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Objective: To investigate the optimal level for femoral shortening osteotomy in patients with dislocated hips undergoing total hip arthroplasty (THA) and make recommendations to avoid union problems. Methods: We retrospectively reviewed 65 hips of 55 patients who underwent total hip arthroplasty for Crowe type IV developmental dysplasia of the hip. Osteotomy level is defined as the distance between the lesser trochanter and osteotomy line. The role of osteotomy level and osteotomy level-stem end distance on non-union rates, radiological union time, unsupported loading time, and Harris Hip Scores were investigated with Pearson correlation analyses. Results: The mean follow-up period was 75.9 ± 32.0 months. The mean radiological union time was 6.5 ± 2.9 months. There was a positive and linear correlation between osteotomy level and radiological union time (r = 0.385; P = .003). Harris Hip Scores were not correlated with osteotomy level (P = .503). The osteotomy performed at a distance of more than 30 mm had higher radiological union times (P = .002). Conclusion: According to the results of the current study, the optimal osteotomy level should be within the 20-30 mm range from the lesser trochanter. Early revision should be avoided for patients with union problems. To prevent non-union, the cable should be well controlled so as not to enter into the osteotomy line. [ABSTRACT FROM AUTHOR]

Background: This study aimed to investigate the risk factors for dislocation in patients diagnosed with developmental dysplasia of the hip (DDH) who underwent total hip arthroplasty.Methods: We retrospectively reviewed 40 patients who developed dislocation and compared them with 400 patients in the control group without hip instability. Patients-, surgery-, and implant-related factors were investigated. Risk factors were evaluated using multivariate logistic regression.Results: The mean follow-up period was 32.3 months. The mean time to dislocation was 4.4 months. There were 7 men (17.5%) and 33 women (82.5%) in the dislocation group and 83 men (20.7%) and 317 women (79.3%) in the control group (P = .627). Diabetes mellitus (DM; P = .032) and history of previous hip surgery for DDH were associated with dislocation (P < .001). The subtrochanteric shortening osteotomy (P = .001), acetabular inclination (P = .037), acetabular anteversion (P < .001), femoral head size (P < .001), and postoperative infection (P = .003) were associated with dislocation. Major predictors of hip dislocation after total hip arthroplasty in patients with DDH were previous hip surgery (odds ratio [OR], 6.76; 95% confidence interval [CI], 1.86-24.6; P = .004), high hip center (OR, 2.90; 95% CI, 1.31-6.38; P = .008), DM (OR, 2.68; 95% CI, 1.06-6.80; P = .037), and acetabular inclination (OR, 2.62; 95% CI, 1.09-6.26; P = .03).Conclusion: Patients with DM and previous hip surgery should be informed about increased dislocation rates. Using a larger head diameter and restoration of the true hip rotation center are essential to prevent hip dislocation in these patients. Furthermore, accurate positioning of the acetabular inclination and anteversion are also important. [ABSTRACT FROM AUTHOR]

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Purpose: The purpose of this study was to assess the variations in tibial tubercle-trochlear groove distance and angle as a function of age and gender in a population of children without patellar instability (PI) compared with those with PI.Methods: A retrospective review of 869 children’s knee MRIs, ages 5 to 15 years, were evaluated using a control group (792 children) without evidence of PI and a group with PI (77 children). Tibial tubercle-trochlear groove distance (TT-TGd) and angle (TT-TGa) were measured twice by two readers to assess intra- and inter-observer reliability and compared between PI and control groups. In both groups, functions of age and gender on TT-TGd and TT-TGa values were evaluated.Results: Both TT-TGd and TT-TGa measurements showed excellent intra- and inter-observer reliability. The mean TT-TGd for the PI group was 17.2 mm (SD 6.6) and significantly higher than the mean TT-TGd for the control group (10.4 SD 3.8 mm, P = 0.001). The mean TT-TGa for the PI was 20.8° (SD 8.3°), which was also significantly higher than the mean TT-TGa for the control group (12.5° SD 4.6°, P < 0.001). Control group revealed a positive correlation between age and TT-TGd measurements (r = 0.243, P < 0.001). The mean TT-TGa for girls (13.3° SD 4.7°) was higher than the mean TT-TGa for boys (11.9° SD 4.4°) in the control group (P < 0.001).Conclusion: TT-TGa and TT-TGd are reliable and can be used for the evaluation of the extansor mechanism alignment in children with and without PI. However, it must be considered that TT-TGd is increasing in growing patients. Soft-tissue procedures may be prone to failure, since bony procedures for patellar alignment cannot be done until skeletal maturity.Level of evidence: III. [ABSTRACT FROM AUTHOR]