Unaffected Hips Research Articles

Finite element analysis evaluation of hypothetical alternative treatment scenarios for neglected developmental dysplasia of the hip.

The study aimed to evaluate three different degrees of correction in the surgical treatment of neglected developmental dysplasia of the hip (DDH) using finite element models based on computed tomography. Three tridimensional FEA models of hypothetical post-operative (PO) outcomes were developed, based on three tridimensional CT of a pediatric patient diagnosed with luxated neglected DDH: One with the acetabular index of the contralateral hip (CLAT); another based on a theoretical Bombelli biomechanical model (BMB); and another recreating the patient's actual PO. The stresses in the affected hip were greater than those in the unaffected hip. CLAT showed the greatest stress and the smallest loading zone (LZ). In contrast, BMB showed the smallest stress and the biggest LZs. The approach based on the BMB gave the best results in terms of the distribution of the stresses over the hip, whereas the worst was CLAT. Qualitatively, estimating the stability and range of movement of the hip, the PO case was considered the best.

Radiological Differences Following Proximal Femoral Nail Antirotation (PFNA) Compared to the Contralateral Side and Its Correlation with Harris Hip Score (HHS) in Intertrochanteric Femoral Fracture After Three Months

Introduction: The incidence of intertrochanteric femoral fractures, which account for 50% of all hip fractures, is increasing as a result of the aging population. While PFNA surgery typically enhances outcomes, certain individuals continue to have pain, stiffness, and difficulties with their gait. This study aims to determine whether there is a correlation between post-surgical complications and changes in hip joint angles assessed three months following PFNA to lead future advances in PFNA surgery for older persons by comparing impacted and unaffected hips and correlating angles with patients' hip ratings. Methods: This study included 42 individuals who underwent surgery for intertrochanteric fractures aged 50 and above. Eligible participants must possess the ability to walk before to the study, have no history of previous leg fractures, and be capable of participating in rehabilitation. Individuals having comorbidities impacting these aspects or those unable to partake were not included. Result : This study looked at hip angles in 42 people who had surgery intertrochanteric fracture. While the participants varied in age and gender, the surgery itself didn't seem to significantly change the angles of their hip bones or their ability to walk. This suggests that PFNA may not directly affect hip mechanics on its own. Conclusion: This study indicates that attaining acceptable hip angles during the procedure could enhance patients' mobility and post-operative condition. Further investigation involving bigger cohorts and extended periods of observation is necessary to validate these findings and ascertain whether modifying these angles during surgery will result in improved outcomes following PFNA. Keywords: Intertrochanteric fracture; Hip fracture; PFNA

Сompletely slipped capital femoral epiphysis in an 11 year old girl successfully treated bu DUNN’s open reduction through GANZ’ surgical dislocation of the hip (clinical case)

Slipped capital femoral epiphysis (SCFE) is a hip condition that occurs in teens and preteens who are still growing. Treatment for SCFE involves surgery to stop the head of the femur from slipping any further. Without early detection and proper treatment, SCFE can lead to potentially serious complications, including rapid degeneration of the femoral head and/or painful arthritis in the hip joint. Objective. Our case is presented to familiarize with the technique of safe surgical hip dislocation for the treatment of intraarticular hip pathologies. Case report and Methods. After collision while playing the 11 year old girl developed left hippain still allowing to walk. Imaging documented an acute slipped femoral capital epiphysis with the metaphysis articulating against the acetabulum. The patient was underwent open reduction could be performed using the DUNN procedure modified by GANZ. 6 weeks later prophylactic screw stabilization of the healthy right hip followed. Results. At 9 months follow-up the patient walks painfree with symmetric range of motion. Conclusion. The goal of treatment is to prevent the mildly displaced femoral head from slipping any further. This is always accomplished through surgery. Early diagnosis of SCFE provides the best chance of stabilizing the hip and avoiding complications. When treated early and appropriately, long-term hip function can be expected to be very good. Once SCFE is confirmed, the child will not be allowed to put weight on their hip and will be admitted to the hospital. In most cases, surgery is performed within 24 to 48 hours. In patients with unstable SCFE, the surgeon may first make an open incision in the hip, then gently manipulate (reduce) the head of the femur back into its normal anatomic position. The surgeon will then insert one or two metal screws to hold the bone in place until the growth plate closes. Sometimes surgeon may recommend inserting a screw into the unaffected hip at the same time to reduce the risk of SCFE. Our case demonstrates the value of open reduction of a severely dislocated femoral capital epiphysis in a case otherwise probably needing endoprosthetic hip replacement for restitution of hip function or hip arthrodesis at short-term follow-up

