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.

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.

Roles of combined femoral and acetabular anteversion in pathological changes of hip dysplasia and hip reconstructive surgery

Combined femoral and acetabular anteversion is the sum of femoral and acetabular anteversion,representing their morphological relationship in the axial plane.Along with the increasing understanding of hip dysplasia in recent years,numerous scholars have confirmed the role of combined femoral and acetabular anteversion in the pathological changes of hip dysplasia.At present,the reconstructive surgery for hip dysplasia includes total hip replacement and redirectional hip preservation surgery.As an important surgery index,combined femoral and acetabular anteversion have a crucial role in these surgeries.Herein,we discuss the role of combined femoral and acetabular anteversion in pathological changes of hip dysplasia,total hip replacement,and redirectional hip preservation surgery.

Total hip arthroplasty preoperative planning for childhood hip disorders’sequelae:Focus on developmental dysplasia of the hip

Developmental dysplasia of the hip(DDH)poses significant challenges in both childhood and adulthood,affecting up to 10 per 1000 live births in the United Kingdom and United States.While newborn screening aims to detect DDH early,missed diagnoses can lead to severe complications such as hip dysplasia and early onset osteoarthritis in adults.Treatment options range from less invasive procedures like hip-preserving surgery to more extensive interventions such as total hip arthroplasty(THA),depending on the severity of the condition.Preoperative planning plays a critical role in optimizing surgical outcomes for DDH patients undergoing THA.This includes accurate imaging modalities,precise measurement of acetabular bone stock,assessment of femoral head subluxation,and predicting prosthesis size and leg length discrepancy.Recent advancements artificial intelligence and machine learning offer promising tools to enhance preoperative planning accuracy.However,challenges remain in validating these technologies and integrating them into clinical practice.This editorial highlights the importance of ongoing research to refine preoperative strategies and improve outcomes in DDH management through evidence-based approaches and technological innovations.

HIPPO artificial intelligence:Correlating automated radiographic femoroacetabular measurements with patient-reported outcomes in developmental hip dysplasia

BACKGROUND Hip dysplasia(HD)is characterized by insufficient acetabular coverage of the femoral head,leading to a predisposition for osteoarthritis.While radiographic measurements such as the lateral center edge angle(LCEA)and Tönnis angle are essential in evaluating HD severity,patient-reported outcome measures(PROMs)offer insights into the subjective health impact on patients.AIM To investigate the correlations between machine-learning automated and manual radiographic measurements of HD and PROMs with the hypothesis that artificial intelligence(AI)-generated HD measurements indicating less severe dysplasia correlate with better PROMs.METHODS Retrospective study evaluating 256 hips from 130 HD patients from a hip preservation clinic database.Manual and AI-derived radiographic measurements were collected and PROMs such as the Harris hip score(HHS),international hip outcome tool(iHOT-12),short form(SF)12(SF-12),and Visual Analogue Scale of the European Quality of Life Group survey were correlated using Spearman's rank-order correlation.RESULTS The median patient age was 28.6 years(range 15.7-62.3 years)with 82.3%of patients being women and 17.7%being men.The median interpretation time for manual readers and AI ranged between 4-12 minutes per patient and 31 seconds,respectively.Manual measurements exhibited weak correlations with HHS,including LCEA(r=0.18)and Tönnis angle(r=-0.24).AI-derived metrics showed similar weak correlations,with the most significant being Caput-Collum-Diaphyseal(CCD)with iHOT-12 at r=-0.25(P=0.042)and CCD with SF-12 at r=0.25(P=0.048).Other measured correlations were not significant(P>0.05).CONCLUSION This study suggests AI can aid in HD assessment,but weak PROM correlations highlight their continued importance in predicting subjective health and outcomes,complementing AI-derived measurements in HD management.

Developmental dysplasia of the hip: What has changed in the last 20 years?

