The purpose of this study was to determine patient-reported
outcomes of patients with mild to moderate developmental dysplasia
of the hip (DDH) and femoroacetabular impingement (FAI) undergoing
arthroscopy of the hip in the treatment of chondrolabral pathology.
A total of 28 patients with a centre-edge angle between 15° and
19° were identified from an institutional database. Their mean age
was 34 years (18 to 53), with 12 female and 16 male patients. All
underwent labral treatment and concomitant correction of FAI. There
were nine reoperations, with two patients requiring revision arthroscopy,
two requiring periacetabular osteotomy and five needing total hip arthroplasty. Patients who required further major surgery were more likely
to be older, male, and to have more severe DDH with a larger alpha
angle and decreased joint space. At a mean follow-up of 42 months (24 to 89), the mean modified
Harris hip score improved from 59 (20 to 98) to 82 (45 to 100; p
<
0.001). The mean Western Ontario and McMaster Universities
Osteoarthritis Index score improved from 30 (1 to 61) to 16 (0 to
43; p <
0.001). Median patient satisfaction was 9.0/10 (1 to
10). Patients reported excellent improvement in function following
arthroscopy of the hip. This study shows that with proper patient selection, arthroscopy
of the hip can be successful in the young patient with mild to moderate
DDH and FAI. Cite this article:
The aim of this prospective study was to investigate
prematurity as a risk factor for developmental dysplasia of the hip
(DDH). The hips of 221 infants (88 female, 133 male, mean age 31.11
weeks; standard deviation ( These results suggests that prematurity is not a predisposing
factor for DDH. Cite this article:
The February 2015 Hip &
Pelvis Roundup360 looks at: Hip arthroplasty in Down syndrome; Bulk femoral autograft successful in acetabular reconstruction; Arthroplasty follow-up: is the internet the solution?; Total hip arthroplasty following acetabular fracture; Salvage arthroplasty following failed hip internal fixation; Bone banking sensible financially and clinically; Allogenic blood transfusion in arthroplasty.
Successful management of late presenting hip
dislocation in childhood is judged by the outcome not just at skeletal
maturity but well beyond into adulthood and late middle age. This
review considers different methods of treatment and looks critically
at the handful of studies reporting long-term follow-up after successful
reduction. Cite this article
In this study we used subject-specific finite
element analysis to investigate the mechanical effects of rotational acetabular
osteotomy (RAO) on the hip joint and analysed the correlation between
various radiological measurements and mechanical stress in the hip
joint. We evaluated 13 hips in 12 patients (two men and ten women, mean
age at surgery 32.0 years; 19 to 46) with developmental dysplasia
of the hip (DDH) who were treated by RAO. Subject-specific finite element models were constructed from
CT data. The centre–edge (CE) angle, acetabular head index (AHI),
acetabular angle and acetabular roof angle (ARA) were measured on
anteroposterior pelvic radiographs taken before and after RAO. The
relationship between equivalent stress in the hip joint and radiological measurements
was analysed. The equivalent stress in the acetabulum decreased from 4.1 MPa
(2.7 to 6.5) pre-operatively to 2.8 MPa (1.8 to 3.6) post-operatively
(p <
0.01). There was a moderate correlation between equivalent
stress in the acetabulum and the radiological measurements: CE angle
(R = –0.645, p <
0.01); AHI (R = –0.603, p <
0.01); acetabular
angle (R = 0.484, p = 0.02); and ARA (R = 0.572, p <
0.01). The equivalent stress in the acetabulum of patients with DDH
decreased after RAO. Correction of the CE angle, AHI and ARA was
considered to be important in reducing the mechanical stress in
the hip joint. Cite this article:
We wished to establish whether delivery by Caesarean section influenced the incidence of developmental dysplasia of the hip in term breech infants compared with those delivered vaginally. We used maternal charts, singleton term breech presentation, mode of delivery and incidence of developmental dysplasia of the hip for births between January 1997 and October 2002. During the study period 46 089 infants were born. We analysed a total of 941 breech infants of whom 756 were delivered by Caesarean section (515 pre-labour, 241 intrapartum) and 185 vaginally. The incidence of developmental dysplasia of the hip according to the mode of delivery was 19 of 515 (3.69%) following pre-labour Caesarean section, 16 of 241 (6.64%) for intrapartum Caesarean section and 15 of 185 (8.11%) after vaginal delivery. There was a lower incidence of developmental dysplasia of the hip among those infants delivered by elective Caesarean section compared with those delivered vaginally (p <
0.02). These results demonstrate a significantly lower incidence of developmental dysplasia of the hip in term singleton breech births delivered by elective, pre-labour Caesarean section and suggest that labour and delivery influence hip stability in predisposed infants.
