years). The combined anteversion in women was 28.29° ± 14.30° (≤ 49 years), 34.99° ± 10.62° (50-59 years), 31.11° ± 11.52° (60-69 years), 34.76° ± 10.86° (70-79 years), and 34.57° ± 11.45° (≥ 80 years). The combined anteversion in men was 27.23° ± 15.11° (≤ 49 years), 28.30° ± 11.23° (50-59 years), 23.63° ± 11.77° (60-69 years), 25.25° ± 12.02° (70-79 years), and 23.72° ± 11.88° (≥ 80 years). Femoral anteversion tended to decrease with age in men and acetabular anteversion tended to increase in both men and women. Combined anteversion showed a tendency to increase slightly in women.

Evaluation of radiological indices of the spine and pelvis ratios in children with a severe form of slipped capital femoral epiphysis

BACKGROUND: Slipped capital femoral epiphysis is one of the most severe diseases of the hip joint in children and is characterized by the displacement of the proximal femoral epiphysis, occurring as a result of a decrease in the mechanical strength of its growth plate. Some pathological processes in the hip joints and lumbosacral spine cause changes in the position (vergence) of the pelvis in the sagittal plane and the development of degenerative dystrophic diseases. The analysis of the spinepelvis relationships in children with slipped capital femoral epiphysis may provide the basis for the development of new approaches to the surgical correction of the deformity of the hip component of the affected joint.&#x0D; AIM: To assess the radiological parameters of the frontal and sagittal spinepelvis relations in children with proximal femur deformity in slipped capital femoral epiphysis.&#x0D; MATERIALS AND METHODS: The study included 30 patients (30 hips) aged 1114 years with a severe form of slipped capital femoral epiphysis characterized by the presence of a posterior displacement of the epiphysis of 60 combined with the downward displacement of no more than 10 in one of the joints and absence of displacement (pre-slip stage) in the other. Patients underwent clinical and radiological examinations. The radiographs taken in the standing position were used to assess the values of thoracic kyphosis and lumbar lordosis, pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), sagittal vertical axis (SVA), and spinesacral angle (SSA). The obtained data were subjected to statistical processing.&#x0D; RESULTS: The patients had pelvic retroversion (decreased values of the PI and SS indices and increased PT index) and formed hypolordotic type of vertical posture according to P. Roussouly classification. In addition, thoracic hyperkyphosis occurred, and the SVA shifted to the front, which can be considered a mechanism of trunk balance compensation for the existing pelvic retroversion and reduction of lumbar lordosis to maintain the ability to move in an upright position.&#x0D; CONCLUSIONS: Children with this severe form of slipped capital femoral epiphysis are characterized by pelvic retroversion, decreased lumbar lordosis and increased thoracic kyphosis, positive trunk imbalance, and PT toward the affected limb. Planning and reconstructive restorative interventions on the affected hip joint should consider existing pathological changes to restore the correct spinepelvis relationships and prevent degenerative dystrophic processes in the lumbosacral spine.

Salter Innominate Osteotomy for The Management of Developmental Dysplasia of The Hip in Children: Radiographic Analysis.

There are a variety of described osteotomies to address acetabular dysplasia in children with Developmental Dysplasia of The Hip (DDH). This study will analyze the radiographic outcome of cases diagnosed with DDH and treated with a Salter innominate osteotomy. A retrospective review of all patients who underwent Salter innominate osteotomy between January 2017 and January 2019 at our institution was performed. 48 procedures (44 patients were evaluated for acetabular index (AI) and center edge angle (CEA) based on the preoperative, immediate postoperative, and the most recent pelvic x-ray. 48 procedures (44 patients) were radiologically evaluated. The AI improved from 34° preoperatively to 19.9° on the final follow up radiograph and the CEA improved from -2.4° preoperatively to 24.6° on the final follow up radiograph. In our hands, use of Salter innominate osteotomy for acetabular dysplasia in patients with DDH was associated with good radiological outcomes. The Salter innominate osteotomy was able to improve lateral acetabular coverage of the hip to almost near-normal radiographic values. Therapeutic IV.

Caregiver Experiences Using Orthotic Treatment Options for Developmental Dysplasia of the Hip in Children.

