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The article discusses prediction of use of modular stems in developmental dysplasia of hip through radiographs. Topics discussed include need of preoperative planning for revision hip arthroplasty, determining femoral anteversion using crosstable radiographs and computed tomography scans, and issues concerning corrosion, implant fracture and cost regarding use of modular stems.

Aim: Hip dysplasia is one of the most common skeletal disorders. As a late consequence 20-25% of the patients are at risk to develop secondary osteoarthritis and may require total hip replacement early in life. The treatment principles of hip dislocation are (1) concentric reposition, (2) retention, i.e., plaster in human post or Pavlik harness and (3) maturation in abduction flexion orthesis. The Tübingen splint was introduced as a further development of abduction devices for the treatment of (residual) hip dysplasia with stable hips. The advantages are easy handling, adjustment according to growth and safe limitation of abduction. The aim of this study was to determine the success of treatment of unstable hips with use of the Tübingen splint from early diagnosis until final end of therapy hence normal ultrasound findings.Methods: From January 2003 to August 2016 79 children with 109 sonographic unstable hips were treated with the Tübingen splint initially consequently 24 h/day. Inclusion criteria were diagnosis of type D, type III a/b or type IV hips according to Graf and beginning of treatment at an age of less or equal 6 weeks, without limitation of abduction on clinical examination.Results: At the time of diagnosis 51 type D (46.8%), 46 type III (42.2%) and 12 type IV (11.0%) hips were noticed. In 30 patients (38.0%) bilateral hip dysplasia (type D-IV) was diagnosed. 104 of 109 hips (95.4%) treated with the Tübingen splint could be transferred in a type I hip after a mean treatment period of 88.9 days (SD ± 26.0). In 5 cases (4.6%, 1 type III and 4 type IV hips) the treatment failed.Conclusion: Our data show, that successful treatment of unstable hips in neonates with the Tübingen splint is a comparably successful treatment modality relative to the Pavlik harness and Fettweis plaster. [ABSTRACT FROM AUTHOR]

Copyright of Advances in Rehabilitation is the property of Termedia Publishing House and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: This retrospective study was designed to determine complications, functional and radiographic results of transverse subtrochanteric osteotomy during cementless, modular total hip arthroplasty (THA) in a series of active patients younger than 45 years with Crowe Type-III or IV developmental dysplasia of the hip (DDH).Methods: We followed 49 patients (56 hips) with DDH who were treated with cementless THA, where the acetabular cup was positioned in the anatomic hip center and where a simultaneous transverse femoral osteotomy was performed. Complication rate evaluation and clinical outcomes were measured by validated clinical scores and radiographic evaluation were performed at a mean follow up of 10 years (range, 4.8-14.3 years).Results: The mean limb-length discrepancy was reduced from 4.2 cm to 1.1 cm (P < 0.01). The mean Harris hip score (HSS) significantly improved from 40.6 points to 87.4 points (P < 0.01). Similarly, severity of low back pain, modified MAP, HOOS, and SF-12 also showed significant improvement (P < 0.01). There were 3 cases of postoperative dislocation, 3 cases of transient nerve palsy, 2 cases of nonunion, and 4 cases of intraoperative fracture. At 10 years follow-up, the estimated survival rate with any component revision as end points was 92%.Conclusion: The cementless THA combined with transverse subtrochanteric osteotomy is a reliable technique with restoration of a more normal limb, satisfactory clinical outcomes, and mid-term survival of components. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to investigate the three-dimensional morphological features of the proximal femur of developmental dysplasia of the hip (DDH).Methods: From January 2012 to December 2014, 38 patients (47 hips) of DDH were admitted and 30 normal hips were selected as controls. All hips from both groups were examined by CT scan. CT data were imported into Mimics 17.0. Three-dimensional models of the proximal femur were then reconstructed, and the following parameters were measured: neck-shaft angle, neck length, offset, height of the centre of femoral head, level of isthmus, height of the tip of greater trochanter, the medullary canal diameter of isthmus(Di), the medullary canal diameter 10 mm above the apex of the lesser trochanter(DT + 10), the medullary canal diameter 20 mm below the apex of the lesser trochanter(DT-20), and then DT + 10/Di, DT-20/Di and DT + 10/DT-20 were calculated.Results: There was no significant difference in neck-shaft angle between Crowe I, Crowe II-III DDH and the control group, while the neck-shaft angle was much smaller in Crowe IV DDH. The neck length of Crowe IV DDH was also much smaller than those of Crowe I and Crowe II-III DDH. Height of the tip greater trochanter in Crowe IV was greater than that in Crowe I, Crowe II-III DDH and the control group. The centre of femoral head in Crowe IV DDH was lower than those in Crowe I, Crowe II-III DDH and the control group. The level of isthmus in Crowe IV was much higher than those in Crowe I, Crowe II-III DDH and the control group. DT + 10, DT-20, DT + 10/Di and DT-20/Di were much smaller in Crowe IV DDH than those in Crowe I, Crowe II-III and the control group.Conclusions: Neck-shaft angle in the DDH groups was not larger than that in the control group. Comparing to Crowe I, Crowe II-III DDH and the control group, Crowe IV DDH had a dramatic change in the intramedullary and extramedullary parameters, especially the dramatic narrowing of medullary canal around the level of the lesser trochanter. The on-shelf modular prosthesis may not be an ideal choice for the Chinese patients with Crowe IV hips. [ABSTRACT FROM AUTHOR]

