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INTRODUCTION: Brace treatment is common to address radiological dysplasia in infants with developmental dysplasia of the hip (DDH); however, it is unclear whether bracing provides significant benefit above careful observation by ultrasound. If observation alone is non-inferior to bracing for radiological dysplasia, unnecessary treatment may be avoided. Therefore, the purpose of this study is to determine whether observation is non-inferior to bracing for infants with radiological dysplasia. METHODS AND ANALYSIS: This will be a multicentre, global, randomised, non-inferiority trial performed under the auspices of a global prospective registry for infants and children diagnosed with DDH. Patients will be included if they present with radiological dysplasia (centred hip, alpha angle 43-60°, percent femoral head coverage greater than 35% measured on ultrasound) of a clinically stable hip under 3 months old. Patients will be excluded if they present with clinical hip instability, have received prior treatment or have known/suspected neuromuscular, collagen, chromosomal or lower-extremity congenital abnormalities or syndromic-associated hip abnormalities. Patients will be enrolled and randomised to undergo observation alone or brace treatment with a Pavlik harness for a minimum of 6 weeks. Follow-up visits will occur at 6 weeks, 1 year and 2 years post-enrolment. The primary outcome will be the norm-referenced acetabular index measured on the 2-year radiograph with a 3° non-inferiority margin. A total of 514 patients will be included.The study is anticipated to start in April 2024 and end in September 2028.The primary outcome will be compared between arms with a mixed-effects model with a random intercept for study centre, and a single covariate for the treatment group. If the lower bound of the 95% CI lies within 3° of the mean, we will treat this as evidence for non-inferiority. ETHICS AND DISSEMINATION: Ethics approval has been obtained from the lead sites ethics board (University of British Columbia, Childrens and Womens Research Ethics Board). Ethics approval will be obtained from the local ethics committees or institutional review boards at each institution prior to patient enrolment. It is intended that the results of this study shall be published in peer-reviewed journals and presented at suitable conferences. TRIAL REGISTRATION NUMBER: NCT05869851.

Background: Developmental dislocation of the hip joint (DDH) is a condition that severely threatens children's healthy growth. Without timely and correct treatment, it will lead to osteoarthritis and hip dysfunction in the evolution of children. Objective: It is essential to develop an intelligent model for diagnosing hip dislocation and performing accurate quantitative analysis. Methods: In this paper, 46 cases of computed tomography (CT) images were retrospectively collected, including 19 cases of hip dislocation and 27 cases of healthy people. The experiment first uses ITK-SNAP to sketch the ilium and femoral head in the original image. Then, it uses 3D U-Net to send the label of the background, ilium, and femoral head into three channels, respectively, to realize the three-dimensional segmentation of the ilium and femoral head. Next, the extraction of the surface of the acetabulum and femoral head is performed. Subsequently, the erroneous points are eliminated, and the spherical surfaces of the acetabulum and femoral head are fitted using the least squares method. Ultimately, the spherical center distance is calculated quantitatively to predict whether the hip joint is dislocated. Results: Under the independent test set, the segmentation average dice coefficients of the ilium and femoral head are 89% and 93%, respectively. The spherical center distance between the acetabulum and femoral head is calculated quantitatively. If the value exceeds 10 mm, it is considered a hip dislocation. Compared with the doctor's diagnosis, the accuracy result is 94.4%. Conclusion: This paper successfully implements a precise and automated intelligent diagnostic system for the identification of hip dislocation. Commencing with the development of a 3D segmentation algorithm for the ilium and femoral head, we further introduce a novel method that computes the spherical distance for the prediction of hip dislocation. This approach provides robust quantitative analysis, thereby facilitating more informed clinical decision-making. [ABSTRACT FROM AUTHOR]

BACKGROUND: Developmental dislocation of the hip (DDH) is a common congenital deformity of the skeletal system in children. OBJECTIVE: To investigate the efficacy of post-surgery cluster nursing in children with DDH. METHODS: A total of 60 children with DDH who underwent hip joint orthopedic surgery in our hospital from September 2021 to September 2022 were enrolled as the research participants in this prospective study, and divided into the control group and the observation group according to the numerical table method, with 30 patients in each group. The control group was given routine pain care, and the observation group was given cluster pain care. The hip joint function scores, pain scores, self-rating anxiety score (SAS) were compared between the two groups and between before intervention and after intervention in the two groups. RESULTS: The pain score of the children and the SAS of the primary caregivers after the intervention in the observation group were lower than those in the control group (P < 0.05), and the hip joint function score and family satisfaction degree were higher than those in the control group (P < 0.05). CONCLUSION: Family-based cluster pain care can reduce pain in children with DDH after surgery, promote hip joint functional recovery, reduce the negative emotions of caregivers, and improve family satisfaction, and has clinical popularization value. [ABSTRACT FROM AUTHOR]

Introduction: Posterior native hip dislocations (NHD) are high-energy injuries. Thompson-Epstein Type I dislocations describe those without significant associated femoral or acetabular fracture. The aim of this study was to compare the clinical and radiological outcomes of patients with Type I NHDs. We also evaluate the association between radiological indicators of femoroacetabular impingement (FAI) and NHD. Patients and methods: A retrospective study from January 2012 to May 2021 compared skeletally mature patients (⩾16 years) with Type I posterior NHD to age and gender-matched controls with Type II–V posterior NHD. Patient demographics, mechanism of injury, complications and patient-reported outcome measures (PROMs) are presented. Post reduction radiographs and computed tomography were used to assess for FAI. Univariate analyses were performed to evaluate radiological outcomes. Results: 13 patients (77% male) with Type I posterior NHD were compared to a control group of 40 patients (80% male) with Type II–V posterior NHD. 11 patients in the study group and 14 in the control group experienced isolated injuries (p = 0.01). Post-reduction complications were similar. The study group had significantly lower post-injury osteoarthritis incidence (n = 0) compared to controls (n = 18, p = 0.0083). Patients reported a mean Oxford Hip Score of 43.5 ± 2.2 and EQ-5D-VAS score of 87.1 ± 7.4, with 6 patients indicating minimal symptoms across all EQ-5D-5L domains. Radiological femoroacetabular impingement (FAI) was prevalent in both groups, especially among males. Conclusions: Patients who underwent emergent closed reduction of Type I NHD demonstrated good short to medium term outcomes. Our radiological findings suggest a high prevalence of FAI. Future work should aim to quantify longer term outcomes following this injury. We call for further comparative studies of patients who suffer NHD with and without fractures to aid our understanding of risk factors. Given the rarity of this injury, multicentre efforts will be required to capture large numbers of patients. [ABSTRACT FROM AUTHOR]

Background: Laterality and bilaterality have been reported as prognostic variables in developmental dysplasia of the hip (DDH) outcomes. However, there is little clarity across the literature on the reporting of laterality in developmental dysplasia of the hip (DDH) due to the variability in severity of the condition. It is widely accepted that the left hip is most frequently affected; however, the true incidence of unilateral left, unilateral right and bilateral cases can be hard to quantify and compare across studies. The purpose of this study was to examine laterality accounting for graded severity in a multi-centre, international prospective observational study of infants with hip dysplasia to demonstrate the complexity of this issue. Methods: A multi-centre, prospective hip dysplasia database was analyzed from 2010 to April 2015. Baseline diagnosis was used to classify patients into a graded laterality category accounting for hip status within the DDH spectrum. Results: A total of 496 patients were included in the analysis; 328 were <6 months old at diagnosis and 168 were between 6 and 18 months old. Of these patients, 421 had at least one frankly dislocated hip. Unilateral left hip dislocations were most common, with 223 patients, followed by unilateral right and bilateral dislocations with 106 and 92 respectively. Stratifying these patients based on status of the contralateral hip, 54 unilateral left and 31 unilateral right dislocated patients also had a dysplastic or unstable contralateral hip. There were significantly fewer bilateral patients in the 6 to 18-month group (p = 0.0005). When classifying laterality by affected hip, bilaterality became the predominant finding, comprising 42% of all patients. Conclusions: Findings from this multi-centre prospective study demonstrate the necessity to account for the graded severity in hip status when reporting DDH laterality. To accurately compare laterality across studies, a standardized, comprehensive classification should be established, as contralateral hip status may impact prognosis and treatment outcomes. Level of Evidence: Level II Prognostic Study. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to assess the incidence of hip displacement and dislocation (denominated as hip migration) among ambulant and non-ambulant Danish children with cerebral palsy (CP) by estimating their cumulative incidence of migrated hips. A secondary objective is to compare the prevalence across different Danish regions. Methods: Data were obtained from the Danish Cerebral Palsy Follow-Up Program (CPOP) from the years 2008 to 2021. This population-based cohort study included 1388 children with CP (58% male; 42% female) as subjects; aged 0–15 years; with an average age of 5.4 years at their last follow-up. The children were categorized according to their Gross Motor Function Classification System (GMFCS) level into ambulators (GMFCS I–III) and non-ambulators (GMFCS IV–V). The Kaplan–Meier estimator was employed to calculate the cumulative incidence of migrated hips from birth until the date of their last radiographic follow-up. Differences between ambulatory and non-ambulatory children and regional differences were assessed with the Log-rank test. Results: Median radiological follow-up for ambulators was 51 months and 94 months for non-ambulators. The cumulative incidence of hip dislocation was 0.3% (95% CI: 0–0.8%) and 22.0% (95% CI: 9.2–34.8%) for ambulators and non-ambulators, respectively (p < 0.0001), whereas the incidence of hip displacement was 21.1% (95% CI: 16.3–25.9%) and 76.7% (95% CI: 68.6–84.7%) for ambulators and non-ambulators, respectively (p < 0.0001). There were no significant regional differences in the incidence of hip dislocation among ambulators, but there were significant differences for non-ambulators. Moreover, significant regional differences were detected in hip displacement for both ambulators and non-ambulators. Conclusions: The prevalence of hip migration in Danish children with CP is significantly higher among non-ambulators, who are at an increased risk of hip migration compared to their ambulant counterparts. However, the low frequency of radiographic follow-up for ambulators might cause the incidence of hip migration to be underestimated. This study highlights the necessity of continued targeted surveillance and interventions in Danish non-ambulators. [ABSTRACT FROM AUTHOR]

