Mean CE Angle Research Articles

Clinical And Radiological Results Of Ludloff Medial Open Reduction Technique In Patients Wıth Developmental Hip Dysplasia

Aim: The aim of this study was to evaluate the clinical and radiological results of Ludloff medial open reduction surgery in patients with the developmental of hip dysplasia, younger than 18 months old.Methods: The radiological and clinical results of 35 patients (49 hips), younger than 18 months of age treated with Ludloff medial approach due to DDH between the years 2013 and 2020 were retrospectively evaluated. Preoperative, final control acetabular index angles and medial apertures were measured according to the McCay criteria, Tönnis classification, Kalamchi-MacEwen classification, IHDI classification and Severin classification were analysed.Results: At the last control, the youngest age was 27 months, the oldest was 88 months and the mean age was 43.90 ± 14.17 months. The follow-up period was performed at a minimum age of 12 months, a maximum age of 72 months, and the mean follow-up period was 24.81 ± 17.17 months. According to the Tönnis classification, 40 hips were Tönnis classification type 1 (81.63%), 4 hips were Type 2 (8.16%), 3 hips were Type 3 (6.12%) and 2 hips were Type 4 (4.08%) in the follow-up visit. According to McCay clinical evaluation criteria, 38 hips (79.59%) were grade 1 which equates to excellent results. Grade 0 (no necrosis) was detected in 38 (77.55%) of 49 hips according to the Kalamchi and MacEwen AVN clinical evaluation criteria. According to the Severin classification, type 1 results were observed in 32 (65.31%) of 49 hips, type 2 in 9 hips (18.37%), type 3 in 1 hip (2.04%) and type 4 in 7 hips (14.29%). The mean CE angle was found to be 18.56 ± 9.93. Additional surgical intervention was required in 8 hips of 6 patients.Conclusion: Clinically and radiologically satisfactory results were obtained in DDH patients with Ludloff medial open reduction technique, below the age of 18 months.

Patient-specific 3D-printed shelf implant for the treatment of hip dysplasia tested in an experimental animal pilot in canines

The concept of a novel patient-specific 3D-printed shelf implant should be evaluated in a relevant large animal model with hip dysplasia. Therefore, three dogs with radiographic bilateral hip dysplasia and a positive subluxation test underwent unilateral acetabular augmentation with a 3D-printed dog-specific titanium implant. The contralateral side served as control. The implants were designed on CT-based pelvic bone segmentations and extended the dysplastic acetabular rim to increase the weight bearing surface without impairing the range of motion. Outcome was assessed by clinical observation, manual subluxation testing, radiography, CT, and gait analysis from 6 weeks preoperatively until termination at 26 weeks postoperatively. Thereafter, all hip joints underwent histopathological examination. The implantation and recovery from surgery was uneventful. Clinical subluxation tests at the intervention side became negative. Imaging showed medialization of the femoral head at the intervention side and the mean (range) CE-angle increased from 94° (84°–99°) preoperative to 119° (117°–120°) postoperative. Gait analysis parameters returned to pre-operative levels after an average follow-up of 6 weeks. Histology showed a thickened synovial capsule between the implant and the femoral head without any evidence of additional damage to the articular cartilage compared to the control side. The surgical implantation of the 3D shelf was safe and feasible. The patient-specific 3D-printed shelf implants restored the femoral head coverage and stability of dysplastic hips without complications. The presented approach holds promise to treat residual hip dysplasia justifying future veterinary clinical trials to establish clinical effectiveness in a larger cohort to prepare for translation to human clinic.

The Development of Leg Length Difference and Influence on Persistent Dysplasia in Patients with Developmental Dysplasia of the Hip.

