Severe Hip Dysplasia Research Articles

Simultaneous Bilateral Femoral Head and Neck Ostectomy for the Treatment of Canine Hip Dysplasia

Simultaneous bilateral femoral head and neck ostectomy (FHO) was performed on 15 dogs for severe bilateral hip dysplasia. A follow-up survey was performed 6 to 48 months after surgery to assess the postoperative recovery and activity levels of the operated dogs. All dogs had normal activity levels and were pain free according to their owners. Owner satisfaction regarding the outcome of the surgery was high. Simultaneous bilateral FHO was a viable surgical option for the treatment of painful bilateral hip disease in dogs, especially when other surgical options were not indicated or were cost prohibitive.

TOTAL HIP ARTHROPLASTY WITH CEMENT AND WITHOUT ACETABULAR BONE GRAFT FOR SEVERE HIP DYSPLASIA

We previously evaluated a cohort of fifty-three patients with severe hip dysplasia (Crowe Type-II, III, or IV subluxation) who underwent a total of sixty-six Charnley total hip arthroplasties. The acetabular component was placed at the anatomic hip center, the superolateral defect was filled with cement, and no bone-grafting was used to supplement the acetabular wall. All but one patient, who was lost to follow-up, were followed until death or for a minimum of twenty years. Radiographic and functional follow-up data were collected prospectively. This retrospective review included twenty-four patients (thirty-four hips) who were alive at a minimum of twenty years following the surgery. Fourteen (22%) of the sixty-five hips underwent revision of a component, with eleven of the revisions performed because of aseptic loosening. Eight of those eleven hips underwent revision because of acetabular loosening alone; two, because of femoral loosening alone; and one, because of loosening of both components. The combined prevalence of revision because of aseptic loosening of the acetabular component and radiographic evidence of failure of the acetabular component was 28% (eighteen hips). With the numbers available, the need for acetabular revision was not associated with the percentage of cement coverage (p = 0.362) or the Crowe classification (p = 0.159). At a minimum of twenty years postoperatively, the survivorship of the acetabular component was 86% ± 8% with revision because of aseptic loosening as the end point and 82% ± 10% with revision because of aseptic loosening or radiographic evidence of loosening as the end point. The results that we evaluated at a minimum of twenty years after use of this technique can be compared with the results of other techniques in studies with similar long-term follow-up periods. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

Total Hip Arthroplasty with Cement and without Acetabular Bone Graft for Severe Hip Dysplasia

We previously evaluated a cohort of fifty-three patients with severe hip dysplasia (Crowe Type-II, III, or IV subluxation) who underwent a total of sixty-six Charnley total hip arthroplasties. The acetabular component was placed at the anatomic hip center, the superolateral defect was filled with cement, and no bone-grafting was used to supplement the acetabular wall. All but one patient, who was lost to follow-up, were followed until death or for a minimum of twenty years. Radiographic and functional follow-up data were collected prospectively. This retrospective review included twenty-four patients (thirty-four hips) who were alive at a minimum of twenty years following the surgery. Fourteen (22%) of the sixty-five hips underwent revision of a component, with eleven of the revisions performed because of aseptic loosening. Eight of those eleven hips underwent revision because of acetabular loosening alone; two, because of femoral loosening alone; and one, because of loosening of both components. The combined prevalence of revision because of aseptic loosening of the acetabular component and radiographic evidence of failure of the acetabular component was 28% (eighteen hips). With the numbers available, the need for acetabular revision was not associated with the percentage of cement coverage (p = 0.362) or the Crowe classification (p = 0.159). At a minimum of twenty years postoperatively, the survivorship of the acetabular component was 86% +/- 8% with revision because of aseptic loosening as the end point and 82% +/- 10% with revision because of aseptic loosening or radiographic evidence of loosening as the end point. The results that we evaluated at a minimum of twenty years after use of this technique can be compared with the results of other techniques in studies with similar long-term follow-up periods.