Objective: In developmental dysplasia of the hip (DDH), concentric reduction of dislocated hips cannot be achieved by closed reduction in many cases, and open reduction is required (‘failure of reduction’). The incidence of cases requiring open reduction and the significance of risk factors for unsuccessful reduction remain unclear. We investigated the overall rate and the risk factors for failed closed reduction in DDH. Methods: We followed the Cochrane recommendations in our systematic review and meta-analysis. We performed a systematic search in three medical databases to identify all studies reporting on pediatric patients with hip dislocation in DDH on 2 July 2022. Eligible studies reported on the rate of failure in children younger than 36 months. We calculated odds ratios (ORs) with 95% CIs from two-by-two tables (event rate in risk group, event rate in non-risk group). Results: We identified 13 316 studies and included 62 studies (5281 hips) for failure rate and 34 studies (3810 hips) for risk factor analysis. The overall rate of failure in closed reduction was 20%. The risk of failure of reduction increased with the grade of dislocation and was significantly higher for high dislocations (group 0–24: IHDI 4 vs IHDI 2 OR: 17.45, CI: 9.26–32.92; Tönnis 4 vs Tönnis 2 OR: 14.67, CI: 1.21–177.37; Graf IV vs Graf III OR: 3.4, CI: 2.27–5.09). Male gender was also a significant risk factor (OR: 2.27, CI: 1.13–4.56) in group 0–36. Conclusion: Higher grade dislocations and male gender are significant risk factors for failure of reduction in closed reduction in hip dislocation in DDH.

Segmental femoral fracture with hip dislocation is rare condition that occurs in dogs due to high energy trauma. A 11-month-old, Labrador dog was presented with non-weight bearing lameness on right hindlimb with swelling of thigh region. Radiological examination revealed segmental femur fracture along with cranio-dorsal dislocation of the right femoral head from the acetabulum. The segmental femur fracture was repaired using static intramedullary interlocking nailing and the dislocated femoral head was corrected by closed reduction under C-arm image intensifier. The dog started complete weight bearing by 12th postoperative day without any lameness. Radiological examination revealed union of fractured fragments by 90th postoperative day. The clinical outcome was excellent with normal limb function and without any implant related complications. The static intramedullary interlocking nailing used to repair segmental femur fracture led to complete anatomical reconstruction and fracture healing. Closed reduction of femoral dislocation under C-arm guidance resulted in good clinical outcome. [ABSTRACT FROM AUTHOR]

Background/Objectives: To determine whether a sitting position with the femoral heads centered into the acetabulum is more effective than the usual sitting position in preventing migration percentage progression in non-ambulatory children with bilateral cerebral palsy. Methods: This was a multicenter, randomized controlled trial. Inclusion criteria: spastic or dyskinetic cerebral palsy, Gross Motor Function Classification System level IV-V, age 1–6 years, migration percentage <41%, and informed consent. Exclusion criteria: contractures affecting the hip, anterior luxation, previous hip surgery, and lumbar scoliosis. The treatment group sat with their hips significantly abducted to reduce the head into the acetabulum in a customized system for at least five hours/day for two years. Controls sat with the pelvis and lower limbs aligned but the hips less abducted in an adaptive seating system. The primary outcome was migration percentage (MP) progression. Health-related quality of life and family satisfaction were among the secondary outcomes. The study was approved by the local ethics board and conducted in accordance with CONSORT reporting guidelines. ClinicalTrials.gov ID: NCT04603625. Results: Overall median MP progression was 1.6 after the first year and 2.5 after the second year. No significant differences were observed between the groups. MP exceeded 40% and 50% in 1.8% and 0% of the experimental group and 5.4% and 3.6% of controls in years 1 and 2, respectively. Both groups expressed satisfaction with the postural system and stable health-related quality of life. Conclusions: MP remained stable over the two-year period in both groups. Considering outliers which progressed over 50%, a more protective trend of the hip-centering sitting approach emerged, but this needs to be confirmed in a final, larger dataset. [ABSTRACT FROM AUTHOR]

Background: Hip dislocations, constituting 2-5 percent of all joint dislocations, predominantly present as posterior dislocations. Bilateral hip dislocations are rare, accounting for 1.25% of cases. Associated fractures often involve the proximal femur and acetabulum. Case Report: A 60-year-old man with no prior hip trauma history sustained bilateral hip dislocations after a 6-meter fall. Initial assessments and a hip computed tomography (CT) scan confirmed posterior dislocation of the right hip and anterior dislocation of the left hip. The patient underwent a successful closed pelvic reduction operation four hours post-injury, as confirmed by a post-reduction CT scan. Conclusion: The study, encompassing 11 relevant studies and 208 patients, predominantly men (81%), revealed that asymmetrical bilateral hip dislocations were exceptionally rare (0.01-0.02 percent). Contrary to expectations, this study challenges the presumed stronger association of traffic accidents with bilateral dislocations, presenting a statistically significant association between the type of dislocation and trauma mechanism. Associated fractures, such as acetabulum fractures in unilateral cases and posterior edge fractures in bilateral cases, varied. Avascular necrosis (AVN), a common complication, was not observed in the current case, where reduction occurred within the critical 6-hour timeframe. This report contributes valuable insights into the characteristics and associations of asymmetric bilateral hip dislocations, emphasizing the importance of prompt intervention to mitigate complications. Further research is needed to validate these findings and explore underlying patterns in this rare clinical scenario. [ABSTRACT FROM AUTHOR]

Neurofibromatosis is an autosomal-dominant multi-system disease affecting the nervous, integumentary, ocular, and musculoskeletal systems. In the small number of reported cases, the cause was either atraumatic or an intra-articular neurofibroma. Only a couple of articles in medical literature have reported synovial and capsular hemangioma originating within the hip joint. In this article, we present a rare case of pathological hip dislocation in a neurofibromatosis patient secondary to capsular hemangioma that would be reported for the first time in medical literature. We present the case of a 20-year-old female, resident of Karachi, who presented to the outpatient clinic with pain in the left hip join and inability to bear weight on left leg for 1 week. Diagnosed as a case of posterior hip dislocation after physical examination and imaging, her dislocation was reduced by the Allis method. This maneuver, however, was unsuccessful. Ultimately, the joint was reduced with open reduction via Steinmann pin because post-reduction hip joint was unstable to be contained into the acetabulum; therefore, Steinmann pin was used. The biopsy specimen taken from joint capsule and femoral neck during the surgery revealed cavernous hemangioma within the capsule. Hence, the etiology of posterior hip dislocation was attributed to the presence of capsular hemangioma within the hip joint. The surgery proved successful. The patient had remarkable recovery. The Steinmann pin was removed at 6 weeks, full weight-bearing started at 3 months, and range of motion extended from 0 to 90 degrees at 1 year with imaging studies showing a normally placed hip joint. The presented case reports an unusual etiology of a rare pathology occurring in association with a common genetic disease. It focuses on the importance of thorough examination and extensive relevant investigations in patients presenting with rare pathologies. These practices not only expedite the diagnosis and treatment of such patients, but can also reveal unusual etiologies responsible for uncommon pathologies. This case would help widen the differential diagnosis and treatment strategies of the physicians while dealing with neurofibromatosis patients with pathological hip dislocation. Level of Evidence This is a case report having Level of Evidence 4 in accordance with the levels developed by the Centre of Evidence Based Medicine (CEBM) for treatment. [ABSTRACT FROM AUTHOR]

