Spasticity used to be considered a contraindication for total hip replacement (THR) procedures. Due to the development of implants as well as surgical skills, THR became an option for the treatment of painful dislocation of the hip joint in patients with spastic plegia. The aim of this study was an evaluation of mid-term results of THR in spastic CP adolescent patients with painful hips with hip joint subluxation or dislocation. In 2014–2022, 18 pts (19 hips) with CP aged 16 to 20 years underwent THR in our department. The mean follow-up was 4 years (range: 1 – 9 years). Results were evaluated using the Gross Motor Function Scale, VAS scale in accordance with the Ashworth scale, types of implants used (dual mobility cup and not dual mobility cup), and radiological assessment (Crowe scale). Complications have been thoroughly analyzed. In 10 pts there has been an improvement in the GMFSC scale average from 1 to 2 points observed after the surgery. All pts have improved in the VAS scale average of 8 points (from 10 to 7). According to the Crowe scale repositioning of preoperative dislocation to primary acetabulum was achieved in all cases. Complications occurred in 4 cases: dislocations of 2 THR with dual mobility cup and 2 THR with non-dual mobility cup requiring revision surgery with good final result. No statistical significance was noted according to the type of cup (Mann-Whitney U Test). The most important risk factor for complications is severe spasticity. We believe, that CP pts with painful hips should be treated using THR. We didn't observe any significant differences between the types of implants. These findings may serve as a basis for the prediction of outcomes of THR treatment in this specific group of pts. Level of evidence: Case-control or retrospective comparative study-Level III
The aim of the study was to evaluate radiological and clinical outcomes of surgical treatment of developmental dysplasia of the hip (DDH) with Periacetabular Osteotomy (PAO) and to determine the values of radiological parameters allowing us to obtain an optimal clinical result. Radiological evaluation included a standardized AP digital radiograph of the hip joints. Centre edge angle (CEA), medialization, distalization, femoral head coverage (FHC) and ilioischial angle were measured. Clinical evaluation based on HHS, WOMAC, Merle d'Aubigne-Postel scales and Hip Lag Sign. Radiological and clinical evaluation was performed preoperatively and approximately 12 months after the surgery. Statistically significant (p<0.05) differences in radiological measurements and all clinical scales have been observed pre- and postoperatively for all of the parameters. The results of PAO presented decreased medialization by 3.4mm (range: 3 to 3.7), distalization by 3.5mm (range: 3.2 to 3.8) and the ilioischial angle by 2.7° (range: 2.2 to 3.7). There was also an improvement in the femoral head bone coverage: CEA increased by 16.3° (range: 12.1˚ to 20.5˚) and FHC by 15.2% (range: 10.8 to 19.8). Clinically we observed an increase in HHS by 22 points (range: 15.8 to 28.2) and M. Postel d'Aubigne by 3.5 points (range: 2.0 to 4.4) and a decrease in WOMAC by 24% (range: 22.6 to 25.8). HLS improvement of gluteal muscles’ efficiency has been observed in 67% of patients postoperatively. This study revealed that the qualification of patients with DDH for an elective PAO is more justified due to the predicted optimal clinical outcomes based on three parameters: CEA <25 degrees, FHC <75%, and ilioischial angle >85.9 degrees. Accordingly, to achieve better clinical results for all scales, it is necessary to increase the average CEA value by 11˚, the average FHC by 11%, and reduce the average ilioischial angle by 3˚.
Developmental dysplasia of the hip (DDH) describes a pathological relationship between the femoral head and acetabulum. Periacetabular osteotomy (PAO) may be used to treat this condition. The aim of this study was to evaluate the results of PAO in adolescents and adults with persistent DDH. Patients were divided into four groups: A, adolescents who had not undergone surgery for DDH in childhood (25 hips); B, adolescents who had undergone surgery for DDH in childhood (20 hips); C, adults with DDH who had not undergone previous surgery (80 hips); and D, a control group of patients with healthy hips (70 hips). The radiological evaluation of digital anteroposterior views of hips included the Wiberg angle (centre-edge angle (CEA)), femoral head cover (FHC), medialization, distalization, and the ilioischial angle. Clinical assessment involved the Harris Hip Score (HHS) and gluteal muscle performance assessment.Aims
Methods
Developmental dysplasia of the hip (DDH) is defined as abnormal, pathological relations between the elements of the hip joint, resulting from disorders of its development. Since 1984, periacetabular bernese osteotomy (PAO) has been a method of treating DDH. The aim of this study was to evaluate the results of the PAO in persistent deformity from childhood and primary late dysplasia in adolescents and adults. Patients were divided into four groups: Improvement in radiological parameters and statistical significance were achieved in all measurements in all patients. The greatest improvement was achieved in: CEA − 19˚ in Group B, Medialization − 3mm in Group C, Distalization − 6mm in Group B, FHC − 17% in Group B, Ilio-ischial angle − 5˚ in Group B. The greatest correction of radiological parameters was obtained in children operated in childhood. Surgical treatment of DDH in childhood worsens the operating conditions in adolescents and adults due to scars, adhesions and altered bone anatomy but leaves the need for less deformity correction. The surgical treatment of DDH in childhood has a beneficial effect on the final outcome of the treatment of patients undergoing PAO surgery in adolescents and young adults.