Background: Neonatal instability of the hip (NIH), where the femoral head can move away from the acetabulum, in the first weeks of life, is an important risk factor for developmental dysplasia of the hip (DDH). In rural areas in Australia, there is a recent trend to increased late diagnosis of DDH. Clinical screening of infant hips, a common practice in Australia, is experience dependent. Best practice early screening techniques are still debated with different techniques and timing used internationally. This systematic review examines early dynamic ultrasound (eDUS) screening for hip instability in the first 6 weeks after birth, and the early interventions informed by these findings and considers the findings for the context of rural Australia.Methods: The Cochrane Library, Medline, CINAHL and PEDro were searched for original research or systematic reviews, and clinical studies 1998 to 2015 involving dynamic ultrasound. Critical Appraisal Skills Programme tools were used to appraise the studies.Result: Nineteen studies were included. Early Dynamic Ultrasound (DUS) is consistently described as a reliable assessment of NIH. Early DUS is recommended for risk factors including geographical areas of high prevalence. Approaches to early intervention of hips with excessive movement are somewhat discipline-related and include: primary prevention (advice), secondary prevention (abduction supports), and conservative management (removable splints).Conclusions: In the context of increased prevalence of DDH in rural Australia, contemporary evidence suggests that introduction of early DUS could provide rural infants with more effective screening than clinical examination alone. Targeted early advice about posturing and simple removable supports to abduct infant hips could prevent some cases of DDH in rural Australia. [ABSTRACT FROM AUTHOR]

Eccentric rotational acetabular osteotomy (ERAO) is a modification of rotational acetabular osteotomy (RAO); it has been reported that ERAO allows the femoral head to translate medially and distally. However, no study has compared femoral head translation following RAO or ERAO. The purpose of this study was to compare immediate postoperative translation of the femoral head after RAO and ERAO in comparison with the preoperative position by radiological methods.~Purpose~Objective~Patients treated by RAO or ERAO between 2006 and 2014 were retrospectively evaluated. 19 hips (17 patients) were treated with RAO, and 25 hips (22 patients) were treated with ERAO. The acetabular roof angle and the location of the femoral head were measured on anteroposterior pelvic radiographs.~Methods~Methods~The mean preoperative acetabular roof angle was 20.9° in the RAO group and 22.0° in the ERAO group, showing no significant difference. The mean acetabular roof angle immediately postoperatively was -0.5° in the RAO group and -0.4° in the ERAO group, again showing no significant difference. The mean femoral head translation immediately postoperatively was 3.1 mm (95% confidence interval (CI), 1.5-4.7 mm) laterally and 3.0 mm (95% CI, 1.3-4.7 mm) proximally in the RAO group and 0.8 mm (95% CI, -0.7-2.3 mm) medially and 2.8 mm (95% CI, 1.5-4.1 mm) distally in the ERAO group; this difference was very highly significant (p<0.001).~Results~Results~In contrast with RAO, ERAO resulted in significant femoral head translation both medially and distally immediately postoperatively.~Conclusions~Conclusions [ABSTRACT FROM AUTHOR]