Introduction: Extended offset (EO) stems are commonly used in posterior approach (PA) total hip arthroplasty (THA), but usage rates and complications are not well studied with anterior approach (AA) THA. This study evaluated usage rates, radiographic outcomes and complications following AA THA between patients receiving EO stems and a matched cohort receiving standard offset (SO) stems. Materials and methods: This retrospective review evaluated 1515 consecutive AA THA performed between 2014 and 2021. The recent 100 EO were included in radiographic and complication analysis and were matched to 100 SO stems based on stem size, procedure (unilateral/bilateral), sex, body mass index (BMI), and age. Data collection included patient demographics; pre- and postoperative radiographic measurements of leg length difference (LLD) and global hip offset difference (GHOD); and complications within 1 year. Independent t-tests and Chi-squared analyses compared EO and SO groups. Results: EO was utilized in 8% of all AA THA. Despite matching procedures, the distribution of racial groups was different between EO and SO groups, respectively: Caucasian (75% vs. 43%), Asian (12% vs. 35%), Native Hawaiian/Pacific Islander (NHPI) (9% vs. 13%), and other (4% vs. 9%) (p < 0.001). No fractures, dislocations, or revisions occurred within 1 year after surgery in either group. One deep infection was noted in the SO group. The proportions of patients following surgery who had a GHOD < 6 mm (76% vs. 82%; p = 0.193) and LLD < 6 mm (81% vs. 86%; p = 0.223) were not significantly different between EO and SO groups, respectively. Conclusions: Prioritizing hip symmetry over stability results in a high proportion of patients achieving hip symmetry without high usage of EO stems in AA THA. Furthermore, low use of EO stems did not result in increased dislocations. Due to racial anatomical differences, Caucasian patients required EO stems to achieve hip symmetry more frequently than Asian and NHPI patients. [ABSTRACT FROM AUTHOR]

Case reportTraumatic hip dislocations require prompt diagnosis and reduction to preserve the native joint. The classic irreducible posterior hip fracture-dislocation has been described as an immobile, slightly flexed, and internally rotated hip on physical exam. Classically, this irreducible pattern is associated with an ipsilateral femoral head fracture. The purpose of our report is to present an irreducible posterior hip dislocation with preserved motion in the setting of an unstable pelvic ring injury without associated femoral head pathology. Despite lacking clinical features of an irreducible hip, closed reduction in the emergency and operating rooms was unsuccessful, even after frame application for pelvis stability. Persistent irreducibility necessitated open reduction, where the femoral head was found to be buttonholed through the posterior hip capsule and blocking reduction.ConclusionA posteriorly dislocated hip with preserved motion in the setting of a concomitant unstable pelvic ring injury may belie the true locked nature of the femoroacetabular dislocation and high suspicion for femoral head incarceration is required. The description of this unique irreducible fracture pattern and the stepwise approach used for reduction may be useful for other surgeons who may encounter similar patterns of injury.

Purpose: Radiofrequency echographic multi-spectrometry (REMS) is an ultrasound technology currently used for the densitometric evaluation of osteoporosis and has been validated against dual-energy X-ray absorptiometry. However, the use of REMS for bone densitometry in patients with severe motor and intellectual disabilities (SMID) remains to be reported. This study aimed to investigate whether REMS technology can be used for densitometric evaluation of osteoporosis in patients with SMID with hip dislocation and severe scoliosis. Methods: Sixty-five patients with SMID, who resided in a long-term care facility and received comprehensive medical and rehabilitation care, underwent REMS scans of the femoral neck and/or lumbar spine. Data regarding anthropometric parameters (height and weight), bone mineral density (BMD), clinical diagnostic classification, physical ability, presence of scoliosis and hip dislocation, and frontal radiographs of both hip joints were obtained. Results: We included 29 men and 34 women (mean age: 52.6 years). All patients underwent successful scanning at either the femoral neck (82.5 %) or lumbar spine (95.2 %). BMD measurements obtained using REMS revealed low values, with a mean BMD, T-score, and Z-score of 0.67 g/cm2, −2.39 standard deviation (SD), and − 1.38 SD, respectively, at the femoral neck and 0.66 g/cm2, −2.70 SD, and − 1.87 SD, respectively, at the lumbar spine. The average Cobb angle of the lumbar spine was 34.0°; furthermore, dislocation rates did not significantly differ between those with and without successful BMD measurements (p = 0.073). Lumbar BMD T-scores were significantly correlated with femoral neck BMD T-scores (p

Purpose: Dislocation following total hip arthroplasty (THA) remains a significant clinical problem and can occur even with optimal implant alignment. We hypothesized that different patterns of pelvic flexion/extension (PFE) during daily activities may influence acetabular alignment and contribute to impingement and instability following THA. Recently, there has been an increased interest in spinopelvic alignment and its impact on THA. Therefore, this study aimed to identify different patterns of PFE that could be predictive of instability following THA. Methods: A range of motion (ROM) simulator was used to demonstrate the effects of different patterns of PFE on ROM and impingement. The findings were applied to PFE measurements obtained from 84 patients in standing and sitting positions. Results: Three different categories of PFE were identified: normal, hypermobile, and stiff. ROM simulator revealed that changes in PFE had affected ROM and impingement significantly. Patients in the stiff pelvis category, even with "optimal" implant alignment, were more susceptible to implant impingement. Conclusions: The different patterns of PFE during daily activities could affect acetabular alignment and stability following THA. We propose a classification system that can identify different types of PFE and predict their effects on the stability of prostheses following THA. Hence, we believe that patients with unfavorable PFE may require modified cup alignment. [ABSTRACT FROM AUTHOR]

BACKGROUND: Most scholars now believe that children with cerebral palsy who have severe spinal deformities in early childhood (< 15 years of age) may have a higher risk of progression of spinal deformities, which may result from imbalances in movement due to pelvic tilt, pain, etc. OBJECTIVE: To investigate the relationship between lumbar spine development and hip joint development in children with spastic cerebral palsy. METHODS: A retrospective analysis was performed in 102 children with spastic cerebral palsy admitted at Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine from January 2014 to December 2021. All admitted children had X-rays of the pelvic position and the lumbar lateral position. Anteroposterior X-ray of the pelvis was performed to measure femoral head migration percentage, central edge angle, neck-shaft angle, and acetabular index. The sagittal Cobb angle, sacral slope, arch-top distance, and lumbar lordosis index were measured by the lateral X-ray of the lumbar spine. Correlation of the two sets of indicators was further analyzed. All children were divided into normal group, risk group, hip subluxation group and total hip dislocation group according to their femoral head migration percentage, and the differences in lumbar spine indexes between groups were evaluated. RESULTS AND CONCLUSION: Pearson correlation analysis showed that the femoral head migration percentage was moderately positively correlated with sagittal Cobb angle and arch-top distance, and weakly positively correlated with lumbar lordosis index; the central edge angle was moderately negatively correlated with the arch-top distance and weakly negatively correlated with the sagittal Cobb angle; the neck-shaft angle was weakly positively correlated or not correlated with the sagittal Cobb angle and lumbar lordosis index; and the acetabular index was weakly positively correlated with the sagittal Cobb angle and arch-top distance. No statistically significant correlation was found between the remaining indicators. According to the femoral head migration percentage, the children were divided into four groups, including 25 cases in the normal group, 41 cases in the risk group, 27 cases in the hip subluxation group, and 9 cases in the total hip dislocation group. The sagittal Cobb angle was significantly increased in the risk group, the hip subluxation group and the total hip dislocation group compared with the normal group, showing an increasing trend group by group, and there were significant differences between groups (P < 0.05). Compared with the normal group, the lumbar lordosis index in the risk group and the hip subluxation group increased significantly, and there were significant differences between groups (P < 0.05). There was an increase trend in the lumbar lordosis index of the total hip dislocation group compared with the normal group. Compared with the normal group, the arch-top distance in the hip subluxation group and the total hip dislocation group increased significantly (P < 0.05), and there was a stepwise increasing trend. There was no significant difference in sacral slope between groups. To conclude, the development of the lumbar spine in children with cerebral palsy is closely related to the development of the pelvic hip joint, and the most obvious relationship is between lumbar lordosis and hip dislocation. [ABSTRACT FROM AUTHOR]

Developmental hip dysplasia is an abnormality of the hip joint which is associated with an unstable or dislocatable hip. During infancy, hips should be screened to determine whether they are stable, unstable or dislocated. In Australia, this screening is often performed by nurses using physical assessment. Physical examination includes a number of assessments which seek to identify underlying abnormalities in hip joint anatomy and function. This scoping review outlines the physical assessments used by nurses in the screening and surveillance of developmental hip dysplasia. A review of the literature identified 15 (N = 15; 100%) sources of evidence, which included original research articles (n = 6; 40%), expert opinion pieces (n = 2; 13.3%) and practice guidelines (n = 7; 46.7%). There were 18 physical assessments identified as being used by nurses in the screening process for developmental hip dysplasia. However, it is apparent that high quality research is required to examine the timing, specificity and sensitivity of the physical assessments identified. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Anterior acetabular wall fractures that extend into the anterior inferior iliac spine are more likely to be unstable, and more likely to require surgical fixation. Conventional acetabular anterior wall fractures originate below the anterior inferior iliac spine (AIIS) level and involve the pelvic brim. Since surgical treatment is preserved for instability and hip incongruency, atypical variation of this fracture usually jeopardizes hip stability. We report on a 33‐year‐old case of an acetabular anterior wall fracture extending to the anterior inferior iliac spine. He was prepared for the stress test and hip stability checked, that was unstable in extension and external rotation. The joint was exposed with the Smith–Peterson approach. Hip congruency was restored, and the AIIS fragment was stabilized by open reduction. Acetabular anterior wall fracture involving AIIS with preservation of pelvic brim is a rare equivalent of anterior wall fracture that jeopardizes hip stability and should be managed surgically. Anterior approaches are preferred in order to visualize the joint. [ABSTRACT FROM AUTHOR]

We are reporting a case of asymmetrical bilateral dislocation of hip in a 60 years old man after falling from 6 meters height. 4 hours after injury the patient was transferred to OR and a closed reduction of hip was done for him which was successful. The time interval between injury and reduction is crucial for these patients. A literature review to compared sexual distribution, mechanism of dislocation, and associated fractures between patients with asymmetrical bilateral dislocation of hip (n=103) and unilateral dislocation of hip (n=105) revealed that female to male ratio is almost similar in both groups but most patients were male in our population (81%). Traffic accidents are the most common cause of dislocation. But the odds of this mechanism is about 2 times larger in unilateral patients (OR=0.46). Fractures were more common among patients with asymmetrical bilateral dislocation and the most common associated fractures included: Acetabulum (52.8%), posterior edge (21.3%), femur neck (18.5%), femur head (3.7%) and pelvis (3.7%).

