Hip Patients Research Articles

THE EVALUATION OF TOTAL HIP ARTHROPLASTY IN THE MANAGEMENT OF SPASTIC PAINFUL HIP DISLOCATION IN CEREBRAL PALSY

Spasticity used to be considered a contraindication for total hip replacement (THR) procedures. Due to the development of implants as well as surgical skills, THR became an option for the treatment of painful dislocation of the hip joint in patients with spastic plegia. The aim of this study was an evaluation of mid-term results of THR in spastic CP adolescent patients with painful hips with hip joint subluxation or dislocation.In 2014–2022, 18 pts (19 hips) with CP aged 16 to 20 years underwent THR in our department. The mean follow-up was 4 years (range: 1 – 9 years). Results were evaluated using the Gross Motor Function Scale, VAS scale in accordance with the Ashworth scale, types of implants used (dual mobility cup and not dual mobility cup), and radiological assessment (Crowe scale). Complications have been thoroughly analyzed.In 10 pts there has been an improvement in the GMFSC scale average from 1 to 2 points observed after the surgery. All pts have improved in the VAS scale average of 8 points (from 10 to 7). According to the Crowe scale repositioning of preoperative dislocation to primary acetabulum was achieved in all cases. Complications occurred in 4 cases: dislocations of 2 THR with dual mobility cup and 2 THR with non-dual mobility cup requiring revision surgery with good final result. No statistical significance was noted according to the type of cup (Mann-Whitney U Test).The most important risk factor for complications is severe spasticity. We believe, that CP pts with painful hips should be treated using THR. We didn't observe any significant differences between the types of implants.These findings may serve as a basis for the prediction of outcomes of THR treatment in this specific group of pts.Level of evidence: Case-control or retrospective comparative study-Level III

DOES TOTAL HIP ARTHROPLASTY BENEFIT PATIENTS WITH MINIMAL RADIOLOGICAL OSTEOARTHRITIS?

There is some evidence to suggest that outcomes of THA in patients with minimal radiographic osteoarthritis may not be associated with predictable outcomes. The aim of this study was to:Assess the outcome of patients with hip pain who underwent THA with no or minimal radiographic signs of osteoarthritis,Identify patient comorbidities and multiplanar imaging findings which are predictive of outcome,Compare the outcome in these patients to the expected outcome of THA in hip OA.A retrospective review of 107 hips (102 patients, 90F:12M, median age 40.6, IQR 35.1–45.8 years, range 18–73) were included for analysis. Plain radiographs were evaluated using the Tonnis grading scale of hip OA. Outcome measures were all-cause revision; iHOT12; EQ-5D; Oxford Hip Score; UCLA Activity Scale; and whether THA had resulted in the patient's hip pain and function being Better/Same/Worse.The median Oxford Hip Score was 33.3 (IQR 13.9, range 13–48), and 36/107 (33.6%) hips achieved an OHS≥42. There was no association between primary hip diagnosis and post-operative PROMs. A total of 91 of the 102 patients (89.2%, 93 hips) reported that their hip pain and function was Better than prior to THA and would have the surgery again, 7 patients (6.8%, 10 hips) felt the Same, and 4 patients (3.9%, 4 hips) felt Worse and would not have the surgery again.Younger patients undergoing total hip arthroplasty with no or minimal radiographic osteoarthritis had lower postoperative Oxford Hip Scores than the general population; though most felt symptomatically better and knowing what they know now, would have surgery again. Those with chronic pain syndrome or hypermobility were likely to benefit less. Those with subchondral cysts or joint space narrowing on CT imaging were more likely to achieve higher functional scores and satisfaction.

The Role of the Hip Capsule in Restoring Stability in the Initial Phase of Hip Distraction: An In Vivo Analysis