Changes in leg length and hip offset in navigated imageless vs. conventional total hip arthroplasty

While previous studies on navigated total hip replacement (nTHA) focused on acetabular component positioning, we compared the results of nTHA with conventional total hip replacement (cTHA) in respect of changes in leg length and hip offset. In a single-center study results radiographic parameters of patients with unilateral THA were included. Data were retrospectively analyzed from computer navigation data and radiographs. Analysis concentrated on the discrepancy in leg length (LLD) and hip offset (OSD) between the affected and unaffected hip. The effect of the procedure was defined as the difference between postoperative and preoperative LLD and OSD values in each group. 2332 patients were analyzed. Both nTHA and cTHA were effective in restoring LLD and OSD by reducing the preoperative value significantly (p < 0.001). Regarding changes in LLD, no statistical difference between nTHA and cTHA could be found. Changes in OSD nTHA was a slightly more effective than cTHA (− 2.06 ± 6.00 mm vs. − 1.50 ± 5.35 mm; p < 0.05). Both navigated and conventional THA were successful in reconstruction of leg length and hip offset, while postoperative offset discrepancy was significantly lower in the navigated group at the cost of longer operation times. If these results are clinically relevant further investigation is needed.

Association Between Hip Bone Mineral Density and Mortality Risk After Hip Fracture: A Prospective Cohort Study.

Factors related to mortality after osteoporotic hip fracture (HF) have been investigated intensively, except for proximal femoral bone mineral density (BMD), which is also the primary cause of osteoporosis. In this study, we aimed to investigate the association of hip BMD with mortality risk after HF. Four hundred and eleven elderly patients with HF in Beijing, China, were included and prospectively followed up with a median time of 3years. At baseline, quantitative CT technique (QCT) was used to measure areal BMD (aBMD) of the unaffected hip. Areal BMDs of the total hip (TH), femoral neck (FN), trochanter (TR), and intertrochanter were analyzed with postoperative mortality as the primary outcome. A total of 394 patients (78.59 ± 7.59years, 75.4% female) were included in our final analysis, with 86 (82.23 ± 7.00years, 81.4% female) dead. All hip bone densities demonstrated a significant association with mortality risks in the unadjusted model, but only TR aBMD remained significantly correlated after adjusting for all covariates. Compared to the lower TR aBMD group, the higher TR aBMD group yielded significantly lower death risks (HR 0.21 95% CI 0.05-0.9, P = 0.036). Higher survival probabilities were observed for higher TH and TR aBMD in survival analysis (P < 0.001). Hip BMD, especially TR BMD assessed by QCT, is an independent risk factor for postoperative mortality following HF. QCT may present a promising avenue for opportunistic analysis in immobilized patients, providing valuable information for early detection and personalized interventions to enhance patient outcomes.

Slipped Upper Femoral Epiphysis in Adolescents: Evolving Information on Its Mode of Presentation and Management

Background and objective Slipped upper femoral epiphysis (SUFE) is one of the most common hip pathologies in adolescents and pre-adolescents, the diagnosis of which is often missed due to delayed presentations. In this study, we aimed to conduct a retrospective analysis of SUFE cases treated in the hospital during the 15-year period from 2003 to 2018 and examine its bilateral presentation and the need for prophylactic pinning on the unaffected side. Methods This retrospective cohort study involved cases that were treated from 2003 to 2018. The case details were retrieved from the medical records department. Records older than 15 years were excluded owing to their inaccuracy, and 26 cases of SUFE were included in the final analysis. Each case was subjected to physical and radiological examinations of the symptomatic and asymptomatic hips. IBM SPSS Statistics v23 (IBM Corp., Armonk, NY) was used for data analysis. Results In this study, six of the 26 patients had bilateral SUFE and required subsequent surgical pinning. The duration of surgical interventions ranged from two to 22 months, while the mean intervention duration was 10.3 months. Among the cases, 61.5% (p&lt;0.05) were idiopathic in nature upon documentation. However, 19% (p&lt;0.05) of the cases were shown to be associated with an underlying condition or prior symptoms of the condition, whereas 7.6% (p&lt;0.05) had an increased basal metabolic index; 11% (p&lt;0.05) of the cases had an inherited family history of SUFE. A comparison between males and females showed a slightly higher frequency of complications in males (n=14) than in females (n=12) (p=0.556). The age of the patients at the presentation ranged between and 10-15 years, with an average age of 12.5 years. Conclusion Based on our findings, males were affected more than females and most of the cases were idiopathic. There is no significant evidence to support the need for prophylactic pinning of the unaffected hip. We recommend prospective studies with a larger sample of patients to gain more insight into the topic.