Developmental dysplasia of the hip(DDH) describes the spectrum of structural abnormalities that involve the growing hip. Early diagnosis and treatment is critical to provide the best possible functional outcome. Persistence of hip dysplasia into adolescence and adulthood may result in abnormal gait, decreased strength and increased rate of degenerative hip and knee joint disease. Despite efforts to recognize and treat all cases of DDH soon after birth, diagnosis is delayed in some children, and outcomes deteriorate with increasing delay of presentation. Different screening programs for DDH were implicated. The suspicion is raised based on a physical examination soon after birth. Radiography and ultrasonography are used to confirm the diagnosis. The role of other imaging modalities, such as magnetic resonance imaging, is still undetermined; however, extensive research is underway on this subject. Treatment depends on the age of the patient and the reducibility of the hip joint. At an early age and up to 6 mo, the main treatment is an abduction brace like the Pavlik harness. If this fails, closed reduction and spica casting is usually done. After the age of 18 mo, treatment usually consists of open reduction and hip reconstruction surgery. Various treatment protocols have been proposed. We summarize the current practice for detection and treatment of DDH, emphasizing updates in screening and treatment during the last two decades.

Developmental dysplasia of the hip in the newborn: A systematic review

Developmental dysplasia of the hip(DDH) denotes a wide spectrum of conditions ranging from subtle acetabular dysplasia to irreducible hip dislocations. Clinical diagnostic tests complement ultrasound imaging in allowing diagnosis, classification and monitoring of this condition. Classification systems relate to the alpha and beta angles in addition to the dynamic coverage index(DCI). Screening programmes for DDH show considerable geographic variation; certain risk factors have been identified which necessitate ultrasound assessment of the newborn. The treatment of DDH has undergone significant evolution, but the current gold standard is still the Pavlik harness. Duration of Pavlik harness treatment has been reported to range from 3 to 9.3 mo. The beta angle, DCI and the superior/lateral femoral head displacement can be assessed via ultrasound to estimate the likelihood of success. Success rates of between 7% and 99% have been reported when using the harness to treat DDH. Avascular necrosis remains the most devastating complication of harness usage with a reported rate of between 0% and 28%. Alternative non-surgical treatment methods used for DDH include devices proposed by LeD amany, Frejka, Lorenz and Ortolani. The Rosen splint and Wagner stocking have also been used for DDH treatment. Surgical treatment for DDH comprises open reduction alongside a combination of femoral or pelvic osteotomies. Femoral osteotomies are carried out in cases of excessive anteversion or valgus deformity of the femoral neck. The two principal pelvic osteotomies most commonly performed are the Salter osteotomy and Pemberton acetabuloplasty. Serious surgical complications include epiphyseal damage, sciatic nerve damage and femoral neck fracture.

Total hip arthroplasty in developmental dysplasia of the hip: Review of anatomy, techniques and outcomes

Total hip arthroplasty(THA) in developmental dysplasia of the hip(DDH) presents many challenges to the reconstructive surgeon. The complex femoral and acetabular anatomy makes standard reconstruction technically challenging. Acetabular coverage can be improved by medialization of the component or augmentation of the deficient areas with bone graft. Femoral shortening osteotomies are considered in cases of severe dysplasia and frankly dislocated hips. Each patient's unique anatomy dictates what options of reconstruction are available. The functional outcomes of THA in DDH are generally excellent, though higher rates of mechanical failure have been reported in this group. This article reviews the anatomy, classification, technical considerations, and outcomes of THA in patients with DDH.

Bernese periacetabular osteotomy for hip dysplasia: Surgical technique and indications

For young, active patients with healthy hip cartilage, pelvic osteotomy is a surgical option in to address hip pain and to improve mechanical loading conditions related to dysplasia. Hip dysplasia may lead to arthrosis at an early age due to poor coverage of the femoralhead and abnormal loading of the joint articulation. In patients with symptomatic dysplasia and closed triradiate cartilage(generally over age 10), including adolescents and young adults(generally up to around age 40), the Bernese periacetabular osteotomy(PAO) is a durable technique for addressing underlying structural deformity. The PAO involves a modified Smith-Petersen approach. Advantages of the Bernese osteotomy include preservation of the weight-bearing posterior column of the hemi-pelvis, preservation of the acetabular blood supply, maintenance of the hip abductor musculature, and the ability to effect powerful deformity correction about an ideal center of rotation. There is an increasing body of evidence that preservation of the native hip can be improved through pelvic osteotomy. In contrast to hip osteotomy and joint preservation, the role of total hip arthroplasty in young, active patients with correctable hip deformity remains controversial. Moreover, the durability of hip replacement in young patients is inherently limited. Pelvic osteotomy should be considered the preferred method to address correctable structural deformity of the hip in the young, active patient with developmental dysplasia. The Bernese PAO is technically demanding, yet offers reproducible results with good long-term survivorship in carefully selected patients with preserved cartilage and the ability to meet the demands of rehabilitation.