Developmental dysplasia of the hip (DDH) is a common condition affecting 5 in 1000 newborns. The standard first line of treatment is the use of an orthotic, which has generally high success rates, but can pose substantial difficulties and put undue burden on caregivers. The general experience of caregivers using these orthotics has not been well documented on an orthotic-specific basis. The purpose of this study was to investigate caregiver experience using prescribed DDH orthotics to identify challenges, differences between treatment options, and areas of improvement. A survey assessing treatment prescription, respondent demographics, and caregiver experience was distributed online to caregivers whose child/children were treated for DDH with an orthotic. Seven-point positively phrased Likert scale statements and open-ended questions were included to assess caregiver experience. The results were analyzed using summary statistics and orthotics with more than 30 responses were selected for more in-depth analysis. A total of 530 survey responses were collected with 63% (334/530) of respondents using a Pavlik harness, 45% (236/530) a Rhino brace, and 13% (67/530) a Denis Browne Bar. The overall weighted average score across all Likert Scale statements was positive for the Pavlik harness, Rhino brace, and Denis Browne Bar at 4.19 (95% CI, 3.83 to 4.54), 4.63 (95% CI, 4.27 to 4.99) and 4.91 (95% CI, 4.58 to 5.24), respectively. In the open-ended responses, all 3 orthotics were perceived as easy to use and not hindering child-caregiver bonding, but raised concerns of discomfort and skin irritation, as well as preventing the ability to cuddle their child the way they desired. The Pavlik harness respondents consistently brought up concerns regarding cleanability. The results show that the DDH orthotics analyzed are generally easy to use and perceived positively by caregivers, but have orthotic-specific challenges that should be a focus of future improvement work. This study evaluated opinions and attitudes of caregivers for children being treated with DDH orthotics, revealing experiences, concerns, and challenges associated with the use of commonly prescribed options.

How are adults who had Perthes' disease functioning? : results of over 900 participants from an international web-based survey.

Perthes' disease (PD) is a childhood hip disorder that can affect the quality of life in adulthood due to femoral head deformity and osteoarthritis. There is very little data on how PD patients function as adults, especially from the patients' perspective. The purpose of this study was to collect treatment history, demographic details, the University of California, Los Angeles activity score (UCLA), the 36-Item Short Form survey (SF-36) score, and the Hip disability and Osteoarthritis Outcome score (HOOS) of adults who had PD using a web-based survey method and to compare their outcomes to the outcomes from an age- and sex-matched normative population. The English REDCap-based survey was made available on a PD study group website. The survey included childhood and adult PD history, UCLA, SF-36, and HOOS. Of the 1,182 participants who completed the survey, the 921 participants who did not have a total hip arthroplasty are the focus of this study. The mean age at survey was 38 years (SD 12) and the mean duration from age at PD onset to survey participation was 30.8 years (SD 12.6). In comparison to a normative population, the PD participants had significantly lower HOOS scores across all five scales (p < 0.001) for all age groups. Similarly, SF-36 scores of the participants were significantly lower (p < 0.001) for all scales except for age groups > 55 years. Overall, females, obese participants, those who reported no treatment in childhood, and those with age of onset > 11 years had significantly worse SF-36 and HOOS scores. Pairwise correlations showed a strong positive correlation within HOOS scales and between HOOS scales and SF-36 scales, indicating construct validity. Adult PD participants had significantly worse pain, physical, mental, and social health than an age- and sex-matched normative cohort. The study reveals a significant burden of disease on the adult participants of the survey, especially females.Cite this article: Bone Joint J2022;104-B(12):1304-1312.

HIP ANKYLOSIS AS SEQUELAE OF CHILDHOOD HIP PATHOLOGY TREATED WITH TOTAL HIP ARTHROPLASTY: REPORT OF TWO CASES

Total hip arthroplasty (THA) is an emerging surgery in the field of orthopedics with a successful outcome in treating various problems of the hip joint. THA in hip ankylosis is a challenging procedure. Comprehensive pre-operative planning is needed to avoid complications and obtain reasonable functional outcomes. Complete history taking is needed to determine the etiology, indications, type of ankylosis (spontaneous or surgical), age since ankylosis occurred, and previous complications. Physical examination is also important and is focused on the location of the previous incision, limb length discrepancy (LLD), femoral and sciatic nerves, vascular status, pelvic obliquity, spine problems, and range of motion of the ipsilateral knee, and also of contralateral hip and knee. In addition, surgery rehabilitation also becomes one of the important points to get a good clinical outcome. We reported the results of total hip arthroplasty to treat hip ankylosis as sequelae of childhood hip pathology.