Trans-Table Intraoperative Fluoroscopic Technique for Obtaining a True Lateral View of the Proximal Femur in the Lateral Decubitus Position.

The management of proximal femoral fractures, especially comminuted subtrochanteric ones, poses a surgical challenge. It is relatively easier to perform the open reduction of these fractures in the lateral position on a standard radiolucent table, but obtaining an accurate lateral view of the femoral head and neck remains difficult. This study presents a method that overcomes the limitations of fluoroscopy in the lateral decubitus position and improves the accuracy of obtaining a true lateral view. The technique involves positioning the patient in the lateral decubitus position with the unaffected hip flexed at a 45° angle. Additionally, the C-arm is tilted 30-35° cephalad, eliminating the need for position changes or leg manipulation. This method reduces the risk of losing reduction, particularly in cases involving obese patients or complex fractures. By simplifying proximal femur fixation in the lateral decubitus position, this technique can potentially improve patient outcomes.

Midterm Clinical, Radiological, and Functional Results of Arthroscopic Excision of Osteoid Osteoma of the Hip Joint: a Case Series.

We aimed to evaluate the midterm functional and clinical outcomes of the patients who underwent arthroscopic excision of hip osteoid osteoma (OO). We reviewed records of patients diagnosed with intra-articular hip OO, treated with hip arthroscopic excision procedure, and a minimum of 1-year postoperative between 2011 and 2020. Clinical outcomes were assessed range of motion (ROM) pre and postoperatively, and functional outcomes were evaluated with a modified Harris hip score (modified HHS) and Visual analog scale test. All patients were assessed by hip radiography, and three radiological measurements, including lateral center-edge angle (LCEA), alpha angle, and Tönnis angle, were measured. These parameters were compared with unaffected hips. Fifteen (5 female and 10 male) patients were included in the study, with a mean age of 32.6 ± 12.7 (range 12-53). The average postoperative follow-up period was 59.1 ± 28 (range 13-106) months. The functional and clinical scores were significantly improved at the final visit compared to the preoperative values. No differences were found between the operated and unaffected sides with respect to the radiological parameters. The preoperative alpha was significantly higher on the operated side than on the unaffected side (p = 0.007). In this study, within an average of 5years after surgery, hip arthroscopy provided successful clinical outcomes in the treatment of OO of the hip joint without recurrence. The modified HHS, VAS, and HOS values improved significantly at the final follow-up; 14 of 15 patients had satisfactory outcomes after hip arthroscopy for hip OO. Prognostic Level IV study.

Evaluation of the short-term curative effect of closed reduction in the treatment of developmental dysplasia of the hip based on three-dimensional magnetic resonance imaging finite element analysis

