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Objectives: Due to the technical challenges associated with femoral reconstruction in total hip arthroplasty for patients with developmental dysplasia of the hip (DDH), the exact indications for using femoral modular stems, despite their satisfactory clinical outcomes, remain poorly investigated. This study sought to assess the morphology of the femur and acetabulum, and to investigate the discriminative ability of femoral anteversion (FA), acetabular anteversion (AA), and combined anteversion (CA) on the selection of femoral modular stem in dysplastic hips. Methods: Retrospective data were collected from multiple centers on a total of 230 cases who underwent THA due to DDH from January 1, 2020, to March 1, 2023. There were 46 males and 184 females, with an average age of 51.57 ± 14.87. Patients were stratified according to Crowe and Eftekhar classifications. FA, AA, and CA were measured using computed tomography (CT). The distribution of these indices in different grades of dysplastic hips was compared, and the correlation between these indices and the selection of femoral modular stem was analyzed. Receiver operating characteristic (ROC) and likelihood statistics were performed to investigate the discriminating and predictive value of each index in selecting modular stem. Results: Two hundred and thirty hips were included in the study. FA increased as the subluxation percentage increased: type I, 21.5°; type II, 28.6°; type III, 34.9°; and type IV, 39.7°. AA was smaller in type I (16.9°) and higher in types II, III, and IV (18.9–22.6°). The area under the curve for the modular stem was 0.87 for FA, 0.86 for CA, and 0.65 for AA. The optimal cutoff values were FA > 32.6°, CA > 50.7°, and AA > 23.3°. Conclusion: Excessive AA and femoral anteversion FA were observed in Crowe types II, III, and IV cases. FA and CA demonstrated strong discriminative ability and predictive value in the selection of a modular stem. The best cutoff values were ≥32.6° for FA and ≥50.7° for CA in discriminating the use of modular stem. Surgeons may contemplate the use of a modular stem when the preoperative evaluation approaches the cutoff value. [ABSTRACT FROM AUTHOR]

BACKGROUND: There are some differences in acetabular anatomical parameters among different regions and different populations, which are very important for the diagnosis and treatment of acetabular diseases. However, the characteristics of acetabular imaging parameters in the Guizhou population are still unclear. OBJECTIVE: To analyze the imaging parameters of acetabular plain radiographs, so as to provide a reference for the diagnosis and treatment of acetabular diseases and the design and installment of the acetabular prosthesis. METHODS: Adult patients who underwent anteroposterior radiography of both hip joints at the Affiliated Hospital of Guizhou Medical University from January 2015 to February 2017 were collected. The acetabular radiographic parameters were measured using the medical imaging software SIEMENS Syngo.Plaza PACS. The data were grouped and analyzed according to age, sex and left and right sides. Pearson correlation analysis was performed between acetabular parameters. The data in the current study were compared with domestic and foreign studies containing the same type of data. RESULTS AND CONCLUSION: (1) Sharpe angle, center edge angle, anteversion angle, abduction angle, acetabular depth, acetabular diameter, modified acetabular index, and acetabular head index were (39.70±3.65)°, (31.10±6.03)°, (19.17±4.26)°, (39.71±3.67)°, (1.16±0.22) cm, (6.45±0.52) cm, (0.33±0.03), and (84.72±4.19)%, respectively. (2) There were statistical differences in Sharp angle between males and females at different age groups (P < 0.05); statistical differences in abduction angle were found in males among different age groups (P < 0.05). (3) There were differences in Sharp angle, center edge angle, anteversion angle, abduction angle, acetabular depth and acetabular diameter between genders. Sharp angle, anteversion angle and abduction angle were smaller in males than those in females (P < 0.05). The center edge angle, acetabular depth, and acetabular diameter were greater in males than that in females (P < 0.05). (4) There were no significant differences in acetabular parameters between the sides. (5) There were differences in the acetabular imaging parameters of the population in the Guizhou district when compared with the same type of data from domestic and foreign studies. Taken together, the acetabular imaging parameters of the population in Guizhou have certain characteristics. The regional features of acetabular imaging parameters should be fully considered in the clinical diagnosis and treatment of acetabular diseases to achieve greater clinical benefits. [ABSTRACT FROM AUTHOR]

