Hip Dysplasia In Young Adults Research Articles

Neonatal Ultrasound and Radiographic Markers of Hip Dysplasia in Young Adults.

To examine radiologic outcomes at skeletal maturity of sonographically normal, immature, mildly, and severely dysplastic newborn hips. During 1988 to 1990, 11 925 newborns were enrolled in a randomized controlled trial examining screening strategies for developmental hip dysplasia. In total, 4469 were invited to clinical and radiologic follow-up 18 years later, of which 1735 had received neonatal ultrasound. Radiographic markers for dysplasia in left adult hips included the center-edge (CE) angle. At follow-up, 984 of 1735 (56.7%) with newborn ultrasound met, of which 966 (614 females) had valid radiographs and were thus included. For females, 34 (10.2%) and 1 (0.3%) of the 332 sonographically normal left neonatal hips were judged borderline (20°≤ CE <25°) or dysplastic (CE <20°) at skeletal maturity respectively. Corresponding numbers were 36 (19.7%) and 3 (1.6%) of the 183 immature, 12 (15.6%) and 2 (2.6%) of the 77 mildly dysplastic, and 3 (13.6%) and 3 (13.6%) of the 22 severely dysplastic neonatal left hips (P ≤ .001). In males, no associations were found. In females, adult joint hypermobility was associated with sonographic neonatal hip instability (P = .046), as well as with adult acetabular dysplasia (P = .024). Significant associations between neonatal hip phenotypes and adult dysplasia were revealed in females. This indicates the possibility of different mechanisms affecting the course of developmental dysplasia of the hip for females and males, prompting consideration of prolonged clinical and radiologic follow-up for females with dysplastic neonatal hips. Results in males are limited by low numbers of dysplastic hips. The significance of joint hypermobility warrants further investigation.

Prevention ofmotor ascending branch ofthe rectus femoris injuries inBernese periacetabular osteotomy: a cadaveric study.

The Bernese periacetabular osteotomy (PAO) is a surgical procedure used to treat hip dysplasia in young adults, but it carries the risk of neurological complications, including injury to the motor ascending branch of the rectus femoris (MABRF). This study aimed to describe anatomical considerations to prevent MABRF injuries during PAO. A cadaveric study was conducted on seven specimens. The original and modified PAO approaches were used, with and without disinsertion of the rectus femoris muscle origin. The femoral nerve was dissected in all specimens from the endopelvic position to the MABRF origin (T-point). The average distance from the anterosuperior iliac spine to the T-point was 10.2 ± 0.4 cm. To protect the MABRF, a safety zone was identified for the osteotome placement during the ischial cut. The osteotome was slid over the joint capsule, deflecting the iliocapsularis muscle medially and distally. This manoeuvre shields the MABRF with the iliocapsularis muscle, reducing the risk of neurological injury. Both the original and modified PAO approaches were considered safe techniques with low risk to the rectus femoris innervation. These findings offer valuable insights for surgeons performing PAO, emphasizing the significance of understanding anatomical relationships and implementing protective measures to enhance patient outcomes and minimize complications. In conclusion, implementing these anatomical considerations can help prevent MABRF injuries during PAO, contributing to safer and more successful surgical interventions for hip dysplasia in young adults.

Correcting Hip Dysplasia in Young Adults: Intraoperative Navigation and Outcomes.

Developmental dysplasia of the hip (DDH) often leads to characteristic acetabular dysplasia and typical femoral anomalies. There are numerous treatments for skeletally mature patients with DDH including hip arthroscopy, pelvic and femoral osteotomies, as well as total hip arthroplasty. Before proceeding to an arthroplasty procedure, it can be helpful to obtain an opinion of a hip preservation specialist to ascertain if alternative surgical treatments could contribute to the patient's care. In general, the use of robotic navigation has been associated with a higher proportion of cups placed in the Lewinnek safe zone, larger improvements in Harris Hip Scores, and no difference in overall complication rates in comparison to manual total hip arthroplasty. The use of robotic navigation allows for both 2-dimensional and 3-dimensional preoperative templating, enabling the surgeon to plan the position of the construct such that it achieves maximum bony purchase and hip stability. In complex DDH cases, surgeons can work with a biomechanics department to complete a fit check assessment, which utilizes 3-dimensional templating software to ascertain the appropriateness of the implant's geometry with the patient's anatomy. Furthermore, a 3-dimensional printed plastic model of the pelvis and/or femur can be constructed in order to complete a rehearsal procedure, which may be particularly helpful for those cases involving osteotomies. The literature on the use of robotic-assisted total hip arthroplasty in patients with DDH demonstrates improved component positioning in comparison to navigated as well as manual methods; however, studies with long-term follow-up in this patient population are lacking.