The aim of the study was to compare two methods of calculating pelvic incidence (PI) and pelvic tilt (PT), either by using the femoral heads or acetabular domes to determine the bicoxofemoral axis, in patients with unilateral or bilateral primary hip osteoarthritis (OA). PI and PT were measured on standing lateral radiographs of the spine in two groups: 50 patients with unilateral (Group I) and 50 patients with bilateral hip OA (Group II), using the femoral heads or acetabular domes to define the bicoxofemoral axis. Agreement between the methods was determined by intraclass correlation coefficient (ICC) and the standard error of measurement (SEm). The intraobserver reproducibility and interobserver reliability of the two methods were analyzed on 31 radiographs in both groups to calculate ICC and SEm.Aims
Methods
The femoral head receives blood supply mainly
from the deep branch of the medial femoral circumflex artery (MFCA).
In previous studies we have performed anatomical dissections of
16 specimens and subsequently visualised the arteries supplying
the femoral head in
55 healthy individuals. In this further radiological study we compared
the arterial supply of the femoral head in 35 patients (34 men and
one woman, mean age 37.1 years (16 to 64)) with a fracture/dislocation
of the hip with a historical control group of 55 hips. Using CT
angiography, we identified the three main arteries supplying the femoral
head: the deep branch and the postero-inferior nutrient artery both
arising from the MFCA, and the piriformis branch of the inferior
gluteal artery. It was possible to visualise changes in blood flow
after fracture/dislocation. Our results suggest that blood flow is present after reduction
of the dislocated hip. The deep branch of the MFCA was patent and
contrast-enhanced in 32 patients, and the diameter of this branch
was significantly larger in the fracture/dislocation group than
in the control group (p = 0.022). In a subgroup of ten patients
with avascular necrosis (AVN) of the femoral head, we found a contrast-enhanced
deep branch of the MFCA in eight hips. Two patients with no blood
flow in any of the three main arteries supplying the femoral head
developed AVN. Cite this article:
The femoral head receives its blood supply primarily
from the medial femoral circumflex artery, with its deep branch being
the most important. In a previous study, we performed classical anatomical dissections
of 16 hips. We have extended our investigation with a radiological
study, in which we aimed to visualise the arteries supplying the
femoral head in healthy individuals. We analysed 55 CT angiographic
images of the hip. Using 64-row CT angiography, we identified three main arteries
supplying the femoral head: the deep branch of the medial femoral
circumflex artery and the posterior inferior nutrient artery originating
from the medial femoral circumflex artery, and the piriformis branch
of the inferior gluteal artery. CT angiography is a good method
for visualisation of the arteries supplying the femoral head. The
current radiological studies will provide information for further
investigation of vascularity after traumatic dislocation of the
hip, using CT angiography.
We performed a series of 16 anatomical dissections
on Caucasian cadaver material to determine the surgical anatomy
of the medial femoral circumflex artery (MFCA) and its anastomoses.
These confirmed that the femoral head receives its blood supply
primarily from the MFCA via a group of posterior superior nutrient
arteries and the posterior inferior nutrient artery. In terms of
anastomoses that may also contribute to the blood supply, the anastomosis
with the inferior gluteal artery, via the piriformis branch, is
the most important. These dissections provide a base of knowledge
for further radiological studies on the vascularity of the normal
femoral head and its vascularity after dislocation of the hip.
Improvement in coverage achieved by double or triple osteotomies is limited by the size of the acetabular fragment and the ligaments connected with the sacrum. Correction is achieved with the notable asymmetry of the pelvis. In periacetabular Ganz osteotomy (PAO) the acetabular fragment has no connection with the sacrum, which creates enormous possibilities for correction, leaving the pelvic ring untouched. The aim of the study is to present our experience and early results of using PAO in the treatment of hip dysplasia in adolescents and young adults who were previously treated operatively in childhood, and to find the technical and clinical impact of previous operations on our Results: In the years 1998–2005 262 periacetaubular osteotomies were performed in our hospital. All the patients were operated by one surgeon (JC). From this group 41 patients (43 hips) had previously been operated in childhood for the treatment of hip dysplasia. The previous treatment consisted of: open reduction in 10 hips, DVO in 14 hips, pelvic osteotomy (Salter, Dega, Chiari) in 8 hips, combined: open reduction+DVO+pelvic osteotomy in 10 hips, greater trochanter transfer in 3 hips, bone lengthening in 4 hips, acetabular cyst removal in 1 hip. The age at the primary operation ranged from 1–20.. The follow-up period ranged from 1–7,5 ys av. 2 ys. In 31 hips the Smith-Petersen, and in 12 hips ilioinguinal approach were performed.
We find the technique of PAO as a safe, and effective tool for treating hip joint pathology increasing treatment possibilities for hip joint preservation.
