Congenital Dysplasia and Dislocation of the Hip in Children and Adults

Background Osteonecrosis of the femoral head secondary to treatment of developmental dysplasia of the hip (DDH) affects acetabular remodeling but the magnitude of this effect is unclear. Questions/purposes Using four measures of acetabular development, we (1) determined whether acetabular remodeling differed in hips with and without osteonecrosis; and (2) determined the impact of severity of osteonecrosis contributing to acetabular remodeling. Methods We retrospectively reviewed 95 patients (118 hips) treated for DDH by closed or open reduction with or without femoral osteotomy between 1992 and 2006. We evaluated serial radiographs from the time when a stable reduction had been achieved. In 902 radiographs taken over 19 years, we measured the acetabular index and three other indices of hip development. Patients were followed for a mean of 8 years (range,

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Osteonecrosis Complicating Developmental Dysplasia of the Hip Compromises Subsequent Acetabular Remodeling

Roposch

Ridout

Protopapa

et al. 2013

“…There were 13 male patients and 36 female patients, with an average age of 58 years (range, 17-84 years). None of the acetabula had osteoarthritic changes of Grades 1 to 3 according to Tönnis grade [29]. Among the 62 hips, there were 11 hips in eight patients with idiopathic osteonecrosis of the femoral head (Stages 1-3a [27]), nine hips in nine patients with developmental dysplasia (defined by Sharp angle [23] greater than 45°or lateral center-edge angle less than 20° [31], one hip was the contralateral hip of the patient with a labral tear), 15 contralateral hips in 15 patients with osteoarthritis, eight hips in six patients without traumatic acetabular changes of fracture or dislocation, one hip in one patient with a labral tear, and 18 hips in 11 patients scheduled for TKAs (CT scans of the hip were obtained to establish the femoral functional axis for planning the TKA).…”

Section: Methodsmentioning

confidence: 97%

New Radiographic Index for Evaluating Acetabular Version

Koyama

Hoshino

Suzuki

et al. 2013

Background Several qualitative radiographic signs have been described to assess acetabular retroversion. However, quantitative assessment of acetabular version would be useful for more rigorous research purposes and perhaps to diagnose and treat hip disorders. Questions/purposes We developed a new quantitative index for acetabular version (p/a ratio). We determined the average p/a, compared it with previous radiographic signs for acetabular retroversion, and evaluated its relationship with anatomic acetabular version. Methods We calculated the p/a ratio by measuring p (distance from acetabular articular surface to posterior wall) and a (distance from acetabular articular surface to anterior wall) on plain hip AP radiographs and dividing p by a. P and a were assessed on the perpendicular bisector of the line between the teardrop and the lateral edge of the acetabulum. Using 185 hip radiographs from patients with suspected idiopathic osteonecrosis, we measured p/a and compared it with previous qualitative signs for acetabular retroversion. Using 62 hip CT images from patients with no osteoarthritis, we measured the anatomic anteversion at the height of the central femoral head and investigated its relationship with p/a. Results The average p/a was 2.05 in 185 hips, and most patients with a p/a greater than 2.05 had a negative qualitative retroversion sign. A correlation was observed between central anteversion and p/a (r = 0.84). Conclusions We believe this ratio can be considered a simple quantitative parameter to assess acetabular version using plain AP radiographs.

“…Isolated hardware removal was not included in the number of previous procedures nor was it considered an unplanned operative procedure after PAO. We used conventional radiographic parameters that best assessed subtle morphologic findings present in hip dysplasia, including the anterior center-edge angle of Lequesne and de Seze (ACEA) [16], lateral center-edge angle of Wiberg (LCEA) [34], acetabular inclination (AI) [18,20], and Tönnis grade for osteoarthritic changes in the hip [29]. Complete data were not available for all failed initial pelvic procedures because the majority of cases was not performed within the ANCHOR network.…”

Section: Methodsmentioning

confidence: 99%

Does Previous Pelvic Osteotomy Compromise the Results of Periacetabular Osteotomy Surgery?

Stambough

Clohisy

Baca

et al. 2015

Background As the Bernese periacetabular osteotomy (PAO) has grown in popularity, specific indications and the results in patients treated for those indications need to be evaluated. Currently, although many patients undergo PAO after having had prior pelvic osteotomy, there is limited information regarding the efficacy of the PAO in these patients.Questions/purposes The purpose of this study was to compare the (1) early pain, function, activity, and quality of life outcomes; (2) radiographic correction; and (3) major complications and failures between patients who underwent PAO after prior pelvic reconstruction versus those who had a PAO without prior surgery. Methods Between February 2008 and January 2012, 39 patients underwent PAO after prior pelvic osteotomy at one of 11 centers and were entered into a collaborative multicenter database. Of those, 34 (87%) were available for followup at a mean of 2.5 years (range 1-5 years). This group was compared with a matched group of 78 subjects, of whom 71 (91%) were available for followup at a similar interval. We compared clinical outcomes including UCLA activity score, SF-12, and Hip Disability and Osteoarthritis Outcome Score (HOOS); radiographic measures-anterior and lateral center-edge angle and acetabular inclination (AI)-and reoperations, major complications, and conversions to total hip arthroplasty. CI,) than the primary cohort. The revision cohort achieved a smaller average radiographic correction than in patients undergoing PAO without prior pelvic surgery. The mean correction in AI was less dramatic when directly comparing the revision and comparison groups (À12°to À17°, p\ 0.001, SD 2.3-8.5). Although there was no difference in severe complications requiring further surgery, there were two conversions to hip arthroplasty (p = 0.109; 95% CI, 0.004-2.042) in the study group. Conclusions PAO performed after prior pelvic surgery is associated with improvements in pain, function, radiographic correction, and early complication rates, but the improvements observed at short-term followup were smaller and more variable than those seen in patients who had not undergone prior pelvic surgery. We recommend considering PAO for residual deformities after prior osteotomy to improve function and quality life but warning patients of potential ceiling effects with a second periacetabular surgery. Level of Evidence Level III, therapeutic study.