Radiographic markers of hip dysplasia in young adults: predictive effect of factors in early life

AbstracBackground and objectivesAcetabular dysplasia in young adults occurs, despite screening for developmental hip dysplasia (DDH) in the neonatal period. We aimed to examine how early life factors predict radiographic measurements of acetabular dysplasia at 18–19 years of age.MethodsFrom a previous randomized trial (n = 12,014; 1988–90) evaluating the role of hip ultrasound in newborn screening of DDH, 4469 participants (2193 males) were invited to a follow-up 18 years later (2007–09), of which 2370 (53% attendance; 932 males) met. We examined associations between early life factors and four radiographic measurements for acetabular dysplasia at skeletal maturity. Hierarchical regressions, with addition of variables observed/measured consecutively in time, were analyzed using mixed effects models considering hip as the unit in the analyses. The study is approved by the Regional Ethics Committee.ResultsIn total, 2340 participants (921 boys), mean age 18.7 years, (SD 0.6) had hip radiographs performed at follow-up and were included. Early life factors significantly predicting radiographic acetabular dysplasia at age 18–19-years included female gender, breech, low acetabular inclination (alpha) angle and sonographic instability, abduction treatment, as well as the velocity of growth during childhood. A positive family history of DDH was not associated with acetabular dysplasia at skeletal maturity.ConclusionThe acetabular inclination (alpha) angle as measured on ultrasound at birth turned out to be a significant predictor of dysplasia at 18–19 years of age. The discordant role of a positive family history in early versus adult hip dysplasia is intriguing, warranting further studies on the genetic mechanisms of DDH.

Risk Factors for Composite Failure of Hip Dysplasia Treated With Periacetabular Osteotomy: A Minimum 10-Year Follow-up

Periacetabular osteotomy (PAO) is a common surgical treatment of prearthritic hip dysplasia in young adults, but there are few long-term studies of clinical outcomes. The purpose of this investigation was to report a minimum 10-year clinical follow-up of hip dysplasia treated with PAO and identify risk factors for composite failure. We identified 151 patients (198 hips) who underwent PAO to treat hip dysplasia at a single institution. Enrolled subjects completed a series of six patient-reported outcome instruments and provided information about subsequent surgeries. We defined composite failure as conversion to total hip arthroplasty or modified Harris Hip Score ≤70. Logistic regression with generalized estimating equations was used to evaluate the relationships between odds of failure and potential predictor variables in univariate and multivariate analyses. A total of 124 subjects (167 hips) with a minimum 10-year follow-up were enrolled. The median time from PAO to the final follow-up was 13 years (range 10-18 years). There were 71 hips that met criteria for failure: 32 with total hip arthroplasty and 39 with modified Harris Hip Score ≤70. Univariate logistic regression analyses revealed multiple preoperative factors that predicted composite failure: increased age and body mass index, osteoarthritis (OA), and more severe acetabular dysplasia. Postoperative factors that predicted failure included lateral undercoverage and formation of heterotopic ossification (HO). The final multivariate model identified body mass index ≥30 kg/m2 (odds ratio [OR], 3.84 [95% confidence interval (CI), 1.68-8.78], P = 0.001), higher preoperative Tönnis grade OA (OR, 2.65 [95% CI, 1.50-4.66], P < 0.001), and HO formation (OR, 16.52 [95% CI, 2.08-135.96], P = 0.009) as independent predictors of failure. This study corroborates current hip dysplasia literature, identifying increasing age and presence of preoperative OA as risk factors for composite failure in univariate analyses. In addition, we found that obesity and HO formation were independent predictors of persistent hip dysfunction. Therapeutic Level IV.

