Assessment of the relationship between joint laxity and migration of the hip in children with down syndrome

Eshuis, Rienk; Boonzaaijer, M.; Wieringen, Hester van; Pruijs, J. E. H.; Sakkers, R. J. B.

doi:10.1007/s11832-012-0427-x

Cited by 14 publications

(12 citation statements)

References 18 publications

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“…Although generalized muscle hypotonia and ligamentous laxity may play a role, the hip is a deep and tridimensional complex joint whose stability is mostly influenced by the cartilaginous and bone anatomy. One study 8 reported no relationship between ligamentous laxity and the migration of the hip, suggesting that the joint laxity may not be the major risk factor for hip instability in Down syndrome. Hence, isolated soft-tissue procedures including capsular plication have a limited role.…”

Section: Discussionmentioning

confidence: 99%

“…In addition to ligamentous laxity and generalized muscle hypotonia, 6 - 8 there is a spectrum of skeletal anatomical abnormalities that might contribute to the hip instability in Down syndrome. 4 , 9 - 14 Abnormalities of the femur including increased femoral anteversion and coxa valga have been reported and have been described as the rationale for treatment by femoral intertrochanteric osteotomy.…”

Section: Introductionmentioning

confidence: 99%

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Preliminary results of an anteverting triple periacetabular osteotomy for the treatment of hip instability in down syndrome

Maranho

Kim

Williams

et al. 2018

Journal of Children's Orthopaedics

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PurposeTo investigate the outcomes of an anteverting triple periacetabular osteotomy for the treatment of hip instability in skeletally immature patients with Down syndrome.MethodsWe evaluated 16 patients (21 hips) with Down syndrome and hip instability who underwent an anteverting triple periacetabular osteotomy between 2007 and 2016. There were nine females and seven males with an average age of 7.4 years SD 2.0. We assessed the level of hip pain, gait ability and clinical stability at a minimum of one year after surgery. Radiographic evaluation included pre- and postoperative lateral centre-edge angle (LCEA), Tönnis acetabular angle and extrusion index.ResultAfter an average follow-up of 4.1 years SD 2.6, 20 of 21 hips (95%) remained clinically stable. In all, 12 of 16 (75%) patients had a full gait without a major limp, but three patients (19%) had a persistent limp. Of the 21 procedures, one hip (5%) was considered a failure due to persistent instability. There was a mean increase of 18.3º SD 15.3º of the LCEA (p < 0.001); a mean decrease of 15.2º SD 11.6º (p < 0.001) for the Tönnis angle and the extrusion index had a mean decrease of 0.27 SD 0.20 (p < 0.001). The most common complications were minor and included nonunion of the pubis or ischium (24%) and stress fractures of the pubis and ischium (14%). Only one patient required unplanned surgery for the treatment of an infection; which was considered a major complication.ConclusionThe anteverting triple periacetabular osteotomy provided global deformity correction and achieved hip stability in 95% of the hips after a mean follow-up of 4.1 years.Level of EvidenceTherapeutic level IV.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Preliminary results of an anteverting triple periacetabular osteotomy for the treatment of hip instability in down syndrome

Maranho

Kim

Williams

et al. 2018

Journal of Children's Orthopaedics

View full text Add to dashboard Cite

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“…Since the study by Ehuis et al ., joint laxity has been known to be correlated with age 28 . This collinearity could induce multicollinearity in the model with instability and inaccuracy in the estimation of the RC.…”

Section: Methodsmentioning

confidence: 99%

Assessment of Pelvic-Lumbar-Thigh Biomechanics to Optimize The Childbirth Position: An “In Vivo” Innovative Biomechanical Study