Copyright of Saudi Medical Journal is the property of Saudi Medical Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Developmental dysplasia of the hip (DDH) is a common cause of hip pain in young patients, and may require treatment with total hip arthroplasty (THA). This study evaluates implant survival and describes patient-reported outcomes after primary THA in DDH patients aged 35 or younger.~Background~Background~A retrospective study with prospective follow-up was conducted at a major academic medical centre. Patient charts were reviewed to identify young THA patients with DDH, and follow-up surveys were conducted to determine implant survival and patient-reported outcomes. Kaplan-Meier survival analysis was performed to evaluate implant survival, and the hip disability and osteoarthritis outcome score (HOOS) was used to describe patient-reported outcomes.~Methods~Methods~This study included 61 patients (75 THAs, 75% follow-up), and the mean time to follow-up was 13 years (range 3-25 years). The 10-year and 20-year implant survival was 87% (95% CI, 78%-94%) and 55% (95% CI, 37%-72%), respectively, and implant survival was significantly better in patients over the age of 25 at the time of surgery (p value <0.01). The mean HOOS patient scores were 83 for pain (SD 20.29), 78 for symptoms (SD 19.72), 83 for ADLs (SD 20.89), and 74 for sports (SD 25.92). Patients that were younger at the time of surgery or required custom implants reported worse HOOS-Symptom scores at follow-up (p value = 0.02).~Results~Results~Young patients with DDH have good outcomes after surgery. Patient factors and implant characteristics should be considered when predicting implant survival and outcomes after THA in young patients with DDH.~Discussions~Conclusions [ABSTRACT FROM AUTHOR]

A comparison was made of the clinical and radiological results of cylindrical fully porous-coated femoral stems (Group A) and Zweymüller-type femoral stems (Group B) used for the treatment of hip osteoathrosis, secondary to Crowe III and IV dysplasia, with total hip arthroplasty combined with femoral transverse shortening osteotomy.~Purpose~Objective~This study is a retrospective evaluation of 86 hips in 50 patients. Group A comprised of 43 hips and Group B comprised of 43 hips. During final follow-up evaluation, patients were clinically assessed with Harris Hip Score (HHS), Merle d'Aubigne-Postel scale (MAP), and SF-36 scale. For radiological examination the Gulman THA score was used. Femoral osteotomy union, osteolysis around the components and component migration were also recorded and evaluated.~Method~Methods~In Group B, nonunion of the osteotomy site was found in 18.6% and delayed union in 20.9% of the hips. In Group A, delayed union was found in 7% of the hips. Patients' mean daily walking distance was found to be lower in Group A when compared to Group B. When the postoperative clinical HSS, and MAP and the radiological Gulman scores were compared, no statistically significant differences (p = 0.275) were found.~Results~Results~Patients with hip osteoarthritis secondary to Crowe III and IV dysplasia, who were treated with THA and transverse osteotomy showed a higher incidence of osteotomy complications when the Zweymüller femoral stem was used. However, these complications did not affect clinical outcomes.~Conclusions~Conclusions [ABSTRACT FROM AUTHOR]

