One-stage hip reconstruction in late neglected developmental dysplasia of the hip presenting in children above 8 years of age

Purpose  To assess the clinical and radiological results of one-stage hip reconstruction for late neglected developmental dysplasia of the hip (DDH) in children above 8 years of age. Methods  Nineteen hips in 16 patients, 14 females and two males (three being bilateral), were treated by open reduction adequate shortening (up to 5 cm) with derotation, and limited varization if needed, tight capsulorrhaphy, and appropriate pelvic reconstruction (Salter or triple acetabular osteotomy). The average age at operation 10.6 years (range 8–18 years). The period of follow up ranged from 3 to 9 years. A modified approach for the hip joint and upper femur was utilized, allowing better exposure. Pre- and post-operative plain radiography was performed for all cases and at follow up. Computed tomography (CT) or multislice CT with 3D reconstruction were carried out pre-operatively for recent cases and post-operatively for all, and were found to be helpful in providing a panorama of the dysplastic hip and in planning the required surgery and assessing the results. Results  According to the McKay modified criteria, 15 hips (79%) were clinically excellent to good, while four hips (21%) were fair to poor. Radiographically, according to the Severin modified criteria, 16 hips (84%) were excellent to good and three hips (16%) were fair to poor. Limb length discrepancy ranged from 0.5 to 2.1 cm, as measured by CT scanograms. Complications were avascular necrosis (AVN) in an early case due to limited femoral shortening with resultant excessive stress over the femoral head and subluxation in another case. Conclusion  A one-stage hip reconstruction for late neglected cases of DDH have achieved excellent results if adequate shortening with derotation is performed, together with appropriate acetabular reconstruction and tight capsulorrhaphy. Varization should not replace part or all of the required shortening, and should be added if required.     

Does hip strength analysis explain the lower incidence of hip fracture in the People's Republic of China?

To explore whether there are ethnic differences in calculated hip strength that might explain the low incidence of hip fracture in China, we used Lunar DPX 'beta' version of hip strength analysis (HAS) and hip axis length (HAL) programs to compare hip geometry, calculated strength and densitometric values from Chinese subjects in Shenyang to those of Caucasian subjects in Oslo and Leuven participating in the European Prospective Osteoporosis Study (EPOS). Subjects were 210 Chinese and 403 Caucasian men and women aged 53-77 years. Parameters investigated included bone mineral density (BMD), bone mineral content (BMC), bone area (BA), cross-sectional moment of inertia (CSMI) and section modulus (both indicating strength and rigidity of the femoral neck), HAL, neck length (NL), neck diameter, tensile stress (Tstress) and compressive stress (Cstress) (indicating the stress in the femoral neck at its weakest cross section arising from walking or a standard fall, respectively), safety factor (SF, indicating the resistance to fracture for forces generated during walking) and fall index (FI, indicating the resistance to fracture from force generated during a fall in the greater trochanter). The Chinese men and women were significantly shorter and lighter than their Caucasian counterparts (P<0.01) and had significantly lower BMD, BMC and BA of the femoral neck (P<0.01). After adjusting for BA, weight and height, there was no significant ethnic difference in either gender in BMC. CSMI and section modulus were significantly lower, and HAL, NL and neck diameter were significantly shorter in the Chinese men and women (P<0.01). These differences all remained after adjusting for weight and height. There were no significant differences in Tstress, Cstress, SF and FI between ethnic groups in either gender. Most of the parameters of calculated hip strength in the Chinese subjects were similar to or poorer than those in the Caucasian subjects. There was no evidence to indicate that Shenyang Chinese have superior BMD or BMC or better calculated hip strength. The short HAL and NL of the population, however, could be an independent factor contributing to the low incidence of hip fracture.     

The management of intracapsular hip fractures in the 'young elderly' internal fixation or total hip replacement?