Does Flexion Varus Osteotomy Improve Radiographic Findings Compared With Patients Treated in a Brace for Late-onset Legg-Calvé-Perthes Disease?

Does Flexion Varus Osteotomy Improve Radiographic Findings Compared With Patients Treated in a Brace for Late-onset Legg-Calvé-Perthes Disease?

Splinting for the non-operative management of developmental dysplasia of the hip (DDH) in children under six months of age.

Splinting for the non-operative management of developmental dysplasia of the hip (DDH) in children under six months of age.

Children's Hip Predictive (CHiP) Score: A Triage Tool for Hip Dislocation in Children Referred With Suspected Hip Dysplasia.

A fundamental tenent of treating developmental dysplasia of the hip is to identify patients with dislocated hips early so as to avoid the long-term sequelae of late diagnosis. The aim of this study was to develop a readily useable triage tool for patients with suspected hip dislocation, based on the clinical history and examination findings of the referring practitioner. All primary care referrals (n=934) over a 3-year period for suspected developmental dysplasia of the hip to a tertiary pediatric center were evaluated. Defined parameters with respect to history and clinical examination were evaluated. Multivariable logistic regression was used to establish predictors of hip dislocation, and from this a predictive model was derived which incorporated significant predictors of dislocation. An illustrative nomogram translated this predictive model into a usable numerical scoring system called the Children's Hip Prediction score, which estimates probability of hip dislocation. There were 97 dislocated hips in 85 patients. The final predictive model included age, sex, family history, breech, gait concerns, decreased abduction, leg length discrepancy, and medical/neurological syndrome. The area under receiver operating curve for the model is 0.761. A Children's Hip Prediction score of≥5 corresponds to a sensitivity of 76.3% and a score of≥15 has a specificity of 97.8%, corresponding to an odds ratio of 27.3 for increased risk of dislocation. We found that a novel clinical prediction score, based on readily available history and examination parameters strongly predicted risk of dislocations in hip dysplasia referral. It is hoped that this tool could be utilized to optimize resource allocation and may be of particular benefit in less well-resourced health care systems. Level II.

Analysis of X-ray parameters of the acetabulum in patients with cerebral palsy

BACKGROUND: Among the orthopedic consequences of cerebral palsy, instability of the hip joints is one of the most common. Most children with cerebral palsy at birth have close to normal relationships in their hip joints that gradually deteriorates. Progressive instability of the hip joint leads to subluxation and then dislocation of the hip, to a decrease in the range of motion in the joints, to movement disorders and a defect in the ability to sit, as well as an impairment in hygienic care of the child.&#x0D; AIM: To analyze the X-ray anatomical structure of the acetabulum in unstable hip joint in children with cerebral palsy.&#x0D; MATERIALS AND METHODS: We examined 42 hip joints in 23 patients with cerebral palsy. Participants were divided into two groups. The main group included the results of the examination of unstable hip joints (31 studies), and the control group included the results of the examination of stable joints (11 studies).&#x0D; RESULTS: The average index of anteversion of the acetabulum in the main group with a functioning Y-shaped cartilage was 2.5 more than the average value of the norm (p = 0.029), with a nonfunctioning Y-shaped cartilage at 6 less than the normal value (p = 0.017). There was a positive moderate correlation between the anteversion of the acetabulum and the anterior margin angle (r = 0.424, p = 0.017), and a positive moderate correlation between the acetabular index and the anterior margin angle (r = 0.398, p = 0.027).&#x0D; CONCLUSIONS: The study showed that changes in the acetabulum in patients with pathological dislocation or subluxation of the hip against the background of spastic cerebral palsy were manifested by deformation in the horizontal plane due to retroversion of the acetabulum.

Retrospective Comparison of Outcomes Between Closed and Open Reduction for Developmental Dysplasia of the Hip in Children Aged 6-24Months.