Purpose: Clinical evidence of risk factors for union failure at osteotomy sites after total hip arthroplasty (THA) using subtrochanteric shortening osteotomy (SSO) in patients with high hip dislocations is limited because of the rarity of this dislocation type. The aim of this study was to identify the factors influencing bone union at osteotomy sites in patients with high hip dislocations undergoing this procedure. Methods: This retrospective, case-control study included a total of 28 hips of 24 patients with high hip dislocations who had undergone THA using SSO at a single institution from 1993 to 2018. Fourteen hips were categorized into the union-failure group at 6 months after surgery and compared with a control group including the other 14 hips. We compared various demographic, clinical, and radiological characteristics between the two groups, including age, sex, body mass index, cement usage of stem, stem bypass characteristics, clinical evaluations, and implant survival. Results: The union-failure group had inferior results for clinical evaluations and implant survival. Multivariable analysis found that the stem bypass ratio was significantly shorter in the union-failure group than in the control group (48 vs 64%; odds ratio, 1.18; 95% confidence interval, 1.02 to 1.38; p ​= ​.028). Conclusion: Our results demonstrated that shorter stem bypasses were related to union failure at osteotomy sites in patients with high hip dislocations who underwent THA using SSO. We recommend that the femoral stem be inserted more than 50% of the stem length below the osteotomy site, especially for cemented THA.

Purpose: This study aims to assess the incidence of hip displacement and dislocation (denominated as hip migration) among ambulant and non-ambulant Danish children with cerebral palsy (CP) by estimating their cumulative incidence of migrated hips. A secondary objective is to compare the prevalence across different Danish regions. Methods: Data were obtained from the Danish Cerebral Palsy Follow-Up Program (CPOP) from the years 2008 to 2021. This population-based cohort study included 1388 children with CP (58% male; 42% female) as subjects; aged 0–15 years; with an average age of 5.4 years at their last follow-up. The children were categorized according to their Gross Motor Function Classification System (GMFCS) level into ambulators (GMFCS I–III) and non-ambulators (GMFCS IV–V). The Kaplan–Meier estimator was employed to calculate the cumulative incidence of migrated hips from birth until the date of their last radiographic follow-up. Differences between ambulatory and non-ambulatory children and regional differences were assessed with the Log-rank test. Results: Median radiological follow-up for ambulators was 51 months and 94 months for non-ambulators. The cumulative incidence of hip dislocation was 0.3% (95% CI: 0–0.8%) and 22.0% (95% CI: 9.2–34.8%) for ambulators and non-ambulators, respectively (p < 0.0001), whereas the incidence of hip displacement was 21.1% (95% CI: 16.3–25.9%) and 76.7% (95% CI: 68.6–84.7%) for ambulators and non-ambulators, respectively (p < 0.0001). There were no significant regional differences in the incidence of hip dislocation among ambulators, but there were significant differences for non-ambulators. Moreover, significant regional differences were detected in hip displacement for both ambulators and non-ambulators. Conclusions: The prevalence of hip migration in Danish children with CP is significantly higher among non-ambulators, who are at an increased risk of hip migration compared to their ambulant counterparts. However, the low frequency of radiographic follow-up for ambulators might cause the incidence of hip migration to be underestimated. This study highlights the necessity of continued targeted surveillance and interventions in Danish non-ambulators.

Recently, it has been recognized that changes in sagittal alignment and spinopelvic mobility due to alterations of the lumbosacral spine can influence the dislocation of a hip replacement. The biggest difficulties for this problem are: a) the bibliography related to this topic has been written in English and there is confusion in its terminology; b) there is no consensus on what parameters should be used to identify, measure, and estimate the risks of dislocation occurring; c) the basic concepts that interrelate spinal disorders and prosthetic dislocation are not clearly understood; and d) spine and hip surgeons pursue different goals. The objective of this narrative review is to overcome the aforementioned difficulties by using a strategy to answer some questions: Is hip dislocation really a problem? What is the interrelationship between alterations in the pelvic spinal balance and the dislocation of a prosthesis? How is sagittal balance and lumbosacral mobility defined and how can their alterations be measured? What are their compensatory mechanisms to achieve a good functioning and how these mechanisms can be used to correctly orient the acetabulum? To document this review, we consulted the databases of PubMed, Scopus, SciELO and Google Scholar with the keywords: Spinopelvic, Total Hip Arthroplasty, Hip Dislocation, Spine-Pelvis-hip Arthroplasty. The articles that, in the author's opinion, were the most objective and/or relevant for the study of this topic were selected. [ABSTRACT FROM AUTHOR]

Soccer is one of the most popular sports with millions of active professional and non-professional players worldwide. Traumatic hip dislocations are rare in soccer but can lead to major sequelae both physically and psychologically. The aim of this review was to obtain insight into the outcomes after surgerically repaired hip fracture-dislocation in soccer players as well as rehabilitation and prevention. Two cases of a posterior hip fracture-dislocation that occurred during an amateur soccer match are presented and mechanism of injury, complications and rehabilitation were analysed. Follow-up of both patients was at least one year after surgery. Questionnaires and physical examinations were obtained to quantify and qualify outcome. In both cases the hip-dislocations were reduced within 3 h after injury. Semi-elective open reduction and internal fixation was performed within seven days. In one case, there was a concomitant Pipkin fracture and sciatic nerve neuropathy. There were no postoperative complications. Follow-up showed full of range of motion and normal hip functionality in both cases. However, both patients indicated a reduced quality of life and anxiety related to the accident. Traumatic hip fracture-dislocations during soccer practice are extremely rare. Despite uncomplicated fracture healing after surgery and return of hip function, both patients still suffer from psychological problems resulting in a decreased quality of life. Further research is required to enhance psychological outcomes, as well as to facilitate return to pre-injury levels of participation and engagement in sports following traumatic hip fracture-dislocations related to soccer. [ABSTRACT FROM AUTHOR]

Purpose: This systematic review and meta-analysis aimed to identify risk factors of dislocation after total hip arthroplasty (THA) in patients with developmental dysplasia of the hip (DDH). Methods: A systematic literature review was performed on 18th August 2022 using Medline, Embase, Scopus, Web of Science electronic databases, and a manual search. The study was conducted according to the PRISMA guidelines and registered with PROSPERO. Statistical analysis includes assessment of heterogeneity and data synthesis using RevMan 5.4. Results: Review of five studies including 2865 patients and 116 dislocated hips found that lower body mass index (BMI) (SMD = 0.22, p = 0.04, I2 = 0%), Crowe classification type IV versus I, II, and III (OR = 2.70, p = 0.004, I2 = 51%), higher cup inclination (SMD = 0.39 p = 0.0007, I2 = 0%), femoral head size < 28 mm (OR = 5.07, p = 0.003, I2 = 71%), lateral surgical approach (OR = 1.96, p = 0.02, I2 = 0%), and postoperative infection (OR = 6.26, p < 0.0001, I2 = 0%) were significant risk factors. However, age, gender, cup anteversion, femoral osteotomy, vertical (V-COR) centre of rotation, intraoperative fracture, preoperative and postoperative leg length discrepancy (LLD) and previous hip surgery were not found to be significant risk factors. Conclusion: This study underscores importance of these risk factors in THA planning for DDH patients to reduce dislocation risk. Further research needed to understand mechanisms. [ABSTRACT FROM AUTHOR]