Background: The labral suction seal has been shown to provide the majority of resistance in the initial phase of hip distraction. However, the effect of an unrepaired interportal capsulotomy and capsular repair on the initial phase of hip distractive stability in vivo is not well understood. Purpose: To investigate the effect of capsular repair on the initial phase of distractive stability of hip joints in patients with femoroacetabular impingement (FAI) syndrome. Study Design: Controlled laboratory study. Methods: Patients undergoing primary hip arthroscopy for FAI between March and August 2020 were prospectively enrolled. Total joint space was measured on fluoroscopic images at the medial and lateral edges of the sourcil at 12.5-lb (5.7-kg) axial traction intervals (up to 100 lb [45.4 kg]) in 3 capsular states: (1) native capsule, (2) interportal capsulotomy, and (3) capsular repair. Distraction on anteroposterior radiographs was calculated as the difference between total joint space at each traction interval and baseline joint space at 0 lb, normalized to millimeters. The native, capsulotomy, and capsular repair states were compared using Wilcoxon signed-rank and McNemar tests. Results: Included were 36 hips in 35 patients. The median force required to distract ≥3 mm was 75 lb (34.0 kg; 95% CI, 70-80 lb [31.8-36.3 kg]) in both the native and capsular repair states ( P = .629), which was significantly greater than the median force required to distract ≥3 mm in the capsulotomy state (50 lb [22.7 kg]; 95% CI, 45-55 lb [20.4-24.9 kg]) ( P < .001). The most rapid rates of change in joint space were observed at the traction interval at which hips first achieved ≥3 mm of distraction (n = 33 hips; 92%). Conclusion: The traction force at which hips distracted ≥3 mm was 75 lb (34.0 kg) in both the native capsular and capsular repair states. Significantly less traction force (50 lb [22.7 kg]) distracted hips ≥3 mm in the capsulotomy state. Complete capsular closure after interportal capsulotomy resulted in restoration of initial distractive stability relative to the unrepaired capsulotomy state at time zero after primary hip arthroscopy. Clinical Relevance: This study provides surgeons with an improved understanding of the additional stability to the hip joint from capsular repair after hip arthroscopy for FAI syndrome.

The use of biologic therapy in patients with ankylosing spondylitis and coxitis: dynamics of clinical and laboratory parameters and structural progression

Hip joint inflammation (coxitis) occurs in almost half of patients with ankylosing spondylitis (AS) and often leads to early disability. A therapy for this condition has not yet been developed, although it is one of the indications for the initiation of biologic therapy in national recommendations. The review presents data from recent clinical trials on the use of biologics, focusing on the Russian national multicenter study of GO-COX in patients with AS with coxitis.Tumour necrosis factor-α inhibitors have been shown to be effective against inflammatory affection of the hip joint in patients with AS, and their administration over a two-year period inhibits the progression of coxitis.

Percutaneous pulsed radiofrequency ablation of articular nerves of the hip joint in patients with chronic hip pain refractory to conventional analgesics.

Total Hip Arthroplasty (THA) may be a risky proposition in patients with comorbidities, and they may require systemic analgesics for chronic hip pain (CHP). Since traditional pain medications may not provide complete pain relief or carry prohibitive adverse effects, pulsed radiofrequency (PRF) treatment of the hip articular nerves (HAN) has been proposed for effective clinical outcomes. We determined the efficacy of PRF-HAN in improvement in CHP compared to baseline pain on conventional systemic analgesics. Between August 2015 and December 2021, 31 adult patients with severe comorbid conditions and excruciating chronic hip pain were subjected to a PRF-HAN procedure following a diagnostic block. All 31 patients received PRF of the articular branches of the femoral and obturator nerves. Demographic parameters, numerical rating scale (NRS), Harris Hip Score (HHS), WOMAC scores, the change of these scores from baseline, and any adverse effects were recorded before treatment and on day 1, 1st week, 6 weeks, and 6 months after treatment. All the patients who underwent the PRF-HAN reported a significant improvement in NRS, HHS, and WOMAC scores compared to the baseline values on day 1, at the end of the 1st week, and the 6th week (p<0.001). No adverse events were documented in the study post-procedure until the end of 6 months. PRF-HAN is a strong alternative for chronic pain management and augments physical functioning and a return to daily activity in patients who would be deprived of arthroplasty considering associated comorbid conditions.

The Anatomic Position of the Sciatic Nerve During Percutaneous Retrograde Posterior Column Fixation is Determined by Hip Position.

There are multiple established patient positions for placement of a percutaneous retrograde posterior column screw for fixation of acetabulum fractures. The sciatic nerve is at risk of injury during this procedure, as it lies adjacent to the start point at the ischial tuberosity. The purpose of this study is to define how the position of the sciatic nerve, relative to the ischial tuberosity, changes with respect to the patient's hip position. In a cohort of 11 healthy volunteers, ultrasound was used to measure the absolute distance between the ischial tuberosity and the sciatic nerve. Measurements were made with the hip and knee flexed to 90 degrees to simulate supine and lateral positioning, and with the hip extended to simulate prone positioning. In both positions, the hip was kept in neutral abduction and neutral rotation. The distance from the lateral border of the ischial tuberosity to the medial border of the sciatic nerve was greater in all subjects in the hip flexed position versus the extended position. The mean distance was 17 mm (range, 14-27 mm) in the hip extended position, and 39 mm (range, 26-56 mm) in the hip flexed position (P < .001). The sciatic nerve demonstrates marked excursion away from the ischial tuberosity when the hip is flexed compared with when it is extended. The safest patient position for percutaneous placement of a retrograde posterior column screw is lateral or supine with the hip flexed to 90 degrees.

