Three-dimensional MRI Analysis of Femoral Head Remodeling After Reduction in Patients With Developmental Dysplasia of the Hip

Tsukagoshi, Yuta; Kamada, Hiroshi; Kamegaya, Makoto; Takeuchi, Ryoko; Nakagawa, Souichi; Tomaru, Yohei; Tanaka, K.; Onishi, Mio; Nishino, Tomofumi; Yamazaki, Masashi

doi:10.1097/bpo.0000000000001186

Cited by 7 publications

(5 citation statements)

References 14 publications

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“…On the one hand, MRI can visualize the cartilage surface. Besides, recent developments in image analysis techniques have enabled 3D morphological analysis based on MRI both from other groups and our own research [30,31]. Further investigations, which are based on an evaluation method that considers cartilage thickness, such as MRI, are necessary to validate the present results.…”

Section: Plos Onementioning

confidence: 73%

Three-dimensional curvature mismatch of the acetabular radius to the femoral head radius is increased in borderline dysplastic hips

et al. 2020

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Whether borderline hip dysplasia is pathologic remains unclear. In order to evaluate the three-dimensional joint congruity, this study sought to answer the question: are borderline dysplastic hip curvature mismatch and eccentricity between the acetabulum and the femoral head different from dysplastic or control hips three-dimensionally? The 113 hips, categorized as: dysplastic (LCEA � 20˚), 47 hips; borderline (20˚� LCEA < 25˚), 32 hips; and control (25˚� LCEA < 35˚), 34 hips; were evaluated. Three-dimensional (3D) femoral and coxal bone models were reconstructed from CT images. Using a custom-written Visual C++ routine, the femoral head and acetabular radii of curvature, and the femoral head and the acetabular curvature center were calculated. Then the ratio of the acetabular radius to the femoral head radius (3D curvature mismatch ratio), and the distance between the acetabular curvature center and the femoral head center (3D center discrepancy distance) were calculated. These indices were compared statistically among the three groups using Tukey's post hoc test. The mean 3D curvature mismatch ratio in the borderline (1.13 ± 0.05) was smaller than in the dysplasia (1.23 ± 0.08, p < 0.001), and larger than in the control (1.07 ± 0.02, p < 0.001). The mean 3D center discrepancy distance in the borderline (3.2 ± 1.4 mm) was smaller than in the dysplasia (4.8 ± 2.3, p < 0.001) and larger than in the control (1.6 ± 0.7, p < 0.001). These results demonstrated that three-dimensional congruity of the borderline dysplastic hip is impaired, but its incongruity is not as severe as in dysplastic hips. The 3D curvature mismatch ratio and the 3D center discrepancy distance can be valuable signs of joint congruity in patients with borderline dysplasia. However, future studies are necessary to clarify any associations between curvature mismatch and pathogenesis of osteoarthritis in borderline dysplasia.

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Section: Plos Onementioning

confidence: 73%

Three-dimensional curvature mismatch of the acetabular radius to the femoral head radius is increased in borderline dysplastic hips

et al. 2020

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“…In a follow-up study, the same author again used three-dimensional MRI to evaluate 10 of these hips at an average of 18 months postreduction and found that the areas of the femoral head that were aspherical prereduction had largely remodeled and were similar to the contralateral unaffected hip. 14 Sankar et al 9 used arthrogram and fluoroscopy at the time of reduction to measure femoral head sphericity in 37 hips. They found that the femoral head is usually dysplastic and aspherical in DDH; however, there was significant variability in the sphericity of the femoral head in dislocated hips at the time of reduction.…”

Section: Discussionmentioning

confidence: 99%

“…They found that the diameter of the dislocated femoral head was smaller and the head aspherical compared with the unaffected contralateral femoral head. In a follow-up study, the same author again used three-dimensional MRI to evaluate 10 of these hips at an average of 18 months postreduction and found that the areas of the femoral head that were aspherical prereduction had largely remodeled and were similar to the contralateral unaffected hip 14 . Sankar et al 9 used arthrogram and fluoroscopy at the time of reduction to measure femoral head sphericity in 37 hips.…”

Section: Discussionmentioning

confidence: 99%

Femoral Head Remodeling After Surgical Reduction of Developmental Hip Dislocations