Leg-length difference (LLD) is common in patients with developmental dysplasia of the hip (DDH). LLD of > 1cm at skeletal maturity is reported in > 40% of patients, with the majority related to ipsilateral overgrowth. A longer DDH leg might lead to excessive mechanical loading at the acetabular margin, resulting in compromised acetabular development. We hypothesised that the LLD would negatively influence acetabular development. If so, it would be advantageous to identify such patients early in the course of follow-up, and address this if necessary. A retrospective study was conducted on a consecutive series of DDH patients managed surgically at the Royal National Orthopaedic Hospital, Stanmore, United Kingdom. We included patients with adequate long-leg radiographs at the age of 4-8years (early-FU) and skeletal maturity (final-FU). Bilateral cases and those who underwent surgical procedures for hip dysplasia during the follow-up period were excluded. Measurements including leg length and centre-edge-angle (CE-angle) were obtained at the 2 time points. Twenty-seven patients were included, mean age at early-FU 5.7 (± 0.9)years, and 13.9 (± 1.0)years at final-FU. Mean LLD at early-FU was 9.5 (± 7.6)mm and 10.9 (± 9.4)mm at final-FU, p = 0.337. Correlation between early- and final-FU LLD was 0.68 (p < 0.001). The mean CE-angle at early follow-up was 14.6° (± 9.8), this improved to 23.2° (± 8.2) at skeletal maturity (p = 0.003, paired samples t-test). Linear regression analysis showed a non-significant trend towards less CE-angle improvement in patients with more initial residual dysplasia and more initial LLD. Most leg-length differences can be identified early in the follow-up period, nevertheless, considerable individual changes in LLD are observed on continued follow-up. Furthermore, a trend was observed towards impaired acetabular improvement in patients with more LLD. These findings justify careful clinical and radiological monitoring of LLD from an early stage in the follow-up period. The online version contains supplementary material available at 10.1007/s43465-021-00492-5.

Model construction and application for automated measurement of CE angle on pelvis orthograph based on MASK-R-CNN algorithm

Developmental dysplasia of the hip (DDH) is a common orthopedic disease. A simple and cost-effective scientific tool for assisting the early diagnosis of DDH is urgently needed. This study proposed a new artificial intelligence (AI) model for automated measure of the CE angle to aid the diagnosis of DDH by modifying the Mask R-CNN algorithm.13228 anteroposterior pelvic x-ray images were collected from the PACS system of the second Hospital of Jilin University, of which 104 images were randomly selected as test data. The rest of x-ray images were labelled and preprocessed for model development. The new AI model was the constructed based modified Mask R-CNN model to detect key points for CE angle measurement. The performance of AI model on measuring CE angle was verified by comparing with three attending orthopaedic doctors. The mean CE angles on left and right pelvis measured by the AI model was 29.46 ± 6.98°and 27.92 ± 6.56°, respectively, while the mean CE angle measured by the three doctors was 29.85 ± 6.92°and 27.75 ± 6.45°, respectively. AI model displayed a higly consistency with the doctors in measuring CE angles. Besides, AI model showed a much high efficiency in term of measuring time-consumption. In this study, we successfully constructed a new effective model for measuring CE angle by identifying key points, which provided a new intelligent measurement tool for orthopedic image measurement and evaluation.

To evaluate the treatment modality by CE angle of Wiberg in various hip joint pathologies

