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Acta Orthopaedica Feb 2014Residual acetabular dysplasia is one of the most common complications after treatment for developmental dysplasia of the hip. The acetabular growth response after...
BACKGROUND
Residual acetabular dysplasia is one of the most common complications after treatment for developmental dysplasia of the hip. The acetabular growth response after reduction of a dislocated hip varies. The options are to wait and add a redirectional osteotomy as a secondary procedure at an older age, or to perform a primary acetabuloplasty at the time of the open reduction to stimulate acetabular development. We present the early results of such a procedure-open reduction and an incomplete periacetabular acetabuloplasty-as a one-stop procedure for developmental dysplasia of the hip.
PATIENTS AND METHODS
We retrospectively reviewed the results obtained with 55 hips (in 48 patients, 43 of them girls) treated between September 2004 and February 2011. This cohort included late presentations and failures of nonoperative treatment and excluded unsuccessful previous surgical treatment (including closed reductions), neuromuscular disease, and other teratological conditions. Patients were treated once the ossific nucleus was present or when they reached one year of age. 31 cases were late presentations while 17 represented failures of nonoperative treatment. The mean age of the patients at surgery was 1.3 (0.6-2.6) years. The mean follow-up period was 4 (2-8) years. According to the IHDI classification, 1 was grade I, 9 were grade II, 13 were grade III, and 32 were grade IV. Results The mean acetabular index fell from 38 (23-49) preoperatively to 21 (10-27) at the last follow-up. There were no infections, nerve palsies, or graft extrusions. None of the cases required secondary surgery for residual acetabular dysplasia. 8 patients developed avascular necrosis (AVN) of grade II or more. The incidence of AVN was significantly associated with previous, failed nonoperative treatment. 1 patient developed coxa magna requiring shelf arthroplasty 4 years after the index procedure and 1 patient with lateral growth arrest required medial screw epiphysiodesis.
INTERPRETATION
This incomplete periacetabular acetabuloplasty is a reliable adjunct to open reductions, and it is followed by a rapid acetabular growth response that avoids secondary pelvic procedures. It is a one-stop surgery with predictable outcome that can be performed in 0.5- to 2.5-year-old children.
Topics: Acetabulum; Child, Preschool; Female; Femur Head; Follow-Up Studies; Hip Dislocation, Congenital; Humans; Infant; Male; Osteotomy; Radiography; Retrospective Studies; Treatment Outcome
PubMed: 24460107
DOI: 10.3109/17453674.2014.886030 -
Jornal Vascular Brasileiro 2016Endovenous laser treatment of saphenous veins offers patients a procedure with low rates of complications and an early return to occupational activities.
BACKGROUND
Endovenous laser treatment of saphenous veins offers patients a procedure with low rates of complications and an early return to occupational activities.
OBJECTIVE
To compare rates of formation of bruising, of paresthesia along the path of the great saphenous vein (GSV), and of GSV obliteration 30 days after thermal ablation in the thigh, performed with or without tumescence and using two different types of fiber.
METHODS
This was a prospective study, analyzing three groups of patients who underwent GSV thermal ablation in the thigh, using a wavelength of 1470 nm. Patients in group 1 were treated with a conventional fiber using tumescence; those in group 2 were treated with a conventional fiber without using tumescence; and patients in group 3 were treated with a double radial fiber without tumescence. After 30 days, the rates of obliteration shown by Doppler ultrasonography, of paresthesias, and of bruising were compared.
RESULTS
Comparison of the results of thermal ablation of 90 GSVs in the thigh revealed similar rates of obliteration, with no statistical differences. The rate of paresthesia along the path of the GSV in the thigh was higher in the groups without tumescence than in the group with tumescence, but the difference only attained statistical significance for the comparison with the group that was treated with the conventional fiber. There was bruising in all groups, with greater frequency in group 1 (73.33%).
CONCLUSIONS
Tumescence proved useful for preventing minor neurological injuries, but didn’t have any influence on the rates of bruising occurrence or of occlusion of the GSV in the thigh up to 30 days after thermal ablation.