Total hip replacement in patients with developmental dysplasia of the hip (DDH) is a difficult technical procedure for surgeons to perform because of the potential for these patients to have severe anomalies in their bones and soft tissues.~Introduction~Background~We performed acetabuloplasty in 54 hips from 44 patients by reaming the posterior wall of the native acetabulum and medialising the acetabular component to restore the anatomic centre of hip rotation using a small cup without bone grafting. Median time to post-surgery follow-up was 5 (range 2-14) years.~Materials and Methods~Methods~Prosthetic survival rates in patients after 2 and 5 years post hip replacement were 93% (50/54) and 89% (48/54), respectively. 4 patients required early revision because of malposition and instability of the acetabular cup. 3 patients with Crowe type IV dislocations had transient sciatic nerve palsy and 3 had deep vein thrombosis.~Results~Results~Placement of the acetabular shell using posterior bone stock to provide normal hip rotation is a successful alternative technique for acetabuloplasty in patients with DDH.~Conclusions~Conclusions [ABSTRACT FROM AUTHOR]

Developmental dysplasia of the hip (DDH) is a spectrum of disorders that results in anatomic abnormalities leading to increased contact stress in the joint and, eventually, secondary osteoarthritis. However, many patients with DDH become symptomatic before the severe degenerative changes of the hip because of abnormal hip biomechanics, mild hip instability, impingement, or associated intra-articular pathology. Early diagnosis and appropriate treatment for DDH are of the utmost importance. With the modification of techniques like pelvic osteotomy and capsular arthroplasty, and the introduction of intracapsular procedures such as arthroscopy and femoral head-neck junction osteochondroplasty, many young patients with symptomatic hip dysplasia may benefit from joint preservation procedures. We review the current development of these concepts and the associated surgical techniques. [ABSTRACT FROM AUTHOR]

Purpose: Acetabular coverage deficiency displays individual difference among patients with developmental dysplasia of the hip (DDH). Therefore, the correct direction and degree of the acetabular fragment is patient-specific during Bernese periacetabular osteotomy (PAO). This paper introduces a feasible method using 3D computed tomography (CT) and computer image processing technology for customised surgical planning.Methods: CT data of 96 hips in 60 DDH patients (male 15, female 45; average age/range 30 ± 8/14-49 years) and 53 normal hips (male 13, female 37; average age/range 52 ± 13/16-69 years) were reconstructed using commercially available software Mimics and Imageware. Geometric parameters of each hip were measured in relation to the anterior pelvic plane after correcting for pelvic tilt and rotation. Deficiency types and degrees of acetabular dysplasia in patients with DDH were determined by comparison with normal hips, and improvement in femoral-head coverage was analysed again after virtual PAO. A customised surgery programme for each DDH patient was designed and provided the reference for the actual operation.Results: We produced a 3D pelvic model using image processing software, doing precise measurement and with close approximation to the actual PAO. Lateral centre-edge angle (LCEA), anterior centre-edge angle (ACEA), acetabular anteversion angle (AAVA), anterior acetabular sector angle (AASA) and posterior acetabular sector angle (PASA) of normal hips in the control group were 35.128 ± 6.337, 57.052 ± 6.853, 19.215 ± 5.504, 61.537 ± 7.291 and 99.434 ± 8.372°, respectively. Angles of hips with DDH before surgery were 11.46 ± 11.19, 35.79 ± 13.75, 22.77 ± 6.13, 43.58 ± 9.15 and 88.46 ± 8.24, which were corrected to 33.81 ± 2.36, 55.38 ± 2.09, 20.16 ± 2.18, 58.29 ± 7.60, and 4.71 ± 7.75°, respectively, after surgery. After virtual Bernese PAO, LCEA, ACEA, AAVA, AASA and PASA were corrected significantly (p < 0.01). There was no statistically significant differences between LCEA, ACEA and AAVA after virtual Bernese PAO and normal hips (p = 0.06, p = 0.23, p = 0.06°, respectively). AASA improved significantly (p = 0.002) post-operatively at the cost of reducing posterior coverage represented by PASA, which is significantly smaller than in normal and pre-operative hips of DDH patients (p < 0.01).Conclusions: The geometric feature of the pelvis for patients with DDH can be assessed comprehensively by using 3D-CT reconstruction and image processing technology. Based on this method, surgeons can design individualised treatment scheme and improve the effect of PAO. [ABSTRACT FROM AUTHOR]