Adolescent hip dysplasia: what are the symptoms and how to diagnose it.

Adolescent and young adult hip dysplasia is a cause of hip pain which can lead to early hip osteoarthritis. This may result in early hip osteoarthrosis and possible total hip arthroplasty if dysplasia is not recognized and treated. Hip dysplasia in this population can be difficult to diagnose. It is important for primary care providers and pediatricians to recognize the symptoms, physical examination findings, and radiographic findings associated with adolescent hip dysplasia so that the patient can be referred to an orthopedist specializing in hip disorder. The current review includes the most up-to-date literature on the diagnosis of adolescent hip dysplasia. Recent studies have shown that most patients presenting with symptomatic hip dysplasia present with insidious onset hip pain localized to either the groin or lateral aspect of the hip in a C-shape distribution around the inguinal crease. Patients most commonly see several different providers and have pain for a long period prior to accurate diagnosis. There are myriad radiographic measurements of hip dysplasia, many of which are described below that are helpful in initial diagnosis. Adolescent and young adult hip dysplasia can be a cause of early, progressive hip osteoarthritis. Hip dysplasia is a term that represents a spectrum of disorder due to abnormal formation of the hip joint, resulting in an acetabulum that does not sufficiently cover the femoral head. The ability to recognize symptoms, physical examination findings, and radiographic evidence of adolescent hip dysplasia is critical so that the patient can be referred to the appropriate provider and receive timely treatment prior to the onset of degenerative hip disease. This article will focus mainly on the diagnosis of adolescent hip dysplasia. The standard for treatment of acetabular dysplasia in skeletally mature patients is the periacetabular osteotomy; however, nonoperative management and occasionally arthroscopic surgery can also be considered in cases of symptomatic borderline dysplasia.

Periacetabular Osteotomy for Developmental Dysplasia of the Hip and Femoroacetabular Impingement: A Study Using the U.K. Non-Arthroplasty Hip Registry (NAHR) Data Set.

Periacetabular osteotomy (PAO) is a well-recognized procedure for the treatment of hip dysplasia in young adults and can be used for the surgical management of femoroacetabular impingement (FAI) with acetabular retroversion. The aim of this study was to use a national database to assess the outcomes of PAO for developmental dysplasia of the hip (DDH) and for FAI. All patients in whom an isolated PAO had been performed between January 2012 and February 2019 were identified in the Non-Arthroplasty Hip Registry (NAHR). Their outcomes were assessed using the EuroQol-5 Dimensions (EQ-5D) index and the International Hip Outcome Tool (iHOT)-12 preoperatively and then at 6 months, 12 months, and 2 years postoperatively. Six hundred and thirty (630) PAOs were identified, with 558 (89%) performed for DDH and 72 (11%) performed for FAI. Most patients (90%) were female. The mean age in the DDH group (31.2 years) was significantly higher (p < 0.0001) than that in the FAI group (26.5 years). There were no other significant between-group demographic differences. Preoperatively and at each follow-up time-period, iHOT-12 scores were better in the DDH group than in the FAI group; however, only the preoperative scores differed significantly. There was significant improvement between the preoperative and 6-month iHOT-12 and EQ-5D index scores in both the DDH and the FAI group. This improvement was maintained at 12 months postoperatively, by which time almost 90% of the patients had achieved the minimum clinically important difference (MCID) in their iHOT-12 score. This study shows that PAO is a successful surgical intervention for DDH and FAI in the short term, with significant improvement in patient-reported outcome scores that is maintained up to 2 years postoperatively. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Young Adult Hip Dysplasia: An Important and Under-recognised Clinical Cause of Hip Pain on Plain Radiographs

Young Adult Hip Dysplasia: An Important and Under-recognised Clinical Cause of Hip Pain on Plain Radiographs