The August 2014 Children’s orthopaedics Roundup360 looks at: Conservative treatment still OK in paediatric clavicular fractures; Femoral anteversion not the usual suspect in patellar inversion; Shoulder dislocation best treated with an operation; Perthes’ disease results in poorer quality of adult life; Physiotherapy little benefit in supracondylar fractures; Congenital vertical talus addressed at the midtarsal joint; Single-sitting DDH surgery worth the effort; and cubitus valgus associated with simple elbow dislocation
The practice of regular radiological follow-up of infants with a positive family history of developmental dysplasia of the hip is based on the widespread belief that primary acetabular dysplasia is a genetic disorder which can occur in the absence of frank subluxation or dislocation. We reviewed all infants who were involved in our screening programme for developmental dysplasia of the hip, between November 2002 and January 2004, and who had a normal clinical and ultrasound examination of the hip at six to eight weeks of age, but who, because of a family history of developmental dysplasia of the hip, had undergone further radiography after an interval of 6 to 12 months. The radiographs of 89 infants were analysed for signs of late dysplasia of the hip and assessed independently by three observers to allow for variability of measurement. There were 11 infants (11%) lost to follow-up. All the patients had normal radiographs at the final follow-up and none required any intervention. We therefore question the need for routine radiological follow-up of infants with a positive family history of developmental dysplasia of the hip, but who are normal on clinical examination and assessment by ultrasound screening when six to eight weeks old.
We describe the clinical and radiological results
of cementless primary total hip replacement (THR) in 25 patients
(18 women and seven men; 30 THRs) with severe developmental dysplasia
of the hip (DDH). Their mean age at surgery was 47 years (23 to
89). In all, 21 hips had Crowe type III dysplasia and nine had Crowe
type IV. Cementless acetabular components with standard polyethylene
liners were introduced as close to the level of the true acetabulum
as possible. The modular cementless S-ROM femoral component was
used with a low resection of the femoral neck. A total of 21 patients (25 THRs) were available for review at
a mean follow-up of 18.7 years (15.8 to 21.8). The mean modified
Harris hip score improved from 46 points pre-operatively to 90 at
final follow up (p <
0.001). A total of 15 patients (17 THRs; 57%) underwent revision of the
acetabular component at a mean of 14.6 years (7 to 20.8), all for
osteolysis. Two patients (two THRs) had symptomatic loosening. No
patient underwent femoral revision. Survival with revision of either
component for any indication was 81% at 15 years (95% CI 60.1 to
92.3), with 21 patients at risk. This technique may reduce the need for femoral osteotomy in severe
DDH, while providing a good long-term functional result. Cite this article:
Peri-acetabular osteotomy is an established surgical
treatment for symptomatic acetabular dysplasia in young adults.
An anteroposterior radiograph of the pelvis is commonly used to
assess the extent of dysplasia as well as to assess post-operative
correction. Radiological prognostic factors include the lateral
centre-edge angle, acetabular index, extrusion index and the acetabular
version. Standing causes a change in the pelvis tilt which can alter
certain radiological measurements relative to the supine position.