Purpose: Open surgery, nonsurgical positioning device and casting are mainstay treatments of developmental dysplasia of the hip (DDH). The optimal indicators for surgical interventions remain unclear. In this study, we aim to establish empirical, sensitive radiographic indicators for peri-acetabular osteotomy intervention in developmental dysplasia in Chinese children.Methods: One hundred and three DDH patients treated in The Soochow University Children's Hospital between 2006 and 2012 were assessed; patients with known causes of neuron muscular and abnormal hip joint origin were excluded. Fifty-four suitable patients, demonstrating 71 dysplasia hips with complete clinical record and adequate X-ray films, were enrolled in this study. Patients were divided into group A (conservative interventions failed, followed by salvage peri-acetabular osteotomy) and group B (conservative treatment only); a total of 16 quantitative parameters were measured on each pelvic X-ray film.Results: Among 71 hip joints measured, 29 hips of group A underwent salvage peri-acetabular osteotomy (40.8 %,) showed higher X2, Y, h, and Smith c/b (Vh) (p < 0.05). The age, c, HT, b, A2 in the group A salvage operation were statistically significantly different compared to group B patients (without salvage operations) (p < 0.05).Conclusions: Pre-operative pelvic X-ray film assessment of acetabulum lateralization markers (X2, c, HT, c/b ratio) and the superior migration measurements (Y, h, h/b ratio) are potentially valuable radiographic indicators for determining which DDH patients will require peri-acetabular osteotomy. [ABSTRACT FROM AUTHOR]

Copyright of Saudi Medical Journal is the property of Saudi Medical Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

There is no consensus on the definition of dysplasia of the hip (DH). Past and present concepts used to describe DH do not form a complete view of the pathology. Moreover, some authors still present the disease as congenital, not developmental. This prompted authors to analyze the evolution of the definition of DH. Based on the biomedical databases 500 articles and books in the field of hip dysplasia were found and analyzed. Fifteen definitions of hip dysplasia met inclusion criteria, subsequently were analyzed and presented in chronological order. The analysis revealed that currently there is no single, universal definition of hip dysplasia in the aspect of morphological, clinical, and radiological studies. Despite the widely-used term of DH, it is described imprecisely and in different ways. Therefore, it is necessary to develop a multidisciplinary definition of this pathology covering all aspects of hip disorders considered valid in modern orthopaedics. [ABSTRACT FROM AUTHOR]

Purpose: Total hip arthroplasty (THA) in the presence of developmental dysplasia of the hip (DDH) presents many challenges to the reconstructive surgeon. The complexity of femoral and acetabular anatomy in these cases makes standard reconstruction technically challenging. Restoring the anatomic centre of hip rotation may require femoral osteotomy. The aim of this study was to determine the rate of union, complications and functional results in a series of patients with Crowe IV dysplastic hips who underwent cementless THA and simultaneous subtrochanteric oblique osteotomy. Methods: A retrospective study was designed in a series of 13 patients (14 hips) with Crowe IV DDH who underwent cementless THA and simultaneous subtrochanteric oblique osteotomy at a mean age of 37 years. Patients were reviewed clinically and radiographically with a minimum follow-up of two years. Complications were noted. Harris Hip Score (HHS) was recorded pre-operatively and at six and 12 months postoperatively. Results: Union occurred in 14 of 14 femora (100 %). The overall revision rate was 14 % (7 % femoral, 7 % acetabular). No dislocations necessitated further surgery. No patient had intraoperative femoral fracture, sciatic nerve injury, infection or deep venous thrombosis. Mean HHS improved from 42 preoperatively to 79 at 6 months and 86 at 12 months. Conclusion: Combined subtrochanteric femoral osteotomy and cementless THA is technically demanding and proved to be safe and effective in femoral shortening for treatment of Crowe IV DDH. [ABSTRACT FROM AUTHOR]