Cementless total hip arthroplasty in the treatment of severe hip dysplasia or dislocated hips

We present our experience over 6 years with the use of uncemented total hip arthroplasty (THA) for developmental dysplasia of the hip (DDH) with a mean follow-up of 3 years. In a 6-year period, 26 THAs were performed in 19 patients with Hartofilakidis grades 2 and 3 dislocation of the hips. Out of 19 patients, seven had bilateral dislocations. Uncemented acetabular and femoral components were used in all patients. Patients with a minimum follow-up of 1 year were included in the study. The average age at the time of surgery was 38 (range 20–69) years. Approaches used include trochanteric osteotomy in 14 (54%) patients and a lateral approach in 12 (46%) patients. In addition, subtrochanteric osteotomy was performed in four (15%) patients. A Mallory-head femoral stem was used in 15 (58%) patients; a DDH femoral stem was in nine (35%), and the S-ROM femoral prosthesis in two (8%). A Mallory head acetabular shell was used in all cases, a 22.2-mm chrome cobalt head was used in 18 (69%), and a 28-mm chrome cobalt head was used in eight (31%). The average follow-up was 3 (range 1–6) years. The Harris hip score (HHS) improved in the cohort from a mean preoperative score of 51 to a mean postoperative score of 86 (p<0.05). The mean preoperative SF36v2 score was 42 compared to postoperatively of 67(p<0.05). The complication rate was 11% with nonunion of a subtrochanteric osteotomy in one patient, dislocation in one, and trochanteric bursitis due to fracture of Dall-Miles cables in one. THA for DDH is a technically demanding procedure. This short-term follow-up of THA for DDH using uncemented implants is encouraging for arthrosis secondary to DDH. It provides better function compared to arthrodesis or excision arthroplasty, especially in young individuals. A long-term follow-up is required in order to establish the role of this management strategy.

Gait Analysis before and after Total Hip Arthroplasty in Hip Dysplasia and Osteonecrosis of the Femoral Head

Purpose: The aim of this study was to objectively evaluate the abnormal gait patterns and gait improvements after a total hip arthroplasty (THA) in patients with hip dysplasia and osteonecrosis of the femoral head (ONFH). Materials and Methods: Thirty-four patients (mean age of 43.7 years) with hip dysplasia who underwent THA were divided into the Crowe types (15 type 1, 11 type 2, 3 type 3, and 5 type 4), and gait analyses of these patients were performed using the Vicon 370 motion analysis system. The results of this group were compared with those of 39 age and gender matched patients with ONFH who received a THA and a group of 24 individuals with normal hips. Results: Preoperatively, the gait pattern of the hip dysplasia group did not differ significantly from that of the ONFH group with respect to the temporal gait measurement parameters, kinematics, and kinetics. However, the hip dysplasia group had a different gait pattern than the normal control group and one year after surgery, there were significant differences in the moments and powers of the hip flexors and abductors of patients with severe hip dysplasia (Crowe types 3 and 4) compared with those of the ONFH patients. Conclusion: There were less postoperative gait improvements in the patients with severe hip dysplasia than in those with ONFH who had a relatively normal anatomy. These observations might be the result of their weakened hip muscles, particularly the flexors and abductors, despite their increased range of motion after surgery. Perioperative muscle strengthening exercises may be needed to improve gait patterns in patients with hip dysplasia.

Hip dysplasia in Charcot-Marie-Tooth disease: report of a family

AbstractCharcot-Marie-Tooth disease is classified into hereditary motor and sensory neuropathy (HMSN) types I and II, and affected patients present with progressive peripheral neuropathy. Some previous orthopedic studies have revealed the association of hip dysplasia with HMSN, in addition to pes cavovarus, scoliosis, and recurrent dislocation of the patella. We describe three patients from the same family who were each diagnosed as having HMSN type I with associated bilateral severe hip dysplasia, borderline abnormalities of both acetabula, and dysplastic osteoarthritis. Based on our experience with these patients and a review of previous reports, we concluded that routine screening of hip joints, especially for those with a family history of HMSN, is necessary for early diagnosis.

