Transpositional Periacetabular Osteotomy with Allografting in Patients with Severe Dysplasia: Mid-Term Results

2016 ◽  
Vol 27 (1) ◽  
pp. 35-41 ◽  
Author(s):  
Motoki Sonohata ◽  
Yutaka Yonekura ◽  
Masaru Kitajima ◽  
Syunsuke Kawano ◽  
Masaaki Mawatari
Keyword(s):  
Acetabular Dysplasia ◽  
Periacetabular Osteotomy ◽  
Clinical Results ◽  
Harris Hip Score ◽  
Acetabular Roof ◽  
Allogenic Bone ◽  
Edge Angle ◽  
Centre Edge Angle ◽  
Acetabular Head Index

Aim The purpose of this study was to analyse the extent of surgical correction and the early clinical results obtained using periacetabular osteotomy with allogenic bone grafting in patients with severe acetabular dysplasia. Methods 44 hips in 38 patients were confirmed to have severe acetabular dysplasia and underwent this procedure. The mean follow-up period was 4.2 (range 1.5-8.2) years. Severe acetabular dysplasia was defined as a centre-edge angle less than 0°, an acetabular-head index less than 50% and an acetabular roof obliquity greater than 30°. Periacetabular osteotomy was performed with transpositional osteotomy of the acetabulum. The patients were divided into 2 groups according to the radiographic appearance: 34 hips in the early stage group and 10 hips in the advanced stage group. Postoperatively, the hips were radiographically assessed for dysplasia correction. The clinical results and hip function were measured using the Harris Hip Score. Results The average pre-operative Harris Hip Score improved from 70 to 91 points at the latest follow-up. The average centre-edge angle, acetabular-head index and acetabular roof obliquity improved from −9° to 36°, 41% to 91% and 31° to 2°, respectively. Continuity of the Shenton line improved from 15 to 35 hips. No instances of nonunion or of transported segment collapse were encountered in this series; however, a grafted allogenic bone was absorbed in 1 case. Conclusions The usage of allogenic bone grafting combined with periacetabular osteotomy is an effective technique for treating severe acetabular dysplasia. In this series, the early clinical and radiographic results were excellent.

Factors Predicting the Outcomes of Incomplete Triple Pelvic Osteotomy

2017 ◽  
Vol 27 (6) ◽  
pp. 608-614 ◽  
Author(s):  
Engin Eceviz ◽  
Esat Uygur ◽  
Mehmet S. Söylemez ◽  
Abdullah Eren
Keyword(s):  
Clinical Outcomes ◽  
Acetabular Dysplasia ◽  
Pelvic Osteotomy ◽  
Crossover Sign ◽  
Patient Age ◽  
Edge Angle ◽  
Centre Edge Angle ◽  
Patient Âgé ◽  
Osteoarthritis Progression

Introduction In the present study, we identified factors affecting the outcomes of patients who underwent incomplete triple pelvic osteotomies due to acetabular dysplasia. Methods Data on a total of 58 hips in 50 patients for whom adequate data were available and who had undergone appropriate follow-up were retrospectively evaluated. We used Ömeroğlu scores for radiological evaluation, Harris Hip Scores for clinical evaluation, Tönnis scores to evaluate osteoarthritis progression and a modified Clavien-Dindo classification to evaluate complications. Results The average patient age was 23.26 (14-47) years, and the average follow-up duration 105.59 (18-191) months. The complication rate was 10.3%, and complications negatively influenced clinical outcomes. Patients with radiologically poorer outcomes had more advanced osteoarthritis. We found minimal improvements in lateral centre edge angle (LCEA), refined centre-edge angle (RCEA), and lateral acetabulum head index (LAHI) were associated with osteoarthritis progression and that good improvements in LCEA, RCEA, acetabular angle (AA), and LAHI were associated with radiological outcomes. Neither patient age at the time of operation nor development of a postoperative relative crossover sign affected osteoarthritis progression or clinical or radiological outcomes. Conclusions The most important factors influencing clinical outcomes were complications. However, neither postoperative acetabular retroversion nor a positive supra-equatorial crossover sign (often viewed as prognostically negative) directly affected clinical outcomes. When treating patients with acetabular dysplasia, either inadequate correction or overcorrection may negatively affect outcomes. In such patients, an incomplete triple pelvic osteotomy (allowing controlled correction) is both safe and effective.

scholarly journals Sex dimorphism of postural parameters of the human acetabulum

2011 ◽  
Vol 63 (1) ◽  
pp. 137-143
Author(s):  
D. Jeremic ◽  
B. Jovanovic ◽  
Ivana Zivanovic-Macuzic ◽  
Gordana Djordjevic ◽  
Maja Sazdanovic ◽  
...  
Keyword(s):  
Gender Differences ◽  
Acetabular Dysplasia ◽  
Acetabular Roof ◽  
Sex Dimorphism ◽  
Edge Angle ◽  
Centre Edge Angle ◽  
Acetabular Angle ◽  
Center Edge ◽  
Acetabular Morphology ◽  
Center Edge Angle

The aim of this investigation was to examine normal acetabular morphometry, its sex dimorphism and the acetabular dysplasia rate in Serbian adults. For each hip, the centre-edge angle of Wiberg, the acetabular angle of Sharp, acetabular depth and acetabular roof obliquity were measured. The center-edge angle of Wiberg correlated negatively with the acetabular angle of Sharp and acetabular roof obliquity, but positively correlated with acetabular depth. Our results suggest that the prevalence of acetabular dysplasia in the Serbian population is lower than in Western countries. We confirmed the existence of significant gender differences in acetabular morphology among the subjects of our study. These sex-related differences in acetabular morphology were the cause for more dysplastic female acetabula compared with male acetabula.