Aim There is uncertainty about the risk of developmental dysplasia of the hip ( DDH) in breech preterm infants and therefore uncertainty about the benefits of using ultrasound screening in this population. The aim of this study was to determine if preterm infants born in the breech position are at risk of DDH. Methods A retrospective audit of preterm and term infants born in the breech position was performed to determine the incidence of DDH. Group 1 included breech preterm infants (<37 weeks gestational age) born between 2004 and 2008. Group 2 included breech term infants (≥37 weeks gestational age) born between 2005 and 2007. Infants were screened with clinical examination and ultrasound of the hip and were classified into two outcome groups: positive or negative for DDH. Results Three out of 129 (2.3%) preterm infants screened had DDH. For term infants, 3 out of 163 (1.8%) infants screened had DDH. The odds ratio for DDH in breech preterm infants compared with breech term infants was 1.27 (95% confidence interval 0.25 to 6.40). Conclusion Preterm infants born in the breech position appear to have a similar incidence of DDH to term infants and thus require similar screening guidelines. [ABSTRACT FROM AUTHOR]

The psychosocial impact of hip disease on the young adult has not been elucidated. This study aimed to identify the functional and psychosocial characteristics of a cohort of young patients (age less than 40 years) presenting to our tertiary care complex hip clinic. A postal questionnaire comprising of a Visual Analogue Scale (VAS) for Pain, the Oswestry Disability Index (ODI) and the Hospital Anxiety and Depression Scale (HADS) was posted to 63 patients. Forty-nine (n = 49) patients (79%) responded to the questionnaire. Mean age was 20 years (range 16-38) with a gender ratio of 2:1 (female: male). More than half of our patients had moderate to severe pain based on the VAS and at least moderate disability on the ODI. HADS showed that 32% and 49% of patients were classified as having borderline to abnormal levels of depression and anxiety respectively. Multiple regression showed ODI scores to be a significant predictor of anxiety and depression. Comparison with asymptomatic controls shows that these patients have significantly worse ODI and HADS scores compared to normal population. This study quantifies the degree of functional and psychosocial compromise present in young patients with hip problems. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this study was to review the clinical and radiographic outcomes and report the major complications in a group of hips with Crowe type IV developmental dysplasia that underwent reconstruction with a cementless total hip arthroplasty and a transverse subtrochanteric shortening osteotomy fixed with locking compression plate and screws. Method: Fifteen consecutive patients (21 hips) who had coxarthrosis secondary to Crowe Group IV developmental dysplasia of the hip were treated with a cementless prosthesis and a transverse subtrochanteric osteotomy fixed with locking compression plates at a mean age of 41. The mean follow-up period was 5 years. The acetabular cup was placed in the position of the anatomical hip center in every patient. Subtrochanteric femoral shortening osteotomy was fixed with plates and screws in all patients. Results: The mean Harris hip score improved from 36.2 ± 9.8 points to 90.8 ± 2.5 points. Trendelenburg sign was positive in seven hips and two patients complained about continuing anterior thigh pain at the final follow-up. There was no infection. No cases of nonunion were encountered. Two patients had dislocation on early postoperative period (15th and 20th postoperative day). Of these patients, femoral head was changed to 28 mm with stem revision in one patient, and one had acetabular component revision with use of constrained acetabular liner. There was one permanent sciatic nerve palsy. One patient had implant related pain during lying laterally. Plate and screws were removed at postoperative 16th month. Conclusion: Cementless total hip arthroplasty combined with subtrochanteric osteotomy for the treatment of patients with Crowe Group IV developmental dysplasia of the hip is an effective technique to reduce the hip to its original acetabular location and restore the rotational deformities. Plate and screw fixation is a viable option for a secure and stable fixation of femoral stem after subtrochanteric osteotomy. [ABSTRACT FROM AUTHOR]