Subtrochanteric shortening and derotational osteotomy in primary total hip arthroplasty for patients with severe hip dysplasia: 5-year follow-up

Twenty-one primary hip arthroplasties were performed in Crowe grade 3 or 4 hip dysplasia using a subtrochanteric shortening osteotomy. Average patient age was 48.2 years. Average follow-up was 5.8 years (minimum, 2 years). Femoral fixation was cemented in 10 hips and uncemented in 11 hips. All acetabular components were uncemented, with 33% requiring structural autograft. Ninety-one percent of femoral osteotomies healed without complication. Two osteotomy nonunions required revision. Two acetabular revisions were performed for malposition and polyethylene failure. Three patients experienced postoperative dislocation. One cemented femoral component was revised for loosening. However, no neurologic deficiencies were identified. Harris hip score improved from 32.5 to 73.6. Limp improved in 60% of patients and dependence on assistive walking device improved in 40% of patients. Subtrochanteric shortening osteotomy is a safe and predictable method of restoring the anatomic hip center in high developmental hip dislocation. However, the complication rate in these patients is higher than primary hip arthroplasty for osteoarthritis. © 2003 Elsevier Inc. All rights reserved.

Deterioration of a primarily normal hip without developmental disorders

Ultrasonography of the hip joint in babies has been established as a standard method for examination and classification of dysplasia of the hip as well as for monitoring of the treatment. It has been believed until now that, in a hip once classified as normal, the development of the hip joint will continue to be normal if there is no developmental disorder or other skeletal dysplasia. We report the case of a patient who clearly showed normal sonographic and radiological findings initially but who experienced significant developmental dysplasia of the hip (DDH) within the first two years of life. Even more interesting aspects are the treatment of the contralateral side for severe hip dysplasia: with both hips in optimally centered position the initially affected hip had been operated successfully while the initially normal hip deteriorated. Therefore we consider this as one of the rare examples of “endogenous hip dysplasia” which underlines the occurence of DDH and which does not necessarily mean inadequate primary diagnosis or inadequate reading of ultrasonographic or radiographic images.

Long-term results of total hip arthroplasty with a cemented custom-designed swan-neck femoral component for congenital dislocation or severe dysplasia: a follow-up note.

This follow-up study updates the results in a consecutive series of nineteen cemented total hip replacements with a swan-neck femoral component in patients with congenital dislocation or severe hip dysplasia. The series was previously reported on in 1993. The patients were petite, with an average height of 152 cm and an average weight of 50 kg, and the femoral canals could not accommodate an off-the-shelf femoral component. Sixteen of the nineteen hips were available for follow-up at an average of 13.3 years (range, eleven to twenty years). Fourteen hips had up-to-date clinical and radiographic examinations. At the time of the latest follow-up, thirteen hips were rated as excellent; two, as good; and one, as a failure because of loosening of both components requiring revision eleven years after the index operation. Another hip required acetabular revision because of loosening fifteen years after the index operation. The rates of femoral and acetabular component revision were 6% and 12.5%, respectively. Radiographic analysis demonstrated that no femoral component was loose. One cup was definitely loose at 19.5 years, and three cups were possibly loose at an average of fourteen years. The radiographic rate of acetabular loosening was 33%. The total rate of cup failure (radiographic loosening and revision) was 43%. The excellent clinical and radiographic results associated with the swan-neck femoral component, and the 94% rate of survival, at an average of 13.3 years (range, eleven to twenty years) indicate that the biomechanical objectives of this custom-designed prosthesis for patients with congenital dislocation or severe hip dysplasia were met. On the basis of this favorable long-term experience, we still use this prosthesis when the anatomic abnormality cannot be adequately addressed by use of a commercially available prosthetic component.