PubMed: 29930593
DOI: 10.1590/1677-5449.004616 -
Srpski Arhiv Za Celokupno Lekarstvo 2011Femoroacetabular impingement is an undesirable contact between acetabular rim and femoral neck and presents abnormality of proximal femoral part and acetabulum, as well.... (Review)
Review
Femoroacetabular impingement is an undesirable contact between acetabular rim and femoral neck and presents abnormality of proximal femoral part and acetabulum, as well. Two forms may appear: cam impingement and pincer impingement. Femoroacetabular impingement related to Legg-Calvé-Perthes disease may be caused by various reasons, as the consequence of the disease itself, and as the consequence of its treatment. Coxa magna deformity (large femoral head and neck) and coxa brevis deformity (shortened femoral neck) may produce cam femoroacetabular impingement during hip flexion. After the disease, the flattened femoral head (coxa plana) may persist. Chiari pelvic osteotomy is the only treatment option for such femoral head deformity. Acetabular labrum squeezed continuously between the femoral head and the non-articular part of the cut iliac bone lead to cam femoroacetabular impingement, as well. If Salter or triple pelvic osteotomy is used that may cause a very large iatrogenic acetabular retroversion, we can also refer to radial type pincer femoroacetabular impingement. Treatment of Legg-Calvé-Perthes disease should be conducted according to the natural course of the disease and prognosis. Treatment should start on time, well before a crushed femoral head develops, because it is the easiest way to establish hip spherical congruency at the end of treatment. This is the best option to prevent secondary hip arthrosis caused by femoroacetabular impingement or by insufficient head coverage at the end of remodelling. In each case of delayed hip pain, followed by a limited range of movements, femoroacetabular impingement should be taken into consideration, confirmed, and treated by some of the available therapeutic methods.
Topics: Femoracetabular Impingement; Humans; Legg-Calve-Perthes Disease
PubMed: 22338487
DOI: 10.2298/sarh1112834v -
Folia Medica Cracoviensia 2019Articular cartilage is highly-organized nonvascularized tissue which is responsible in humans for pressure absorption under load, as well as for the smoothness of the...
BACKGROUND
Articular cartilage is highly-organized nonvascularized tissue which is responsible in humans for pressure absorption under load, as well as for the smoothness of the opposite tangential bone surfaces. The purpose of our research is to study structural and functional features of articular cartilage at light- optical level by using state-of-the-art research methods of bone-cartilage tissue.
MATERIAL AND METHODS
the study was conducted on samples of femoral heads. Hyper fine sections were subject to hematoxylin and eosin, Van Gieson's and PAS staining. In order to identify the receptor profile of chondrocytes and the features of protein arrangement in extracellular matrix we undertook an immunohistochemical study.
RESULTS
An articular cartilage is quite organized tissue. As any other organ, it has parenchyma and stroma. Parenchyma is represented by one type of cells - chondrocytes, which, depending on how deep they are located in cartilage, have a different shape, size and functional features. The chondrocytes and extracellular matrix have different degrees of receptors expression.
CONCLUSIONS
the cartilage is being constantly self-renewed, what is manifested by means of a rather slow division of the surface-located chondrocytes and programmed death of dystrophic-modi ed cells. The features of extracellular matrix structure determine the originality of cell location in different areas of cartilage tissue. Due to synthesis of specific proteins, chondrocytes self-regulate properties of cartilage tissue.
Topics: Adult; Animals; Antibodies; Cartilage, Articular; Coxa Magna; Extracellular Matrix; Humans; Male; Mice; Middle Aged; Rabbits
PubMed: 31891362
DOI: 10.24425/fmc.2019.131138 -
Journal of Children's Orthopaedics Aug 2018Developmental dysplasia of the hip (DDH) after walking age is difficult to treat. Dega pelvic osteotomy is combined with open reduction and femoral osteotomy to obtain...
PURPOSE
Developmental dysplasia of the hip (DDH) after walking age is difficult to treat. Dega pelvic osteotomy is combined with open reduction and femoral osteotomy to obtain concentric stable reduction with good coverage of the femoral head. The purpose of this study is to evaluate the use of the Dega osteotomy in the treatment of DDH in two different age groups.
METHODS
A total of 45 patients (52 hips) with a mean age of 3.9 years (1.2 to 12.8) were treated with open reduction, Dega osteotomy and femoral osteotomy. There were 38 dislocated and 14 subluxated hips. Bilateral DDH was observed in seven female patients. Radiographic parameters included acetabular index, centre-edge angle of Wiberg and migration percentage. The final radiographic outcome was evaluated according to the Severin classification.
RESULTS
The mean follow-up period was four years (3 to 9). According to the Severin criteria 78.8% were types I or II whereas 21.2% showed types III or IV. There was no statistically significant difference in final outcome between children less than three years of age and older children at the time of surgery.One hip in children with unilateral involvement had developed coxa magna, that interfered with hip concentricity. Three hips (5.8%) showed avascular necrosis of the femoral head.
CONCLUSION
Dega osteotomy is a safe and adequate procedure for the management of developmental dysplasia of the hip in walking patients with low complication rates. Restoring the acetabulum to normal or nearly normal can result in good medium-term results.
LEVEL OF EVIDENCE
III.