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.

Developmental Dysplasia of the Hip (DDH) in Saudi Arabia: Time to Wake up. A Systematic Review (1980-2018)

The objective of this systematic literature review was to assess the incidence of DDH among the Saudi Arabian population. Methods: A systematic review was performed for all the published articles in the English language literature on DDH in Saudi Arabia. Data sources were PubMed Medline (1980-2018) (http://www.ncbi.nlm.nih.gov/pubmed/), Ovid Medline (1980-2018), EMBASE MEDLINE (1980 to May 2018), EMBASE (1991 to May 2018), the Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews, the Science Citation Index (1966 to May 2018), published data from the Saudi Medical Journal (1985-2018) and Annals of Saudi Medicine (1985-2018). The author independently reviewed articles and abstracted the data. The key words used were Saudi Arabia developmental dysplasia of the hip ORDDH, congenital hip dislocation or congenital subluxation of the hip, and congenital dysplasia of the hip. Results: The authors identified 18 potentially relevant articles published in the last 38 years, and 10 met the inclusion criteria. The 10 studies analyzed included 2037 studies of infants diagnosed with DDH;and they gave an average incidence of 10.46/1000. Two studies (303 subjects) did not report the affected gender;in the remaining 338 were boys and 1396 were girls and one study did not report the side of affection. The majority presented after 12 months of age. The right side was affected in 532 (27.2%) affected, 734 (37.6%) were left side and 687 (35.2%) infants were affected bilaterally. Consanguinity, breech presentation, and family history were found to be the risk factors in 32.9%, 17.3%, and 23.6% of the patients, respectively. Conclusions: There is paucity of available literature on DDH in Saudi Arabia. New strategies have to be developed that include mandatory screening programs in all hospitals (private and public) so that more children can be treated by nonsurgical methods.

Diagnosis of Developmental Dysplasia of the Hip Using Sound Transmission in Neonates

The developmental dysplasia of the hip disease is in 1% of newborns, and it is a risk factor for dislocation of the hip;only 1 from 7000 newborns develops dislocation of the hip. Newborns were selected from public and private hospitals in Celaya, Guanajuato. Parents were asked to sign informed consent. Clinical maneuvers were applied for diagnosis of developmental dysplasia of the hip, on three consecutive occasions, two by the same investigator and the third by a different observer: Ortolani, Barlow, Piston, Galeazzi, Peter Baden, the comparative sound transmission test, and comparative sound transmission with extension/flexion test were applied. The diagnosis was confirmed with ultrasound of hip, technique Graf, I healthy hip, II functionally immature, III subluxation, and IV dislocation. Sample size was 8 affected hips and 56 healthy hips. Kappa for intra observer and inter observer reliability were measured;the validity was measured by sensitivity, specificity, positive and negative predictive values, using the ultrasound diagnosis as the gold standard. The sample consisted of 78 neonates hips with female’s predominance. With comparative sound transmission test was obtained Kappa intra observer 0.80, Kappa inter observer 0.93, sensitivity 45.45%, specificity 96.27%, positive predictive value 66.67% and negative predictive value 91.49%;with comparative sound transmission with extension/flexion, was 0.83, 0.92, 72.73%, 95.52%, 72.73%, and 95.52%, respectively. The tests compared the sound transmission help better diagnose developmental dysplasia disease of the hip.

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.

Seasonal variation in adult hip disease secondary to osteoarthritis and developmental dysplasia of the hip

AIM To determine if there was a seasonal variation in adults undergoing total hip arthroplasty for end stage hip disease due to osteoarthritis(OA) or sequelae of developmental dysplasia of the hip(DDH).METHODS The total hip registry from the author's institution for the years 1969 to 2013 was reviewed. The month of birth,age,gender,and ethnicity was recorded. Differences between number of births observed and expected in the winter months(October through February) and non-winter mo(March through September) were analyzed with the χ2 test. Detailed temporal variation was mathematically assessed using cosinor analysis.RESULTS There were 7792 OA patients and 60 DDH patients who underwent total hip arthroplasty. There were more births than expected in the winter months for both the DDH(P < 0.0001) and OA(P = 0.0052) groups. Cosinor analyses demonstrated a peak date of birth on 1st October. CONCLUSION These data demonstrate an increased prevalence of DDH and OA in those patients born in winter.