Matrixplasty for the Treatment of Severe Incurved Toenail with Growth Plate Deformity

2012 ◽  
Vol 102 (3) ◽  
pp. 198-204
Author(s):  
J.-Young Kim
Keyword(s):  
Growth Plate ◽  
Clinical Results ◽  
New Technique ◽  
Partial Removal ◽  
Edge Angle ◽  
Results Of Treatment ◽  
The Mean ◽  
A New Technique ◽  
Ingrown Toenails

Background: Severely incurved toenails are accompanied by deformity of the toenail growth plate. In such a condition, partial removal of the nail and nail bed and simple unfolding of the nail itself frequently result in the recurrence of symptoms. We sought to design and develop a new technique for the treatment of incurved toenail with growth plate deformity and to report the results of treating this disease entity. Methods: Forty consecutive patients (52 cases) underwent treatment of symptomatic incurved toenails with a new technique named matrixplasty. The mean ± SD patient age was 40.3 ± 18.9 years. Last follow-up was at a mean ± SD of 18.0 ± 1.3 months. An American Orthopedic Foot and Ankle Society (AOFAS) forefoot hallux score was assigned, and patients were evaluated before treatment and at last follow-up. Patient satisfaction and the recurrence rate of the deformity were evaluated. For evaluation of improvement in toenail shape, the center to edge angle of the toenail was measured before treatment and at last follow-up. The complication rate was also evaluated. Results: All of the ingrown toenails healed, and the nail deformities were corrected within 3 weeks after the procedure. None of the incurved toenails had recurred by last follow-up. The mean pretreatment AOFAS forefoot hallux score was 72.9, and it improved to 99.6 by last follow-up (P < .001). Every patient was very satisfied or satisfied with the results of treatment. The mean ± SD center to edge angle of the toenail improved from 53.3° ± 9.5° to 15.3° ± 5.2° by last follow-up (P < .001). Minor paronychia, which was managed with local wound dressing and oral antibiotics, was identified in four cases. No other complication was identified. Conclusions: Matrixplasty showed excellent clinical results in the treatment of severe incurved toenail, and this newly developed procedure showed improvement of the deformed toenail and its growth plate. (J Am Podiatr Med Assoc 102(3): 198–204, 2012)

scholarly journals Arthroscopic treatment of internal snapping hip

2018 ◽  
Vol 6 (12_suppl5) ◽  
pp. 2325967118S0017
Author(s):  
Gonzalo J. Magi ◽  
Juan Pablo Carucci ◽  
Sebastián Bergués
Keyword(s):  
Recurrence Rate ◽  
Clinical Results ◽  
Arthroscopic Treatment ◽  
Harris Hip Score ◽  
Iliopsoas Muscle ◽  
Average Score ◽  
Iliopsoas Tendon ◽  
Snapping Hip ◽  
Endoscopic Release

Introduction: Internal snapping hip syndrome (ISHS) is caused by the iliopsoas tendon snapping over either the iliopectineal ridge or the anterior femoral head. Excellent results are achieved only with activity modification, rest, and stretching the iliopsoas muscle. The literature favors iliopsoas tendon release if conservative therapy fails. There is little evidence about the gold standard of this condition. Objective: Describe clinical results, complicactions and recurrence rate of arthroscopic treatment of ISHS. Methods: We included all patients who failed conservative treatment and were treated with arthroscopy for ISHS between March 2012 and March 2018. Patients with less than 2 years of follow up and previous surgery on the hip were excluded. We performed Ilizariturri´s technique with a transcapsular endoscopic release in central compartment. We registered modified Harris hip score (MHHS), Hip outcome score activity of daily living (EHOSDL), patients satisfaction, recurrence rate and complications. Results: Eight patients were included. Average follow up was 36 months (range 24-60 months). MMHS improved from preoperative average score of 70 (range 62-72) to postoperative average of 93 (range 92 to 96). Average EHOSDL improvement was 30% (from 55% preoperative to 85% postoperative). All patients had excellent results. Average patient satisfaction was 8 (range 7-9). We had no recurrence or complications. Conclusion: Arthroscopic treatment of ISHS allowed us to obtain very good clinical results with no complications or recurrences with a minimum 2 years follow up.