PubMed: 30154924
DOI: 10.1302/1863-2548.12.180091 -
Journal of Hip Preservation Surgery Jun 2021Residual hip deformity secondary to Perthes disease may lead to early symptomatic joint degeneration. The altered anatomy results in biomechanical and biological...
Residual hip deformity secondary to Perthes disease may lead to early symptomatic joint degeneration. The altered anatomy results in biomechanical and biological problems that can be surgically addressed in adolescents or young adults with hip preservation procedures. This case report aims to demonstrate a customized surgical treatment performed on a 15-year-old male who developed painful hips with significant intra- and extra-articular impingement, secondary to bilateral Leg-Calvé-Perthes disease residual deformity. Intra-articular procedures were executed through a safe surgical dislocation of the hip, with a mosaicplasty using osteochondral autografts from the exceeding peripheral ipsilateral femoral head, a femoral head-neck osteochondroplasty and a labrum repair. A relative lengthening of the femoral neck was also carried out with a trochanteric advancement to solve the extra-articular issues. On follow-up, he referred to a substantial improvement in pain and function, being his radiographic studies satisfactory. At 4 and 5 years from surgery, the patient was able to exercise regularly with minimal complaints, with a Harris Hip Score of 85.85% and a Hip Outcome Score of 94.1% for activities of daily life and 86.1% for sports. In patients with hip deformity after healed Perthes disease, treatment strategies that address both the morphological disturbance of coxa magna, plana and breva, as well as the biological concerns arising from osteochondral injuries or labral tears, and mechanical dysfunctions lead to improvements in symptomatology, function and medium-term prognosis. Further procedures to address residual adaptative acetabular dysplasia would favor outcomes of conservative hip surgery in the sequelae of LCPD.
PubMed: 34178366
DOI: 10.1093/jhps/hnab021 -
Indian Journal of Orthopaedics Sep 2022We aimed to compare the outcomes between closed reduction (CR) and open reduction (OR) in children aged 6-24 months with developmental dysplasia of the hip (DDH) who...
PURPOSE
We aimed to compare the outcomes between closed reduction (CR) and open reduction (OR) in children aged 6-24 months with developmental dysplasia of the hip (DDH) who could be reduced safely and stably by the closed reduction operation.
METHODS
We retrospectively reviewed the medical records of 77 patients who underwent CR or OR for DDH. Fifty-one patients (56 hips) underwent CR, 26 (29 hips) underwent OR. The demographic data, International Hip Dysplasia Institute classification and acetabular index (AI) before reduction and the centre-edge angle (CEA), AI, Alsberg angle (AA), Reimer's migration index (RMI), and height-to-width index (HWI) of the epiphysis were compared between two groups at the final follow-up. The percentage of coxa magna > 15% of the normal side and AA > 81° were calculated.
RESULTS
At the final follow-up, the mean AA in the CR and OR groups were 77.66° (60°-89°) and 81.97° (73°-91°) ( = 0.001), respectively, there were 32.14% and 58.62% of the hips with an AA > 81° ( = 0.019). The frequency of coxa magna > 15% of the normal side was higher in the OR group (60.9%) than in the CR group (6.5%) ( < 0.001). There was no difference in the improvement of AI, CEA, HWI, and RMI.
CONCLUSION
In children aged 6-24 months with DDH, if a stable and safe CR can be obtained but with medial joint space up to 6mm, CR should be attempted first.
PubMed: 36052390
DOI: 10.1007/s43465-022-00690-9 -
BMC Musculoskeletal Disorders Jul 2018Treponema Pallidum (TP), the pathogen of syphilis, commonly infects bones in cases of congenital and tertiary syphilis, but it is rare in the primary and secondary... (Review)
Review
BACKGROUND
Treponema Pallidum (TP), the pathogen of syphilis, commonly infects bones in cases of congenital and tertiary syphilis, but it is rare in the primary and secondary stages. With its mild symptoms and rare clinical findings, it might be easy to dismiss the diagnosis of early syphilis. Usually, effective results can be achieved after the conventional strategy of antibiotic treatments, mainly penicillin. To our knowledge, our case is so far the most serious reported case of destructive bone lesion in secondary syphilis, and our treatment for the case is the first strategy using total hip arthroplasty in secondary syphilis.
CASE PRESENTATION
We present the case of a 71-year-old man with local repeated pain and dysfunction in the right hip. Radiologic examinations showed the disappearance of the ipsilateral femoral head and neck. After excluding the aetiologies of cancer metastasis and tuberculosis, we confirmed the diagnosis of syphilitic arthritis. The patient received the medical treatment of antibiotics and the surgical treatment of total hip arthroplasty. At the follow-up of 1, 3, and 5.5 years after the operation, the patient presented with a pain-free and functional hip prosthesis without local signs of infection and loosening.