The aim of the study was to assess the results of posterolateral fusion (PLF) of L5/S1 level spondylolisthesis.
In every case suspension in prone position were applied before surgery.
On MRI scans disc degeneration was observed in 2 patients.
We think that PLF in painful grade I and II spondylolisthesis is adequate method of treatment.
The term of hip dysplasia means an abnormality of shape, size or spatial configuration of the acetabulum. It also concerns the femoral head, with mutual relationships, proportions and alignment between the femoral head and the acetabulum the most crucial factors. The reason of any symptoms in hip dysplasia is the dysplastic acetabulum and its disproportion in relation to the femoral head. Dysplasia of the acetabulum appearing at puberty has been attributed to secondary “absorption” of bony acetabulum. The presence of fatigue fractures at a later age has been considered as resulting from trauma. However, the fragments of the acetabular rim should be ascribed to overloading of the rim in dysplastic hips, causing fracture and separation of its segment. They are sometimes associated with cysts in the acetabular roof. Limbus tears with or without an associated bony fragment are known to occur after traumatic dislocation of the hip but also without any history of injury. There is no explanation of their cause or their relation to acetabular dysplasia. Limbus tears have been diagnosed by arthroscopy, arthrography and CT scans.
Reorientation of the dysplastic acetabulum can be achieved with a simple Salter or Dega osteotomy. While this may be beneficial in children, it is usually insufficient in more severe adolescent or adult dysplasias. Improvement in coverage with double and triple oste-otomies is limited by the size of the acetabular fragment and the ligaments connected to the sacrum. Correction is achieved with the notable asymmetry of the pelvis. The development of these osteotomies results in making the acetabular fragment smaller and smaller and without ligamentous connection between sacrum and sciatic bone. The periacetabular Ganz osteotomy (PAO) is a compromise of the size of acetabular fragment between triple and dial (spherical) osteotomies. The acetabular fragment as in triple Carlioz and Tonnis osteotomies has no connection with the sacrum, what results in enormous possibilities for correction . Finally, the pelvic ring is left untouched. The aim of the study is to present our experience and early results in using this technique in the treatment of dysplasia with subluxation in adolescent and young adults. Our material consists of 42 hips in 35 patients (29 females and 6 males) operated in years 1998 – 2001. In 7 cases there was bilateral involvement, the rest were unilateral. The age at operation was between 11 and 39 years, mean 17,5 years. The indication for the PAO in all cases was acetabular dysplasia with different degree of subluxation. In 10 hips there was severe subluxation with CE below 0°, in 4 hips the signs of osteoarthritis were found. The follow-up ranged from 1 to 4 years. Methods. The PAO as a single procedure was done in 39 hips. In only 3 hips the subtrochanteric DVO was done simultaneously. In clinical pre-op. and post-op. examination the following factors were regarded: pain, limping, Trendelenburg sign, range of motion, leg length discrepancy. Radiographic pre-op. and post-op. examination consisted of AP view of the pelvis, false profile and AP view with leg in abduction. Classic and anterior CE angles were measured. Results. Flexion slightly decreased from pre-op. 90-140° (av.118°) to 80-130° (av.104°) post-op., abduction left unchanged 15-80° (av.40°) and 15-80° (40°) respectively, adduction slightly increased 15-50° (av.31°) and 20-50° (av. 33°). The range of rotation did not change after operation. The sign of Trendelenburg was found in 27 hips pre-op. and in 8 hips post-op. Pain was found in 29 hips before operation and in 4 after surgery. Either classic or anterior CE angle increased after surgery to the normal value in almost all cases from −14° to 34° and from −10° to 35° respectively. We had a rather low complication rate. In our group 35 operations were done without any complications. In 7 hips the following complications were found: in 1 hip overcorrection and in 2 others insufficient correction, 2 urinary infections, ectopic bone formation in 1 hip, local soft tissue infection in 1 hip and in 1 bad scar formation. We did not find any signs of AVN in our series.
There is a very long way from diagnosis to treatment of the developmental dysplasia of the hip. Everything is complex: clinical examination is subtle and requires a long training. Treatment is not as simple as could be thought. The risks include approximate examinations and of standard, ready-made ones. The discussion has not been settled as to whether all children with hip instability can be clinically detected at birth. The complexity of the problem arises from the fact that only 10% of children who have instability at birth develop long-term problems if they are left untreated. It is well known, affirmed by several different studies that at birth the incidence of hip instability in approximately 1–4% of patients, with figure being higher in girls. There is also a consensus that a large majority of these unstable hips will become stable during the first few days of life, even without treatment. Some children are at particular risk of hip instability. Those infants are labeled as “high risk”. They include children born in families with hip instability, those presented by breech, first born children or products of oligohydramniotic pregnancies, particularly girls, those with the generalized joint laxity, those with torticollis and scoliosis, those with foot deformities and increased birth-weight over 4000g. Whilst all children should be screened at birth by a doctor experienced in clinical examination with particular attention directed to those children, who are considered high risk. It must be emphasized that