Change of Symptoms after Total Hip Arthroplasty in Patients with Hip-Spine Syndrome.

Elderly patients with degenerative diseases undergo treatment for the hip and spine; these patients present with various symptoms. This study focused on patients with residual symptoms, predominantly pain, even after receiving treatment for their spinal lesions. Patients who underwent total hip arthroplasty (THA) between 2016 and 2022 at a single tertiary hospital were included in the study. Of the 417 patients who underwent primary THA, a retrospective review of 40 patients with previous lesions of the spine was conducted. Patients were stratified to two cohorts: Patients with symptoms related to the spine (Group A), and those with hip-related symptoms (Group B). Pre- and postoperative comparisons of groups A and B were performed. Improvements in patients' symptoms were observed in groups A and B after THA. In Group A, the mean preoperative visual analog scale (VAS) score was 5.10±0.876, which showed a postoperative decrease to 2.70±1.767. In Group B, the mean preoperative VAS score was 5.10±1.539, which showed a postoperative decrease to 2.67±1.493. According to the findings, promising results were achieved with THA in treatment of debilitating diseases of the hip for both the prognosis of the disease, as well as the patients' symptoms. In addition, in some cases elderly patients with dual pathologies underwent treatment for spinal lesions without performance of any evaluation related to the hip. Thus, evaluation of a patient's hip must be performed and performance of THA in patients with symptoms even after treatment of spinal lesions is recommended.

Investigating sagittal spinopelvic alignment and equivalent stress on the femoral head in patients with rapidly destructive coxarthrosis.

Rapidly destructive coxarthrosis (RDC) is a rare syndrome of unknown etiology. This study evaluated sagittal spinopelvic alignment (SSPA) in patients with RDC and compared it with that in patients with hip osteoarthritis (HOA). In addition, finite element analysis (FEA) was performed to investigate the distribution of stress on the femoral head in RDC versus HOA. This retrospective study included patients who hadundergone primary total hip arthroplasty for RDC (n = 33) and HOA (n = 99; age- and sex-matched to patients with RDC) at three hospitals from June 2014 to September 2020. Preoperative SSPA parameters and inflammatory blood markers were compared between the two groups. FEA on the computed tomography data was performed for four patients from each group with similar pelvic tilt (PT) and lateral center-edge angle (LCEA). The distribution of Drucker-Prager equivalent stress was assessed at the loaded area of the femoral head. Patients with RDC had significantly higher PT, lower sacral slope, decreased lumbar lordosis (LL), higher sagittal vertical axis, and higher pelvic incidence minus LL than patients with HOA, indicating sagittal spinal imbalance. Blood test revealed patients with RDC had higher levels of inflammation markers than patients with HOA. FEA revealed no statistically significant difference in the degree of stress concentration or the maximum equivalent stress between the two groups when PT and LCEA were comparable. Patients with RDC tend to have sagittally imbalanced spine. Decreased acetabular coverage of the femoral head may heighten mechanical load of the hip joint in patients with RDC.

