Purpose. The purpose of this study was to analyse inter- and intra-rater reliability of the Head-Shaft angle (HSA) on radiographs from a surveillance programme for children with cerebral palsy (CP). Method. A high HSA is a risk factor for hip displacement in children with CP. To evaluate inter- and intra-rater reliability of the HSA, hip radiographs from the CP surveillance programme CPUP in the southern part of Sweden during the first half of 2016 were included in this study. Results. We analysed 50 radiographs from children in Gross Motor Function Classification System (GMFCS) levels II-V with a mean age of 6.6 (SD 3.2) years from 11 different radiology departments. Three raters measured the HSA of one hip at baseline and after four weeks. Intra-Class Correlation Coefficient (ICC) showed excellent inter- and intra-rater reliability of the HSA with ICC 0.92 (95% CI 0.87–0.96) and ICC 0.99 (95% CI 0.98–0.99) respectively. Conclusion. We conclude that the HSA, important when predicting hip displacement in CP, showed high inter-and intra-rater reliability when analysed on radiographs from various radiology departments in a surveillance program for CP

Aims. Hip disease is common in children with cerebral palsy (CP) and can decrease quality of life and function. Surveillance programmes exist to improve outcomes by treating hip disease at an early stage using radiological surveillance. However, studies and surveillance programmes report different radiological outcomes, making it difficult to compare. We aimed to identify the most important radiological measurements and develop a core measurement set (CMS) for clinical practice, research, and surveillance programmes. Methods. A systematic review identified a list of measurements previously used in studies reporting radiological hip outcomes in children with CP. These measurements informed a two-round Delphi study, conducted among orthopaedic surgeons and specialist physiotherapists. Participants rated each measurement on a nine-point Likert scale (‘not important’ to ‘critically important’). A consensus meeting was held to finalize the CMS. Results. Overall, 14 distinct measurements were identified in the systematic review, with Reimer’s migration percentage being the most frequently reported. These measurements were presented over the two rounds of the Delphi process, along with two additional measurements that were suggested by participants. Ultimately, two measurements, Reimer’s migration percentage and femoral head-shaft angle, were included in the CMS. Conclusion. This use of a minimum standardized set of measurements has the potential to encourage uniformity across hip surveillance programmes, and may streamline the development of tools, such as artificial intelligence systems to automate the analysis in surveillance programmes. This core set should be the minimum requirement in clinical studies, allowing clinicians to add to this as needed, which will facilitate comparisons to be drawn between studies and future meta-analyses. Cite this article: Bone Jt Open 2023;4(11):825–831

Slipped capital femoral epiphysis (SCFE) is traditionally treated with in situ fixation using a threaded screw, leading to physeal arrest while stabilizing the femoral head. Recently, there has been interest in alternative methods of fixation for SCFE, aiming to allow growth and remodelling of the femoral neck postoperatively. One such option is the Free Gliding SCFE Screw (Pega Medical), which employs a telescopic design intended to avoid physeal compression. The objective of this study is to evaluate radiographic changes of the proximal femur following in situ fixation using the Free Gliding SCFE Screw. This study retrospectively evaluated 28 hips in 14 consecutive patients who underwent in situ hip fixation using the Free Gliding SCFE Screw between 2014 and 2018. Initial postoperative radiographs were compared to last available follow-up imaging. Radiographic assessment included screw length, articulotrochanteric distance (ATD), posterior sloping angle (PSA), alpha angle, head-neck offset (HNO) and head-shaft angle (HSA). Of the 28 hips reviewed, 17 were treated for SCFE and an additional 11 treated prophylactically. Average age at surgery was 11.7 years, with an average follow-up of 1.44 years. Screw length increased by 2.3 mm (p < 0.001). ATD decreased from 25.4 to 22.2 mm (p < 0.001). Alpha angle decreased from 68.7 to 59.8 degrees (p = 0.004). There was a trend towards an increase in HNO (p = 0.07). There was no significant change in PSA or HAS. There were three complications (two patients with retained broken guide wires, and one patient requiring screw removal for hip pain). With use of the Free Gliding SCFE Screw, there was evidence of screw expansion and femoral neck remodelling with short-term follow-up. More research is required to determine the long-term impact of these changes on hip function, and to aid in patient selection for this technology