臼蓋形成不全に合併した股関節部ガングリオンの１例

Ganglion cyst of the hip is rare. This case report describes a large ganglion cyst in a 44-year-old woman with hip dysplasia. She experienced mild right groin pain after prolonged activity. Physical examination revealed a large soft mass in her right inguinal region. No obvious evidence of infection was noted. Radiographic evaluation of her right hip revealed evidence of severe hip dysplasia. Magnetic resonance imaging revealed the mass to have signal characteristics similar to water. It was diagnosed as ganglion cyst. Periacetabular osteotomy was performed for hip dyaplasia. The mass was covered by pseudocapsule and filled with clear mucinous fluid. Further dissection revealed a typical stalk arising from the hip capsule. Histologic examination showed a fibrous connective tissue wall with no distinct cellular lining. Diagnosis of ganglion cyst should be considered when patients present inguinal mass and hip dysplasia.

Gait analysis of dogs with hip dysplasia treated with gold bead implantation acupuncture

SummaryA “double blinded” prospective study was undertaken to determine whether gold bead implantation acupuncture alleviates lameness and pain in dogs, affected by moderate to severe hip dysplasia. Nineteen large-breed adult dogs, of various breeds with clinical and radiographic evidence of hip dysplasia, were randomly assigned to the acupuncture or the placebo group. The acupuncture treatment with gold bead implantation was performed by a licensed acupuncturist. Objective data were acquired, in the gait analysis laboratory, using kinetic and kinematic parameters before and at one and three months after treatment. In the acupuncture group there was a decrease in vertical and peak vertical impulse formation at one month, which indicated an increase in lameness, without any significant difference between groups at three months post-treatment.Subjective data were gathered by radiographs as well as serial complete physical examinations by an experienced clinician and an owner questionnaire, before and at one and three months after treatment. Subjective grading of hip dysplasia radiographs did not show any difference in severity between the two groups. According to the physical examination, one dog in the acupuncture group improved, five stayed the same and three worsened. In the placebo group two dogs improved, four stayed the same and three worsened. According to the questionnaire, three dogs in the acupuncture group improved, four stayed the same and two worsened. In the placebo group three dogs improved and six stayed the same. Serial blood analyses were performed and the results were within normal limits at all times.

Estimates of genetic parameters for hip and elbow dysplasia in Finnish Rottweilers.

Data from 2,764 Rottweiler dogs born from 1987 to 1996 were analyzed with a Restricted Maximum Likelihood procedure using a mixed linear animal model to obtain variance component estimates for hip and elbow dysplasia. The data included 2,764 hip dysplasia and 2,278 elbow dysplasia records. Hip joints were scored as normal (0), borderline (1), slight (2), moderate (3), and severe (4, 4.5, and 5) hip dysplasia. Elbow joints were graded normal or borderline (0), slight (1), moderate (2), and severe (3) elbow dysplasia. The mean for the hip scores was 1.07 and for the elbow scores .60. Environmental effects influencing hip dysplasia were age, birth year, birth year x season interaction, and experience of the veterinarian responsible for x-raying the dog. For elbow dysplasia, statistically significant effects were age, birth year, sex of the dog, and panelist responsible for each screening. Estimates of heritability for hip and elbow dysplasia were .58 +/- .04 and .31 +/- .04, respectively, with a genetic correlation of .37 +/- .08 between the traits. Genetic improvement of almost one genetic standard deviation was observed in both traits during the 10 yr covered by the data.

Controlling canine hip dysplasia in Finland

The aim of the study was to evaluate the Finnish Kennel Club's hip-dysplasia screening and control programs. As a retrospective study, records of hip-dysplasia screening of 69,349 dogs in 22 breeds that were born in 1988–1995 were analyzed and compared to data from prior to 1988. In most breeds, no significant changes in dysplasia prevalence could be found. In English cocker spaniels, golden and Labrador retrievers and Rottweilers a significant decrease – but in boxers, Dobermans, German Shepherd dogs and rough collies a significant increase – in prevalence was detected. In flat-coated retrievers overall prevalence increased – but the prevalence of severe hip-dysplasia decreased significantly during the study period. The present control program has not resulted in fast progress. Selecting against hip-dysplasia cannot be expected to be very effective, when based only on mass selection on phenotypic observations. Predicted breeding values based on progeny testing would probably give better results. Also, breeders' compliance and commitment to programs is not always high and other selection criteria in breeding are thought to be more important. Modern society has high demands for animal welfare and consumer issues, and breeders and kennel societies should pay more attention to health issues in breeding pedigreed dogs.