Optimization of surgical access in hip arthroplasty

Relevance. Total hip joint arthroplasty with a wide range of both classical and modifi ed approaches is a successful method of treating joint diseases in the fi nal stages. It should be noted that in recent years, there has been an increased interest among scientists — specialists in this fi eld — in developing and implementing new, more optimal approaches for primary and revision arthroplasty.Research objective: to determine the advantages and disadvantages of surgical approaches in arthroplasty of the hip joint in patients with dysplastic coxarthrosis.Material and methods. For this study, we observed 80 patients (18 men, 16 women) aged 45 to 60 years with dysplastic coxarthrosis of the hip joint who were undergoing treatment in the trauma and orthopedics department of the therapeutic surgical clinic of the Azerbaijan Medical University. The comparison group included 25 patients who underwent total hip joint arthroplasty from a posterior-lateral approach; 25 control group patients underwent surgery with a Harding approach, and 30 main group patients underwent surgery from the proposed modifi ed approach. All approaches were performed as indicated. Before and 6 and 12 months after arthroplasty, the WOMAC index, C-reactive protein level, and ESR in the blood were studied in patients.Results. In the control group, some positive dynamics of clinical and biochemical indicators were noted at 6 and 12 months, but their values did not diff er signifi cantly from those of the comparison group (p &gt; 0.05), but were signifi cantly higher than those of the main group (p &lt; 0.001). Analysis of arthroplasty outcomes revealed a higher percentage of positive clinical outcomes with a signifi cant reduction in WOMAC index values and a decrease in C-reactive protein and ESR levels when using minimally invasive surgical techniques. Thus, the anterior approach with low intraoperative trauma is more optimal for patients with dysplastic coxarthrosis, as it promotes faster functional recovery and causes fewer infl ammatory complications. The posterior-lateral approach, like the anterior one, is optimal, since the above indicators did not diff er signifi cantly from those of the anterior approach. With the lateral approach, due to a higher risk of wound infection, the recovery time and reduction of the infl ammatory reaction are longer.

Incidence and factors influencing neck shortening after screw fixation of femoral neck fractures with the femoral neck system

ObjectiveTo investigate the effects of postoperative femoral neck shortening in patients with femoral neck fractures fixed with femoral neck system screws (FNS) and to explore the factors influencing femoral neck shortening.MethodTo retrospectively analyze the data of 113 patients with femoral neck fractures admitted to the Second Hospital of Fuzhou City, affiliated with Xiamen University, between December 2019 and January 2022. Of these, 87 patients were followed up for more than 12 months, 49 men and 38 women: 36 cases of Garden I and II fractures and 51 cases of Garden III and IV fractures, to record the patient's hip Harris score at 12 months postoperatively. Patients were divided into femoral neck shortening group and femoral neck no shortening group according to their regular postoperative follow-up radiographic measurements. To count the incidence of femoral neck shortening, a comparison of postoperative complication rates and hip Harris scores between the two groups was made. Statistical comparison of the two groups and a multifactorial logistic regression analysis were also performed to analyze the factors affecting femoral neck shortening.ResultsAll 87 patients were followed up for more than 12 months after surgery. In 34 of these cases, neck shortening occurred, and the incidence rate was 39.1%. 15 cases of severe shortening, incidence of 17.2%; fracture healing 84 cases, fracture healing rate of 96.5%. The hip Harris score was 83.99 (81.95, 89.20) in the neck shortening group at 12 months postoperatively, 90.87 (87.95, 94.80) for the group without neck shortening; the difference between the two groups was statistically significant (P < 0.01). 32 cases of fracture healing in the neck shortening group at 12 months after surgery, fracture healing rate of 94.1%; 52 cases healed without neck shortening group, fracture healing rate of 98.1%. The difference between the two groups was not statistically significant (P = 0.337). High incidence of neck shortening after FNS fixation of femoral neck fractures, cortical comminution of the severed end, fracture fractionation and quality of reduction were significantly correlated with neck shortening.ConclusionHigh incidence of postoperative neck shortening after internal fixation of femoral neck fractures with the femoral neck system, the cortical comminution, the type of fracture, and the quality of fracture reduction are the influencing factors; femoral neck shortening can affect postoperative hip function, but does not affect fracture healing.

Survival and complications at a minimum 5 years’ follow-up of the modular Mark-2 Extreme™ cementless femoral stem: Does the reduced modularity resolve the mechanical issues of the Mark-I stem?