BackgroundBased on the Digital Imaging and Communications in Medicine (DICOM) data of three-dimensional magnetic resonance imaging (3D-MRI), finite element models of the hip joints of children with developmental dysplasia of the hip were established. The primary objectives included simulation and analysis of the finite element model pre- and post-closed reduction under different stances and loads, and evaluation of the size and distribution of von Mises stress in the acetabulum and femoral head pre- and post-operation and the short-term effects.MethodsAcetabular index measurements of both the unaffected and affected sides were conducted, alongside International Hip Dysplasia Institute (IHDI) classification of the affected hip. Establishing the finite element model of both the affected and unaffected hips was based on the 3D-T1WI sequence DICOM data, using Mimics, 3-matic, and Ansys software, before and after closed reduction surgery. The size and distribution data of von Mises stress on the affected side of the acetabulum and femoral head were collected pre- and post-operation.ResultsThe study indicated that the increasing acetabular index of the affected hip was directly proportional to the increasing severity based on IHDI classification (P < 0.05). Preoperative IHDI classification significantly correlated with the von Mises stress (r = 0.560–0.569, 0.562–0.564, P < 0.05). Under different stances and load conditions, the von Mises stress on the affected side post-operation was lower than that noted pre-operation (P < 0.01), while that on the acetabulum increased proportionally to the load. Although the magnitude and distribution of von Mises stress on the affected side of the acetabulum were similar to those on the healthy side post-operation, there were statistical differences between the two (P < 0.01). The von Mises stress of the lateral column of the femoral head post-operation was significantly lower than that noted pre-operation (P < 0.01). While the high-stress points of the lateral column disappeared post-operation, the von Mises stress was evenly distributed in the femoral head.ConclusionsThe 3D-MRI finite element could provide the von Mises stress value and distribution characteristics of the acetabulum and femoral head pre- and post-operation. Closed reduction can, therefore, improve the size and distribution of von Mises stress on the affected acetabulum and femoral head.

The British Orthopaedic Surgery Surveillance study: slipped capital femoral epiphysis: the epidemiology and two-year outcomes from a prospective cohort in Great Britain.

AimsThe aim of this study was to inform the epidemiology and treatment of slipped capital femoral epiphysis (SCFE).MethodsThis was an anonymized comprehensive cohort study, with a nested consented cohort, following the the Idea, Development, Exploration, Assessment, Long-term study (IDEAL) framework. A total of 143 of 144 hospitals treating SCFE in Great Britain participated over an 18-month period. Patients were cross-checked against national administrative data and potential missing patients were identified. Clinician-reported outcomes were collected until two years. Patient-reported outcome measures (PROMs) were collected for a subset of participants.ResultsA total of 486 children (513 hips) were newly affected, with a median of two patients (interquartile range 0 to 4) per hospital. The annual incidence was 3.34 (95% confidence interval (CI) 3.01 to 3.67) per 100,000 six- to 18-year-olds. Time to diagnosis in stable disease was increased in severe deformity. There was considerable variation in surgical strategy among those unable to walk at diagnosis (66 urgent surgery vs 43 surgery after interval delay), those with severe radiological deformity (34 fixation with deformity correction vs 36 without correction) and those with unaffected opposite hips (120 prophylactic fixation vs 286 no fixation). Independent risk factors for avascular necrosis (AVN) were the inability of the child to walk at presentation to hospital (adjusted odds ratio (aOR) 4.4 (95% CI 1.7 to 11.4)) and surgical technique of open reduction and internal fixation (aOR 7.5 (95% CI 2.4 to 23.2)). Overall, 33 unaffected untreated opposite hips (11.5%) were treated for SCFE by two-year follow-up. Age was the only independent risk factor for contralateral SCFE, with age under 12.5 years the optimal cut-off to define ‘at risk’. Of hips treated with prophylactic fixation, none had SCFE, though complications included femoral fracture, AVN, and revision surgery. PROMs demonstrated the marked impact on quality of life on the child because of SCFE.ConclusionThe experience of individual hospitals is limited and mechanisms to consolidate learning may enhance care. Diagnostic delays were common and radiological severity worsened with increasing time to diagnosis. There was unexplained variation in treatment, some of which exposes children to significant risks that should be evaluated through randomized controlled trials.Cite this article: Bone Joint J 2022;104-B(4):519–528.

Role of the prophylactic fixation of contralateral unaffected hip in paediatric unilateral slipped capital femoral epiphysis: a systematic review.

The aim of this systematic review is to assess the role of the prophylactic fixation of contralateral unaffected hip in unilateral slipped capital femoral epiphysis (SCFE) in children, focusing on the possible complications of this surgical procedure.A systematic review of medical literature was conducted, according to the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) statement, to analyse the complications of prophylactic contralateral hip fixation in unilateral paediatric SCFE. We registered the complications reported in the included studies, scoring their severity according to the orthopaedic adaptation of Clavien–Dindo classification.From 1695 studies primarily identified, 14 studies were finally included: 1 prospective cohort study, 4 retrospective case-control studies and 9 retrospective case series, with a total of 811 children diagnosed with unilateral SCFE and treated on the unaffected contralateral hip. Grade IV complications were very rare (0.37%), while the rate of grade III events was 8%. No death was recorded. The most frequent complication was unplanned further surgery (6.29%) that was an epiphyseal refixation, owing to the physiologic growth of the proximal femur, in 42 cases. Cannulated screws fixation showed to have a lower major complication rate than pinning with K-wires, 5.37% vs 17.95%.The prophylactic fixation of contralateral unaffected hip in paediatric unilateral SCFE is a safe procedure. Although a benefit-cost analysis on this topic has not been published yet, considering the low rate of complications, prophylactic hip fixation is a viable option for patients presenting with unilateral SCFE, to prevent the occurrence of severe hip deformity and avoid future invasive surgeries.