Purpose of the study: The extramedullary anatomy of the femur must be reproduced during total hip arthroplasty in order to ensure correct tension on the gluteus muscles. This requires:. correct offset of the femur, measured as the distance between the center of the head and the anatomic axis of the shaft;. offset of the center of rotation, measured as the distance between the center of the head and the pubic symphesis. Addition of these two offsets gives the overall offset. The purpose of this work was to analyze postoperative offset after standard total hip arthroplasty as a function of the preoperative head-shaft angle. Material and methods: Prospective study of 150 files of patients who underwent first-intention total hip arthroplasty. A prosthesis with matched increasing head size was implanted. The head-shaft angle was 135°. Mean offset was 41.7 mm (range 33–47 mm) for the 0 head-neck. The preoperative neck-shaft angle was measured on the upright ap view (comparable rotation of the two hemipelvi). Pre- and postoperative femur and center of rotation offset were noted. Results: The preoperative neck-shaft angle varied from 118° to 1400. Mean preoperative femur offset was 40.2 mm (range 29–52 mm). Mean postoperative femur offset was 42.2 mm. This gave a 2 mm lateralization of the femur, which was apparently negligible, favorable, and therefore satisfactory. Mean offset was 90.5 mm preoperatively and 84.5 mm postoperatively, medializing the center of rotation 6°. Mean overall offset was thus displaced medially (6 mm minus 2 mm = 4 mm). This was considered acceptable. Among these 150 files, 24 were coxa vara hips with a neck-shaft angle 125°. For these 25 coxavara hips, the mean preoperative femur offset was 44.5 mm. The mean postoperative femur offset was 42.2 mm. This produced, inversely, a medial displacement of the postoperative femur offset of 2.3 mm. The center of rotation was displace medially 6 mm. Thus globally the medial displacement was 6 mm plus 2.3 mm = 8.3 mm. This appeared to be excessive. Discussion: The postoperative offset of the femur is prosthesis-dependent. The majority of implants currently marketed have a mean offset in the 40–45mm range. The offset of the center of rotation is operator-dependent: as the acetabular reaming is accentuated, the center of rotation is displaced medially. Acetabular reaming is necessary to reach the subchondral bone. The medial offset can be limited but at least some displacement is inevitable. Thus in the event of a coxavara hip, it is very difficult to limit excessive overall medial offset when using a standard prosthesis. If the goal is to mimic the anatomic femur offset, it would appear justified to use prostheses with a smaller neck-shaft angle for patients with coxavara. A 10° reduction, from 135° to 125° would increase the femur offset 5 mm and thus enable reproduction of the preoperative anatomy

A review of the first two hundred and ten patients undergoing Birmingham hip re-surfacing between January 2003 and June 2005 was performed. All surgeries were performed by a single consultant orthopaedic surgeon. All resurfacings were carried out utilising the antero-lateral approach to the hip. Mean review post-operatively was at six weeks. The following clinical parameters were evaluated: length of in-hospital patient stay, intra-operative blood loss and post-operative range of joint movement. In addition, the following radiological measurements were made: the acetabular inclination angle, the head-shaft angle and evidence of leg-length discrepancy. One patient experienced fracture of the femoral neck and two other patients underwent revision surgery. Our results demonstrate that the anterolateral approach represents an alternative approach, with short-term results comaprible to the posterior approach for hip resurfacing