Purpose: Bone quality of non-ambulatory patients with cerebral palsy (CP) is a matter of concern for proximal femoral varus derotational osteotomies (VDRO). Locking plates (LCP) have been designed to compensate this biological downfall. Little data exist comparing the LCP with the conventional femoral blade plate. Methods: We retrospectively studied 32 patients submitted to VDRO (40 hips), operated with blade plates or LCP. Groups were matched, and the minimal follow-up was 36 months. Clinical (age at surgery, sex, GMFCS class, CP patterns) and radiological characteristics (neck shaft angle [NSA], acetabular index [AI], Reimers migration index [MP] and time until bone healing), as well as postoperative complications and the cost of treatment, were evaluated. Results: Preoperative clinical characteristics and radiographic measurements were comparable, except for a higher AI in the BP group (p < 0.01). Mean follow-up was longer in the LCP group (57.35 vs 34.6 months). Mean NSA, AI and MP had comparable correction with surgery (p < 0.01). At final follow-up, dislocation recurrence speed was higher in BP group although not statistically significant (0.56% vs 0.35%/month; p = 0.29). The complication rate was similar in both groups (p > 0.05). Finally, the cost of the treatment was 62% higher in the LCP group (p = 0.01). Conclusion: Our cohorts showed LCP or BP equivalence clinically and radiographically in mid-term follow-up, with the former increasing the cost of treatment by a mean of 62%. This may raise a question on the real necessity of locked implants for these operations. Level of evidence: Level III—Retrospective comparative study. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study was to analyze the results from a cohort of patients who underwent a revision total hip arthroplasty (THA) using a dual mobility cup (DMC) implant. Materials and Methods: A retrospective review of revised THAs was conducted using the database from a single tertiary referral hospital. A total of 91 revision THAs from 91 patients were included in the study. There were 46 male hips and 45 female hips. The mean age was 56.3±14.6 years, and the mean follow-up period was 6.4± 5.9 years. In performance of revision THAs, the DMC implants were used in 18 hips (19.8%), and the conventional implants were used in 73 hips (80.2%). Results: During the follow-up period, three dislocations were identified, and the overall dislocation rate was 3.3%. Early dislocation (at one month postoperatively) occurred in one patient, while late dislocation (at a mean of 7.5 years) occurred in two patients. There was no occurrence of dislocation in the DMC group (0%), and three dislocations were detected in the conventional group (4.1%). However, no significant difference in the rate of dislocation was observed between the two groups (P=0.891). Conclusion: Although the rate of dislocation was higher in the conventional group, there were no statistically significant differences between the two groups due to the small number of patients. Nevertheless, we believe that the dual mobility design is advantageous in terms of reducing dislocation rate and can be recommended as an option for a revision THA. [ABSTRACT FROM AUTHOR]

Surgical treatment is indicated for hip dislocation in patients with cerebral palsy (CP), but it requires care due to the state of nutrition and associated clinical comorbidities. The use of resources that minimize blood loss and the need for blood transfusions are essential to avoid complications. Tranexamic acid (TXA) has been highlighted for orthopedic surgeries to control intraoperative bleeding; however, there is a lack of large studies for its use in hip surgeries in patients with CP. This study aims to evaluate the efficacy and safety of tranexamic acid to reduce bleeding in pediatric patients with cerebral palsy undergoing surgical treatment for hip instability. A sample of 31 patients with CP who underwent surgical treatment for hip dislocation (hip adductor stretching, varization osteotomy of the proximal femur and acetabuloplasty using the Dega technique) was randomly divided into groups: control (n = 10) and TXA (n = 21). Preoperative and 24 h hemoglobin concentrations, the length of hospital stay (LHS), and intraoperative bleeding (IB) were analyzed. TXA significantly reduced the IB (p = 0.02). The variance in hemoglobin concentration was lower for the TXA group, but without statistical significance (p = 0.06). There was no difference in LHS. Also, no statistical difference was observed for the number of transfusions (p = 0.08). The findings provide evidence of the effectiveness of TXA in decreasing intraoperative bleeding and its safety for use in pediatric patients with cerebral palsy. [ABSTRACT FROM AUTHOR]

Introduction: Reported cases of inferior dislocation in the literature are found under several names (inferior, anteroinferior, obturator, or erecta), which may be source of confusion. The purpose of this comprehensive review of the literature is to collect as many cases of inferior dislocation as possible to determine better therapeutic strategies, outcome after reduction, complications, and prognostic factors. Methods: In April 2020, a literature search was performed in Pubmed, Medline, Scopus, Cochrane, and Embase databases. The MeSH keywords were "OBTURATOR DISLOCATION HIP" or "ANTERIOR DISLOCATION HIP" or "INFERIOR DISLOCATION HIP." Authors independently selected articles that met the selection criteria, with no time limit. Results: Out of the 97 articles selected, there were 119 cases of primary inferior hip dislocations. This review of the literature has allowed us to differentiate 3 radiographic subtypes of inferior dislocations, which correspond to 3 different anatomical positions of the femoral head: "obturator" dislocation, "proximal anterior-inferior" dislocation, and "distal anterior-inferior" dislocation. Our subtype classification yielded 39 obturator subtype inferior dislocations (32.8%), 66 proximal anteroinferior subtypes (55.4%), and 14 distal anteroinferior (11.8%). The obturator subtype is at risk of reduction failure and femoral neck fracture during the reduction manoeuver. Conclusions: Our study identified 3 subtypes with different prognosis, with obturator and distal anteroinferior dislocations having a poorer prognosis because of their pre- and post-reduction complications. We were unable to determine the correct manoeuver to reduce inferior dislocations without taking the risk of femoral neck fracture, but each of these subtypes may require a different manoeuver. [ABSTRACT FROM AUTHOR]

Following closed reduction of hip dislocations, computed tomography (CT) is considered standard of care to identify occult fractures or intra-articular loose bodies that may be missed on X-ray. The purpose of this study was to evaluate the sensitivity of post-reduction X-rays and the usefulness of subsequent post-reduction CT imaging. All patients presenting to our hospital system for traumatic hip dislocations from 2013 to 2022 were retrospectively reviewed. Participants were included if they had a simple dislocation of a native hip, underwent closed reduction, and received post-reduction X-ray and CT imaging. A sensitivity analysis was performed for the detection of associated fractures and intraarticular loose bodies by post-reduction X-ray, using CT as a reference standard. Thirty-five subjects with a mean age of 26 years were included. Post-reduction CT revealed 6 fractures and 3 loose bodies, whereas post-reduction X-ray identified 3/6 (50%) fractures and 3/3 (100%) loose bodies. Four cases received operative management, all of which were identified by X-ray. Post-reduction X-ray had a sensitivity of 67% for identifying pathology that was subsequently found on CT, and a sensitivity of 100% for identifying pathology requiring surgery. Of the 13 cases with pre-reduction CT scans, none had new findings identified on post-reduction CT. Post-reduction X-rays are effective in the evaluation of acute pathology associated with closed reduction of traumatic hip dislocations, especially for cases requiring operative management. Our findings suggest that if a fracture or loose body was not identified on post-reduction X-ray, a post-reduction CT added no value in surgical decision-making and was not necessary. [ABSTRACT FROM AUTHOR]

Background: In developing countries, patients usually present to the hospital several days after trauma, and many receive alternate therapies before. Management of unreduced dislocation of the hip becomes more challenging as time progresses. Traumatic hip dislocation with trans-epiphyseal fracture of the head of the femur (Delbet TYPE Ib) is a rare association with a high complication rate. Delayed presentation, failure of closed reduction, or instability of the hip joint are indications to perform open reduction and internal fixation. Case report: We report a 14-year-old boy who presented nearly a week after sustaining a trans-epiphyseal separation of the left femoral head with a dislocation and posterior acetabular wall fracture. He was treated with open reduction and internal fixation of the femoral head and the posterior acetabular wall. At a two-year follow-up, the boy had a satisfactory outcome and no signs of avascular necrosis. Conclusion: A detailed literature search showed that similar injury has been reported only five times in the past and good outcomes can be expected if careful early surgical intervention is planned irrespective of the duration since injury and the number of closed reductions attempted.

Key Clinical Message Anterior acetabular wall fractures that extend into the anterior inferior iliac spine are more likely to be unstable, and more likely to require surgical fixation. Abstract Conventional acetabular anterior wall fractures originate below the anterior inferior iliac spine (AIIS) level and involve the pelvic brim. Since surgical treatment is preserved for instability and hip incongruency, atypical variation of this fracture usually jeopardizes hip stability. We report on a 33‐year‐old case of an acetabular anterior wall fracture extending to the anterior inferior iliac spine. He was prepared for the stress test and hip stability checked, that was unstable in extension and external rotation. The joint was exposed with the Smith–Peterson approach. Hip congruency was restored, and the AIIS fragment was stabilized by open reduction. Acetabular anterior wall fracture involving AIIS with preservation of pelvic brim is a rare equivalent of anterior wall fracture that jeopardizes hip stability and should be managed surgically. Anterior approaches are preferred in order to visualize the joint.