Results of periacetabular osteotomy in adolescent and young adult hip dysplasia

Background Dysplasia of the hip is one of the most common causes of secondary osteoarthritis because of its associated structural instability. The Bernese periacetabular osteotomy (PAO) now is the preferred and the gold standard procedure for the treatment of symptomatic acetabular dysplasia. Objective The primary aim of our study was to evaluate the results of PAO in the treatment of adolescent and young adult patients with symptomatic hip dysplasia. Patients and methods This prospective case series’ study included 22 patients (26 hips, 13 left hips, 13 right hips) with hip dysplasia after surgical reorientation of the acetabulum by PAO procedure. This study included three male patients and 19 female patients. The mean age of our patients was 23 years (13–40 years). The mean follow-up period was 15 months (6–24 months). Twenty-one hips had undergone isolated PAO, while five hips had undergone combined surgery with the PAO at the same time (three hips had proximal femoral varus osteotomy and two hips had arthrotomy and osteochondroplasty). Results Twenty-five hips had good clinical and radiographic outcomes with respect to hip function and radiographic parameters. One patient developed avascular necrosis (AVN) of the femoral head 6 months after PAO and was treated by total hip replacement 1 year after PAO. The mean lateral central edge angle was 10.57°±11.61° preoperatively and was corrected to a mean value of 31.96°±4.42° with a mean correction of 21.38°. The mean postoperative acetabular index was 7.57°±1.81°, with a mean correction of 15.34°. In our series, the mean postoperative Harris hip score was 91.36±4.14, and the mean improvement was 29.08. Conclusion The PAO is an effective and valuable method for preservation of the natural hip joint and should be learned in a specialized center before using it in clinical practice.

Computer-Assisted Planning, Simulation, and Navigation System for Periacetabular Osteotomy.

Periacetabular osteotomy (PAO) is an effective approach for surgical treatment of hip dysplasia in young adults. However, achieving an optimal acetabular reorientation during PAO is the most critical and challenging step. Routinely, the correct positioning of the acetabular fragment largely depends on the surgeon's experience and is done under fluoroscopy to provide the surgeon with continuous live x-ray guidance. Our developed system starts with a fully automatic detection of the acetabular rim, which allows for quantifying the acetabular 3D morphology with parameters such as acetabular orientation, femoral head extrusion index (EI), lateral center-edge (LCE) angle, and total and regional femoral head coverage (FHC) ratio for computer-assisted diagnosis, planning, and simulation of PAO. Intraoperative navigation is conducted to implement the preoperative plan. Two validation studies were conducted on four sawbone models to evaluate the efficacy of the system intraoperatively and postoperatively. By comparing the preoperatively planned situation with the intraoperatively achieved situation, average errors of 0.6° ± 0.3°, 0.3° ± 0.2°, and 1.1° ± 1.1° were found, respectively, along three motion directions (flexion/extension, abduction/adduction, and external rotation/internal rotation). In addition, by comparing the preoperatively planned situation with the postoperative results, average errors of 0.9° ± 0.3° and 0.9° ± 0.7° were found for inclination and anteversion, respectively.

The Iliofemoral Line: A Radiographic Sign of Acetabular Dysplasia in the Adult Hip

Background: Several radiographic parameters utilized for the diagnosis of acetabular dysplasia in adults suffer from poor reproducibility and reliability. Purpose: To define and validate a novel radiographic parameter (the iliofemoral line [IFL]) for the detection of frank and borderline hip dysplasia and to compare the sensitivity and specificity of this radiographic marker to those of previously validated qualitative parameters. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: A consecutive cohort of 222 adult patients (436 hips) undergoing hip preservation surgery was included. The IFL, which extends from the lateral femoral neck through the inner cortical lip of the iliac crest, intersects the femoral head in cases of dysplasia. Percent medialization of the IFL was defined as the horizontal distance of the exposed femoral head lateral to the IFL, relative to the horizontal femoral head width at the center of the femoral head. Results: Percent medialization of the IFL was strongly correlated to the lateral center edge angle (P < .0001). Values of percent medialization ranging from 15% to 22% predicted the presence of borderline hip dysplasia with a sensitivity of 62% and specificity of 89%, while values exceeding 22% predicted the presence of frank acetabular dysplasia with a sensitivity of 77% and specificity of 94%. By comparison, abnormality of the Shenton line demonstrated a sensitivity of 3.7% and specificity of 97% for the detection of borderline dysplasia and a sensitivity of 16% and specificity of 99% for the detection of frank acetabular dysplasia. Compared with the Shenton line, percent medialization of the IFL was significantly more sensitive for the detection of both borderline and frank acetabular dysplasia (both P < .0001). The intraobserver and interobserver reproducibility of the horizontal difference outside the IFL were 0.99 and 0.96, respectively. Conclusion: Percent medialization of the IFL is a reliable and accurate radiographic marker of frank acetabular dysplasia and, to a lesser extent, borderline dysplasia. The use of this radiographic parameter as an additional tool may enable the earlier detection of borderline and frank hip dysplasia in young adults presenting with hip pain.