Slipped capital femoral epiphysiolysis (SCFE) is a rare condition with a unknown aetiopathogenesis. An early diagnosis and treatment is essential to minimize premature degeneration of the joint. The authors reviewed the cases treated between 1980 and 2005 in our institution. This study was aimed at evaluating patients with hip epiphysiolysis surgically treated by canullated screws or pinning and previously controlled by short-term follow-up, in order to evaluate radiographic medium/ long term evolution, looking for evidence of degenerative arthritis or femoroacetabular impingement. We performed a retrospective review of the clinical notes and radiographs of all patients with slipped upper femoral epiphysis who were surgically treated at our institution between January 1980 and December 2005. These patients performed radiographs to detect evidence of osteonecrosis, chondrolysis, degenerative arthritis or femoroacetabular impingment. To grade the radiological osteoarthritic changes the grading system of Kellgren and Lawrence was used. These changes were correlated with the existence of femoroacetabular impingement. The radiological results were correlated with the Loder'sclassification of stability and the morphological classification. 43 patients were reviewed, corresponding to 47 treated hips. AP and Lowenstein x-ray views were taken in all patients. The alfa angle and the head-shaft angle were measured in the Lowenstein view (frog-leg). Of 16 patients with impingement only 1 patient didn't present pistol grip deformity. 4 contralateral hips also presented the deformity. The mean alfa angle was 99,4. 43% of the patients with unstable hips have impingment. In stable hips this percentage is of 35%. The Patrick test was positive in 30% of the hips with SCFE and only 17% of the unafected hips. The Kellgren and Lawrence scale was very diferent between trhe SCFE and control groups, with 43% grade 2, 17% grade 3 and 6% grade 4, versus 30% grade 2, 6% grade 3 and 0% grade 4. Some patients show bilateral pistol grip deformity and clinical signs of impingment, despite only having one hip with SCFE

We evaluated the results of Cementless Surface Replacement Arthroplasty (CSRA) of the shoulder in 67 patients with advanced glenohumeral destruction who have an intact rotator cuff. Between november 2002 and december 2008, 70 CSRA (32 Copeland/ Biomet and 38 SMRR/ Lima) were implanted in 67 patients. A deltopectoral approach was used in 34 cases and an anterosuperior approach in 36 cases. Patients were assessed using Constant score, a patient satisfaction score and a detailed radiographic analysis. The mean follow up was 3.4 years (range 1 to 7.5 years). The mean Constant score improved preoperatively from 17.6 points (range 2–55) to an average postoperative score of 66.1 (range 13–91). The pain score improved from 1.13 points (range 0–6) to 12.3 points (range 3–15). The forward flexion and external rotation improved from 71° (range 20 to 140) and 0° (range −40 to +45) to 143° (range 60 to180) and 34.4° (range −20 to +60) respectively. Complications included: 1 subscapularis detachment, 5 secondary rotator cuff tear, 1sepsis, 3 patients with shoulder stiffness. No shift in implant position was observed. 11 humeral components developed radiolucencies at the prosthesis-bone interface. The radiographic analysis involved a system of dividing the prosthesis/bone interface into 5 zones. The best clinical results were significantly achieved in patients with necrosis compared with osteoarthritis (Constant Score, ant. elevation, ext. Rotation). Using regression analysis we found that changes in the head-shaft angle position of the implant (valgus/varus placement of the CSRA) significantly predicted the age and sex adjusted Constant score. When the inclination angle of the humeral head decreases, the adjusted Constant score increases. In the same model, we also found that the lateral offset of the humerus significantly predicted the adjusted Constant score. When the lateral offset of the humerus decreases, the adjusted Constant score increases. The medialization of the glenoid significantly and negatively predicted the Constant score. Conclusion. CSRA of the shoulder outcomes have been comparable with those of stemmed arthroplasties. Radiolucent lines occur with follow up and most of the time located in the S1 area. Glenoid wear and humeral head lateralization negatively impact the clinical score. Cementless Shoulder resurfacing is a viable alternative to conventional shoulder arthroplasty

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).

The June 2013 Hip & Pelvis Roundup³⁶⁰ looks at: failure in metal-on-metal arthroplasty; minimal hip approaches; whether bisphosphonates improve femoral bone stock following arthroplasty; whether more fat means more operative time; surgical infection; vascularised fibular graft for osteonecrosis; subclinical SUFE; and dentists, hips and antibiotics.