Desseauve

Pierre

Fernández

et al. 2019

Sci Rep

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The study aimed to assess the associations between the pelvis orientation, lumbar curve and thigh postures throughout pregnancy in a population of healthy women. Additionally, optimal mechanical birth conditions in terms of the pelvic inlet and lumbar curve were researched. The individuals’ posture was assessed with three-dimensional motion analysis and the lumbar curve with the Epionics SPINE system. The association between the hip joint angles (flexion and abduction), the pelvis external conjugate, and lumbar curve position was assessed with a generalized linear mixed model (GLMM) adjusted to individuals’ characteristics. Joint laxity was assessed with a modified Jobbin’s extensometer. For all of the subjects, hip flexion and hip abduction were significantly associated with the angle between the external conjugate and spine, with higher correlation in the multivariate regression model. The association between hip flexion and the lumbar curve was less significant in multivariate than univariate regression analysis. Optimal birth conditions were never reached. The findings contribute to the understanding of the association between the hip position (flexion and abduction), pelvic orientation, and lumbar curve adjusted for joint laxity in healthy pregnant women. They lay the groundwork for future research in the field of obstetrical biomechanics.

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“… 5 Whereas some studies have proposed joint laxity as a possible cause of hip instability, 5 , 6 others did not find a relationship between joint laxity and hip migration in DS patients. 3 , 7 Another plausible aetiological factor of hip instability might be muscular inbalance. 3 Children with DS portray delayed motor development, associated with muscle hypotonia, ligament laxity and cerebellar dysfunction.…”

Section: Introductionmentioning

confidence: 99%

“… 3 , 7 Another plausible aetiological factor of hip instability might be muscular inbalance. 3 Children with DS portray delayed motor development, associated with muscle hypotonia, ligament laxity and cerebellar dysfunction. 8 Characteristics of motor dysfunction are longer reaction times, longer movement times and co-contraction of agonist-antagonist muscles.…”

Section: Introductionmentioning

confidence: 99%

Effect of the Sharrard procedure on hip instability in children with down syndrome: A retrospective study

Mulder

Bok

Douveren

et al. 2021

Journal of Children's Orthopaedics

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Purpose The aim of this study was to retrospectively analyze the effect of the Sharrard procedure on hip instability in children with Down syndrome (DS), as measured by the migration index. Methods In total, 17 children (21 hips) were included from six hospitals in the Netherlands between 2003 and 2019. The primary outcome, hip instability, was assessed with the Reimers’ migration index on preoperative and postoperative plain anteroposterior pelvic radiographs. The mean age at surgery was 8.1 years, the majority of children were male (64.7%) and the mean follow-up time was 7.3 years. Results The mean preoperative migration index was 46% (sd 23.5) and the mean postoperative migration index was 37% (sd 28.4). The mean Delta migration index (the difference in pre-operative migration index and most recent post-operative migration index) showed an improvement of 9.3% (sd 22.7). An improvement in migration index was observed in 52%, no change in 29% and deterioration in 19% of hips. No (re)dislocations occurred in 91% of the hips. No major complications were observed during the follow-up period. Conclusion Early intervention is warranted in children with DS showing hip instability or hip migration, in order to succeed with less complex procedures. The Sharrard procedure should be considered in children with DS showing hip instability or hip migration, since it aims to rebalance the muscles of the hip joint, is less complex than bony procedures of the femur and acetabulum, surgery time is often shorter, there are fewer major complications and the rehabilitation period is shorter. Level of Evidence IV - retrospective case series

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Assessment of the relationship between joint laxity and migration of the hip in children with down syndrome

Abstract: This study showed no relationship between joint laxity and migration of the hip in children with Down's syndrome. This implicates that we were not able to prove that joint laxity is the major factor in developing hip migration in children with Down's syndrome.

Cited by 14 publications

References 18 publications

Preliminary results of an anteverting triple periacetabular osteotomy for the treatment of hip instability in down syndrome

Preliminary results of an anteverting triple periacetabular osteotomy for the treatment of hip instability in down syndrome

Assessment of Pelvic-Lumbar-Thigh Biomechanics to Optimize The Childbirth Position: An “In Vivo” Innovative Biomechanical Study

Effect of the Sharrard procedure on hip instability in children with down syndrome: A retrospective study

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