Background The results of primary total hip arthroplasties (THAs) after pediatric hip diseases such as developmental dysplasia of the hip (DDH), slipped capital femoral epiphysis (SCFE), or Perthes' disease have been reported to be inferior to the results after primary osteoarthritis of the hip (OA). Materials and methods We compared the survival of primary THAs performed during the period 1995-2009 due to previous DDH, SCFE, Perthes' disease, or primary OA, using merged individual-based data from the Danish, Norwegian, and Swedish arthroplasty registers, called the Nordic Arthroplasty Register Association (NARA). Cox multiple regression, with adjustment for age, sex, and type of fixation of the prosthesis was used to calculate the survival of the prostheses and the relative revision risks. Results 370,630 primary THAs were reported to these national registers for 1995-2009. Of these, 14,403 THAs (3.9%) were operated due to pediatric hip diseases (3.1% for Denmark, 8.8% for Norway, and 1.9% for Sweden) and 288,435 THAs (77.8%) were operated due to OA. Unadjusted 10-year Kaplan-Meier survival of THAs after pediatric hip diseases (94.7% survival) was inferior to that after OA (96.6% survival). Consequently, an increased risk of revision for hips with a previous pediatric hip disease was seen (risk ratio (RR) 1.4, 95% CI: 1.3-1.5). However, after adjustment for differences in sex and age of the patients, and in fixation of the prostheses, no difference in survival was found (93.6% after pediatric hip diseases and 93.8% after OA) (RR 1.0, CI: 1.0-1.1). Nevertheless, during the first 6 postoperative months more revisions were reported for THAs secondary to pediatric hip diseases (RR 1.2, CI: 1.0-1.5), mainly due to there being more revisions for dislocations (RR 1.8, CI: 1.4-2.3). Comparison between the different diagnosis groups showed that the overall risk of revision after DDH was higher than after OA (RR 1.1, CI: 1.0-1.2), whereas the combined group Perthes' disease/SCFE did not have a significantly different risk of revision to that of OA (RR 0.9, CI: 0.7-1.0), but had a lower risk than after DDH (RR 0.8, CI: 0.7-1.0). Interpretation After adjustment for differences in age, sex, and type of fixation of the prosthesis, no difference in risk of revision was found for primary THAs performed due to pediatric hip diseases and those performed due to primary OA. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The incidence of DDH (Developmental Dysplasia of Hip) in Malaysia was low compared to other countries. We conducted a study to review cases of DDH in our practice since last 8 years. The aim of the study is to find out the effectiveness of perinatal screening of DDH in our practice. METHODS: A retrospective review of DDH from January 1998 till March 2006 was conducted. Patients records for sex, age at presentation, site, method of delivery and risk factors of DDH were reviewed. RESULTS: There were 16 patients presented to our clinic for DDH ,10 Female, and 6 male . Only 5 patients (31%) diagnosed at birth from perinatal screening. Out of that, 5 involved left hip, 6 right and 5 had bilateral. None had a positive family history. Three were first born baby. 3 cases were breech delivery and four associated with other abnormalities. CONCLUSION: High rate of late presention may indicate a poor perinatal screening of DDH in our practice. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the incidence and the causes of redislocation after different operative corrections of the developmental dysplasia of the hip and its relations to age of the patients. Methodology: It was a prospective observational study during five year period between July 2000 to August 2005. Forty seven patients were admitted for corrective operation of the developmental dysplasia of the hip and a total of 59 hip surgeries have been done in our centre at Razi hospital, Ahwaz Jondishapour University of Medical Sciences, Iran.The rate and causes of redislocation in relation to the type of operation and age of these patients was recorded and analysis of the data was done by T-test and the P-values of less than 0.005 considered as a significant difference. Results: Nine out of 59 operations redislocated after beginning of weight bearing. It included mostly in those who had adductor tenotomy, femoral shortening, derotation and Salter innominate osteotomy (P<0.05). Conclusion: We conclude that if Salter innominate osteotomy is necessary after open reduction and femoral shortening in patients with developmental dysplasia of the hip, it is better not to perform femoral derotation. [ABSTRACT FROM AUTHOR]

One thousand consecutive infants, 437 girls and 563 boys, attending their first DPT vaccination at a mean age of 48 days underwent ultrasonological screening of the hips by Graf's technique at the immunization clinic of a tertiary hospital in South India. Graf I (mature) hips were seen bilaterally in 925 children. The incidence of Graf type II hips was 74/1000 infants. The incidence of sonographically abnormal hips (II, III and IV) in this population was 7.5%. The hip dislocation rate was 1 in 1000 (0.1%). [ABSTRACT FROM AUTHOR]

