Total Hip Arthroplasty With the Wagner Cone Femoral Stem in Patients With Crowe IV Developmental Dysplasia of the Hip: A Retrospective Study

BackgroundThe aim of this study is to assess treatment of Crowe type IV hip dysplasia with the Wagner cone femoral stem combined with transverse subtrochanteric shortening osteotomy and augmenting the osteotomy site using the intercalary segment as a strut autograft.MethodsOne hundred twenty-seven hips of 91 patients diagnosed with Crowe type IV hip dysplasia and treated with total hip arthroplasty using the Wagner cone stem combined with transverse subtrochanteric shortening osteotomy were retrospectively evaluated by clinical and radiographic outcomes as well as complications.ResultsThe mean follow-up was 8.4 years. The Harris Hip Score and the Western Ontario and McMaster University Osteoarthritis Index scores were significantly improved postoperatively (P = .000). Intraoperative femoral cracks were observed in 70 hips (55.1%) and all femurs healed smoothly. Femoral cracks did not have a significant effect on clinical outcomes, except for heterotopic ossifications (P = .032). The probability of 10-year survivorship of the components free of revision for any reasons as end point was 94.5%; when only the femoral components were considered the survivorship was of 96.9%.ConclusionTransverse subtrochanteric shortening and augmenting the osteotomy site using the intercalary segment of bone resected from the shortened femur with the Wagner cone stem is an effective and reliable technique in the management of total hip arthroplasty in Crowe type IV hip dysplasia. Stable and firm placing of the femoral component which leads to an increased frequency of intraoperative femoral cracks does not have an unfavorable effect on clinical and radiological outcomes.     

Determination of hip reduction in spica cast treatment for DDH: a comparison of radiography and ultrasound

Purpose  In this retrospective study we compared the efficacy of ultrasound and radiography for determining the position of the femoral head after closed or open reduction in DDH. Materials and methods  The ultrasound was performed using the van Douveren technique by a transinguinal approach through a perineal window of the spica cast. Sixty-eight a.p. radiographs of the pelvis were correlated to 68 ultrasound images. Results  Thirty-two radiographs were not useful for precisely determining the femoral head position, whereas the criteria described by van Douveren et al. could be identified in all ultrasound images. All ultrasound images in the study were useful and gave reliable information about the position of the femoral head. Conclusion  Consequently, standard radiographic documentation is no longer used as a standard in our clinic. MRI and CT are reserved for special cases. We recommend transinguinal ultrasound as a standard diagnostic method to determine the position of the femoral head in hip spica casts safely and reliably.     

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.     

下肢伸直襁褓体位对髋臼发育影响的实验研究

目的 模拟婴儿下肢伸直襁褓体位建立动物模型,探讨该体位对髋臼发育的影响.方法 将29只新生Wista幼鼠用医用胶带将双小腿、双髋关节缠绕同定10 d.保持髋关节伸直内收位.模拟双下肢伸直襁褓体位,作为实验组;另29只新生幼鼠双下肢不予处置,作为对照组,同样条件正常喂养8周后.通过大体标本及X线摄片,观察髋臼变化.结果 实验组标本可见髋臼变浅周围软组织增生.髋臼上缘变钝、变直,向上倾斜,有45髋发生髋关节脱位(45髋/50髋),50髋全部发生髋臼发育不良(50/50),对照组无髋脱位、髋臼发育不良发生,实验组与对照组髋臼指数存在明显差异(P<0.05).结论 双下肢伸直襁褓体位可,导致髋臼发育不良.     

Developmental Dysplasia of Hip and Post-natal Positioning: Role of Swaddling and Baby-Wearing

IntroductionTraditional swaddling, which implies restrictive immobilisation of the infant’s lower limbs with the hips in forced extension and adduction, has been shown to be a risk factor for Developmental Dysplasia of Hip (DDH).MethodsWe reviewed the literature regarding the correlation between DDH and post-natal positioning by swaddling and baby-wearing, to draw awareness of healthcare professionals towards an important risk factor for DDH that has often been overlooked.ResultsThere is overwhelming evidence in the literature, by both experimental and clinical studies, that proves the close association between improper post-natal positioning of the baby’s hips in extension-adduction and an increased incidence of DDH. On the other hand, “hip safe” swaddling which allows unrestricted flexion-abduction movements of the infants’ hips, and the use of baby-wearing devices which keep the lower limbs in an attitude of hip flexion-abduction and knee flexion, is optimal for hip development. Populations which practice these “hip-safe” techniques of infant immobilisation have a lower incidence of DDH as compared to those which practice restrictive immobilisation. Furthermore, populations which have adopted “hip-safe” positioning have demonstrated a significant decrease in the incidence of DDH. Understanding this association is vital, since this is a modifiable risk factor, rectification of which can decrease the incidence of DDH.ConclusionPolicy makers and governments must design educational campaigns tailored to their respective populations to increase awareness regarding the benefits of “hip-safe” techniques of infant positioning, since this simple intervention has the potential of decreasing the incidence of DDH.     

