Treatment of bilateral developmental dysplasia of the hip joint with an improved technique:A case report

BACKGROUND Developmental dysplasia of the hip(DDH)is a common osteoarticular deformity in pediatric orthopedics.A patient with bilateral DDH was diagnosed and treated using our improved technique"(powerful overturning acetabuloplasty)"combined with femoral rotational shortening osteotomy.CASE SUMMARY A 4-year-old girl who was diagnosed with bilateral DDH could not stand normally,and sought surgical treatment to solve the problem of double hip extension and standing.As this child had high dislocation of the hip joint and the acetabular index was high,we changed the traditional acetabuloplasty to"powerful turnover acetabuloplasty"combined with femoral rotation shortening osteotomy.During the short-term postoperative follow-up(1,3,6,9,12,and 15 months),the child had no discomfort in her lower limbs.After the braces and internal fixation plates were removed,formal rehabilitation training was actively carried out.CONCLUSION Our"powerful overturning acetabuloplasty"combined with femoral rotational shortening osteotomy is feasible in the treatment of DDH in children.This technology may be widely used in the clinic.

Effects of different pelvic osteotomies on acetabular morphology in developmental dysplasia of hip in children

Developmental dysplasia of hip seriously affects the health of children,and pelvic osteotomy is an important part of surgical treatment.Improving the shape of the acetabulum,preventing or delaying the progression of osteoarthritis is the ultimate goal of pelvic osteotomies.Re-directional osteotomies,reshaping osteotomies and salvage osteotomies are the three most common types of pelvic osteotomy.The influence of different pelvic osteotomy on acetabular morphology is different,and the acetabular morphology after osteotomy is closely related to the prognosis of the patients.But there lacks comparison of acetabular morphology between different pelvic osteotomies,on the basis of retrospective analysis and measurable imaging indicators,this study predicted the acetabular shape after developmental dysplasia of the hip pelvic osteotomy in order to help clinicians make reasonable and correct decisions and improve the planning and performance of pelvic osteotomy.

Outcome after early mobilization following hip reconstruction in children with developmental hip dysplasia and luxation

Background Most orthopedic surgeons prefer spica cast immobilization in children for 4 to 12 weeks after surgical hip reconstruction in children with developmental hip dysplasia.This challenging treatment may be associated with complica-tions.Studies are lacking that focus on early mobilization without casting for postoperative care after hip reconstruction.Methods Twenty-seven children(3.4±2.0 years),including 33 hips with developmental hip dysplasia(DDH)and dislocation of the hip(Tonnis grade 1 to 4),who underwent hip reconstruction(Dega acetabuloplasty,varisation-derotation osteotomy and facultative open reduction)were retrospectively included in this study.Postoperatively the patients were placed in an individual foam shell with 30 degrees of hip abduction,hip extension,and neutral rotation.Early mobilization physiotherapy was performed within the first few days after the surgery under epidural anaesthesia.Full weight bearing was allowed after 3-4 weeks.All children received a clinical examination and radiographic evaluation before and after surgical intervention.The follow-up period was 12.3±2.9 months.Results On average,the postoperative acetabular index decreased significantly from 36.9 to 21.7 degrees and the center-edge angle increased from 9.9 to 28.6 degrees.All hips had reached Tonnis grade 1 at the time of the last follow-up.No complications such as dislocation of the bone wedge,avascular necrosis of the acetabulum or femur,lack of non-union,or nerve injury,were reported.Conclusions In this cohort study,hip reconstruction was successful according to clinical and radiographic outcome param-eters after early mobilization without cast therapy.Early mobilization may be used as an alternative treatment option after hip reconstruction in DDH.

Lower-limb valgus deformity associated with developmental hip dysplasia

Background Treating developmental dysplasia of the hip is often challenging. The difficulties include not only the hip surgery itself but also the treatment of the associated lower-limb valgus deformity. However, there have been very few studies on such deformity in patients with developmental hip dysplasia. In this study, we investigated the prevalence and severity of lower-limb valgus deformity, along with the relationship between the severity of valgus deformity and mechanical alterations of the hip or the ipsilateral knee. Methods Two hundred and six affected lower limbs of 116 adult patients with untreated developmental dysplasia of the hip were included in the study, grouped according to the severity of hip dysplasia. Each study participant＇s radiographs were measured to quantitatively evaluate the mechanical axis deviation of the lower limb, and further to evaluate the prevalence and severity of the lower-limb valgus deformity. Some mechanical alterations of the hip and the ipsilateral knee were also measured on the radiographs. Results Of the affected lower limbs, 14.1% had valgus deformities. Study participants with Crowe type III hip dysplasia had the most severe deformity and the highest prevalence of deformity. Severity of valgus deformity had a strong positive correlation with the lateral migration of the femoral head but not with the superior migration. A decreased lateral distal femoral angle contributed to the lower-limb valgus deformity, and the lateral distal femoral angle had a strong negative correlation with the severity of valgus deformity. Conclusions Hip dysplasia is commonly associated with lower-limb valgus deformity, and the severity of the lower-limb valgus deformity is mostly affected by lateral migration but not superior migration of the femoral head. The valgus deformity may originate mainly in the distal femur, in addition to the hip joint itself. These findings can be taken into account when planning to treat the patients with hip dysplasia.