We aimed to compare the outcomes between closed reduction (CR) and open reduction (OR) in children aged 6-24months with developmental dysplasia of the hip (DDH) who could be reduced safely and stably by the closed reduction operation. We retrospectively reviewed the medical records of 77 patients who underwent CR or OR for DDH. Fifty-one patients (56 hips) underwent CR, 26 (29 hips) underwent OR. The demographic data, International Hip Dysplasia Institute classification and acetabular index (AI) before reduction and the centre-edge angle (CEA), AI, Alsberg angle (AA), Reimer's migration index (RMI), and height-to-width index (HWI) of the epiphysis were compared between two groups at the final follow-up. The percentage of coxa magna > 15% of the normal side and AA > 81° were calculated. At the final follow-up, the mean AA in the CR and OR groups were 77.66° (60°-89°) and 81.97° (73°-91°) (p = 0.001), respectively, there were 32.14% and 58.62% of the hips with an AA > 81° (p = 0.019). The frequency of coxa magna > 15% of the normal side was higher in the OR group (60.9%) than in the CR group (6.5%) (p < 0.001). There was no difference in the improvement of AI, CEA, HWI, and RMI. In children aged 6-24months with DDH, if a stable and safe CR can be obtained but with medial joint space up to 6mm, CR should be attempted first.

Children's hip discomfort from the uncommon etiology of van neck-odelberg illness

Children's hip discomfort from the uncommon etiology of van neck-odelberg illness

Editorial: Proceedings of the Hip Society: A Hip Society-Journal of Arthroplasty Collaborative Partnership!

It is a distinct privilege for the Journal of Arthroplasty to be awarded the opportunity to publish the Proceedings of The Hip Society going forward. The Hip Society was founded in 1968 by Dr Frank Stinchfield of New York with 21 founding members throughout North America who devoted their time to research studies aimed at understanding both disease processes and patient care through medical and surgical management of the arthritic hip to include the secondary causes from childhood hip disease. The goal was to have membership based on a proven ability to perform research, teach, and demonstrate exceptional skills as a clinician and surgeon.

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

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

Acetabular plasty assisted by 3D printing for the treatment of dislocation of hip joint in children with cerebral palsy

To identify types of acetabular dysplasia, select the most suitable acetabular plasty, and analyze indications and efficacy of three types of acetabular plasty in treating dislocation of hip joint in children with cerebral palsy by 3D printing technology. From July 2019 to December 2019, 7 children with cerebral palsy with hip dislocation were treated with acetabular plasty assisted by 3D printing technology, including 3 males and 4 females, aged from 3 from 8 years old;3 patients on the left side, 2 patients on the right side, and 2 patients on both sides. Subluxation of hip joint occurred in 2 patients and dislocation of hip joint occurred in 5 patients. Preoperative full-length CT scan of pelvis and femur was performed in all children. The types of acetabular dysplasia were determined by 3D printing reconstruction technology, and the results were presented as follows:2 anterior hips, 2 anterior outer hips, 1 outer upper hip, 2 posterior hips, 1 posterior outer hip, and 1 hip without dysplasia(with no acetabular plasty). Pemberton, Dega and San Diego surgery simulations were performed on the 8 hips respectively to find the most suitable and the suitable operations were then conducted. Migration percentage (MP), acetabular index (AI) and cenal-edge angle (CEA), Shenton line, and gross motor function classification system(GMFCS) between preoperative and last follow-up were compared and complications were recorded. The wound healed well after operation and no complication occurred. Seven patients were followed up for 18 to 24 months. The 8 hips were underwent soft tissue release for the first stage+proximal femoral varus and rotation reduction osteotomy+hip reduction+acetabular plasty;1 hip was underwent soft tissue release for the first stage+proximal femoral varus removal and rotation reduction osteotomy +hip reduction. MP decreased from 58% to 100% preoperatively to 0 to 17.9% at the latest follow-up. AI decreased from 25.0° to 47.6° preoperatively to 11.1° to 25.3° at the latest follow-up. CEA increased from 0° preoperatively to 21.1° to 48.5° at the latest follow-up. Shenton's lines changed from interrupted ones to continuous ones. The GMFCS grade of 5 cases decreased by 1 grade, and 2 cases showed no change. There is diversity for the hip dislocation of hip in children with cerebral palsy of acetabular dysplasia present type. Accurate judgments could be made with the help of 3D printing reconstruction techniques. There are differences between scopes of applications for three kinds of acetabulum keratoplasty. 3D printing technology could be helpful to choose the most suitable operation method and estimate the treatment effect. Thus the individualized and accurate treatment for hip dislocation in children with cerebral palsy can be gained with 3D printing technology.

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.