Surgical treatment for young adult hip dysplasia: joint-preserving options

Developmental dysplasia of the hip (DDH) is a spectrum of disorders that results in anatomic abnormalities leading to increased contact stress in the joint and, eventually, secondary osteoarthritis. However, many patients with DDH become symptomatic before the severe degenerative changes of the hip because of abnormal hip biomechanics, mild hip instability, impingement, or associated intra-articular pathology. Early diagnosis and appropriate treatment for DDH are of the utmost importance. With the modification of techniques like pelvic osteotomy and capsular arthroplasty, and the introduction of intracapsular procedures such as arthroscopy and femoral head-neck junction osteochondroplasty, many young patients with symptomatic hip dysplasia may benefit from joint preservation procedures. We review the current development of these concepts and the associated surgical techniques.

Adolescent and young adult hip dysplasia

Adolescent and young adult hip dysplasia

Fovea Alta on MR Images: Is It a Marker of Hip Dysplasia in Young Adults?

The objective of our study was to investigate the association between high fovea capitis (fovea alta) and hip dysplasia in young adults. In a retrospective study, blinded observers reviewed 82 pelvic radiographic and hip MRI studies of three groups of patients: those with developmental dysplasia of the hip (DDH) (center-edge angle, ≤20°), those with borderline DDH (center-edge angle, 21°-25°), and control patients (center-edge angle, >25°). The center-edge angle and coxa valga (femoral neck-shaft angle, >135°) were assessed on pelvic radiographs, and fovea alta was assessed on MR images (delta angle, ≤10°). The Mann-Whitney and Fisher exact tests were used to correlate fovea alta with DDH and with coxa valga, respectively. Interobserver agreement for center-edge and delta angles and the diagnostic performance of fovea alta as a marker of DDH were calculated. Thirty-one patients with DDH, 23 with borderline DDH, and 28 without DDH were included. Excellent interobserver agreement was found for center-edge angle (concordance correlation coefficient, 0.94) and for delta angle (concordance correlation coefficient, 0.91). Fovea alta had a significant association with DDH (p<0.001) but no association with coxa valga (p>0.57). A significant difference (p<0.001) was found between patients with DDH (3.4°) and those without DDH (21.7°) with respect to mean delta angle measurements. Fovea alta had 69.4% sensitivity, 82.1% specificity, 67.2% positive predictive value, 81.0% negative predictive value, and 75.6% overall accuracy as an indicator of DDH. Fovea alta shows promise as a strong MRI marker of DDH.

(iii) Bernese periacetabular osteotomy

The periacetabular osteotomy is a strategy for the treatment of residual hip dysplasia in young adults with the aim of preventing secondary coxarthrosis. This polygonal, juxta-articular osteotomy respects the vascular blood supply to the acetabular fragment and thus facilitates an extensive acetabular reorientation with improvement of the insufficient coverage of the femoral head, including medial displacement of the fragment. All osteotomies are performed by one approach, the modified Smith-Petersen, which allows an anterior capsulotomy. Inspection of the joint not only provides information on acetabular rim pathologies, but also facilitates the control of impingement-free range of motion after the correction. The posterior column remains partially intact, allowing minimal internal fixation of the acetabular fragment and early mobilization similar to that after an intertrochanteric osteotomy. The dimensions of the true pelvis are unchanged, providing the capacity to have an unimpeded delivery in women. This paper describes the preoperative evaluation, current indications, surgical technique, postoperative care, and the results of this osteotomy.