Objective: To evaluate the treatment modality by CE angle of Wiberg in various Hip joint pathologies. Method: This is a non-Randomised Prospective, observational study carried out at Department of Orthopaedics, Index medical college hospital and research centre, Indore (M.P.) during the period of 15 months from January 2018 to March 2019. Ethical clearance taken by Ethical Committee. In this study 35 hips of 28 patients who fulfilled our inclusion criteria were included. In our study patients with hip pathologies with age more than 5 years of both genders, hip pathologies like CAM and/or Pincer type of Femoroacetabular impingement, Acetabular retroversion, Perthes like deformity, Osteoarthritis Hip, Avascular necrosis of femoral head, Developmental dysplasia of hip, Patients who are doubtful for hip preservation or salvage procedure, who were willing to provide their voluntary written informed consent were included. Patients with congenital hip pathologies were exclude. In this study, we assessed the CE angle of Wiberg, in various aspheric hip conditions and formulate a protocol for further management of these Hip pathologies. Result: In this prospective study total 28 patients (35 Hips) of various hip pathologies 21 males (25 hips) 75% and 7 females (10 hips) 25% with age range of 5 years - 65 years with mean age of 41.32 ± 18.50 years out of which males were from 5 - 65 years with mean age 40.86 ± 20.44 and females were in the age range of 23 - 52 years with mean age 42.71 ± 12.04. Out of 28 patients 9 (32.14%) were FAI, 8 (28.57%) were OA hip, 8 (28.57%) were Avascular necrosis of Femoral head and 3 case (10.71%) is of Perthes' disease. In FAI cases 4(44.44%) patients were of Pincer type, 5(55.55%) were of Combined type with no any case of isolated CAM form. All were unilateral involvement with average CE angle of 32.67 ° ± 11.67 °. In Pincer type mean CE angle was 36.25 ° ± 7.5 ° while in combined form the mean CE angle was 29.8 ° ± 14.4 °. Out of 4 patients of Pincer FAI, 3 patients of Pincer type had CE angle between 25 - 40 ° which comes under normal range of CE angle so all were planned for non-operative management. Conclusions: We have found that all the hip pathologies reported to us had spectrum of variations in CE angle depending on the severity of disease. Variation was maximum seen in Osteoarthritis and Femoroacetabular impingement, in the cases of FAI maximum were of Pincer type.

Evaluation of CE angle of Wiberg for the functional outcome in various hip pathologies: an observational study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The objective of the study was to evaluate CE Angle of Wiberg for the functional outcome in various hip pathologies.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This is a non-randomised prospective, observational study carried out for the period of 15 months. In this study 35 hips of 28 patients with hip pathologies with age more than 5 years of both genders, hip pathologies like CAM and/or Pincer type of femoroacetabular impingement, Acetabular retroversion, Perthes like deformity, osteoarthritis hip, avascular necrosis of femoral head, developmental dysplasia of hip were studed.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In this prospective study out of 28 patients 9 (32.14%) were FAI, 8 (28.57%) were OA hip, 8 (28.57%) were avascular necrosis of femoral head and 3 case (10.71%) is of Perthes' disease. In FAI cases 4(44.44%) patients were of Pincer type, 5 (55.55%) were of combined type with no any case of isolated CAM form. All were unilateral involvement with average CE angle of 32.67&lt;sup&gt;0&lt;/sup&gt;±11.67&lt;sup&gt;0&lt;/sup&gt;. In Pincer type mean CE angle was 36.25&lt;sup&gt;0 &lt;/sup&gt;±7.5&lt;sup&gt;0 &lt;/sup&gt;while in Combined form the mean CE angle was 29.8&lt;sup&gt;0&lt;/sup&gt;±14.4&lt;sup&gt;0&lt;/sup&gt;. Out of 4 patients of Pincer FAI, 3 patients of Pincer type had CE angle between 25&lt;sup&gt;0&lt;/sup&gt;-40&lt;sup&gt;0 &lt;/sup&gt;which comes under normal range of CE angle, so all were planned for non operative management.&lt;/p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; We have found that all the hip pathologies reported to us had spectrum of variations in CE angle depending on the severity of disease. Variation was maximum seen in osteoarthritis and femoroacetabular impingement, in the cases of FAI maximum was of Pincer type.

Long-term results of a modified Spitzy shelf operation for developmental dysplasia of the hip in adults and adolescents.