Due to the change in the structure of the proximal femur and acetabulum in patients with developmental dysplasia of the hip, total hip arthroplasty (THA) was difficult to perform for surgeons. To elevate the acetabular coverage rate, we developed a technique in the use of a patient-specific instrumentation (PSI) graft in patients with developmental dysplasia of hip (DDH) undergoing surgery. This study aims to evaluate the peri-operative outcomes of THA with PSI graft in patients with DDH. This study recruited 6 patients suffering from Crowe I DDH with secondary Grade IV osteoarthritis. All the patients underwent THA with PSI graft performed by a well-experienced surgeon. Perioperative outcomes included surgical procedures, blood loss during operation, the volume of blood transfusion, length of hospitalization, complications, and the mean difference in hemoglobin levels before and after surgery. All the outcomes analyzed were assessed by mean and standard deviation. The average duration of the surgical procedure was found to be 221.17 min, with an SD of 19.65 min. The mean blood loss during the operation was 733.33 mL, with an SD of 355.90 mL. The mean length of hospital stay was calculated to be 6 days, with an SD of 0.89 days. Furthermore, the mean difference between the pre- and postoperative hemoglobin levels was 2.15, with an SD of 0.99. A total of three patients received 2 units of leukocyte-poor red blood cells (LPR) as an accepted blood transfusion. There were no reported complications observed during the admission and one month after the operation. This study reported the peri-operative outcomes in the patients with DDH who underwent THA with PSI graft. We found that THA with PSI graft would provide a safe procedure without significant complications. We assumed that the PSI graft in THA may increase the coverage rate of the acetabulum, which may increase the graft union rates. Further cohort studies and randomized controlled trials were needed to confirm our findings. [ABSTRACT FROM AUTHOR]

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Background: Osteopoikilosis (OPK) is a rare benign sclerosing bone dysplasia and is often incidentally found on plain radiography. OPK generally does not require treatment. Nevertheless, osteonecrosis or degenerative joint disease can occur in the setting of OPK, and little is known with regard to the longevity of arthroplasty prostheses implanted into OPK-bearing bones.Case Presentation: A 55-year-old male presented with progressive right hip pain in 2012. He was diagnosed with coexisting osteopoikilosis and developmental dysplasia of the right hip with advanced osteoarthritis after a series of imaging studies including radiographs, magnetic resonance imaging (MRI), and bone scan. A cementless total hip arthroplasty was performed to treat his right hip pain. Radiographs at eight-year follow-up showed the prosthetic components were well-fixed. Harris hip score of the patient's right hip was 93. The patient can walk without assistance and work as a construction worker.Conclusion: Cementless arthroplasty can be considered in patients with hip arthropathies and co-existing osteopoikilosis. Continued follow-up is required to establish the long-term results. [ABSTRACT FROM AUTHOR]

Introduction: The anatomic abnormalities in developmental dysplasia of hip (DDH) often make total hip replacement (THR) inevitable at a younger age. However, there is no universal gold standard technique of THR for high dislocated dysplastic hips.Materials and methods: Here we present the outcomes of midterm follow-up after THR in patients diagnosed with DDH Crowe type III and IV hospitalized in a tertiary center in Iran for whom placement of a cup in true acetabulum and selective transverse subtrochanteric osteotomy was performed. Pre- and postoperative Harris Hip Score, leg length discrepancy and postoperative complications were evaluated.Results: A total of 48 patients with DDH Crowe type III and IV (uni- or bilateral which made 52 hips) were studied. Mean age of patients was 41 years with minimum follow-up ranging from 12 months to 3 years. Mean Harris Hip Score significantly improved from 41.70 preoperatively to 88.1 at last follow-up postoperatively. Leg length discrepancy of less than 2 cm was observed which was well tolerated using shoe lifts. Regarding postoperative complications, two patients had transient peroneal nerve palsy in early postoperative period which recovered within 2 months. No other major complication was encountered.Conclusion: THR in patients with DDH (Crowe III and IV) with a cup positioned in true acetabulum and transverse subtrochanteric osteotomy is a safe successful procedure. [ABSTRACT FROM AUTHOR]