Background: The anatomical sacral slope is considered as an anatomical pelvic parameter independent of femoral head centers for measurement of anatomical sacral slope and was previously described to strongly correlate with pelvic incidence on a two-dimensional examination of healthy subjects. However, the correlation between anatomical sacral slope and pelvic incidence was unclear in patients with developmental dysplasia of the hip. This study aimed to examine the correlation between anatomical sacral slope and other spinopelvic parameters by analyzing plain radiographs of female patients with developmental dysplasia of the hip. Methods: Eighty-four women with developmental dysplasia of the hip were examined. Lumbar lordosis, thoracic kyphosis, pelvic incidence, sacral slope, and anatomical sacral slope (the angle formed by the straight line of the S1 superior endplate and a line at a right angle to the anterior pelvic plane) were determined by analyzing plain radiographs. The correlations were examined by Pearson's correlation coefficients, and intra- and inter-rater intraclass correlation coefficients were evaluated for reliability. Results: A strong correlation was observed between pelvic incidence and anatomical sacral slope (r = 0.725, p < 0.001). In addition, the correlation between anatomical sacral slope and lumbar lordosis was similar to that between pelvic incidence and lumbar lordosis (r = 0.661, p < 0.001, and r = 0.554, p < 0.001, respectively). The intra-rater intraclass correlation coefficient values were 0.869 and 0.824 for anatomical sacral slope and pelvic incidence, respectively. Furthermore, the inter-rater intraclass correlation coefficient values were 0.83 and 0.685 for anatomical sacral slope and pelvic incidence, respectively. Conclusions: We observed that the strong correlation between anatomical sacral slope and pelvic incidence in patients with developmental dysplasia of the hip was equal to that in normal healthy subjects. The correlation between anatomical sacral slope and lumbar lordosis was equal to that between pelvic incidence and lumbar lordosis. Additionally, the intraclass correlation coefficient values for the anatomical sacral slope were slightly higher than those for pelvic incidence. Thus, we conclude that anatomical sacral slope can be considered as a helpful anatomical pelvic parameter that is a substitute for pelvic incidence not only in normal healthy subjects, but also in patients with developmental dysplasia of the hip. [ABSTRACT FROM AUTHOR]

Background: Bernese periacetabular osteotomy (PAO) has been shown to be applicable as a hip-preserving technique for the treatment of developmental dysplasia of the hip (DDH). The approach could be designed preoperatively using various types of reverse-engineering software and finite element analysis, but how to implement it in the actual PAO remains a challenge. This study examines and evaluates a solution to achieve higher accuracy when performing a PAO. Methods: A patient-specific cutting and rotating template was predesigned through computer-aided design (CAD) with three-dimensional (3D) modeling programs. The templates were then reproduced with rapid prototyping (RP) technology and used in the actual PAO. Finally, the clinical and radiographic effects were assessed and compared between the newly developed PAO and conventional PAO groups. Results: The customized cutting template fit well with the bone surface and served as a guide for surgeons as they slid the osteotome to the precise location that had been determined prior to surgery. A very similar acetabular fragment was reproduced, and no major complications occurred when performing the osteotomy along the edge of the cutting template. The acetabular fragment was then corrected to the predetermined position through one-off manipulation with the customized rotating template. The final position of the acetabular fragment in the new developed PAO group was highly consistent with the planned position, and the postoperative morphological parameters were consistent with the preoperative planned data compared to the conventional PAO group. The duration of the operation and the number of irradiation decreased significantly. The Harris hip score (HHS) and visual analogue scale (VAS) score improved significantly with the use of the new developed PAO. Conclusions: We demonstrate that our system, which was based on CAD-RP technology, is feasible and could realize the predicted results accurately during the actual PAO. [ABSTRACT FROM AUTHOR]