One-stage total hip arthroplasty for advanced hip tuberculosis combined with developmental dysplasia of the hip:A case report

BACKGROUND A patient with advanced tuberculosis of the hip joint combined with Crowe type IV developmental dysplasia of the hip(DDH)and a drainage sinus is a rare condition.There are no previous reports of this condition,and it is a complex challenge for surgeons to develop a treatment scheme.CASE SUMMARY We report a 73-year-old male patient with severe hip pain and drainage sinus of the left hip for one month.Approximately 40 years ago,a drainage sinus occurred at the lateral left hip was healed at the local hospital with anti-infectious therapy.After the sinus healed,gradual pain occurred in the left hip for 40 years.Approximately one month prior,hip pain was sharply aggravated,and a drainage sinus reoccurred in the left hip.The X-ray and computed tomography examinations showed destruction of the head and neck of the left femur,as well as an acetabular deformity.The results of Mycobacterium tuberculosis antibody and Xpert were positive.Therefore,the patient was diagnosed with advanced TH combined with Crowe type IV DDH.After 22 d of treatment with anti-tuberculosis chemotherapy,the sinus healed,and the patient underwent one-stage total hip arthroplasty(THA)surgery consisting of debridement,osteotomy,and joint replacement.After surgery,the patient received anti-tuberculosis chemotherapy drugs for nine months,with no recurrent infection.After one year of follow-up,the Harris score of the patient increased from 21 pre-THA to 86.CONCLUSION Although drainage sinuses are a contraindication to one-stage THA,one-stage THA is still an effective and safe surgical method after the sinus heals.

Total Hip Arthroplasty in Neglected Developmental Dysplasia Hip, a Case Report

Developmental dysplasia of hip is a disorder of abnormal development of the hip joint resulting early osteoarthritis of the hip. In late stage of disease, total hip arthroplasty is the option to reduce pain. Total hip arthroplasty in development dyplastic hip is a very challenging procedure in view of abnormal anatomy and biomechanic of the hip. A proper pre-operative planning is important of successful surgery. We report a case of a 60-year-old woman with neglected DDH with severe hip pain, who underwent total hip replacement with good result.

Developmental Dysplasia of the Hip: Management of Graf IIa Dysplastic Hip

Developmental Dysplasia of the Hip (DDH) describes a wide range of anatomic abnormalities of the growing hips which might result in permanent abnormal gait. Therefore, early detection and management is crucial to improve the outcome and minimise the risk of osteoarthritis in later life. Hip ultrasound is used to evaluate DDH based on Graf classification. Graf score is a widely used ultrasound grading score to evaluate DDH in infants. There is conflicting evidence regarding the management of the developmentally immature Graf type IIa hip. Some physicians adopt watchful waiting for natural maturation of hips while other early treatment. This article will provide an evidence-based review on the management modalities of the Graf type IIa hip.

Prevalence of Developmental Dysplasia of the Hip in Chinese Adults： A Cross-sectional Survey

Background： The prevalence of developmental dysplasia of the hip （DDH） is unknown in China. We aimed to determine the prevalence of DDH in Chinese adults. Methods： In this study, we performed a cross-sectional survey of a nationally representative sample of Chinese adults. All participants underwent questionnaire investigation, physical examination, and X-ray examination. Factors associated with DDH were analyzed with logistic regression. Results： We invited 29,180 individuals aged 18 years and over to participate, randomly selected from 18 primary sampling units （street districts in urban areas and townships in rural areas）. The survey and examination were completed in 25,767 people （I 0,296 men and 15,471 women）. DDH was diagnosed in 391 people, yielding an overall DDH prevalence of 1.52%. Based on this information, we estimate the number of individuals with DDH in China to be approximately 16.05 million. DDH prevalence increased with age （odds ratio = 1.53 [1 .03-2.27], P = 0.036）, was significantly higher among women than men （2.07% vs. 0.75%, P 〈 0.001）, and was higher among rural residents than urban residents （1.75% vs. 1.29%, P 〈 0.001）. Economic development was independently associated with the presence of DDH. There was no evidence of an association between body mass index alone, education~ or current smoking or drinking and risk of DDH （P 〉 0.05）. Conclusions： DDH has become an important public health problem. Special attention should be paid to residents with DDH. Screening for DDH should be performed in China.

Inverted Acetabular Labrum： An Analysis of Tissue Embedment in Hip Joint in 15 Patients with Developmental Dysplasia of the Hip

The acetabular labrum is a triangular fibrocartilaginous structure that forms a horseshoe-shaped attachment to the acetabular rim, which connects the acetabulum to the underlying transverse acetabular ligament [Figure la].m Up to 90% of symptomatic patients with developmental dysplasia of the hip （DDH） are found to combine with lesions of acetabular labrum.