Morphology of Acetabulum and Femoral Head-Neck Junction in Hip Dysplasia Which Underwent Rotational Acetabular Osteotomy

The purpose of this study was to evaluate the preoperative radiographs with cases of developmental dysplasia of the hip (DDH) leading to rotational acetabular osteotomy (RAO) or curved peri-ace-tabular osteotomy (CPO), and examine the frequency of femoroacetabular impingement (FAI) related bone morphology in the acetabulum and femoral head-neck junction. Twenty-four hips with hip dyaplasia who underwent CPO or RAO were included in this study. Six hips had grade 0 and eighteen hips had grade 1 OA according to the T&ouml;nnis classification. We excluded patients with moderate and severe hip osteoarthritis and major femoral head deformities. Preoperative radiograph was evaluated on sharp angle, center-edge angle, alpha angle, crossover sign and posterior wall sign. Crossover signs were revealed in 7 hips (29.2%);posterior wall signs were revealed in 16 hips (66.7%);and cam-type deformities with an alpha angle of ≥50.5&deg;were observed in 19 hips (79.2%) in preoperative evaluation. As determined using the T&ouml;nnis scale, no progression of osteoarthritis was found in 16 of the 24 hips;there was a one-grade progression in 8 hips. Among the 8 hips, either positive cross-over sign or posterior sign in acetabulum, and an alpha angle of ≥50.5&deg;in femur were observed in six hips with progression of osteoarthritis. The presence of cam-type deformity and acetabular retroversion in patients who underwent RAO or CPO was relatively high in preoperative radiographs, and caution should be employed during surgery in patients with DDH. There is a possibility of secondary FAI due to excessive forward coverage of the bone fragments after RAO and CPO.

The Relation between Canine Hip Dysplasia, Genetic Diversity and Inbreeding by Breed

Objectives: To assess the relation between the prevalence of canine hip dysplasia, inbreeding and genetic diversity by breed. Methods: Retrospective pedigree analysis of 9 breeds based on a reference population of 41,728 individuals, and hip dysplasia assessment in 1745 dogs. Results: Hip dysplasia was less common among breeds with higher coefficient of inbreeding, lower genetic diversity, and highest contribution of one single ancestor to the population. Inbreeding not exceeding 3.25% should be considered safe since it will maintain a sufficiently high genetic diversity within the breed. Clinical Significance: Together with published data on single breeds, the present findings question the general assumption that line-breeding or in-breeding has an adverse effect on the prevalence of hip dysplasia. Hip assessment is indicated in all breeds, but better methods are needed for selecting dogs suitable for reproduction.

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.

Revision of Outcomes and Complications Following Open Reduction, and Zigzag Osteotomy Combined with Fibular Allograft for Developmental Dysplasia of the Hip in Children