Congenital diaphragmatic hernia (CDH) is a severe congenital anomaly that is often accompanied by other anomalies. Although the role of genetics in the pathogenesis of CDH has been established, only a small number of disease-associated genes have been identified. To further investigate the genetics of CDH, we analyzed de novo coding variants in 827 proband-parent trios and confirmed an overall significant enrichment of damaging de novo variants, especially in constrained genes. We identified LONP1 (lon peptidase 1, mitochondrial) and ALYREF (Aly/REF export factor) as candidate CDH-associated genes on the basis of de novo variants at a false discovery rate below 0.05. We also performed ultra-rare variant association analyses in 748 affected individuals and 11,220 ancestry-matched population control individuals and identified LONP1 as a risk gene contributing to CDH through both de novo and ultra-rare inherited largely heterozygous variants clustered in the core of the domains and segregating with CDH in affected familial individuals. Approximately 3% of our CDH cohort who are heterozygous with ultra-rare predicted damaging variants in LONP1 have a range of clinical phenotypes, including other anomalies in some individuals and higher mortality and requirement for extracorporeal membrane oxygenation. Mice with lung epithelium-specific deletion of Lonp1 die immediately after birth, most likely because of the observed severe reduction of lung growth, a known contributor to the high mortality in humans. Our findings of both de novo and inherited rare variants in the same gene may have implications in the design and analysis for other genetic studies of congenital anomalies.

Abstract Background Pipkin type III femoral head fractures are relatively rare injuries. Few studies have explored and described the treatment and outcomes of Pipkin type III femoral head fractures. The purpose of this study was to evaluate the efficacy of open reduction and internal fixation (ORIF) in treating Pipkin type III femoral head fractures. Methods We retrospectively reviewed 12 patients with Pipkin type III femoral head fractures who underwent ORIF from July 2010 and January 2018. The complications and reoperations were recorded. The visual analog scale (VAS) pain score, Harris hip score (HHS), Thompson–Epstein criteria, and SF-12 score [including the physical component summary (PCS) and the mental component summary (MCS)] were used for functional assessment. Results Among the 12 patients, ten were males and two were females, with a mean age of 34.2 ± 11.9 years. The median follow-up time was 6 years (range 4–8 years). Five patients (42%) developed osteonecrosis of the femoral head, and one patient (8%) developed nonunion. These six patients (50%) underwent total hip arthroplasty (THA). One patient (8%) developed heterotopic ossification and underwent ectopic bone excision; this patient also presented with post-traumatic arthritis. The mean final VAS pain score and HHS were 4.1 ± 3.1 points and 62.8 ± 24.4 points, respectively. According to the Thompson–Epstein criteria, there was one patient (8%) with excellent, four patients (33%) with good, one patient (8%) with fair, and six patients (50%) with poor outcomes. The PCS score and MCS score were 41.7 ± 34.7 points and 63.2 ± 14.5 points, respectively. Conclusion Limited by the high incidence of osteonecrosis of the femoral head, it is difficult to achieve satisfactory functional outcomes when treating Pipkin type III femoral head fractures using ORIF, and a primary THA may be considered. However, for younger patients, considering the survivorship of prosthesis, ORIF may be recommended with the proviso that the patient is fully informed of the high complication rate associated with this procedure. Level of evidence: IV.

Aims: Reimers migration percentage (MP) is a key measure to inform decision-making around the management of hip displacement in cerebral palsy (CP). The aim of this study is to assess validity and inter- and intra-rater reliability of a novel method of measuring MP using a smart phone app (HipScreen (HS) app). Methods: A total of 20 pelvis radiographs (40 hips) were used to measure MP by using the HS app. Measurements were performed by five different members of the multidisciplinary team, with varying levels of expertise in MP measurement. The same measurements were repeated two weeks later. A senior orthopaedic surgeon measured the MP on picture archiving and communication system (PACS) as the gold standard and repeated the measurements using HS app. Pearson’s correlation coefficient (r) was used to compare PACS measurements and all HS app measurements and assess validity. Intraclass correlation coefficient (ICC) was used to assess intra- and inter-rater reliability. Results: All HS app measurements (from 5 raters at week 0 and week 2 and PACS rater) showed highly significant correlation with the PACS measurements (p < 0.001). Pearson’s correlation coefficient (r) was constantly over 0.9, suggesting high validity. Correlation of all HS app measures from different raters to each other was significant with r > 0.874 and p < 0.001, which also confirms high validity. Both inter- and intra-rater reliability were excellent with ICC > 0.9. In a 95% confidence interval for repeated measurements, the deviation of each specific measurement was less than 4% MP for single measurer and 5% for different measurers. Conclusion: The HS app provides a valid method to measure hip MP in CP, with excellent inter- and intra-rater reliability across different medical and allied health specialties. This can be used in hip surveillance programmes by interdisciplinary measurers. Cite this article: Bone Jt Open 2023;4(5):363–369.

Background: Dual-mobility (DM) total hip arthroplasty (THA) combines the stabilization advantage provided by large head articulation with the low friction advantage provided by small head articulation. There is momentum for DM to be used in a wider selection of patients, with some advocating for DM to be the routine primary total hip construct. Further investigation is needed to determine whether the use of DM in younger adults is validated by aggregate data. Our objective was to review the literature for the clinical performance of DM THA in patients aged 55 years and younger. Methods: A systematic review of the literature was performed according to the guidelines of Preferred Reporting in Systematic Reviews and Meta-Analyses. Inclusion in the review required clinical outcome reporting for DM primary THA in ambulatory patients aged 55 years or younger. The risk of bias was appraised using the Cochrane risk of bias in nonrandomized studies of interventions and the quality of the evidence was appraised using the Grading of Recommendations Assessment, Development and Evaluation framework. Results: Across a sample of 1048 cases, the frequency weighted term of follow-up was 87.7 months. The pooled rate of revision was 9.5%. The Harris Hip Score significantly improved from 49.1 preoperatively to 93 postoperatively. The Postel-Merle d'Aubigné score significantly improved from 10.5 preoperatively to 17.1 postoperatively. Conclusions: The literature demonstrates satisfactory short-term outcomes with a mitigated risk of dislocation for DM used as primary THA in patients aged 55 years and younger. The current findings suggest that third-generation designs provide reduced rates of intraprosthetic dislocation and improved survivorship.

Purpose: The aim of this study was to assess the difference in success rates of closed reduction in septic and aseptic revision total hip arthroplasty (THA) performed with a dual mobility (DM) implant. Our objective was to answer the following questions: (1) Is there a difference in success rates of closed reduction between septic and aseptic revision THA with a DM implant? (2) Is closed or open reduction more successful in preventing re-dislocation? Methods: Between January 2009 and October 2021, 924 revisions were performed with a DM implant. All patients presenting to our institution with a dislocation following septic or aseptic revision THA using a cemented DM cup were included in this study. We analyzed 106 cases of dislocation in 74 patients. For all patients, we collected reason for revision, and classified index surgery as septic or aseptic. Results: Overall, 106 dislocations occurred (106/924, 11.5%). Thirty-nine cases (52.7%) had a dislocation after a septic exchange THA, while in 35 patients (47.3%), a dislocation occurred after an aseptic rTHA. In 29 patients (39.2%), successful closed reduction under general anesthesia was feasible, while the majority of cases required open reduction. In 31 of these patients (67.4%), open reduction was combined with a revision arthroplasty. Conclusions: In case of DM cup dislocation, there is a low success rate of closed reduction. To prevent re-dislocation, total revision leads to a significantly reduced risk compared to open or closed reduction alone. Careful X-ray analysis for a halo sign showing intra-prosthetic DM cup dislocation is mandatory to avoid futile reduction attempts. Level of evidence: III. [ABSTRACT FROM AUTHOR]

Purpose: Pavlik harness treatment is the most common treatment in newborns diagnosed with developmental dysplasia of the hip (DDH). The success rates and predictors for failure have been debated over the last decade. In this study, we explored our treatment failure rate and potential prognostic factors that could predict the failure of Pavlik harness (PH) treatment in patients with DDH. Methods: Two hundred and sixty-five patients were treated with PH based on the Graf hip types of classification. Age, gender, first born status, family history, foot deformity, plagiocephaly, breech presentation, hip abduction, hip stability, Graf hip type, Galeazzi sign, bilateralism, and femoral nerve palsy were tested as predictors for failure in multivariate logistic regression mode. Success and failure were determined by the normalization of the hip based on the Graf hip classification. Results: The failure rate of patients treated with Pavlik harness was 16.6% which is within the reported range of failure rate. The mean age of patients who were successfully treated was 6.73 weeks in comparison to 8.84 weeks for those who failed. Age, plagiocephaly, hip instability, Graf classification, and the development of femoral nerve palsy were found to be predictors for failure of PH treatment upon univariate analysis only. However, only the presence of Galeazzi sign, hip instability, high grades of Graf hip classification, and the development of femoral nerve palsy proved to be independent predictors for failed PH treatment upon multivariate logistic regression analysis. Conclusions: Pavlik harness treatment is a successful treatment with an average success of 83.4%. Several independent predictors for failure of PH treatment have been identified. These include a positive Galeazzi sign, a frankly dislocated hip, Graf types III and IV, and the development of femoral nerve palsy. [ABSTRACT FROM AUTHOR]