The Intergluteal Fat Stripe in Patients With Hip Abductor Tears.

Background:With a hip abductor tendon tear, widening of the intergluteal space, or “fat stripe,” is a characteristic change seen in and around the gluteus medius and minimus.Purpose:To determine the relationship of the intergluteal fat stripe in hips with pathologic abductor tears compared with the contralateral side and to evaluate the association of fat stripe size with hip-specific patient-reported outcome measures.Study Design:Case series; Level of evidence, 4.Methods:Of the 43 patients (42 female, 1 male; mean age, 56.6 years; range, 38-85 years) who underwent endoscopic gluteus medius repair, 19 met inclusion criteria of preoperative bilateral hip magnetic resonance imaging (MRI) scans and 2-year follow up. A single board-certified fellowship-trained orthopaedic surgeon (J.F.), who was blinded to outcomes, evaluated the MRI scans to measure the intergluteal fat stripe on the operative and nonoperative sides. The 2-year postoperative International Hip Outcome Tool (iHOT-12) and modified Harris Hip Score (mHHS) values were analyzed to determine their relationship to the size of the fat stripe. Statistical analysis was performed using a paired t test, and associations were determined using Pearson product correlation as well as nonparametric measurements.Results:The size of the intergluteal fat stripe differed significantly between the operative and nonoperative sides. The area of the fat stripe on the operative side was 645.73 ± 513.09 mm2, and on the nonoperative side it was 313.47 ± 360.71 mm2, an average of 332.36 mm2 greater than the nonoperative side (P = .02). The width of the fat stripe was 9.10 ± 4.60 mm on the operative side and 5.15 ± 3.87 mm on the nonoperative side, 3.95 mm greater than the nonoperative side (P < .01). There was no correlation between the width or area of the fat stripe on the operative side and iHOT-12 or mHHS values at 2-year follow-up.Conclusion:The study findings indicated that the intergluteal fat stripe is significantly wider and has a significantly larger area in hips with abductor tears compared with unaffected hips. This did not correlate with 2-year patient-reported outcomes.

Femoroacetabular impingement in the unpinned contralateral hip in patients with primary unilateral slipped capital femoral epiphysis: preliminary radiographic outcomes.

The study evaluated femoroacetabular impingement (FAI) in the unpinned contralateral hip in patients with unilateral slipped capital femoral epiphysis (SCFE) and verified initial age, posterior sloping angle (PSA) and center-edge angle (CEA) as predictors of FAI in the contralateral hip. 152 patients with unilateral SCFE with a mean index age of 13.2 years (8.2-17.2 years) were enrolled retrospectively into the study. Mean follow-up was 8 years (3-14 years). PSA and CEA were measured on initial radiographs of the unaffected hip. Alpha-angle and CEA were measured on radiographs taken at the last follow-up to identify FAI. Four groups of patients were distinguished: (1) no FAI (10 patients, 17.54%); (2) CAM-type FAI (41 patients, 71.9%); (3) pincer-type FAI (3 patients, 5.26%) and (4) mixed-type FAI (13 patients, 22.8%). The mean PSA was 12.1°, 12°, 16.8°, 11.9° for groups 1, 2, 3 and 4, respectively, with no significant difference ( P = 0.65). The mean initial CEA for groups 1, 2, 3 and 4 was 34.4°, 35.5°, 42° and 42° respectively, with significant differences between groups 1 versus 4 ( P = 0.034) and 2 versus 4 ( P = 0.009). Conclusions are as follows: 1. Radiographic features of FAI were present in 85.1% of unpinned contralateral hips in patients with unilateral SCFE. 2. 71.9% of unpinned contralateral hips developed CAM deformity. 3. CEA can be used in predicting pincer-type FAI in the contralateral hip in unilateral SCFE. 4. PSA and age revealed negligible value in predicting FAI.