Ellsworth,

Lee,

Sankar

2023

Journal of Pediatric Orthopaedics

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Objective: Developmental dysplasia of the hip is prevalent and is associated with dysplasia of both the femoral head and acetabulum. There is a paucity of literature describing femoral head remodeling after surgical reduction of developmentally dislocated hips. The purpose of this study was to describe and quantify changes in femoral head sphericity after closed or open reduction for developmental dysplasia of the hip. Methods: A retrospective cohort study was performed including patients with typical developmental hip dislocations who underwent closed or open reduction from 2009 to 2022 at a single institution and had immediate postoperative and average 3-week follow-up magnetic resonance imaging (MRI) scans. A subset of patients also had 3-year follow-up MRI scans. Patients with insufficient imaging or bony procedures at the time of reduction were excluded. We developed a technique to quantify femoral head “sphericity” by comparing differences in measured radii of the femoral head on axial and coronal plane MRI slices. We then calculated the variance of the radii for each plane and averaged these to calculate a combined variance. The variance was used to represent “sphericity,” with a larger variance indicating a wider distribution of radii and thus a less spherical shape. Results: A total of 74 patients (69 females) with 96 hips were included in this series. The median age of the child at the time of reduction was 8.7 months [interquartile range (IQR): 2.2]. Over half (58.3%) of the hips had a closed reduction, whereas the remaining were open reduced (41.7%). Immediately postoperatively, at the 3-week time point, and at the 3-year time point the median combined variance was 1.1 (IQR: 3.93), 0.51 (IQR: 1.32), and 0.31 (IQR: 0.50), respectively, indicating improved sphericity over time. Conclusions: Sphericity of the femoral head in developmental hip dislocations improves in both the immediate postoperative period, as well as the first few years after reduction. Further research is needed to evaluate the mechanism of remodeling, the ideal timing of reduction, and the relationship between femoral head and acetabular remodeling. Level of Evidence: Level IV—case series, therapeutic study.

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“…This is also the principle of conservative treatment for DDH in infancy ( 39 ). In immature patients with skeletal development, when the mechanical environment of the femoral head growth plate improves, it can cause deformation of the femoral head shape ( 40 – 42 ). Therefore, early intervention is necessary when abnormal head-acetabulum relationships are occurred to prevent abnormal growth and development of the epiphysis and growth plates due to long-term abnormal mechanical stress, which can affect the postoperative effect.…”

Section: Discussionmentioning

confidence: 99%

Effect of hip dysplasia on the development of the femoral head growth plate

Ren,

Zhang,

et al. 2023

Front. Pediatr.

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PurposeThe purpose of this study was to observe whether developmental dysplasia of the hip (DDH) affects the development of the femoral head growth plate and to analyze the risk factors.MethodsWe selected female patients aged between 11 and 20 years with unilateral DDH and unclosed femoral head growth plate (s). The selected patients underwent anteroposterior radiography of the hip joint to compare the degree of development of the femoral head growth plate on both sides and to identify risk factors that affect the development of the growth plate in the femoral head.ResultsWe included 48 female patients with unilateral DDH, with an average age of 14 years (range: 11.1–18.5 years) and an average BMI of 20.4 kg/m² (range: 15.5 kg/m²−27.9 kg/m²). Among them, 23 patients had earlier development of the femoral head growth plate on the affected side than on the healthy side, while the degree of development of the femoral head growth plate in 25 patients was the same as that on the contralateral side. When the Tönnis angle was greater than 29.5°C and/or the Reimers migration index was greater than 48.5%, there was a statistically significant difference in the acceleration of femoral head growth plate development.ConclusionAn abnormal relative position of the acetabulum–femoral head caused by DDH can accelerate closure of the femoral head growth plate in immature female patients. The risk factors are a Tönnis angle greater than 29.5°C and/or Reimers migration index greater than 48.5%.

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Three-dimensional MRI Analysis of Femoral Head Remodeling After Reduction in Patients With Developmental Dysplasia of the Hip

Abstract: Level IV-case series.

Cited by 7 publications

References 14 publications

Three-dimensional curvature mismatch of the acetabular radius to the femoral head radius is increased in borderline dysplastic hips

Three-dimensional curvature mismatch of the acetabular radius to the femoral head radius is increased in borderline dysplastic hips

Femoral Head Remodeling After Surgical Reduction of Developmental Hip Dislocations

Effect of hip dysplasia on the development of the femoral head growth plate

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