There is a lack of consensus about how to treat intracapsular hip fractures in the 'young elderly' (50-75 years). Evidence for older more mobile patients seems to point towards Internal Fixation (IF) for undisplaced fractures and Total Hip Replacement (THR) for displaced fractures. Radiographs of 263 patients from the Norfolk and Norwich University Hospital, who have suffered an intracapsular hip fracture between 2000-2009 were reviewed. The complication and mortality rates were noted. A Hip function questionnaire (Oxford hip score (OHS)) and Numeric pain score (NPS) were sent out to patients, then methods of treatment (IF and THR) were compared. In displaced fractures THR compared favourably to IF, OHS (16.0 vs. 20.0 p 0.029), NPS (2.0 vs. 4.0 p 0.007), complications (Odds Ratio (OR) 2.90; p 0.006) and death rate (OR 3.61; p 0.007). Although not statistically significant when stratified for age, the youngest age group (50-60) still achieved better function with a THR (13.0 vs. 18.0 ; p 0.129). There was little difference in the results for undisplaced fractures. This retrospective cross-sectional study showed IF is associated with a much higher complication rate than THR for patients who sustained a displaced hip fracture. THR also showed a better functional outcome and reduced pain. IF should be used in undisplaced fractures as there was no difference in functional outcome or complication rate. A large randomised controlled trial is needed to confirm these results.     

Secular trends of hip fractures in Québec, Canada

Summary

This study examined the secular trends of hip fracture incidence among individuals 50?years and older in Québec between 1993 and 2004. Age-standardized rates decreased at both the provincial and regional levels. The largest relative decrease was observed among younger females, and rates declined more slowly in the elderly.

Introduction

The population of the province of Québec is among the oldest in North America. Before the trend rupture reported in the late 1990s in several countries, hip fracture (HF) incidence rates did not show a secular trend (between 1981 and 1992). This study examined the secular trends of HF incidence at the provincial level and in two of the most important urban areas of the province, Montréal and Québec City, between 1993 and 2004.

Methods

All hospitalisations of individuals 50?years and older living in the province of Québec between 1993 and 2004 with a main diagnosis of HF were included. Standardized rates of HF incidence were calculated for females and males, 50–74?years and 75?years and older.

Results

The Québec City area showed a strong decreasing trend in HF rates for younger females, but the other groups did not show an obvious trend. Although our models did not support the existence of significant differences in trends between both areas, the rates of HF of younger males and, to a lesser extent, of older women in the Montréal area were significantly higher than in the Québec City area.

Conclusions

Differences observed in hip fracture rates as well as in secular trends between age groups and gender emphasise the need for decision makers to rely on results based on age-specific and sex-specific analyses.     

Rising incidence of hip fracture in Uppsala, 1965–1980

The frequency and incidence of hip fracture in persons aged 55 years and older in the county of Uppsala during the years 1965,1970,1975 and 1980 are reported. For every 5-year interval, the number of hip fractures increased by 21–25 per cent. The ratio of women to men changed from 3.8 in 1965 to 3.1 in 1980. Trochanteric fractures were more common during the later years. The ratio of femoral neck fractures to trochanteric fractures decreased from 1.8 to 1.1 between 1965 and 1980. The incidence of hip fracture in the investigated part of the population increased from 43 per 10 000 in 1965 to 65 in 1980. The age-specific incidence increased especially in the group aged 85 years and older, in which fractures of the femoral neck were three times and trochanteric fractures four times more common in 1980 than in 1965. This investigation shows that the incidence of hip fracture has increased, particularly in the higher age groups. If the age-specific incidences continue to rise in the higher age groups, the frequency of hip fractures will be doubled within a 20-year period.     

New ��L value�� parameter simplifies and enhances hip ultrasound interpretation in the detection of developmental dysplasia of the hip

Purpose  

The purpose of this study was to simplify and enhance the ultrasound (US) analysis of the infant’s hip by introducing a novel parameter named “L value” into the widely used Graf method.     

Evaluation of P-POSSUM scoring system in predicting mortality in patients with hip joint arthroplasty

Itisimportanttopredictapatient srisklevelofoperationaccurately.Theassessmentofoperativeriskmainlydependsonthepatient sclinicalsymptoms,signs,physiologicalparameters,operativeseverity,andsoon.Thephysiologicaland operativeseverityscorefortheenumerationofmortality andmorbidity(POSSUM)wasdesignedbyCopeland etal1in1991,whichhadbeenshowntobebetterthan theacutephysiologyandchronichealthevaluation(APACHE)forestimatingtherisklevel.2However,P POSSUMwasdevelopedin1996byWhitleyetal,3thescholarsof…     

Are there advances in the treatment of extracapsular hip fractures in the elderly?