Background: Arthroscopic reduction has become increasingly popular as an alternative to open reduction for the treatment of developmental dysplasia of the hip (DDH). However, patient outcomes beyond one and a half years after surgery remain unclear. The purpose of this study is to report the medium-term outcomes of walking-age patients who received arthroscopic reduction after an unsuccessful closed reduction. This research was conducted as part of a retrospectively registered study. Methods: We performed arthroscopic reduction in eight children with DDH after failed closed reduction between January 2010 and January 2012 and followed all cases for a minimum of 5 years. Arthroscopic reduction was performed using a two-portal approach without traction. Capsular release and resection of the transverse acetabular ligament were also performed if needed. Patient demographics, clinical variables, anatomical assessment measures, and post-operative complications were extracted from medical records. Results: Wetreatedfivemaleandthreefemalepatientswithanaverageageatoperationof15.6months(range, 12 to 22 months). All obstacles to reduction were corrected arthroscopically. Concentric reduction of the hip joint was observed in post-operative X-rays in all cases. The average safe zone was increased from 17.5° (8° to 30°) to 42.1° (36° to 50°) after the operation. The average acetabular (AC) index was reduced from 40.3° (33° to 65°) to 21. 9° (19° to 26°) at the end of follow-up. No complications occurred and no patients developed necrosis of the femoral head, recurrent dislocation, or residual hip dysplasia. Conclusions: Arthroscopic reduction is a suitable surgical procedure for the treatment of DDH among walking-age children with failed closed reduction and severe dislocation. This method is quick and safe, and it can be performed without post-operative complications over the medium term. [ABSTRACT FROM AUTHOR]

Background: Performing successful total hip replacement (THR) in dysplastic, subluxed, and dislocated hip is a challenging task. Here, we assessed midterm clinical and radiological outcomes of uncemented total hip arthroplasty in osteoarthritis (OA) of hip secondary to Hartofilakidis low and high-dislocated hips with a mean follow-up of 8.8 years. Materials and Methods: A retrospective study of prospectively collected data was designed involving all consecutive patients who underwent uncemented THR for OA of hip secondary to developmental dysplasia of the hip and Grade II or Grade III Hartofilakidis classification. Results: Thirty-two patients underwent 45 THR, with 23 Grade II (low dislocation) and 22 Grade III (high-dislocation) of Hartofilakidis classification. Thirteen patients had bilateral hip replacements, 19 patients had unilateral THR. There was highly statistically significant difference between preoperative and postoperative HHS and SF-36v2TM at each follow-up. Survivorship of original implant was 98.88% at a mean follow-up of 8.8 years. The mean improvement in leg length in this series was 3.6 cm (1.8-4.5, 95% confidence interval). No sciatic nerve or femoral nerve palsies were observed. Conclusions: Uncemented THR provides better function and quality of life. However, longer follow-up studies are needed to assess survivorship of uncemented THR in Hartofilakidis low and high-dislocations. [ABSTRACT FROM AUTHOR]

There is limited information about the effect of hip center location on gait parameters of knee and ankle. This study aimed to compare anatomical vs. high hip center arthroplasty according to gait parameters of knee and ankle and investigate whether the high hip center has any adverse effect on these joints or not. 20 patients who underwent unilateral total hip arthroplasty (Group 1; 10 patients with anatomical reconstruction, Group 2; 10 patients with high hip center) due to Crowe type III-IV developmental dysplasia of the hip and completed 2 years of follow-up were included. The patients were examined by 3-D gait analysis. The maximum extension of the knee on the operated side was lower in Group 2 (p = 0.044). Longitudinal knee joint force was higher in Group 2 on both operated (p = 0.041) and non-operated sides (p = 0.031). Lateral knee joint force was also higher in Group 2 (p = 0.023). No significant difference was detected in ankle parameters. Unilateral high hip center has been shown to restrict the dynamic knee range of motion on the operated side and increase the knee load on both sides, thus putting the knees at risk for osteoarthritis. Level III, Retrospective comparative study. • Unilateral high hip center adversely affected the gait parameters of the knee. • Dynamic knee range of motion was restricted in patients with high hip center. • Load on the knee was increased in patients with high hip center. [ABSTRACT FROM AUTHOR]

Treatment of fractures in patients with developmental dysplasia of hip is not clear. In patients without any pre-existing hip pathology, open or closed reduction and internal fixation is used to treat hip fractures. Total arthroplasty is used as a salvage procedure in hip fractures of young patients. Total arthroplasty serves perfect functional results in elderly patients with developmental dysplasia of hip. We presented two multi-trauma patients with developmental dysplasia of hip, and their hip fractures were treated with total arthroplasty. Painless and functional hip joints were obtained, and patients were mobilized early to prevent systemic complications. We think that total arthroplasty is the most convenient treatment method for hip fractures in patients with developmental dysplasia of hip. [ABSTRACT FROM AUTHOR]