Total Hip Arthroplasty in Patients With Osteoarthritis Associated With Legg-Calve-Perthes Disease: Perioperative Complications and Patient-Reported Outcomes

BackgroundComplications and patient-reported outcomes (PROs) of total hip arthroplasty (THA) in patients with Legg-Calve-Perthes disease (LCPD) have demonstrated variable results. The purpose of this study was to use a validated grading scheme to analyze complications associated with THA in patients with residual LCPD deformities. Second, we report PROs and intermediate-term survivorship in this patient population.MethodsA retrospective, single-center review was performed on 61 hips in 61 patients who underwent THA for residual Perthes disease. Average patient age was 42 years and 26% of hips had previous surgery. Complications were determined and categorized using a validated grading scheme that included five grades based on the treatment required to manage the complication and on persistent disability. PROs were compared from preoperative to most recent follow-up time points.ResultsMajor complications (grade III) occurred in three patients (5%) which each required a second surgical intervention. The most common minor grade I or II complications (11.5%) were asymptomatic heterotopic ossification (3.3%). Patients were lengthened on the surgical side an average of 1.4 cm with no nerve palsies. All patient PROs improved from preoperative to postoperative time points with the modified Harris Hip Score improving from 46.9 preoperatively to 85.4 postoperatively (P < .01). Patients free from revision for any reason at final follow-up (5.6 years; range 2-13 years) was 98.4% with one patient needing a revision of their femoral component.ConclusionsTHA for the sequelae of the LCPD has an acceptable complication rate and provides excellent patient reported outcomes at mid-term follow-up.     

Management of hip pain in young adults

Aetiology of hip pain in young adults is variable. Hip pain can be caused by an intra- or extra-articular pathology affecting the hip region or can be referred from other areas in the body. The improvement in both clinical assessment and imaging modalities of the hip joint have resulted in more accurate diagnosis of causes of hip pain in adolescents and young adult patients. The treatment of painful hip in young adults is mainly directed to managing the cause of hip pain. In this article, we discuss some of the common causes of hip pain in young adults and their current modalities of treatment.     

股骨头骨骺缺血性坏死模型兔构建及组织病理学变化和p53与bcl-2的表达

背景：研究表明儿童股骨头骨骺缺血性坏死(Perthes病)的发病与儿童股骨头血液供应、髋关节周围病变、外伤、内分泌因素、遗传等多种原因有关。 目的：建立可靠的Perthes病的动物模型,并观察其股骨头组织学变化、细胞凋亡情况及p53和bcl-2基因的表达,并探讨凋亡基因p53和bcl-2与Perthes病的的相关性。 方法：采用C型臂透视下经右侧股骨颈注射TH胶致骺板缺血,建立幼兔Perthes病模型,并以同样方法用经右侧股骨颈给予注射生理盐水的兔作对照,于建模后4,6,8,10,12周分别取模型组和对照组两组右侧股骨头做病理切片,观察两组髋关节骺板细胞凋亡情况,并观察两组右侧股骨头p53和bcl-2等凋亡基因表达阳性率的变化。 结果与结论：建模后4周开始出现模型组右侧髋关节关节间隙增宽,出现点状出血变性区并逐步扩大,随后关节软骨与骨骺的黏附强度下降,骨质松脆,干骺端疏松变软。模型组右侧股骨头骺板细胞凋亡率与p53基因表达阳性率呈明显正相关性(r =0.68, P < 0.05),与bcl-2基因表达阳性率之间呈明显负相关性(r =-0.75, P < 0.01)。实验建立的perthes病动物模型稳定,简单,无反复现象。结果证实了Perthes病的发生与p53和bcl-2凋亡基因相关。     