Immobile patients with cerebral palsy can suffer with painful dislocated hips. Decision-making and surgical management can prove challenging in this cohort of patients, with hips that cannot be reconstructed. We conduced a retrospective chart review of all patients who underwent prosthetic femoral interposition arthroplasty (PFIA) by two surgeons from 2013 to 2021, for unreconstructable hips. We compared pain and range of motion in preoperative period to the postoperative period. Caregiver reported outcomes were used to assess satisfaction post operatively. During the follow up, radiographs of the PFIA were obtained to assess for proximal migration, heterotopic ossification and loosening of implants. Eleven index surgeries, which met the inclusion criteria, were included in this study. These were performed in eleven patients with an average follow up of 45 months. Regarding pain and range of motion post-operatively an excellent or good result was seen in nine cases. Two patients were classified as having a fair result with none having a poor result. Most caregivers reported being satisfied or very satisfied with the post-operative outcomes. A prescriptive operative solution to the painful dislocated hip in children with spastic cerebral palsy remains elusive. In this study, we have demonstrated both clinically and radiologically satisfactory results post proximal femoral interposition arthroplasty, for those patients with unreconstructable hips. Patient caregiver reported outcomes, show that the majority of caregivers were satisfied or very satisfied with the outcome of the surgery. • PFIA reduced hip pain and improved hip ROM, in GMFCS IV and V CP patients. • Hip migration was seen in two patients, this was not clinically significant. • No documented radiographic evidence of heterotopic ossification in follow-up period. [ABSTRACT FROM AUTHOR]

Introduction: Native hip dislocations are high energy injuries that cause substantial patient morbidity. Expedient reduction has been demonstrated to improve patient outcomes. The objective of our study was to compare complication rates in patients with native hip dislocations who presented directly to a level-one trauma center with those transferred from an outside hospital (OSH). Our hypothesis was that those transferred from an OSH would experience a delay in reduction and subsequently would experience higher rates of avascular necrosis (AVN), post-traumatic arthritis (PTA), and need for secondary surgery. Material and methods: We conducted a retrospective chart review of all native hip dislocations from our level-one trauma center between January 2007 and December 2020. The initial query resulted 628 patients which was refined to 90 patients after excluding patients for incorrect diagnosis code or less than 6 months of follow-up. Our primary outcome was the development of AVN, PTA, and need for secondary surgery. Time from injury to reduction was recorded for all patients included. Results: For every one hour of delay in time to reduction, there was a 3.4% increase in the risk of developing AVN (p = 0.004) and a 4.3% increase in risk for developing PTA (p = 0.01). The risk of requiring a secondary surgery increased 4.6% for each hour of delay in reduction (p = 0.03). The average time to reduction of transferred patients was higher compared to those who presented directly to our center (13.8 h vs 5.7 h); however, transfer status was not found to be an independent risk factor for the measured outcomes. Conclusions: Transfer status is not an independent risk factor for the development of AVN, PTA, or the need for a secondary surgery. However, transferred patients did experience an average delay of 8 h in time to reduction compared to those who presented directly to a trauma center. Of the 27 patients with a reduction delay greater than 12 h, 26 (96%) were transferred. [ABSTRACT FROM AUTHOR]

Objectives Infant hip dysplasia or Developmental Dysplasia of the Hip (DDH) occurs in 1–2% of births worldwide and leads to hip arthritis if untreated. We sought to evaluate the feasibility of implementing an artificial intelligence-enhanced portable ultrasound tool for infant hip dysplasia (DDH) screening in primary care, through determining its effectiveness in practice and evaluating patient and provider feedback. Methods A US-FDA-cleared artificial intelligence (AI) screening device for DDH (MEDO-Hip) was added to routine well-child visits from age 6 to 10 weeks. A total of 306 infants were screened during a 1-year pilot study within three family medicine clinics in Alberta, Canada. Patient and provider satisfaction were quantified using the System Usability Survey (SUS), while provider perceptions were further investigated through semi-structured interviews. Results Provider and user surveys commonly identified best features of the tool as immediate diagnosis, offering reassurance/knowledge and avoiding travel, and noted technical glitches most frequently as a barrier. A total of 369 scans of 306 infants were performed from Feb 1, 2021 until Mar 31, 2022. Eighty percent of hips scanned were normal on initial scans, 14% of scans required a follow-up study in the primary care clinic, and DDH cases were identified and treated at the expected 2% rate (6 infants). Conclusions It is feasible to implement a point-of-care ultrasound AI screening tool in primary care to screen for infants with DDH. Beyond improved screening and detection, this innovation was well accepted by patients and fee-for-service providers with a culture and history of innovation. [ABSTRACT FROM AUTHOR]

Objective To apply computer simulation technology to simulate the stress distribution of femur in children with developmental dislocation of the hip ( DDH) with different angles of femoral neck anteversion to find the significance of femoral neck anteversion correction in DDH children and guide the formulation of surgical plan. Methods A 6-year-old girl of right developmental hip dislocation was retrospectively analyzed in June 2021. The femoral scan data of left hip joint at normal side were extracted. A three-dimensional femoral model was reconstructed by 3D-CT scaIL The mechanical simulation models of femoral neck anteversion at 35°, 25° and 15° were designed respectively. The finite element software was utilized for simulation calculation to observe the biomechanical distribution of femur at different neck anteversion angles. Results At a femoral neck anteversion angle of 35°, 25° and 15°, maximal stress of femoral model was 21. 18 MPa,17. 36 MPa and 9. 847 MPa respectively. At a femoral neck anteversion angle of 35°, stress of femoral shaft was concentrated. At a femoral neck anteversion angle of 25 °, stress of distal femoral epiphysis declined by 25 %. At a femoral neck anteversion angle of 15°,femoral stress was concentrated in femoral head and neck to upper femoral shaft. At a femoral neck anteversion angle of 35 °, a displacement > 1 mm interval was from femoral head to middle of femoral shaft; at a femoral neck anteversion angle of 25 °, the range of displacement > 1 mm was from femoral head to middle/upper end of femoral shaft; at a femoral neck anteversion angle of 15°, the range of displacement > 1 mm was from femoral head to femoral neck. At a femoral neck anteversion angle of 35°,25° and 15°, the maximal displacement of distal femoral epiphysis was 0. 0041, 0. 0018 and 0. 0012 mm respectively. Conclusion - Femoral neck anteversion has an important impact on femoral mechanics in children with developmental hip dislocation. With the angles of femoral neck anteversion, stress distribution of femur changes. With a rising femoral neck angle, stress of femoral shaft gradually increases and stress concentration occurs at femoral shaft position. The greater anteversion angle of femoral neck, the greater shielding effect of stress transfer in femoral shaft area and the greater deformation of distal femoral epiphysis in cross section. With a femoral neck anteversion angle of 15°, femoral stress distribution is satisfactory. [ABSTRACT FROM AUTHOR]

Background: Hip dislocation is a common source of pain in children with neurologic impairment. When medical interventions fail, orthopedic surgery does not guarantee a definitive result as the displacement may continue postoperatively and a second operation is often required. Methods: Retrospective analysis of data regarding the safety and effectiveness of an intra-articular corticosteroid injection (IACI) in 11 patients, aged 15 ± 5 years old, collected through a telephonic questionnaire administered to parents. Results: 21 IACIs were performed, a mean number of 1.9 ± 1.5 times for each patient, at a mean age (of the first IACI) of 13.5 ± 5 years. According to the parents, the IACI significantly lowered the number of participants experiencing pain (82% reduction) and using analgesics (60% reduction). There was also a significant improvement in the children's hip mobility (63% reduction in patients experiencing stiffness), decubitus (90% reduction in obligated positioning), behavior (80% reduction in lamenting or crying patients), sleep quality (87.5% reduction in patients awakening every night), and caregivers' quality of life (91% reduction in worried parents). The mean reported duration of the IACIs' benefit was 5.4 ± 2.4 months (range 1–9), with a positive correlation with the number of IACIs (r = 0.48; p-value = 0.04) and a negative correlation with the age at the first injection (r = −0.71; p-value = 0.02). The only reported adverse event was mild local swelling in one child. Conclusions: the IACI could represent a safe and effective intervention for painful hip dislocation, both before and after surgery, with a long-lasting benefit which seems to increase as multiple IACIs are performed. [ABSTRACT FROM AUTHOR]

The present study aimed to investigate the clinical results of the modified Codivilla–Hey Groves–Colonna capsular arthroplasty in the treatment of young patients with developmental dislocation of the hip. We retrospectively evaluated 90 patients (92 hips) who underwent the modified capsular arthroplasty from June 2012 to June 2021. Hips were evaluated using the modified hip Harris score (mHHS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score and the 12-item International Hip Outcome Tool (iHOT-12). The Tönnis osteoarthritis grade and the Severin classification system were used to assess the radiographic outcomes. The average age was 15.7 years (range: 8–26 years). The mean pre-operative mHHS, the WOMAC score and the iHOT-12 score were 83.03, 14.05 and 52.79, respectively. The patients were followed for a mean of 41.1 months (range: 12.1–120.9 months). The patients had a mean mHHS of 83.61 (range: 31.2–97), a WOMAC score of 16.41 (range: 0–51) and an iHOT-12 score of 64.81 (range: 12.9–98.2) at the final follow-up. Capsular thickness had a positive predication on the final functional outcomes. The excellent/good rate of radiological reduction was 79.3%. More than 60% of patients had no/slight osteoarthritis. A total of 54 hips (58.7%) had superior radiographic outcomes. The risk factors for inferior radiographic outcomes were capsular quality (odds ratio [OR]: 0.358, 95% confidence interval [CI]: 0.113–0.931) and capsular thickness (OR: 0.265, 95% CI: 0.134–0.525). Joint stiffness was the most common complication (14.1%). We confirmed the efficacy of this procedure in the treatment of developmental hip dislocation. Patients with poor capsular quality are not suitable for this procedure. With suitable selection according to indications, this procedure can restore the hip rotation center with a low incidence of femoral head necrosis or severe osteoarthritis. [ABSTRACT FROM AUTHOR]