Background: Reports of the efficacy of open reduction and Zigzag Osteotomy combined Fibular Allograft (ZOFA) for developmental dysplasia of the hip. The purposes of this study were to evaluate the long-term outcomes and complications after surgery. Methods: We performed a retrospective match-controlled study in which 158 patients had 181 hips with developmental dysplasia of the hip. Radiographs were found of acetabular index, height of dislocation, T&ouml;nnis grade, abduction angle in the spica cast, and Severin grade. At final follow-up, deformity of femoral head or neck or acetabulum was evaluated according to the Severin. Avascular necrosis was rated according to Kalamchi. Clinical evaluation was made according to modified McKay criteria. Results: Between 2009 and 2012, 133 girls (84.2%) and 25 boys (15.8%) with developmental dysplasia of the hip underwent open reduction and ZOFA;135 (85.4%) were unilateral, and 23 (14.6%) were bilateral. Patients were divided into 2 groups: group 1 included 54 patients (62 hips) aged 12 months - ≤18 months and group 2 included 84 patients (119 hips), aged >18 months - ≤36 months. According to T&ouml;nnis system: type 3 appeared in 127 hips (70.2%), and Type 4 in 54 hip (29.8%). The anterior approach was used to expose inner table of the ilium and ZOFA in all cases. Acetabular index was improved;preoperation was 42.95°, and latest follow-up 17.26°. The Kirschner Wires (KW) were not used to fix the fibular allograft at the pelvic osteotomy site. All of the fibular allografts were completely incorporated in mean time of 14 weeks (range, 12 weeks - 17 weeks) post-surgery. Clinical evaluation according to modified McKay criteria: satisfactory result (excellent and good) was achieved in 141 hips (77.9%). Avascular Necrosis (AVN) happened in 61 hips (33.7%), redislocation in 18 hips (9.9%), coxa vara in 4 hips (2.2%), trendelenburg gait in 4 hips (2.2%), and supracondylar femoral fractures in 2 hips (1.1%). Conclusions: On the basis of this study, ZOFA was strength and graft was not resorption, graft problems;without medial displacement of the distal fragment. Acetabular index was improved, without KW problem. Surgical technique with ZOFA did not expose outer table of the illium, limiting abductor muscle injury with negative trendelenburg gait;on the other hand, the blood loss from this procedure is acceptable. Some complications have been seen in this study: AVN, redislocation, coxa magna, coxa vara, trendelenburg gait, and distal femoral fracture.

Role of Ultrasound in Evaluation of Developmental Dysplasia of the Hip in Infants

Background/Aim: The present study was directed to investigate the accuracy of ultrasound (USG) in early detection of developmental dysplasia of the hip (DDH) to prevent permanent complications. Material & Methods: A total of 276 infants was investigated;their ages range from 1 - 6 months. Patients referred from the clinic based on clinical assessment (mainly Barlo & Ortolani maneuvers). Then the patient’s hips were examined by expert radiologists in USG scan. After that, dynamic (coronal and transverse) & static ultrasound views evaluated by the same radiologist using Graf’s criteria. Infants with abnormal ultrasound findings suggestive of DDH were followed up after 4 - 6 weeks by the same investigator to monitor the progress. At the same time, the patient referred to a specialist for conservative management from the first positive findings. Results: Among the 276 referred patients, infants with normal stable hips (Graf Type I and Type II a+) were 221 (80%), 155 of them were female and 66 male infants. Infants with unstable hips based on Graf’s criteria (Type II a-, II b, II c and Type III a) were 55 (20%). Out of 55 with abnormal findings, the affected hips on both sides, right and left were: 5 cases (1.8%), 7 (2.5%) and 43 hips (15.5%) consecutively. Out of 55 infants affected;3 referred to tertiary centers for further surgical management while 52 managed conservatively. Conclusion: Delayed treatment rates of DDH and complications could be reduced by the usage of the USG after the first month of life. In addition to physical assessment, USG for high-risk infants will provide more accurate diagnosis and minimize complications.

Innate Immunity in the Development of Connective Tissue Dysplasia: Pilot Study in Children with Congenital Hip Dislocation

Introduction: Observing and treatment of hip dysplasia in children have always been in the sphere of interest of modern molecular medicine. The role of molecular factors in the formation of connective tissue dysplasia in children is considered crucial for such multisystem disorders, and connective tissue dysplasia progressing involves immune system parameters and biochemical markers. The aim of this work was to establish the relationship between immune status indicators and biochemical markers of connective tissue using bioinformatics and modeling methods. Materials and Methods: 27 patients with congenital hip dislocation, admitted to the University Clinic of Privolzhsky Research Medical University, Department of children orthopedics for surgical treatment, were examined. Determination of 10 blood parameters was conducted by modern biochemical and immunological methods. Statistica 12.0 software from StatSoft was used for statistical data processing. Methods of nonparametric statistics were used since the samples in the control group partially follow the normal distribution. Correlation methods and regression modeling methods were used to evaluate the relationship of indicators. Results and Conclusion: In our investigation we have shown the presence of statistical and mathematical interactions between the parameters of innate immunity and indicators of connective tissue metabolism. The leading role of the immune system in the development of pathologies associated with connective tissue dysplasia is assumed. In further investigations it is necessary to clarify the role hypoxia in HIF-1 stimulated control of skeletal dysplasia, collagen modification, connective tissue dysplasia development.