改良Chiari术治疗Perthes病术后随访研究

目的：评估改良Chiari骨盆截骨＋滑膜部分切除术治疗Perths病的远期疗疗效,方法：对接受该术式治疗5年以上的47个患儿进行定期随访,通过询问病史,查体和摄片,了解其症状及髋关节变化。结果：47例患儿中6例出现骺板早闭,11例发生大转子上移,3例患髋疼痛,高由术前64．36％增至74．85％。髋殷明显加深,加宽,倾斜度减小,髋对股骨头包容满意,患侧股骨头的负重力矩较健侧增大,最后随访时髋关节Stulberg分级,I,II级占73．9％,III,IV级占24．0％,V级占2．1％,Herring分类与骺高恢复,并病发年龄与Stulberg分级分别显著丰关,结论：本术式治疗Perthes病远期效果满意,Herring分类及患儿发病年龄对本病具有确切的预后价值。     

Perthes病病人与非Perthes病病人健侧骨骺大小的对比测量

将80例单侧Perthes病病人和同期就诊的性别、年龄相同的80例非Perthes病病人的骨盆平片进行比较分析.所有80例非Perthes病病人至少也有一侧髋关节临床和X线表现完全正常.用直尺测量健侧股骨头骨骺高度和宽度.结果发现,Perthes病人的骨骺高度和宽度较非Perthes病病人均小(P<0.05).进一步证实了先天或后天所致的骨骺发育缺陷是多数Perthes病病人的重要发病基础.     

转子下旋转截骨术治疗儿童股骨头缺血性坏死疗效观察

目的：探讨转子下旋转截骨术对儿童股骨头缺血性坏死的疗效。方法：对２６例（３０髋）年龄在６～１２岁，属Ｃａｔｔｅｒａｌ分类Ⅱ、Ⅲ级股骨头缺血性坏死患儿采用转子下旋转截骨术治疗并进行临床分析。结果：优２２髋，良６髋，差２髋，优良率９３．３％。结论：对年龄偏小、Ｃａｔｔｅｒａｌ分类为Ⅱ、Ⅲ级的股骨头缺血性坏死，施行转子下截骨术治疗效果较理想。     

“学步期”儿童发育性髋关节脱位手术治疗的可行性研究

目的探讨手术治疗＂学步期＂儿童发育性髋关节脱位（developmental dislocation of the hip,DDH）的临床可行性。方法选择本院12～18个月发育性髋关节脱位患儿56例（均为Tonnis分级Ⅲ、Ⅳ度）。患儿中采取切开复位Salter骨盆截骨术者为实验组,共36例;采用传统手法复位蛙式位石膏外固定（复位困难采取内收肌群切断术）患儿对照组,共20例。结果随访14～60个月,实验组优良率92.31%,对照组优良率83.33%,2种治疗方法对比有明显的统计学意义（P〈0.05）。且对照组在后期随访中出现2例再脱位,2例股骨头坏死,而实验组无一例出现。结论采取手术治疗＂学步期＂儿童发育性髋关节脱位可以更准确还原髋臼和股骨头的同心圆关系,而且固定可靠不宜再脱位,更有助于髋关节向正常方向发育,具有临床可行性。     

Avascular necrosis of the femoral head following heart transplant in a child

A case of avascular necrosis of the femoral head following heart transplantation in a 2-year-old child has been followed to skeletal maturity. Avascular necrosis is a well-known complication following steroid use in childhood. There are no reported cases of avascular necrosis following heart transplant in childhood. Similar cases should be reported.     

Perthes disease: A new finding in Floating‐Harbor syndrome

Floating‐Harbor Syndrome (FHS; OMIM #136140) is an ultra‐rare autosomal dominant genetic condition characterized by expressive language delay, short stature with delayed bone mineralization, a triangular face with a prominent nose, and deep‐set eyes, and hand anomalies. First reported in 1973, FHS is associated with mutations in the SRCAP gene, which encodes SNF2‐related CREBBP activator protein. Mutations in the CREBBP gene cause Rubinstein‐Taybi Syndrome (RSTS; OMIM #180849, #613684), another rare disease characterized by broad thumbs and halluces, facial dysmorphisms, short stature, and intellectual disability, which has a phenotypic overlap with FHS. We describe a case of FHS associated with a novel SRCAP mutation and characterized by Perthes disease, a skeletal anomaly described in approximately 3% of patients with RSTS. Thus Perthes disease can be added to the list of clinical features that overlap between FHS and RSTS.