The purpose of the current study was to retrospectively evaluate the long-term outcome of our shelf operation for acetabular dysplasia in adults and adolescents. We evaluated the outcome of shelf operation performed in 35 hips of 32 patients with acetabular dysplasia between 1978 and 1996. The mean age at the time of surgery was 30.6years, and the mean follow-up period was 25.9years. The pre-operative stage of osteoarthritis was Tönnis grade 0 in 12 hips and grade 1 in 23 hips. Clinical evaluation using the JOA hip score showed more than 85 of 100 points over 25years. Radiologically, acetabular index was significantly improved after operation. Osteoarthritis deteriorated to grade 3 in 8 of 35 hips (23%) at an average 17.1years, and accordingly 3 of those 8 hips were converted to THA. The shelf height was significantly higher in those which advanced to grade 3 than in those which did not. There were no significant differences in mean sharp angle, CE angle, AHI, and roundness index. Mean survival was 74% with grade 3 as the endpoint and 72% with THA conversion as the endpoint. Shelf operation provides satisfactory long-term outcome in adults and adolescents with acetabular dysplasia. Higher location of the shelf is a risk factor for advancement of osteoarthritis, whereas sphericity of the femoral head does not affect the long-term results. Further studies are needed to clarify the risk factors about OA progression among the patients with acetabular dysplasia, like as the assessment of three-dimensional morphology of hip joints.

Prévalence des anomalies acétabulaires associées à une déformation en crosse de pistolet dans la coxarthrose

Acetabular retroversion, excessive acetabular coverage and abnormal head-neck-junction with a so-called “pistol-grip-deformity” were added to the classical description of hip dysplasia to describe pathological hip morphology. The aim of the current study was the detection of pathological acetabular geometry in patients with an abnormal head-neck-junction. Femoro-acetabular impingement and hip dysplasia features are frequent in patients with end-stage osteoarthritis before 60 years of age. We analysed our data bank retrospectively for all patients who received a Total Hip Arthroplasty (THA) due to end-stage osteoarthritis before the age of 60 years. The pelvic-views and the Dunn-view of these patients were screened for an abnormal head-neck-junction by measuring the head-ratio and the alpha-angle. An orthopaedic surgeon and a radiologist did this independently. These radiographies were measured for signs of acetabular dysplasia, excessive acetabular coverage and crossing sign. A consecutive series of 135 total hip arthroplasties were performed in patients aged less or equal to 60 years because of end-stage osteoarthritis. From these, 81 patients were classified as having an abnormal head-neck-junction. The mean head-ratio in these 81 patients was 1.52 ± 0.35, the mean alpha-angle was 62.5° ± 9.3°. The mean CE-angle of these 81 patients was 35.8° ± 10.4°, the mean CA-angle was 36.7° ± 5.7°, the mean depth-width-ratio was 49.1 ± 10, the mean extrusion-index was 19.1 ± 9.2 and the mean CCD-angle was 131.7° ± 7.3°. Of these 81 hips, 14 had isolated pistol grip deformity, while 11 hips had associated dysplasia, 38 had excessive acetabular coverage, and 14 had crossing sign. In addition, a crossing sign was identified in four of the 11 dysplastic hips and 19 of the 38 of the hips having excessive acetabular coverage. There was no statistically significant difference in regard to the age between the four groups ( P = 0.087). In contrast, the hips that had excessive acetabular coverage had increased CE angle (44.6° ± 7.2°) and decreased extrusion index (12.6 ± 6.5) ( P < 0.001), while dysplastic hips had increased roof obliquity (17.5° ± 4.5°) and increased extrusion index (29.6 ± 9.1) as well as decreased CE-angle (20.7° ± 3.0°) ( P < 0.001). There is a high coincidence of radiographic findings associated with an abnormal head-neck-junction consisting in excessive acetabular coverage and retroversion as well as hip dysplasia. These results advocate for restoring of the normal anatomy at the early stage to prevent end-stage osteoarthritis. Level IV retrospective historical study.