IntroductionThe Extreme™ modular stem was developed for implant revision with metaphyseal-diaphyseal defect. Due to the high breakage rate, a new “reduced modularity” design has been introduced, but without reported results. We therefore conducted a retrospective assessment of (1) overall stem survival, (2) functional results, (3) osseointegration, and (4) the rate of complications, and notably of mechanical failure. HypothesisReduced modularity reduces the risk of revision surgery for mechanical failure. Material and methodsForty-five prostheses were implanted between January 2007 and December 2010 in 42 patients with severe bone defect (Paprosky≥III) or periprosthetic shaft fracture. Mean age was 69.6years (range: 44–91years). Minimum follow-up was 5years, for a mean 115.4months (range: 60–156months). The main study endpoint was femoral stem survival, counting all-cause explantation as event. Functional assessment comprised subjective rating of satisfaction, Postel Merle d’Aubigné (PMA) and Harris Hip scores, and Forgotten Joint Score (FJS). Whether the revision assembly was carried out in situ, in the patient's hip, or outside, on the operating table, was not known in 2 cases; in the other 43, assembly was in situ in 15 cases (35%) and on the operating table in 28 (65%). ResultsFive-year stem survival was 75.7% (95% CI: 61.9–89.5%), taking all causes of change together. Seventeen patients (45.9%) had complications, 13 (35.1%) requiring revision surgery, including 10 (27.0%) for stem replacement. Five patients (13.5%) had steam breakage at the junction between the metaphysis and the diaphyseal stem, 4 of which occurred within 2 years of implantation or of fixation of a periprosthetic fracture. Mean preoperative Harris score was 48.4 [IQR (25–75% interquartile range): 37–58] and PMA score 11.1 (IQR: 10–12), compared to respectively 74 (IQR: 67–89) and 13.6 (IQR: 12.5–16) at follow-up. Mean FJS at follow-up was 71.5 (IQR: 61–94.5). In the 15 in situ assemblies, there were 3 breakages (20%), compared to 2 (7.1%) in the 28 table assemblies (p=0.21). DiscussionThe stem breakage rate was high despite the reduced modularity, which concentrated all stress on a single junction but without reducing the risk of mechanical failure. Surgical technique was faulty in some cases, with in situ assembly of the metaphysis after implanting the diaphyseal stem, which does not respect the manufacturer's recommendations. Level of evidenceIV; retrospective study.

Problems of physical rehabilitation of movement disorders in the pathology of the hip joint in patients with the consequences of a cerebral stroke

The purpose of the work was to analyze the experience of foreign specialists regarding movement and structural disorders of the proximal part of the femur in patients with the consequences of stroke and their impact on the effectiveness of rehabilitation programs for hip joint pathology. To fulfill the goal, an analysis of foreign literary sources was carried out in modern databases: Google Scholar, Web of Science, PubMed, Medline, Cochrane, Pedro. The search depth is 22 years (from January 2000 to October 2021). The analysis of literature sources indicated that limitation of motor activity and axial loads in patients after acute cerebrovascular accident, in particular limitation of mobility in the hip joint, impairment of muscle strength and tone due to hemiparesis can lead to the development of osteoporosis. Particularly important from the point of view of adverse consequences is a decrease in mineral density and fractures of the proximal part of the femur. On the other hand, disturbed biomechanics of movements in the hip joint in persons with the consequences of a cerebral stroke, under the condition of axial load on the limb, can lead to the development of osteoarthritis of the hip joint. Osteoarthritis results in limited mobility of the hip joint, which leads to secondary immobilization of the hip joint and, as a result, can also lead to further osteoporosis. Existing disorders of neuromuscular control, muscle tone and strength, limitation of mobility of the hip joint, including due to spasticity, problems with static and dynamic balance, and, as a result, an increased risk of falling in patients with the consequences of a stroke, can negatively affect the recovery of motor functions, activity limitation, and, as a result, reduce the effectiveness of rehabilitation of patients after hip joint replacement. Existing movement disorders, as a result of a stroke, require the development and justification of new rehabilitation programs, including the use of modern technical means and virtual reality.

Statistical shape modeling of the large acetabular defect in hip revision surgery.

The assessment of three-dimensional bony defects is important to inform the surgical planning of hip reconstruction. Mirroring of the contralateral side has been previously used to measure the hip center of rotation (CoR). However, the contralateral side may not be useful when diseased or replaced. Statistical Shape Models (SSMs) can aid reconstruction of patient anatomy. Previous studies have been limited to computational models only or small patient cohorts. We used SSM as a tool to help derive landmarks that are often absent in hip joints of patients with large acetabular defects. Our aim was to compare the reconstructed pelvis with patients who have previously undergone hip revision. This retrospective cohort study involved 38 patients with Paprosky type IIIB defects. An SSM was built on 50 healthy pelvises and used to virtually reconstruct the native pelvic morphology for all cases. The outcome measures were the difference in CoR for (1) SSM versus diseased hip, (2) SSM versus plan, and (3) SSM versus contralateral healthy hip. The median differences in CoR were 31.17 mm (interquartile range [IQR]: 43.80-19.87 mm), 8.53 mm (IQR: 12.76-5.74 mm), and 7.84 mm (IQR: 10.13-5.13 mm), respectively. No statistical difference (p > 0.05) was found between the SSM versus plan and the SSM versus contralateral CoRs. Our findings show that the SSM model can be used to reconstruct the absent bony landmarks of patients with significant lysis regardless of the defect severity, hence aiding the surgical planning of hip reconstruction and implant design.