Developmental dysplasia of the hip： A special pathology

Developmental dysplasia of the hip （DDH） is one of the most common congenital disorders in childhood. Its diverse pathological changes require different treatments and result in different outcomes. Although many studies have been conducted on DDH, some special pathology is still unrecognized. We here presented a rare case of a one-year and eleven-month old girl with DDH; a half-free intra-articular osteocartilaginous tissue was found in her right hip joint. X-ray, computer assisted tomography （CT） and magnetic resonance imaging （MRI） were performed to evaluate the pathological changes. MRI revealed some positive findings. The patient experienced open reduction and histopathological examination of the small tissue. Through gross anatomy it is a half-free intra-articular osteocartilaginous tissue, which can fully match a fossa observed at the femoral head. Histopathological examination found that the tissue was composed of collagenous fiber and cartilage-like tissue. Interestingly, we found the expression of type l collagen according to immunohistochemical analysis, which indicated that the cartilage-like tissue was formed due to laceration of the articular cartilage. This kind of disorder should be included as one of the pathologies of DDH. The most possible origin of this tissue is the femoral head which we speculate may have been fractured before.

Application of uncemented Zweymüller hip prosthesis in adult patients with hip osteoarthritis secondary to developmental dysplasia

Background Developmental dysplasia encompasses a wide spectrum of hip pathology ranging from a shallow acetabulum to a completely dislocated ＇high-riding＇ hip. It is a common cause of secondary osteoarthritis in young adults and is the underlying diagnosis in up to 48% of patients requiring total hip arthroplasty （THA） for coxarthrosis. The aim of this study was to evaluate efficiency and safety of THA using Zweym（311er hip implant in the treatment of severe osteoarthritis secondary to developmental dysplasia of the hip （DDH） in adults. Methods From January 2000 to February 2008, 35 patients （40 hips） with developmental dysplasia of the hip were included. Five were male and 30 were female, with ages ranging from 26 to 65 years and an average age of 45 years. According to Hartofilakidis classification, there were type I in 5 hips, type II in 20 hips, type III in 15 hips. All the patients were performed the THA using the Zweym011er hip implant. The preoperative average Harris score was 44. The bilateral arthroplasty was performed in 5 patients and the unilateral arthroplasty in 30 patients. The patients mainly suffered from pain and claudication. Clinical and radiological results were analyzed. The Harris score was used for outcome measurement. Results Thirty five patients （40 hips） were followed and the mean follow-up period was 46 months （ranged from 24 months to 96 months）. The latest follow-up average Harris score was 88.9 （97.1% of good rate）. All the patients were pain-free and there was no sign of infection, aseptic loosening and subsidence. Conclusions In summary, THA using Zweym011er hip implant is a good treatment method for severe osteoarthritis secondary to DDH in adults. The key techniques for the total hip replacement are as follows： good preoperative plan, firmly placing the acetabular component in the true acetabulum, proper preparation of proximal femur, suitable femoral component choosing and improving the techniques of the bone graft.

Two Different Total Hip Arthroplasties for Hartofilakidis Type C1 Developmental Dysplasia of Hip in Adults

Background： Total hip arthroplasty （THA） in developmental dysplasia of the hip （DDH） is more complex than the normal hip, with large replacement risks and many complications.Although nonosteotomy THA is convenient to perform, femoral osteotomy shortening can avoid blood vessel and nerve traction injuries.This study aimed to compare osteotomy THA with nonosteotomy to determine reasonable options for operative management of DDH.Methods： Data on 48 DDH patients who underwent THA were analyzed retrospectively.The patients were divided into two groups： Group A 29 cases （nonosteotomy）, and group B 19 cases （osteotomy）.Harris and Western Ontario and McMaster Universities Osteoarthritis Index （WOMAC） scores, limb length discrepancy （LLD）, radiological data on the hip, and claudication were evaluated.Data were analyzed by using paired-sample Student＆#39;s t-test, independent-sample Student＆#39;s t-test, and Pearson＆#39;s Chi-square test;the test level was α =0.05.Results： Postoperative Harris （90.7 ＆#177; 5.1） and WOMAC scores （88.0 ＆#177; 10.6） were significantly improved compared with preoperative Harris （44.8 ＆#177; 5.7） and WOMAC scores （42.0 ＆#177; 5.3） in group A （P 〈 0.05）.Postoperative Harris （90.4 ＆#177; 2.8） and WOMAC scores （88.2 ＆#177; 5.9） were significantly improved compared with preoperative Harris （44.4 ＆#177; 4.2） and WOMAC scores （43.2 ＆#177; 4.3） in group B （P 〈 0.05）.One case of dislocation occurred in group A;after closed reduction, dislocation did not recur.In group A, 2 patients developed cutaneous branch injury of the femoral nerve, which spontaneously recovered without treatment.Postoperative LLD 〉2 cm was seen in one case in group A and five cases in group B.Postoperative claudication showed no significant difference between the two groups （P 〉 0.05）.No patients developed infection;postoperative X-rays showed that the location of the prosthesis was satisfactory, and the surrounding bone was not dissolved.Conclusions： THA is effective and safe for DDH.For unilateral high dislocation DDH patients with limb lengthening ≤4 cm and good tissue conditions, THA without femoral osteotomy may be considered.