While the rate of failure following hip fracture surgery for extracapsular hip fractures in the elderly is low, an incidence of implant cutout from the femoral head remains regardless of whether fixation is by sliding hip screw or intramedullary nail. In general, a well-executed osteosynthesis is the best assurance of a good outcome with few complications, and typically a less than ideal placement of the implant in the femoral head is the reason for cut-out and failure of the operation. It is clear that there is no difference in the incidence of complications or functional outcome between a sliding hip screw and an intramedullary nail for pertrochanteric fractures (AO/OTA 31-A1 and A2), while the implant of choice in the elderly for the true intertrochanteric fracture (AO/OTA 31-A3; reverse intertrochanteric) is a nail. However, what is less clear is whether there are newer ideas and/or implant designs that represent true advances in the treatment of extracapsular fractures in the elderly. The following review focuses on just this issue.     

Residual hip dysplasia as a risk factor for osteoarthritis in 45 years follow-up of late-detected hip dislocation

Purpose  

The aim of the study was to assess the role of residual hip dysplasia as a risk factor for osteoarthritis (OA) in developmental dysplasia of the hip (DDH).     

Review of total hip resurfacing and total hip arthroplasty in young patients who had Legg-Calvé-Perthes disease

Patients with Legg-Calvé-Perthes disease can often be successfully treated with femoral head-preserving measures, such as bracing, or containment procedures with osteotomies. However, in some cases, after resolution of the disease, the femoral head may proceed to collapse or progress to severe arthritis at a young age. If nonoperative methods have failed, the only treatment options available for these adolescents or young adults may be a total hip resurfacing or a total hip arthroplasty (THA). This article focuses on the results and unique technical considerations of resurfacing and THA for patients who have severe hip osteoarthritis after resolved Legg-Calvé-Perthes disease.     

A modified surgical approach of the hip in children: is it safe and reliable in patients with developmental hip dysplasia?

PurposeTreatment is easier and complications are less likely to occur if developmental dysplasia of the hip (DDH) is diagnosed early. In this study, we examined the early results of open reduction using a medial approach which we had modified for DDH and analyzed the success of this technique and the associated complication rates, with a focus on avascular necrosis (AVN).Methods This is an Institutional Review Board-approved retrospective review of all patients diagnosed with DDH and treated with a modified medial approach at a single institution from July 1999 to December 2010. The patients'' charts were analyzed for clinical and radiographic features.Results Fifty-five hips of 41 patients, all of whom were treated by open reduction using a modified medial approach due to DDH, were evaluated retrospectively. The mean age of the patients at surgery was 19 (range 11–28) months, and the average follow-up was 5.5 (range 3–9.5) years. AVN was the most important complication in terms of radiological outcomes as assessed according to the Kalamchi–McEwen classification. Radiologic results were excellent or good in 51 hips (92.7 %) and fair–plus in four (7.3 %). Type 1 temporary AVN was detected in only two hips (3.6 %), and the lesions had disappeared completely in the final control graphs of these two patients. A secondary intervention was needed for two hips (3.6 %) of the same patients who were operated on due to bilateral DDH. No other complications, such as infection, re-dislocation, or subluxation, were seen in the operated patients.Conclusions We believe that treatment for DDH using a modified medial approach during early childhood is an effective and reliable method with low AVN rates. As shown here, this method achieves great success in radiological and clinical outcomes after a minimum 3-year follow-up.     

Does developmental dysplasia of the hip cause a delay in walking?

Developmental dysplasia of the hip (DDH) is commonly supposed to lead to a delay in walking. The authors present a retrospective review of the age of walking in 86 children with established DDH and compare them with an age- and sex-matched group of controls. While the median age of walking was 1 month later than in the control group, this was clinically insignificant, as all walked within the normal time limits. The authors conclude that children with DDH do not present as late walkers.     