Asymmetrically increased femoral version with high prevalence of moderate and severe femoral anteversion in unilateral Legg-Calvé-Perthes disease.

PurposeTo determine and stratify femoral version in Legg-Calvé-Perthes disease (LCPD), and to compare the femoral version between the LCPD hip and the contralateral unaffected hip.MethodsWe performed a retrospective review of 45 patients with unilateral LCPD who had available CT scan through the hips and knees between January 2000 and June 2017. There were 34 (76%) male cases with a mean age of 14 years (sd 4.69). Two independent readers measured femoral version on the affected and the unaffected contralateral femur. Femoral version was classified as follows: severely decreased version (< 10°); moderately decreased (10° to 14°); normal femoral version range (15° to 20°); moderately increased (21° to 25°); and severely increased version (> 25°).ResultsLCPD hips had predominantly increased femoral version (38% severely increased anteversion, 24% moderately increased anteversion), while 51% of the contralateral unaffected hips had normal femoral version (p < 0.001). LCPD hips had higher mean femoral version than the contralateral, unaffected side (mean difference = 13o; 95% confidence iterval 10o to 16o; p < 0.001). As the version of the affected hip increased, so did the discrepancy between sides. No effect of sex on the LCPD femoral version was detected (p = 0.34).ConclusionThis study included a selected group of patients with unilateral LCPD and available CT scans obtained for surgical planning. The femoral version was asymmetric, with a high proportion of excessive anteversion observed at later stages of disease in the affected hips. Future studies will be necessary to determine the pathogenesis of increased femoral version associated with LCPD.Level of EvidenceLevel IV, retrospective study.

Acetabular remodeling after graft extrusion, rotation or impaction in Dega and Pemberton acetabuloplasties for developmental dysplasia of the hip.

Traditionally graft displacement following Pemberton and Dega acetabuloplasties involves internal fixation for treatment of developmental dysplasia of hip (DDH). This study was performed to assess the acetabular remodeling by conservative management of graft displacement among patients with DDH. This was a retrospective study of 20 patients 17 (85%) women and 3 (15%) men; mean age 22.90 ± 6.96 months with DDH who underwent Pemberton and Dega acetabuloplasties at King Khalid University Hospital, Riyadh between January 2013 and January 2018. All patients after losing acetabular correction during immediate postoperative period were treated by conservative management. The management involved application of Spica cast for 6 weeks that was trimmed to broomstick cast for an extended period of time and finally replaced by nocturnal abduction brace until normal acetabular index (AI) was achieved. The patients were followed up for a mean period of 44.60 ± 12.36 months. Out of the total, 18 (90%) patients with DDH were successfully treated by conservative management. The mean preoperative AI of 43.70° ± 5.91° improved to 21.35o ± 6.32o at the final follow-up (P < 0.001) which was no different when compared to the mean of unaffected hips (19.70o ± 2.96o; P < 0.44). The mean preoperative CEA of all the patients was negative that improved during the conservative treatment to 29.20° ± 10.0° which was no different when compared with the mean of unaffected (31.70° ± 4.64o; P = 0.32) hips at the final follow-up. doption of less aggressive approach for management of displaced, rotated or impacted autograft following acetabuloplasties among children with DDH was not only a useful conservative approach for remodeling of hips but also obviated the need for additional surgical intervention.

Can we still use X-rays to predict contralateral slip in primary unilateral slipped capital femoral epiphysis?