Abstract Background Dual mobility components can be implanted during total hip arthroplasty (THA) for primary osteoarthritis via a direct anterior approach (DAA), anterolateral approach (ALA), direct lateral approach (DLA), or posterior/posterolateral approach (PLA). This review compares dual mobility hip dislocation rates using these approaches for elective primary THA. Methods PubMed, Embase, and Cochrane databases were systematically searched for articles published after January 1, 2006 that reported dislocation rates for adult patients after primary THA with dual mobility implants. Articles were excluded if they reported revision procedures, nonelective THA for femoral neck fractures, acetabular defects requiring supplemental implants, prior surgery, or ≤ 5 patients. The primary outcome was hip dislocation rate. Secondary outcomes included infection, Harris Hip Score (HHS), and Postel-Merle d’Aubigné (PMA) score. Results After screening 542 articles, 63 met inclusion criteria. Due to study heterogeneity, we did not perform a meta-analysis. Eight studies reported DAA, 5 reported ALA, 6 reported the DLA, and 56 reported PLA. Study size ranged from 41 to 2,601 patients. Mean follow-up time ranged from 6 months to 25 years. Rates of infection and dislocation were low; 80% of ALA, 87.5% of DAA, 100% of DLA, and 82.1% of PLA studies reported zero postoperative dislocations. Studies reporting postoperative HHS and PMA scores showed considerable improvement for all approaches. Conclusions Patients undergoing primary THA with dual mobility implants rarely experience postoperative dislocation, regardless of surgical approach. Additional studies directly comparing DAA, ALA, DLA, and PLA are needed to confirm these findings.

Abstract Background Dislocation is a common complication after total hip arthroplasty (THA). This study aimed to compare the outcomes of mesh reconstruction versus conventional capsular repair in maintaining capsular integrity and preventing dislocation after THA. Methods This was a prospective, randomized controlled study of consecutive patients. A total of 124 high-dislocation-risk THAs were identified and randomized into two groups, one using mesh reconstruction and the other using the conventional capsular repair method. Perioperative data and radiological data were collected. Patients were followed up regularly. The main indices were the capsular integrity assessed by magnetic resonance imaging (MRI) and hip dislocation rate. The secondary indices included the Harris hip score (HHS), complications, and satisfaction. Results A total of 106 patients completed the follow-up and the average follow-up times were 19 ± 3.1 and 18 ± 3.3 months. The operation time of the mesh group was longer than that of the conventional group (P

BackgroundThe ligamentum teres (LT) is believed to have a number of functions, including a role in hip stability, nociception, proprioception, vascular supply to the femoral head, and synovial fluid circulation. The LT is often excised in the process of performing a medial open reduction (MOR) of the hip. We sought to conduct a retrospective review of hips undergoing a MOR for dislocated infantile developmental dysplasia of the hip (DDH) to compare clinical and radiographic outcomes for patients with and without LT reconstruction.MethodsWe performed a retrospective review of 38 hips treated with MOR with or without LT reconstruction with minimum two-year follow-up. Radiographic outcomes were determined using the Severin score. Information regarding avascular necrosis (AVN), concomitant surgical procedures, repeat dislocation, subsequent surgery, limp, pain, and range of motion symmetry was recorded.ResultsEighteen hips that underwent MOR with LT reconstruction were compared to 20 hips that underwent MOR without LT reconstruction. Mean follow up for this cohort was 70.1 months (median: 61.8; Range: 24.2 to 182.2 months). The group with LT reconstruction had an 11% rate of AVN, the group without LT reconstruction had a 15% rate of AVN (p=1.0) No hips in either group re-dislocated or had pain at final follow up. Two hips (5%) had a limp at most recent follow up, all were in the group that did not receive a LT reconstruction (p=0.488). Three hips (17%) in the LT reconstruction group and one hip (5%) in the other group had asymmetrical hip range of motion at final follow up (p=0.328).ConclusionThis study offers preliminary data to suggest that ligamentum teres reconstruction is a safe procedure that can minimize the risk for subluxation or re-dislocation that can occur within the post reduction hip spica cast. Although in this study, the patients who did not have LT reconstruction had a similar re-dislocation rate, we believe that ligamentum teres preservation is a useful adjunct to medial open reduction, especially in centers that may only treat occasional cases or have less experience in applying an excellent hip spica cast.Level of Evidence: III.

Background: The aims of this study were to (1) assess the degree of variation in acetabular component placement and combined anteversion in a large cohort of dislocating total hip arthroplasties; (2) assess the spinopelvic characteristics of the cohort; and (3) examine the association between cup anteversion and reported direction of instability. Methods: A commercial database of 245 dislocating total hip arthroplasties referred for postoperative computed tomography and functional radiographic imaging and analysis were reviewed. Spinopelvic parameters and cup and stem positions were measured in the supine, standing, flex-seated, and anterior pelvic plane (APP) positions. Spinopelvic characteristics were stratified by high, neutral, and low cup anteversion using thresholds of >35° and

Case: An obturator hip dislocation with an associated open book pelvic ring injury is an extremely rare injury pattern. This case report will discuss challenges to closed reduction, acute management strategies and review the literature on combined hip dislocations and open book pelvic ring injuries. Conclusion: This injury pattern presents unique reduction challenges that should be recognized early in order to provide effective resuscitation and preserve the femoral head blood supply. Failing to close reduce the hip delays reducing the pelvic ring volume because sheets and binders are precluded from working effectively.

Instrumented posterior lumbar spinal fusion (IPLSF) has been demonstrated to contribute to instability following total hip arthroplasty (THA). It is unclear whether a supine direct anterior (DA) approach reduces the risk of instability. A retrospective review of 1,773 patients who underwent THA through either a DA approach or a posterior approach at our institution over a 7-year period was performed. Radiographic and chart reviews were then used to identify our primary group of interest comprised of 111 patients with previous IPLSF. Radiographic review, chart review, and phone survey was performed. Dislocation rates in each approach group were then compared within this cohort of patients with IPLSF. Within the group of patients with IPLSF, 33.3% (n = 37) received a DA approach while 66.6% (n = 74) received a posterior approach. None of the 9 total dislocations in the DA group had IPLSF, whereas 4 of the 16 total dislocations in the posterior approach group had IPLSF (P =.78). When examining the larger group of patients, including those without IPLSF, patients undergoing a DA approach had a lower BMI and were likely have a smaller head size implanted (P <.001 for both). Using Fischer's exact test, fusion was associated with dislocation in the posterior approach group (P <.01), whereas fusion was not associated with dislocation in the anterior approach group (P = 1.0). While there was no significant difference in dislocation rates between posterior and anterior approach groups, in patients with IPLSF, the anterior approach had a lower percentage of dislocation events compared to the posterior approach. [ABSTRACT FROM AUTHOR]

Background: Pipkin type III femoral head fractures are relatively rare injuries. Few studies have explored and described the treatment and outcomes of Pipkin type III femoral head fractures. The purpose of this study was to evaluate the efficacy of open reduction and internal fixation (ORIF) in treating Pipkin type III femoral head fractures. Methods: We retrospectively reviewed 12 patients with Pipkin type III femoral head fractures who underwent ORIF from July 2010 and January 2018. The complications and reoperations were recorded. The visual analog scale (VAS) pain score, Harris hip score (HHS), Thompson–Epstein criteria, and SF-12 score [including the physical component summary (PCS) and the mental component summary (MCS)] were used for functional assessment. Results: Among the 12 patients, ten were males and two were females, with a mean age of 34.2 ± 11.9 years. The median follow-up time was 6 years (range 4–8 years). Five patients (42%) developed osteonecrosis of the femoral head, and one patient (8%) developed nonunion. These six patients (50%) underwent total hip arthroplasty (THA). One patient (8%) developed heterotopic ossification and underwent ectopic bone excision; this patient also presented with post-traumatic arthritis. The mean final VAS pain score and HHS were 4.1 ± 3.1 points and 62.8 ± 24.4 points, respectively. According to the Thompson–Epstein criteria, there was one patient (8%) with excellent, four patients (33%) with good, one patient (8%) with fair, and six patients (50%) with poor outcomes. The PCS score and MCS score were 41.7 ± 34.7 points and 63.2 ± 14.5 points, respectively. Conclusion: Limited by the high incidence of osteonecrosis of the femoral head, it is difficult to achieve satisfactory functional outcomes when treating Pipkin type III femoral head fractures using ORIF, and a primary THA may be considered. However, for younger patients, considering the survivorship of prosthesis, ORIF may be recommended with the proviso that the patient is fully informed of the high complication rate associated with this procedure. Level of evidence: IV. [ABSTRACT FROM AUTHOR]