Enema of Traditional Chinese Medicine for Patients with Severe Acute Pancreatitis.

Severe acute pancreatitis (SAP) is characterized by high mortality rates, numerous complications, and extreme difficulties in treatment. A traditional Chinese medicine (TCM) enema has been widely utilized in clinical and experimental studies of SAP. It has been demonstrated to have beneficial effects in protecting pancreatic function and delaying disease progression. The procedure of TCM enema is to perfuse the Chinese medicinal liquid of raw rhubarb (Rheum officinale Baill. DaHuang) from the anus into the rectum and colon. Basic steps of the procedure include boiling the herbal solution in advance, using a disposable enema kit to assist patients in taking a left lying position, raising the patient's hip 10 cm, and carefully inserting the enema 30-35 cm into the anus, with a drip speed of 60-80 drops/min. The medicine liquid temperature should be equivalent to the patient's body temperature, typically between 37-39 °C. The end of the enema operation should be slow, and Tui na (massage therapy) should be administered before extubation. The medication liquid should be kept in the rectum for more than 1 h. After issuing an enema, it is essential to observe the patient's feces and abdomen, and to evaluate the remission of abdominal signs and symptoms.

Clinical and Radiographic Dependences of Functional Status, Indices of the Hip Joint and Femur Migration in Patients With Cerebral Palsy

Relevance. Significant incidence of hip pathology in different groups of patients with cerebral palsy and factors that may affect its formation are relevant objects of the study. The goal of the study. To establish the features of the hip joint’s formation, examining the clinical and radiographic dependences of the functional status and indices of the hip joint in patients with cerebral palsy. Materials and methods. The total number of patients was 47 persons (86 joints). We conducted a clinical and radiographic examination of the hip joints using our own methods and standard anterior-posterior radiography, as well as a statistical analysis of hip parameters and factors that may have influenced their formation. Results. Correlation relationships have been established between hip parameters and factors that may affect them: Gross Motor Function Classification System (GMFCS), gait function, level of lesion, developmental dysplasia of the hip, and adductor myotomy in medical history. Conclusions. The Reimers’ index showed greater reliability compared to the Wiberg angle. Positioning of the patient’s body using our own method way can be used to screen the hip joints in cerebral palsy based upon the Reimers index while obtaining the true parameters of the femoral neck–shaft angle and torsion of the femur.

Mathematical Modeling of Indications for Reconstructive Surgery of the Hip Joints in Patients with Cerebral Palsy

Summary. Relevance. Early detection of hip pathology in patients with cerebral palsy is an effective way to prevent spastic hip dislocation.&#x0D; Objective: to improve the diagnosis of diseases of the hip joints in cerebral palsy through the clinical and radiographic screening based on mathematical modeling.&#x0D; Materials and Methods. The total number of patients was 47 (86 joints). We carried out a clinical and radiographometric examination of the hip joints with our own method and using standard anteroposterior radiographs, which were used to determine the parameters of the hip joint. Mathematical modeling of indications for reconstructive surgery using logistic regression was also performed.&#x0D; Results. The mathematical model “probability of indications for surgical interventions” was developed on the basis of the studied indicators and factors of influence.&#x0D; Conclusions. A mathematical model for screening of hip joints based on the acetabular angle (AA), neck-shaft angle (NSA), femoral torsion (FT), migration percentage (MP), gross motor function classification system (GMFCS) level, gait, and age is proposed; the accuracy of 90.6% is valid for establishing correct indications for surgery (the critical level of indicators is &gt;16.95 ̊ for AA, &gt;45 ̊ for FT, &gt; 141.63 ̊ for NSA, &gt;30 % for MP, and ≤11 years for age).