Periacetabular osteotomy

Background When surgical treatment of dysplastic hip osteoarthrosis is necessary, osteotomy is preferable to fusion or THR. We evaluated periacetabular osteotomy as a method of choice.Patients and methods We treated 36 symptomatic dysplastic hip joints (32 patients) with the Bernese periacetabular osteotomy (PAO) between 1994 and 2001. We used the ilio-inguinal (I-I) approach in 32 hips and a modified Smith-Petersen (S-P) approach in 4. The patients were followed for mean 4 (1.5–8) years. In 1 patient with coxa valga, a varus femoral osteotomy was performed 1 year after PAO. 2 hips, in which we used the modified S-P approach, necessitated a capsulotomy.Results The median Merle d'Aubignè score increased from 13 points preoperatively to 16 points postoperatively. This improvement in terms of pain, motion and ambulation was accompanied by spatial reorientation and correction. The lateral center edge angle of Wiberg (CE) improved from an average of 7° to 28°. The anterior center edge angle of Lequesne (FP) improved from an average of 18° to 28°. The acetabular index angle (AC) improved from an average of 22° to 10°.Major complications included 1 partial lesion of the sciatic nerve, 1 malunion and 1 combined nonunion of the pubic and ischiatic osteotomy. 2 patients underwent subsequent total hip replacement (THR) for progressive osteoarthrosis with pain.Interpretation We found good radiographic correction of deformities, improvement of hip function and pain relief with an acceptable complication rate. With appropriate patient selection, this procedure is the most physiological treatment of symptomatic hip dysplasia in young adults. In addition to relieving symptoms, it may prevent and postpone the development of secondary osteoarthrosis.

Examination: Bernese Periacetabular Osteotomy for Hip Dysplasia in Young Adults

AORN JournalVolume 75, Issue 4 p. 752-758 Clinical Examination: Bernese Periacetabular Osteotomy for Hip Dysplasia in Young Adults First published: 01 April 2002 https://doi.org/10.1016/S0001-2092(06)61632-3Citations: 1 AORN, Association of periOperative Registered Nurses, is accredited as a provider of continuing education in nursing by the American Nurses Credentialing Center's (ANCC's) Commission on Accreditation, AORN recognizes this activity as continuing education for registered nurses. This recognition does not imply that AORN or the ANCC's Commission on Accreditation approves or endorses any product included in the activity. AORN maintains the following state board of nursing provider numbers: Alabama ABNP0075, California CEP13019, and Florida FBN 2296. Check with your state board of nursing for acceptability of education activity for relicensure. Professional nurses are invited to submit manuscripts for the Home Study Program. Manuscripts or queries should be sent to Editor, AORN Journal, 2170 S Parker Rd, Suite 300, Denver, CO 80231-5711. As with all manuscripts sent to the Journal, papers submitted for Home Study Programs should not have been previously published or submitted simultaneously to any other publication. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume75, Issue4April 2002Pages 752-758 RelatedInformation

Bernese Periacetabular Osteotomy for Hip Dysplasia in Young Adults

Hip dysplasia is one of the most common disorders of the hip, presenting in the first three years of life. Literature has shown that an association exists between developmental dysplasia of the hip and the development of secondary hip osteoarthritis in early adulthood. Treatment options are directed toward relieving symptoms and delaying or preventing the onset of arthritis in the affected hip. Total hip arthroplasty is a surgical option, but has been associated with a high rate of failure in younger, physically active patients. This article discusses the Bernese periacetabular osteotomy procedure as a treatment modality, which restores coverage of the femoral head with the acetabulum. Changing the anatomy allows the surgeon to increase the surface area of the femoral head that bears the patient's weight. Increasing the weight-bearing surface may prevent further damage to the hip's cartilage and delay the onset of osteoarthritis.