The objective of this study was to assess subsequent contralateral slip (SCS) in the unaffected hip in patients with primary unilateral slipped capital femoral epiphysis (SCFE) using three radiographic parameters: posterior sloping angle (PSA), center-edge angle (CEA) and triradiate cartilage (TC) appearance. A total of 152 patients admitted to two pediatric units between 2001 and 2015 were divided into three groups: A - underwent prophylactic fixation of the unaffected hip at the time of index surgery- high clinical risk of SCS; B - no clinical risk factors but SCS occurred; C - no issues regarding the contralateral hip during follow-up. The mean PSA for groups A, B and C were 22°(6-49), 17°(9-24) and 13°(0-27), respectively. PSA was significantly higher in Group A than in Group C ( P < 0.0001). The differences in PSA between groups A and B, but also B and C were insignificant ( P = 0.12 and p=0.21, respectively). The mean CEA in groups A, B and C was 33(25-43), 35(26-42) and 37(17-53), respectively. CEA did not differ significantly between groups A, B and C ( P = 0.25). Assessment of TC did not differ significantly between the groups ( P = 0.66). Observation of TC in groups B and C combined revealed that the cartilage was open in 65% of 77 patients and 14% of them developed SCS; whereas among the 35% of patients with ossified TC only 7% developed SCS (OR=2.0). PSA and CEA alone have no predictive value in determining the risk of contralateral slip. The absence of TC results in a two-fold decrease in the likelihood of developing an SCS. The decision of prophylactic surgical treatment of the contralateral hip in primary unilateral SCFE should not be based solely on radiographic findings.

Increased Loading Rates During Gait Correlate With Morphology of Unaffected Hip in Juveniles With Treated Developmental Hip Dysplasia.

Long-term follow-up studies on children with surgically treated developmental dysplasia of the hip (DDH) have shown that not only the affected side progresses to premature osteoarthritis, but the unaffected side may also suffer from insidious hip dysplasia or osteonecrosis. The current gait analysis study identified the loading and unloading rates of the ground reaction forces (GRF) and lower limb joint axial forces during gait, and their correlations with the hip morphology in twenty juvenile patients with surgically treated unilateral DDH during toddlerhood. In a gait laboratory, each subject walked at preferred speed on a 10-m walkway while the kinematics and the GRF were measured. Loading and unloading rates of the vertical GRF and the joint axial forces were obtained as the maximum instantaneous slope of these force curves. Radiographic measurements of the hips were taken, and the correlations between the morphological parameters and the loading and unloading rates were obtained. The patients showed greater-than-normal peak loading rates of the joint axial forces, and the loading rates on both the affected and unaffected sides were strongly correlated to the acetabular index on the unaffected side, which was also significantly correlated with the peak unloading rates on the affected side. These results suggest that apart from regular follow-up of the affected hip, routine assessment of the morphological changes and/or increased loading rates on the unaffected hip is also important for early identification of any signs of insidious hip dysplasia and risk of premature degeneration of the cartilage.

Acetabular volume and femoral coverage change following Dega-like osteotomy in treatment of developmental dysplasia of the hip.

Although Dega's acetabuloplasty has become a commonly used osteotomy, there is still an ongoing debate regarding its impact on the volume and depth of the acetabulum. The purpose of our study was to assess the postoperative images of the transverse acetabular plane and version obtained from developmental dysplasia of the hip (DDH) patients after a modified Dega osteotomy. We performed a retrospective study of the morphologic indices obtained from the pelvic X-rays and computer tomography (CT) scans of patients with DDH, who were operated in our institution between July 2005 and October 2013, using the modified Dega osteotomy. Preoperative and postoperative pelvic X-rays were used to measure the acetabular index and the acetabular (ACM) angle. The postoperative CT scans were used to measure the acetabular anteversion angle (AAA), acetabular depth and depth of acetabular coverage [total acetabular index (TAI)]. The contralateral unaffected hips served as control. The postoperative acetabular indices and ACMs showed a significant improvement, with near-normal values measured 1 year after the surgery. Comparing the CT scan parameters (AAA, TAI and the depth of acetabulum) showed that TAI and the depth of acetabulum were not significantly different between the groups (TAI: P = 0.423; depth of acetabulum: P = 0.132), whereas AAA comparison implied a slight advantage of the DDH hips (17.6° DDH vs. 13.3° contralateral, P = 0.001). On the basis of images set of acetabular morphometric parameters, our study substantiates previous reports on an increase of acetabular volume and a significant improvement of femoral head coverage for patients with DDH who underwent Dega acetabuloplasty. Level of evidence: Level III - retrospective comparative study.