CONCLUSIONS
This report highlights the difficulties of early diagnosis of secondary syphilis with bone involvement. Bone defect of the femur with secondary syphilis, especially at the proximal femur, was an extremely rare complication in the previous reports. Our case was the first case of a patient who experienced the disappearance of femoral head and neck caused by secondary syphilis. Follow-up after the operation proved the successful treatment of the extensive bone defect of femur by total hip arthroplasty.
Topics: Aged; Coxa Magna; Femur Neck; Follow-Up Studies; Humans; Male; Syphilis
PubMed: 30045704
DOI: 10.1186/s12891-018-2152-1 -
Journal of Orthopaedic Research :... Sep 2017The purpose of this study was to quantify femoral head deformity in patients with Legg-Calvé-Perthes disease (LCPD) using a novel three dimensional (3D) magnetic...
The purpose of this study was to quantify femoral head deformity in patients with Legg-Calvé-Perthes disease (LCPD) using a novel three dimensional (3D) magnetic resonance imaging (MRI) reconstruction and volume based analysis. Bilateral femoral heads of 17 patients (mean age 9.9 ± 2.0 years; 12 boys, 5 girls) with LCPD were scanned 1-2 times (n = 33 LCPD heads, 20 normal heads) using a 1.5T MRI scanner. Fourteen patients had unilateral and three had bilateral LCPD with five hips in the Waldenström initial stage, 9 in the fragmentation stage, 14 in the reossification stage, and 5 in the healed stage. 3D digital reconstructions of femoral heads were created using MIMICS software. Deformity was quantified using a 3D volume ratio method based on reference hemisphere volume as well as two surface geometry methods. Intra-observer analysis showed that 97% of the LCPD femoral heads were within 10% of the original value and test shapes had 99.6% accuracy. For normal femoral heads, the volume ratios of all except one were between 95 and 98% (n = 20) of a perfect hemisphere volume. For femoral heads affected with LCPD, the volume ratios ranged from 43% to 96% of a perfect hemisphere (n = 33). The volume ratio method and the two surface geometry comparison methods had high correlation (r = 0.89 and 0.96). In summary, the 3D MRI volume ratio method allowed accurate quantification and demonstrated small changes (<10%) of the femoral head deformity in LCPD. This method may serve as a useful tool to evaluate the effects of treatment on femoral head shape. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2051-2058, 2017.
Topics: Child; Coxa Magna; Female; Femur Head; Humans; Imaging, Three-Dimensional; Legg-Calve-Perthes Disease; Magnetic Resonance Imaging; Male
PubMed: 27864891
DOI: 10.1002/jor.23484 -
Acta Orthopaedica Feb 2006In Legg-Calvé-Perthes disease (LCPD), 4 major patterns (coxa plana, coxa magna, coxa vara, subluxation) of the femoral head are commonly observed. However, direct...
BACKGROUND
In Legg-Calvé-Perthes disease (LCPD), 4 major patterns (coxa plana, coxa magna, coxa vara, subluxation) of the femoral head are commonly observed. However, direct observation of pathological specimens is rarely possible. An animal model of LCPD may clarify the pathogenesis of femoral head deformity.
ANIMALS AND METHODS
In 26 piglets, we interrupted the vascular supply to the capital femoral epiphysis by cutting the ligamentum teres and ligating the femoral neck containing the epiphyseal artery. 6-7 piglets in each experimental group were killed at early (2 and 4 weeks: P2 and P4), intermediate (12 weeks: P12), and late (20 weeks: P20) periods. We examined the extracted femoral heads macroscopically and radiographically.
RESULTS
The mean decrease in epiphyseal height was 1.5 mm, 4.1 mm, 5.0 mm, and 7.5 mm in P2, P4, P12 and P20, respectively (rs = 0.76, p = 0.002). The mean increase of diameter was 4.1 mm, 6.9 mm, and 6.8 mm in P4, P12 and P20, respectively. Decrease of the articulotrochanteric distance was mild in P2 and P4, and severe in P12 and P20. Subluxation of the femoral head was observed only in P12 and P20 piglets.
INTERPRETATION
The piglet model of LCPD was useful in the early stage of devascularization for investigation of the developmental pattern of femoral head deformity. However, when the piglets had grown to 20 weeks old or more--that is, to full skeletal maturity--the femoral head and acetabulum showed severe deformities that were most likely caused by heavy body weight.
Topics: Acetabulum; Animals; Body Weight; Disease Models, Animal; Femur Head; Legg-Calve-Perthes Disease; Radiography; Swine
PubMed: 16534700
DOI: 10.1080/17453670610045678