Results of Tönnis-type acetabuloplasty in patients with developmental hip dysplasia

AimThe aim of this prospective study was to evaluate the outcome of open reduction and Tönnis acetabuloplasty as the first method of treating developmental dysplasia of the hip (DDH) in children in early childhood at walking age.Materials and methodsBetween 2005 and 2009, 34 hips of 34 children were operated on with the aforementioned method. Mean age was 25.6 (range 12–44) months, and mean follow-up was 3.6 years. During the follow-up period,the hips were evaluated using the acetabular index and for development of avascular necrosis and redislocation. Functional evaluation was also conducted.ResultsClinically, 97.3 % of patients had excellent and good results. The acetabular angle decreased from 45° preoperatively to 21° early postoperatively and at the last follow-up had improved to 18°. In two hips, type 2 avascular necrosis developed. Hip instability was not observed, and no additional surgery was performed.ConclusionTönnis acetabuloplasty is a powerful tool to increase primary stability of the hip when acetabular coverage is inadequate in DDH. Besides its acute correction ability, when performed properly, it has no unwanted effects on acetabular growth. As an isolated procedure or as a part of combined open reduction and/or femoral osteotomy, Tönnis type acetabuloplasty is a safe and effective method.     

Is the implantation of titanium stems in hip prostheses really obsolete?

AIM: Due to several bad results of studies, titanium is no longer used as an implant material in cemented total hip arthroplasty. This study attempts figure out by means of a meta-analysis if the material titanium itself was responsible for the bad results of some studies or if specific implant characteristics contributed to implant failure, independent of titanium. METHOD: Studies between 1960 and July 2002 were analysed concerning failure rates of cemented titanium total hip arthroplasties regarding their specific implant characteristics. RESULTS: Specific implant characteristics such as roughness of the surface and geometrical features led to significantly different failure rates. Stems of titanium with a dull surface and a wide proximal geometry could achieve such good results as those of the cobalt-chromium stems published in the study results of Malchau. CONCLUSION: Titanium is justified as a cementable material in total hip arthroplasty. By respecting specific implant characteristics, very good failure rates can be achieved. The high failure rates, published in several studies, are based upon implant characteristics which are not suitable for cementing techniques and not upon the implant material titanium itself.     

Radiographic and clinical analysis of cementless acetabular fixation in total hip arthroplasty

Tofruetancloc nthisoitpnru sac.rttih oOrnorpig ltaiensctahylln y(i,qTuH emAa)jfoo irrs a Td HweteAelrli-o etrseatctaehbdnliiqs huheeidpsutilized bone cement for fixation,but loosening rate ofthe acetabular component was very high because ofbone cement tec…     

Evaluation of clinical outcomes of cementless total hip arthroplasty in patients under 30 years of age

Background

Historically, performing a successful hip joint replacement in patients aged fewer than 30 years has been an orthopedic challenge. The newer generation of prostheses and surgical techniques has the potential to increase the longevity of implants. The purpose of this study was to evaluate the outcomes of cementless hip arthroplasty in patients aged fewer than 30 years.

Materials and methods

In this cross-sectional study, 41 patients (46 hips) were studied with a mean age of 24, 4 (from 17 to 30 years) of whom underwent cementless metal–polyethylene hip arthroplasty from 2004 to 2007. The Harris hip score (HHS) was used to assess the functional consequences. Patients were followed up in terms of early complications (thrombophlebitis of the lower limbs, dislocation, hematoma and infection) and late complications (aseptic loosening, dislocation and reoperation) at weeks 3 and 6, at 3 and 6 months, 1 year after surgery and annually thereafter.

Results

Patients were followed for an average of 5 years and 2 months (from 51 to 82 months). One early complication (symptomatic thrombophlebitis) and one late dislocation (2.2 %) were observed. There were no cases of aseptic loosening or osteolysis at the end of follow-up. The preoperative HHS was 59.6 (from 41 to 76), which rose to 82 and 83.5 after the 1-year and final follow-up, respectively, which was a significant increase.

Conclusions

Hip arthroplasty using a new generation of cementless proximal porous prosthesis with resistant polyethylene to cover the joint surfaces in patients aged fewer than 30 years is satisfactory and is accompanied by low complications.     

Surgical treatment of developmental dysplasia of the hip presenting in children above 10 years

Background  

Management of developmental dysplasia of the hip in older children remains controversial. The objective of this study was to evaluate the results of surgical treatment of developmental dysplasia of the hip in children older than 10 years.