PB2212: VARIANT HAEMOGLOBIN ASSESSMENT AND CORRELATION WITH PHENOTYPIC PRESENTATION AT DIAGNOSIS IN SICKLE CELL DISEASE: A SINGLE CENTRE RETROSPECTIVE ANALYSIS OF CENTRAL GUJARAT COHORT

Background: Sickle cell disease (SCD) is caused by heritable point mutation at codon 6 of the human beta-globin gene widely distributed around the world. According to 2011 census, in India, there is a large tribal community of about 180 million. Among them18 million people carry the sickle cell trait and ~140,000 suffer from SCD. Gujarat State of India has a population of about 62 million, there are ~8.9 million tribal populations, among whom ~9, 00,000 people with Sickle cell Trait and ~70,000 people with SCD are expected. Though phenotypic heterogeneity of SCD is well known across the India, there is limited data on phenotypic presentation with variant haemoglobin correlation on large cohort from Central Gujarat. Aims: To correlate variant haemoglobin pattern with phenotypic presentation at diagnosis in SCD. Identify laboratory and clinical parameters to predict risk of complications in SCD. Methods: Five Hundred and seventy three patients registered at Haemato Oncology Care Centre (HOCC), Vadodara, Gujarat between August 2012 to December 2021, and diagnosed to have SCD were included in this study. This cohort represents tribal belt covering Bharuch,Narmada,Vadodara,Panchmahal,Dahod,Sabarkantha and Banaskantha districts of Central Gujarat. Diagnosis was based on clinical profile, complete blood counts (CBC) and peripheral smear evaluation along with variant haemoglobin assessment by High Performance Liquid chromatography / Capillary electrophoresis. Relevant Biochemistry investigations were done along with radiological assessment of hip joints in patients with specific symptoms.Osteonecrosis of Femur head (ONFH) was diagnosed according to Ficat and Arlet classification for ONFH. Recurrent Vaso occlusive episode(R-VOE) was labelled if there are >3 VOE/yr. Occasional VOE (O-VOE) labelled if <3 VOE/yr.Blood transfusion dependency was labelled if > 3 transfusion /yr required to maintain HB > 7 gm%.Splenomegaly was noted as palpable spleen below costal margin. Results: A total 573 SCD patients were evaluated. The median age was 20 years (range: 1-74) with 328 (57%) males and 245 (43%) females.HB was < 10 gm% in 378 (66%),HB <7 gm% in 78(14%),between7gm% to 10 gm% in 300(52.4%).315/378 (83%) had HBA <5%,Only 5/378 (1.32%)had Ferritin <20ng/ml.None had high indirect bilirubin with low HB. Transfusion dependency was found in 28(5%),HBA was 0%,<5%,6 to 10%,>10% in 12/28 (43%),7/28 (25%),6/28(21%),3/28(11%) respectively. R-VOE observed in 207 (36%),O-VOE in 259(45%),No VOE in 107(19%).Splenomegaly was found in 268(47%).HBF <10% in 86 (15%),10 to 20% in 258(45%)>20% in 229(40%).All Patients with no VOE 107(19%) had HBF >10% with palpable splenomegaly.ONFH was diagnosed on imaging in 108 (19%).101/108(93.5%) had HBF >10%.,25/108 (23%)had palpable splenomegaly. Summary/Conclusion: In our cohort High HBF with Splenomegaly was associated with no VOE. No protection for ONFH seen with high HBF or palpable spleen Regional increased prevalence of coinheritance of Thalassemia in SCD play important role in influencing clinical presentation and progression of complication like transfusion dependency and ONFH. In LMIC, Variant haemoglobin assessment with CBC, Retic count values can be used to predict probable coinheritance of Thalassemia; however DNA Mutation analysis on larger cohort can be done for validation. Region specific risk adapted optimization of treatment can modify natural history of disease

Clinical and Radiographic Dependences of Functional Status, Indices of the Hip Joint, and Femur Migration in Children with Cerebral Palsy

Relevance: Significant incidence of hip pathology in different groups of children with cerebral palsy and factors that may affect its formation are relevant objects of the study.&#x0D; The Goal of the Study: To establish the features of the hip joint’s formation, examining the clinical and radiographic dependences of the functional status and indices of the hip joint in patients with cerebral palsy.&#x0D; Materials and Methods: We conducted a clinical and radiographic examination of the hip joints using our own methods and standard anterior-posterior radiography, and statistical analysis of hip parameters and factors that may have influenced their formation. The total number of patients was 47 persons (86 joints).&#x0D; Results: Correlation relationships have been established between hip parameters and factors that may affect them: Gross Motor Function Classification System (GMFCS), gait function, level of lesion, developmental dysplasia of the hip, and adductor myotomy in medical history.&#x0D; Conclusions: The Reimers’ index showed greater reliability compared to the Wiberg angle. Positioning the patient's body using our own method can be used to screen the hip joints in cerebral palsy based upon the Reimers index while obtaining the true parameters of the femoral neck-shaft angle and torsion of the femur.