SLIPPED CAPITAL FEMORAL EPIPHYSIS ACETABULAR ORIENTATION AND SHAPE: A THREE-DIMENSIONAL CT STUDY

Background:Previous studies have analyzed the acetabulum in patients affected by slipped capital femoral epiphysis (SCFE), however controversy remains over how the acetabular shape may be altered in hips experiencing SCFE. In particular, changes in acetabular over-coverage and acetabular version are thought to contribute to SCFE.Hypothesis/Purpose:The purpose of this study was to determine the acetabular morphology in hips with SCFE and compare them to normally developing children.Methods:Images from patients with the diagnosis of SCFE who had a computed tomography (CT) exam of their pelvis were compared to images from an age- and sex-matched cohort of patients with CT exams of the pelvis/abdomen for a non-orthopedic related evaluation (controls). Three dimensional (3D) reconstructions were created from each CT exam (MIMICs software). Custom MATLAB software was used to uniformly align and calculate acetabular parameters from the 3D reconstructions. The acetabular parameters calculated were articular surface area, acetabular tilt, acetabular version, and acetabular coverage angles measured in a radial fashion in 5 out of 8 octants.Results:Two-hundred-ninety-eight hips were evaluated, including 67 hips with SCFE, 39 unaffected contralateral hips in patients with SCFE, and 192 normal controls. The SCFE group consisted of 33 males and 34 females. Acetabular version was similar amongst all SCFE affected hips, unaffected contralateral hips, and normal controls (p=0.575). Control hips had higher acetabular tilt than SCFE affected hips (p=0.001) and unaffected contralateral hips (p=0.012). Acetabular surface area was higher in SCFE affected hips compared to controls (p=0.003)(Table 1). SCFE affected hips had significantly increased acetabular coverage compared to controls in the superior, superior-anterior, and anterior octants (p<0.01). The unaffected contralateral sides had significantly increased acetabular coverage compared to controls in all five regions (p<0.02)(Table 2).Conclusions:Contrary to some previous studies, we did not find the acetabulum to be retroverted in hips with SCFE compared to normal hips. Both the affected and unaffected hips of SCFE patients have decreased acetabular tilt. Acetabular surface area is high in both the affected and unaffected sides in SCFE, suggesting it may be involved in the pathogenesis of the condition. There is increased acetabular coverage in the superior regions of SCFE hips. The shared morphological characteristics of both affected and unaffected sides in SCFE patients suggest that their hip anatomy may predispose them to slips.

Acoustic Feedback in Gait Rehabilitation-Pre-Post Effects in Patients With Unilateral Hip Arthroplasty.

It is known that patients after unilateral hip arthroplasty still suffer from a deficient gait pattern compared to healthy individuals one year after surgery. Through the method of gait sonification, it may be possible to achieve a more efficient training and a more physiological gait pattern. Increased loads on the musculoskeletal system could thus be reduced and rehabilitation times shortened. In a previous investigation with this patient group, we found immediate gait pattern changes during training with dual mode acoustic feedback [real-time feedback (RTF) and instructive model sequences (IMS)]. To determine whether an effect persists without the immediate use of acoustic feedback, we analyze data from four times of testing. Following unilateral hip arthroplasty 22 patients participated in an intervention of ten gait training sessions of 20 min each. During gait training the sonification group (SG) (n = 11) received an acoustic feedback consisting of RTF and IMS compared to a control group (CG) (n = 11). Pre-test, intermediate test, post-test, and re-test were conducted using an inertial sensor-based motion analysis system. We found significant effects (α = 0.05) regarding step length and range of motion (RoM) of the hip joint. Step length of the affected leg increased in the SG from intermediate test to post-test but decreased in the CG [intermediate test: (SG) 0.63 m ± 0.12 m, (CG) 0.63 m ± 0.09 m; post-test: (SG) 0.66 m ± 0.11 m, (CG) 0.60 m ± 0.09 m]. However, from the post-test to the re-test a reverse development was observed [re-test: (SG) 0.63 m ± 0.10 m, (CG) 0.65 m ± 0.09 m]. Also, from post-test to re-test a decrease in the RoM of the unaffected hip for the SG but an increase for the CG could be observed [post-test: (SG) 44.10° ± 7.86°, (CG) 37.05° ± 7.21°; re-test: (SG) 41.73° ± 7.38°, (CG) 40.85° ± 9.28°]. Regarding further parameters, significant interactions in step duration as well as increases in stride length, gait speed, cadence, and a decrease in ground contact time from pre-test to re-test were observed for both groups.Clinical Trial Registration: https://www.drks.de/drks_web/, identifier DRKS00022570.