Developmental Hip Dysplasia in Hereditary Motor and Sensory Neuropathy Type 1

Severe hip dysplasia in children with hereditary motor and sensory neuropathy (HMSN) is not necessarily congenital. We describe three patients with late symptoms, two of them with proven normal hips until early adolescence. A careful follow-up of all children with HMSN for hip dysplasia should be carried out.

Prevalence and inheritance of and selection for hip dysplasia in seven breeds of dogs in Sweden and benefit:cost analysis of a screening and control program

Objective To determine the prevalence and changes over time in the prevalence of hip dysplasia; to ascertain whether prevalence or severity of hip dysplasia was associated with sex of the dogs, age at which coxofemoral joint status was evaluated, or ancestral background; to determine the effects of selective breeding; and to conduct an economic evaluation of the hip dysplasia program operated by the Swedish Kennel Club. Design Analysis of radiographic evaluations of coxofemoral joint conformity. Animals 83,229 dogs from 7 breeds registered by the Swedish Kennel Club. Procedure All radiographs were scrutinized by a single radiologist (LA), and coxofemoral joint conformation was classified as normal or dysplastic, with the degree of dysplasia classified as 1, 2, 3, or 4. Results Decreasing prevalence of hip dysplasia corresponding to selection of breeding stock and high heritabilities was found. Sex differences were documented in 3 of the breeds. This was interpreted as breed differences in the distribution of genes related to hip dysplasia. Economic analyses showed that costs of screening and registration of coxofemoral joints was less than the value of dogs estimated to have been saved from moderate, severe, or very severe hip dysplasia in 6 of the breeds. Clinical Implications Documented effects of age suggest that all dogs should be screened at the same age, rather than screening a few dogs at an older, more revealing age. In screening and control programs based on an open registry with access to family records, decreasing prevalence of hip dysplasia can be expected, and related to selection of breeding stock.

Congenital hip dislocation and subtrochanteric pseudoarthrosis: Hip replacement based on computer-aided analysis

A 57-year-old woman with neglected high congenital dislocation of the right hip (Figure 1) and a severe dysplasia of the left hip had progressive pain in both hips, leg-length discrepancy and limitation of motion. On the right side there was a subtrochanteric pseudoarthrosis after an osteotomy performed when the patient was 10 years of age. The patient was admitted to our department and the physical examination revealed a healthy woman,

Hip Dysplasia Associated with Charcot-Marie-Tooth Disease in the Older Child and Adolescent

Severe hip dysplasia in children with Charcot-Marie-Tooth disease is asymptomatic or minimally symptomatic and usually goes undetected until early adolescence. We report five patients between the ages of 8 and 15 years who presented with hip dysplasia; all five required surgery. The dysplasia in two of these patients was detected only on routine screening because of their older sisters' problems. A multicenter study will be needed to determine the exact incidence of hip dysplasia associated with Charcot-Marie-Tooth disease.

The pelvic osteotomy of Chiari: an anatomical study of the hazards and misleading radiographic appearances.

The medial displacement osteotomy of Chiari has an established place in the management of older children and adults with severe hip dysplasia. The results claimed for the operation are, however, variable. There have also been reports of sciatic nerve lesions. In this study ten cadavers were operated upon. Chiari osteotomy was performed upon five, and five acted as controls. The hemipelvis was removed from each cadaver; each specimen was deep-frozen and sectioned transversely. The distance of the sciatic nerve from the nearest bony point was measured in each section and the results were recorded graphically. A further radiographic and photographic study was performed to determine whether apparent displacement at the osteotomy might be misleading. The conclusion was drawn that the sciatic nerve is angulated at the osteotomy and further endangered by the risk of bone splintering at the sciatic notch. The radiographic study suggested that some poor clinical results may be explained by a radiological artefact, because there is a tendency for the osteotomy to hinge posteriorly at the sciatic notch opening anteriorly like a book. Radiographs may suggest excellent medial displacement whereas in fact the femoral head is very poorly covered.