Morphological Analysis of Hip Joint of Patients Suffering From Recurrent Patella Dislocation.

The purpose was to investigate morphological changes of the hip joint in patients with recurrent dislocation of the patella combined with trochlear dysplasia. There was a retrospective analysis of 148 patients and 150 control subjects. The selection of participants was randomized. Hip and knee data for all participants were obtained from X-ray or computed tomography measurements. Nine values, that is, central edge angle (CEA), acetabulum index angle (AIA), femoral neck-shaft angle, sharp angle, the depth of the acetabulum, femoral anteversion angle (FAA), anterior acetabular section angle (AASA), posterior acetabular section angle (PASA), and sulcus angle, were measured to evaluate differences between the control group and the patient group and analyze the correlation of the sulcus angle in patients to FAA and CEA. Patients with recurrent dislocation of the patella had less acetabular coverage and are more likely to develop developmental dysplasia of the hip than the hips of patients with normal knees. For the patient group, three values, that is, CEA (27.68 ± 5.25 vs. 34.30 ± 3.51 degrees, p < 0.001), AASA (57.14 ± 6.17 vs. 63.08 ± 7.23 degrees, p < 0.001), and PASA (89.53 ± 6.51 vs. 99.63 ± 5.94 degrees, p < 0.001), were decreased. The sharp angle (43.77 ± 3.23 vs. 39.28 ± 3.19 degrees, p < 0.001), AIA (11.52 ± 4.41 vs. 3.73 ± 2.51 degrees, p < 0.001), and FAA (24.68 ± 3.44 vs. 18.49 ± 3.55 degrees, p < 0.001) were increased. The acetabulum became shallower in-depth (7.05 ± 2.18 vs. 10.45 ± 1.61 mm, p < 0.001). There was a weak correlation between the sulcus angle and CEA (r = - 0.302, p < 0.001) and FAA (r = 0.212, p = 0.022). Recurrent patellar dislocation combined with trochlear dysplasia may be associated with the hip morphology. Developmental disorders of the knee joint, and hip joint should be considered in the treatment of patients with recurrent dislocation of the patella.

Is Maximum Available Hip Extension Range of Motion of the Residual Limb Reached During Passive Prone Lying in the Acute Stage After Dysvascular Transtibial Amputation?

ABSTRACT Introduction Individuals after a transtibial amputation (TTA) are at risk to develop a hip flexion contracture, which may adversely affect future ambulation with a prosthesis. Although patients have traditionally been advised to lie prone to maintain or improve hip extension, compensatory pelvic tilting may occur in prone lying (PL). We sought to compare hip extension range of motion (ROM) in PL to the modified Thomas test (MTT) position, because research implies that, in the MTT, patients are better able to control for compensatory pelvic tilting. We hypothesized that individuals after a TTA would have a greater peak hip extension angle in the MTT position compared with the PL position. Methods Ten individuals after a dysvascular TTA, mean age of 60 ± 8.42 years, participated in this study. The same physical therapist marked the femur and pelvis for goniometric measurement of peak hip extension angle by 12 raters blinded to each other's measurements. The markers remained unchanged as six raters measured all participants in PL and six different raters measured all participants in the MTT position. Results and Discussion The intraclass correlation (ICC) indicated high interrater reliability between the raters for the PL and MTT positions (ICC = 0.985 for PL and 0.976 for MTT). The average peak hip extension angle in PL was −14.0° ± 13.3°, standard error of mean = 4.3°; and in the MTT position was −8.6° ± 15.3°, standard error of mean = 4.8° (the negative mean connotes that, on average, participants did not have hip extension to neutral for either condition). We found a mean of 5.4° ± 6.6° more hip extension ROM for the MTT position compared with PL (P = 0.028). Conclusions Our findings show that, on average, patients after a TTA have significantly greater peak hip extension angle in the MTT position compared with the PL position. Thus, passive PL may not be as effective of a stretching position for preventing a hip flexion contracture after a TTA, because PL does not always extend the patient's hip to its maximum available ROM, due to the reduced ability to control the pelvis from tilting anteriorly. Clinical Relevance Adequate hip flexor length is positively correlated with gait parameters, which include increased velocity and step length in people using a prosthesis after transtibial amputation. This study implies that the MTT position may be a better method for improving and maintaining hip flexor length over the traditional strategy of passive PL.