The prevalence of acetabular anomalies associated with pistol-grip-deformity in osteoarthritic hips

Acetabular retroversion, excessive acetabular coverage and abnormal head-neck-junction with a so-called "pistol-grip-deformity" were added to the classical description of hip dysplasia to describe pathological hip morphology. The aim of the current study was the detection of pathological acetabular geometry in patients with an abnormal head-neck-junction. Femoroacetabular impingement and hip dysplasia features are frequent in patients with end-stage osteoarthritis before 60 years of age. We analysed our data bank retrospectively for all patients who received a Total Hip Arthroplasty (THA) due to end-stage osteoarthritis before the age of 60 years. The pelvic-views and the Dunn-view of these patients were screened for an abnormal head-neck-junction by measuring the head-ratio and the alpha-angle. An orthopaedic surgeon and a radiologist did this independently. These radiographies were measured for signs of acetabular dysplasia, excessive acetabular coverage and crossing sign. A consecutive series of 135 total hip arthroplasties were performed in patients aged less or equal to 60 years because of end-stage osteoarthritis. From these, 81 patients were classified as having an abnormal head-neck-junction. The mean head-ratio in these 81 patients was 1.52±0.35, the mean alpha-angle was 62.5°±9.3°. The mean CE-angle of these 81 patients was 35.8°±10.4°, the mean CA-angle was 36.7°±5.7°, the mean depth-width ratio was 49.1±10, the mean extrusion index was 19.1±9.2 and the mean CCD-angle was 131.7°±7.3°. Of these 81hips, 14 had isolated pistol-grip-deformity, while 11 hips had associated dysplasia, 38 had excessive acetabular coverage, and 14 had crossing sign. In addition, a crossing sign was identified in four of the 11 dysplastic hips and 19 of the 38 of the hips having excessive acetabular coverage. There was no statistically significant difference in regard to the age between the four groups (P=0.087). In contrast, the hips that had excessive acetabular coverage had increased CE-angle (44.6°±7.2°) and decreased extrusion index (12.6±6.5) (P<0.001), while dysplastic hips had increased roof obliquity (17.5°±4.5°) and increased extrusion index (29.6±9.1), as well as decreased CE-angle (20.7°±3.0°) (P<0.001). There is a high coincidence of radiographic findings associated with an abnormal head-neck-junction consisting in excessive acetabular coverage and retroversion as well as hip dysplasia. These results advocate for restoring of the normal anatomy at the early stage to prevent end-stage osteoarthritis. Level IV retrospective historical study.

Effect of Pelvic Osteotomy in the Skeletally Immature on Acetabular Coverage

Although pelvic osteotomy in children has been effective in re-establishing containment of the hip joint, its impact on hip joint development with respect to acetabular coverage is ill defined. The purpose of this study is to determine the prevalence of acetabular overcoverage in patients who had pelvic osteotomy during childhood and its impact on patient function. Between 1980 and 2008, all patients who had a pelvic osteotomy done at our institution for non-neuropathic hip dysplasia (DDH) or secondary to Legg-Calvé-Perthes disease (LCP) prior to skeletal maturity were reviewed. A clinical assessment and the WOMAC, UCLA Activity Score, Marx activity score, and SF-36 quality-of-life questionnaires were completed. A standardized AP pelvic X-ray was performed to determine the acetabular coverage, signs of retroversion, and degenerative changes. Twenty-eight patients (32 hips) were identified, of which 14 (9 DDH, 5 LCP) agreed to participate. Impingement sign was positive in eight patients (six DDH, two LCP). Crossover and ischial spine signs were each present in ten hips. Tonnis grades were: 0 in 1 hip, 1 in 10 hips, 2 in 2 hips, and 3 in 1 hip. The mean Tonnis angle was 11.6 ± 8.6°. The mean CE angle was 24.0 ± 15.9° with six hips having a CE angle <20° and one hip with a CE angle >40°. There was no correlation between crossover sign or ischial sign and Tonnis grade (p = 0.739), hip pain (p = 0.520), or impingement sign (p = 1.00). Acetabular overcoverage is common in patients who underwent pelvic osteotomy during childhood. No correlation was identified between retroversion and hip pain in our patient cohort.

Treatment of developmental dysplasia of the hip with periacetabular osteotomy.