改良Zahradnicek手术治疗大龄儿童发育性髋脱位临床应用研究

目的:探讨7～12周岁大龄儿童发育性髋脱位(DDH)治疗优化方法,减少并发症。方法:自2005～2011年应用改良Zahradnicek手术治疗大龄儿童发育性髋脱位37例、41个关节,用特制的小儿髋臼钻有限切削臼软骨,重建髋臼孤形结构,恢复其头臼同心圆关系,同时矫正前倾角至5°～10°,颈干角至120°,用专用的120°鹅颈钢板固定。结果:术后疗效评定:优22髋,为54%;良14髋,为34%;可3髋,为7%;差2髋,为5%,优良率占88%。结论:此种手术在1次手术中使股骨头、髋臼、股骨颈及股骨干恢复或接近恢复正常解剖和功能的方法,使大年龄DDH患儿获得一个功能良好、稳定无痛的关节。     

DDH在乳腺癌组织中的表达及意义

目的研究二氢二醇脱氢酶(DDH)在乳腺癌组织中的表达,初步探讨其与乳腺癌的关系。方法采用免疫组化方法检测DDH在乳腺癌及癌旁组织中的表达情况,并比较DDH在不同分化程度与临床分期(TNM分期)癌组织的表达变化。结果DDH在乳腺癌组织中的表达明显高于癌旁组织(P<0.05),且在分化程度低的肿瘤组织中的表达强于分化高的肿瘤组织(P<0.05),但在不同TNM分期肿瘤组织中的表达无明显差异(P>0.05)。结论DDH在乳腺癌中呈高表达,且与组织分化程度有关,推测其可能与乳腺癌的发生发展有一定关系。     

Screening for hip abnormality in the neonate

Clinical screening policies for the detection of hip instability or dysplasia of the hip vary internationally. There is general agreement in the Western world that at birth all hip joints should be clinically assessed by the Ortolani and Barlow tests. Currently, there is no consistency regarding who should undertake the examination, the results being worse when inexperienced personnel are used. These clinical tests have poor sensitivity and should be regarded as surveillance, not screening methods. Since the 1980s ultrasonographic assessment of the hip has become a valuable diagnostic tool. However there is continuing controversy on whether this imaging method should be used universally or selectively for 'at risk' and clinically unstable hip joints. Universal ultrasonographic evaluation may result in over-treatment and selective screening may be no better than the best clinical screening programs in reducing the incidence of 'late' irreducible dislocation of the hip. It is generally accepted that all clinically unstable hips should be imaged by ultrasound by static and dynamic methods in order to confirm the diagnosis and to monitor treatment.     

Early Cartilage Degeneration in a Rat Experimental Model of Developmental Dysplasia of the Hip

Osteoarthritis (OA) is a common long-term complication of developmental dysplasia of the hip (DDH) that is associated with a higher incidence of OA. In addition, the age of onset of OA in DDH patients is significantly younger than in the general population. In order to investigate the early degeneration in DDH cartilage, we used a rat DDH model that was established by the straight-leg swaddling position. The hips were isolated from the DDH model rats and an untreated control group at postnatal weeks 2, 4, 6, and 8. Histology and proteoglycan levels were observed in articular cartilage using Safranin O staining. Biomarkers of cartilage degeneration, including type X collagen and matrix metalloproteinase (MMP)-13, were assessed using immunohistochemistry and quantitative real-time polymerase chain reaction. In addition, expressions of ADAMTS-4 and ADAMTS-5 were studied using quantitative real-time polymerase chain reaction at different ages. DDH rats showed decreased proteoglycans and derangement of chondrocytes when compared with the control group. Collagen X and MMP-13 expressions were higher in the superficial zone of DDH rats than in that of controls (p < 0.05), and the increase was age-dependent. mRNA expression of Collagen X and MMP-13 showed similar results (p < 0.05). A significant increase in mRNA expression of ADAMTS-5 was found in the DDH model cartilage at 8 weeks (p < 0.05). However, no change was observed in ADAMTS-4 expression. This study shows that degenerative cartilage changes occur at an early stage in the rat DDH model and become aggravated with age.     

Radiographic assessment of developmental dysplasia of the hip – A novel radiology reporting process and one year review of referrals

IntroductionDevelopmental dysplasia of the hip (DDH) is the most common musculoskeletal disorder of childhood. Despite the introduction of ultrasound screening radiography remains the most common imaging investigation for children over 4–6 months. The use of picture archive and communications system (PACS) tools to review key measures is standard but annotation of these images supplemented by a radiology report has not been described previously.MethodReferral and demographic data were identified of all children under the age of 2 years attending for a non-trauma pelvic radiograph within a single NHS Trust between January and December 2012. Retrospective review of all radiographs and reports identified the clinical history, co-morbidities and outcome.ResultsA total of 313 referrals were received, 230 initial and 83 follow-up examinations. 37 examinations identified a dysplastic acetabulum (n = 37/230; 16.1%) with the majority being girls (n = 23/37; 62.1%). A total of 25 abnormal findings in relation to the femoral head epiphyses were identified (n = 25/230; 10.9%) with 12 also having acetabular dysplasia. Children with a dysplastic acetabulum were significantly more likely to have a subluxation or dislocation (X² 183.78, 2df, p ≤ 0.001). Children with acetabular dysplasia were significantly more likely to have been born in the autumn or winter months (proportional difference = 11.0%; 95% CI [0.019,0.202]; p = 0.024).ConclusionThis article presents a novel reporting process which is helping to standardise the results in young children undergoing investigation for DDH. The review of referrals confirmed the published evidence that DDH is more prevalent in girls and children born in the autumn and winter months.