This article discusses the radiological indices used to assess dysplasia
and reviews the effects of patient positioning on these indices
with a focus on assessment for a peri-acetabular osteotomy. Intra-operatively,
fluoroscopy is commonly used and the implications of using fluoroscopy
as a modality to assess the various radiological indices along with
the effects of using an anteroposterior or posteroanterior fluoroscopic
view are examined. Each of these techniques gives rise to a slightly different
image of the pelvis as the final image is sensitive to the position
of the pelvis and the projection of the x-ray beam. Cite this article:
There is little in the literature on the level
of participation in sports which patients undertake after total
hip replacement (THR). Our aims in this study were to determine
first, the level of sporting activity, second, the predictive factors
for returning to sporting activity, and third, the correlation between
participation in sports and satisfaction after THR. We retrospectively
identified 815 patients who had undergone THR between 1995 and 2005. All
were asked to complete a self-administered questionnaire regarding
their sporting activity. A total of 571 patients (71%) met the inclusion
criteria and completed the evaluation. At a mean follow-up of 9.8
years ( In conclusion, we found that most patients participate in sporting
activity after THR, regardless of the advice of their surgeon, and
that there is a correlation between the level of participation and
pre-operative function, motivation, duration of symptoms and post-operative
satisfaction. Cite this article:
Most centres in the United Kingdom adopt a selective
screening programme for developmental dysplasia of the hip (DDH)
based on repeated clinical examination and selective ultrasound
examination. The Newborn Infant Physical Examination protocol implemented
in 2008 recommends a first examination at birth and then a second
and final examination at six to ten weeks of age. Due to concerns
over an increase in late presentations we performed a retrospective
review of our 15-year results to establish if late presentation
increases treatment requirements. Of children presenting before
six weeks of age, 84% were treated successfully with abduction bracing,
whereas 86% of children presenting after ten months eventually required
open reduction surgery. This equates to a 12-fold increase in relative
risk of requiring open reduction following late presentation. Increasing
age at presentation was associated with an increase in the number
of surgical procedures, which are inevitably more extensive and complex,
with a consequent increased in cost per patient. The implementation
of an opportunistic examination at three to five months could help
to reduce the unintended consequences of the Newborn Infant Physical Examination
programme. Cite this article:
The June 2013 Children’s orthopaedics Roundup360 looks at: whether reaching a diagnosis is more difficult than previously thought; adolescent and paediatric DDH; the A-frame orthosis and Legg-Calvé-Perthes’ disease; failure of hip surgery in patients with cerebral palsy; adolescent rotator cuff injuries; paediatric peripheral nerve injuries; predicting residual deformity following Ponseti treatment; and the Dunn procedure.
The term developmental dysplasia of the hip (DDH)
describes a spectrum of disorders that results in abnormal development
of the hip joint. If not treated successfully in childhood, these
patients may go on to develop hip symptoms and/or secondary osteoarthritis
in adulthood. In this review we describe the altered anatomy encountered
in adults with DDH along with the management options, and the challenges
associated with hip arthroscopy, osteotomies and arthroplasty for
the treatment of DDH in young adults. Cite this article:
The February 2013 Children’s orthopaedics Roundup360 looks at: ABC treated with suction and curettage; peri-acetabular osteotomy; cast index; Perthes’ disease associated with accidental injury; brachial plexus birth palsy; MRI assessment of DDH; total meniscectomy; and paediatric septic arthritis.
The April 2012 Children’s orthopaedics Roundup360 looks at osteonecrosis of the femoral head and surgery for dysplasia, femoral head blood flow during surgery, femoroacetabular impingement and sport in adolescence, the Drehmann sign, a predictive algorithm for septic arthritis, ACL reconstruction and arthrofibrosis in children, spinal cord monitoring for those less than four years old, arthroereisis for the flexible flat foot, fixing the displaced lateral humeral fracture, and mobile phones and inclinometer applications
The purpose of this study was twofold: first,
to determine whether the five-year results of hip resurfacing arthroplasty
(HRA) in Canada justified the continued use of HRA; and second,
to identify whether greater refinement of patient selection was
warranted. This was a retrospective cohort study that involved a review
of 2773 HRAs performed between January 2001 and December 2008 at
11 Canadian centres. Cox’s proportional hazards models were used
to analyse the predictors of failure of HRA. Kaplan–Meier survival
analysis was performed to predict the cumulative survival rate at
five years. The factors analysed included age, gender, body mass
index, pre-operative hip pathology, surgeon’s experience, surgical
approach, implant sizes and implant types. The most common modes
of failure were also analysed. The 2773 HRAs were undertaken in 2450 patients: 2127 in men and
646 in women. The mean age at operation was 50.5 years ( The failure rates of HRA at five years justify the ongoing use
of this technique in men. Female gender is an independent predictor
of failure, and a higher failure rate at five years in women leads
the authors to recommend this technique only in exceptional circumstances
for women. Cite this article:
The April 2012 Hip &
Pelvis Roundup360 looks at osteoporotic hip fractures, retrotrochanteric pain, fibrin adhesive and reattachment of articular cartilage, autologous bone marrow mononuclear cells and avascular necrosis, bearing surfaces, stability after THR, digital templating, pelvic tilt after THR, custom-made sockets for DDH, and dogs and THR
Developmental dysplasia of the hip predisposes to premature degenerative hip disease. A number of operations have been described to improve acetabular cover and have achieved varying degrees of success. We present the case of an 84-year-old woman, who underwent a shelf procedure to reconstruct a dysplastic hip 75 years ago. To date, the shelf remains intact and the hip is asymptomatic. We believe this represents the longest documented outcome of any procedure to stabilise the hip.