Objective To report the preliminary results of treatment of developmental dysplasia of the hip (DDH) with periacetabular osteotomy. Methods From February 2002 to February 2008, 53 patients (55 hips) with DDH were treated with periacetabular osteotomy. 51 patients were females, 2 were males, with the average age of 25.5 years (ranged, 13 to 51 years). The hip pain period before surgery varied from 1 month to 6 years (mean 16 months). 6 patients had the history of hip surgery. The mean Wiberg CE angle was 3°(range, -20°to 15°). According to Tonnis osteoarthritis classification, there were 16 cases in grade Ⅰ, 1 in grade Ⅱ. 25 patients had Shenton's line broken. The ilioinguinal approach was used in former 13 cases. The modified Smith-Petersen approach was used in later 40 cases. Intertrachanteric varus osteotomy was done simultaneously in 6 cases. Results The mean follow-up period was 28 months (ranged, 12 to 60 months). Bone union was achieved in 3 months after surgery. The pain relieved in most of patients. The Har-ris hip score increased from 77.4 points (ranged, 68 to 87 points) preoperatively to 94.6 points (ranged, 70 to 100 points) post-operatively. The range of motion of the hip decreased 20°-60° after surgery. The mean CE angle increased to 29°(ranged, 20° to 50°) postoperatively. 5 patients had limp after surgery, mostly due to dysfunction of gluteus medius, and recovered after 6 months of exercises. 18 patients got lateral femoral cu-taneous nerve injury. Two patients suffered pelvic ring broken and healed without affecting on hip function.No complication such as infection, vascular injury, sciatic neve injury happened in this series. Conclusion Satisfactory results can be obtained through periacetabular osteotomy in young patients with DDH. Periac-etabular osteotomy can correct the acetabular deformity in multiplanar. No vascular impair in acetabular fragment. The stability of the pelvic can be reserved. Early rehabilitation is allowed after surgery. Key words: Hip dislocation; congenital; Osteotomy; Acetabulum

Multiple drillings of the acetabular fossa induce early joint remodeling after rotational acetabular osteotomy for hip dysplasia

We previously observed medial and/or lateral expansion of the subchondral bone in the acetabulum 3 years postoperatively in two out of three cases in which rotational acetabular osteotomy (RAO) was performed. Then we performed multiple drillings at the acetabular fossa in order to induce expansion of the medial subchondral bone in the acetabulum. The purpose of this study is to evaluate the effect of multiple drillings on early joint remodeling after RAO. Twenty-one women (21 joints) who had undergone RAO with multiple drillings at acetabular fossa (group D) were included. As a control group, 12 women (14 joints) without drillings in RAO procedure were observed (group C). The center-edge angle (CE angle), acetabular roof obliquity (AC angle), head lateralization index (HLI), and the angle between medial and lateral edge of acetabular roof (LOM angle) were measured on the radiographs preoperatively, at 1 month, 2 years postoperatively, and at the last follow-up. As regards the mean CE angle, AC angle, and HLI, there was no significant difference between the two groups. The mean LOM angle at 2 years and the last follow-up demonstrated significant difference between the two groups. Biomechanical and anatomical changes after RAO cause increasing stress to the medial side of the acetabulum. Moreover, bone marrow-stimulating procedure at acetabular fossa might be beneficial to develop early joint remodeling affected by bone marrow derived cells such as mesenchymal stem cells.

Is varus osteotomy necessary in one-stage treatment of developmental dislocation of the hip in older children?

Innominate osteotomy, varisation-derotation osteotomy, and shortening osteotomy are the most common surgical procedures used to achieve pelvifemoral realignment in the treatment of children over three years of age with developmental hip dislocation. It is well known that varus osteotomy can improve the acetabular index but it does have some disadvantages. The aim of this study was to discuss the results obtained with patients treated only with Salter osteotomy, derotation osteotomy, and shortening, without varus osteotomy, and to evaluate the need for varisation on the basis of these results. Between 1996 and 2001, twenty-four hips, sixteen unilateral and four bilateral, of a total of twenty patients treated with this method and available for final controls were evaluated. The study included sixteen female and four male patients with a mean age of 4 years 2 months (ranging between 2 years 10 months and 8 years). The mean follow-up period was determined as 6.57 years (range 5-10 years). McKay's clinical criteria, Sever's radiological criteria, and the evaluation system modified by Trevor et al. were used for evaluation of the results. Based on McKay's clinical criteria, eighteen hips (75%) were classified as type I, four hips (16%) as type II, and two hips (9%) as type III. According to Sever's radiological criteria, thirteen hips (54%) were graded as grade I, nine hips (37.5%) as grade II, and two (8.5%) as grade III. According to the modified evaluation system of Trevor et al. the results were categorized as excellent in thirteen hips, good in nine hips, and moderate in two hips. Pre-operative mean acetabular index was measured as 37.3 degrees (28 degrees -50 degrees ) and early post-operative mean acetabular index as 26 degrees (18 degrees -38 degrees ). In the final radiological examination the mean acetabular index was measured as 18.3 degrees and the mean CE angle as 30.1 degrees (15 degrees -38 degrees ). Avascular necrosis affecting the results developed in five hips. It is concluded that in older children with developmental dislocation of the hip (DDH) treated with one-stage combined surgical intervention, adequately stable concentric reduction can be achieved without varisation and that varus osteotomy is not always necessary.

Is bladder exstrophy a risk factor for hip arthrosis?

Purpose Although the management of patients born with bladder exstrophy (BE) may include pelvic osteotomies, nothing is known about the long-term natural history of the pelvic deformity. We assessed the orthopaedic outcome in adult patients. Material and methods 22 BE patients treated with ureterosigmoidostomies between 1945 and 1968 were evaluated clinically using Harris hip scores and radiographically using Tonnis classification. Results The mean age of the patients was 50 ±12 years. Clinical evaluation revealed an excellent outcome resulting in 91-100 points of the Harris Hip Score in 80 % of the left and in 76 % of the right hips. Good outcomes of 81-90 points were found in 10 % of the left hips and in 14 % of the right hips, while fair outcomes of 71-80 points were found in the remaining 10 % of both hips. No patient scored less than 70 points. 16% of the patients were classified as Tonnis grade 0, 63% as grade 1 and 21% were classified as grade 2. No patient was classified as Tonnis grade 3. The mean pubic symphysis diastasis was 87 mm (range: 30-152 mm). The mean CE angle on the right hand side varied from 24-44° (mean CE angle 35°) and on the left from 24-50° (mean CE angle 36°). No instability of the symphysis nor the sacroiliac joint was detected. Conclusions We concluded that patients with bladder exstrophy and an untreated pelvic deformity are not at risk of a higher incidence or earlier onset of hip arthrosis than normals. Long-term follow-up reveals no pelvic instability.

Periacetabular Rotational Osteotomy in Hip Dysplasia: Short Term Follow up Result

Purpose: To evaluate the short term results of a periacetabular rotational osteotomy in early and moderate osteoarthritis of hipdysplasia bycomparing the clinical findings and radiological measurements. Materials and Methods: Thirty-six cases (34 patients) who received periacetabular rotational osteotomy for hip dysplasia with pain and could be followed up for more than one year were reviewed. The clinical findings were evaluated by the range of motion and HHS. The radiological measurements were evaluated using the center edge angle (CE angle), Sharp angle, acetabular-head index (A-H index) and Tnnis grade. Results: The average Harris hip score improved from 79.4 points (60 to 89 points) to 95.1 points (82 to 100 points). The average range of motion did not change significantly. The mean CE angle increased from (- to ) to ( to ), the mean sharp angle increased from ( to ) to ( to ), the mean A-H index increased from 56% (34% to 72%) to 90%(73% to 99%). The Tnnis grade had remained unchanged in 25 cases, improved in 9, and worsened in two. One case underwent total hip arthroplasty. Conclusion: The periacetabular rotational osteotomy is the preferred method for treating hip dyaplasia and preventing secondary osteoarthritis. However, a skillful technique is mandatory.

Long-term results of triple osteotomy of the pelvis

We performed triple osteotomy according to the method of Steel in 14 patients with grade 0 and grade 1 osteoarthritis according to Tonnis’ classification of dysplasia of the hip. We examined the long-term results at a mean of 24 years, and evaluated whether the aggravation of osteoarthritis could be prevented by pelvic osteotomy. The mean score of the Merle d’Aubigne’ and Postel scoring system improved from 4.8 (range, 4–6) to 5.3 (range, 3–6) in pain, from 5.3 (range, 4–6) to 5.5 (range, 4–6) in walking, and from 5.4 (range, 4–6) to 5.4 (range, 4–6) in range of motion. The radiographic evaluation revealed that the mean CE angle improved from—3.9°±2.1° before surgery to 15.5°±2.3° at the follow-up. In the 3 hip joints in which the weight-bearing surface was more than halved after surgery, the postoperative CE angle was 2°, 10° and 7° and acetabular dysplasia remained after surgery; 2 hip joints were in grade 2 and 1 hip joint was in grade 3 osteoarthritis.

殿筋群を剥離しない寛骨臼回転骨切り術 Ｃｕｒｖｅｄ Ｐｅｒｉａｃｅｔａｂｕｌａｒ Ｏｓｔｅｏｔｏｍｙの治療成績

We performed Curved Periacetabular Osteotomy (CPO) on 9 patients. All patients were female, and their ages at surgery ranged from 28 to 48 years (average 40 years). The fllow-up period averaged 1 year and 3 months. We compared the CE angle, Sharp angle, AHI, and JOA score. All patients showed improvement of the CE angle, Sharp angle, AHI, and JOA score. The mean CE angle improved from 0.5° to 35.3°, the mean Sharp angle from 50.2° to 35.3°, the mean AHI from 50.5% to 90.5% and JOA score from 58 points to 85 points.CPO does not strip gluteus muscles from the iliac bone nor disrupt the inferior branch of the superior gluteal artery.No osteonecrosis of reorientated acetabular fragments is thought to have occurred.

寛骨臼回転骨切り術の中期成績の検討

We performed rotational acetabular ostetomy (RAO) on 14 patients. All subjects were women, their ages at surgery ranged from 25 to 52 years, and the follow-up period averaged 4 years. We compared the CE angle and AC angle before and after surgery.All patients showed improvement of both the CE angle and AC angle. The mean CE angle improved from 4.4 degrees to 24.6 degrees (p<0.01), and the mean AC angle from 23.8 degrees to 8.3 degrees (p<0.01). The range of motion (flexion and abduction) did not decrease alter surgery. 1 patient showed progression of the degenerative change by the necrosis of the rotated bone.The clinical results for RAO were not significant compared to early stage OA (11 hips) and advanced OA (4 hips).

中年者進行期変形性股関節症に対する寛骨臼回転骨切り術の検討

We performed rotational acetabular osteotomy (RAO) in 9 middle aged patients. All subjects were women with advanced osteoarthritis (OA) of the hip and congruity of the hip improved in abduction. The age at surgery ranged from 47 to 58 years, with a mean of 50.6 years and the follow-up period averaged 4 years and 8 months. We compared CE angle and JOA hip score before and after surgery.All patients improved both in CE angle and JOA score. The mean CE angle improved from -1.7 degrees to 40.2 degrees. The mean JOA score improved from 66 to 90.7 points. Two of three bilateral patients showed progression of the degenerative changes in their contralateral hip after surgery. In one remaining patient, the contralateral hip required, total hip arthroplasty.The indications for RAO in middle aged patients with advanced degenerative arthritis of the hip have been controversial. Our findings suggest that satisfactory results can be obtained when hip congruity improves in abduction. In bilateral cases, early surgery of the contralateral hip may prevent progression of OA of the contralateral hip.