Noncemented Hip Replacement using a Conical Screw-In Cup and a Straight Press-Fit Stem. A Six to Eight-Year Clinical and Radiological follow-up Study

1998 ◽  
Vol 8 (4) ◽  
pp. 208-218 ◽  
Author(s):  
G. Köster ◽  
S. Leib ◽  
H.-G. Willert
Keyword(s):  
Hip Replacement ◽  
Clinical Symptoms ◽  
Bone Ingrowth ◽  
Control Period ◽  
Clinical Results ◽  
Harris Hip Score ◽  
Radiographic Appearance ◽  
Press Fit ◽  
Bone Atrophy

Noncemented hip replacement using a conical titanium metal-backed screw-in cup to be implanted with precutting of the threads (TITAN-METAL-BACKED, AlloPro, Baar, Switzerland), in combination with a straight conical press-fit stem (Zweymüller-“hochgezogen”, AlloPro, Baar, Switzerland) was evaluated clinically and radiologically in 64 consecutive primary arthroplasties with an average 7.2 year follow-up. The clinical results compare very favourably with other cementless systems. The Harris hip score revealed an improvement from 45 to 84. The Merle d'Aubigné index showed an increase during the case-control period from 16 to 26. Thigh pain was practically absent except in one patient. A radiographic appearance of bone ingrowth around the acetabular component was found in nearly all cases. Only one cup migrated in a patient with a large cystic lesion in the acetabular roof, which was not grafted, with no other signs of loosening. Additionally this patient had chemotherapy. In all other cases there were no signs of cup migration, significant radiolucency, osteolysis or definite cup loosening. Around the stem, primary cortical contact was mainly located in the distal zones. Radiolucent lines appeared only proximally, with few exceptions, and were, except in four cases, always smaller than 2 mm. They were never circumferential and usually combined with sclerotic lines. Only one stem subsided, but the patient remained asymptomatic. There was a high incidence of proximal bone atrophy, distal cortical thickening and endosteal bone formation, not correlating with radiological loosening or clinical symptoms. Signs of femoral osteolysis were absent. No patient had to be revised.

scholarly journals Management of Recurrent Posterior Hip Dislocation in a Down Syndrome Patient with Dysplastic Hip Using Ganz Periacetabular Osteotomy: Follow Up After 4 Years

2020 ◽  
Vol 8 (5_suppl5) ◽  
pp. 2325967120S0003
Author(s):  
Ismail H. Dilogo ◽  
Jessica Fiolin
Keyword(s):  
Down Syndrome ◽  
Periacetabular Osteotomy ◽  
Weight Bearing ◽  
Hip Dislocation ◽  
Harris Hip Score ◽  
Syndrome Patient ◽  
Down Syndrome Patient ◽  
Dysplastic Hip ◽  
Posterior Hip Dislocation

Recurrent hip dislocation in a Down Syndrome patient with dysplastic hip is a very challenging case to treat even for an expert orthopaedic hip surgeon. Least compliant patient and family, lowly educated with low socioeconomic status and the dysplastic hip forces limited option as a treatment. This is the first case world wide reporting 4 year follow up of dysplastic hip with Down Syndrome treated successfully with PAO technique. Methods: An eighteen years old female with history of Down Syndrome had multiple posterior hip dislocation episodes since 3 years prior. Several attempts of close reduction and hip spica applications were performed upon dislocation despite no successful retaining of reduction. Acetabular index of right hip were 550 and epiphyseal plate hasclosed. PatientwasperformedopenreductionusingSouthern-Mooreposteriorapproachand osteotomy of ischium, continued with capsulorrhaphy followed with Smith-Peterson anterior approach and osteotomy of superior ramus pubis and iliac bone. Then, derotation maneuver was performed under image intensifier to obtain adequate coveragefollowedwithbonegraftandfixationusing2cannulatedscrewandhipspica castapplication. Results: Within four years after surgery, the hip has never been dislocated again, patient could sit without pain and walk with full weight bearing although Harris Hip Score could not be performed due to Down Syndrome. Leg length discrepancy was negligible,fracture has fully united and acetabularin dex was300. Conclusions: Ganz periacetabular osteotomy, although a technically demanding surgery, is a preferable treatment in recurrent hip dislocation for Down Syndrome patient with good to excellent clinical and radiological ou tcome

Functional acetabular retroversion syndrome: description of a specific sub-type of FAI and results of treatment with minimally invasive PAO

2019 ◽  
Vol 30 (6) ◽  
pp. 779-786 ◽  
Author(s):  
Michael C Wyatt ◽  
Christian Smith ◽  
Ali Zavareh ◽  
Dominik Pfluger ◽  
Marcus JK Bankes
Keyword(s):  
Minimally Invasive ◽  
Smoking Status ◽  
Periacetabular Osteotomy ◽  
Clinical Results ◽  
Acetabular Retroversion ◽  
Crossover Sign ◽  
Results Of Treatment ◽  
Functional Scores ◽  
The Mean

Introduction: Acetabular retroversion syndrome is associated with pincer-type femoroacetabular impingement (FAI) and results, theoretically, from an externally rotated hemipelvis. The purpose of this study was to examine our surgical experience and the clinical results of functional acetabular retroversion syndrome treated with minimally-invasive periacetabular osteotomy (PAO). Methods: We performed a retrospective cohort study of prospectively collected data in consecutive patients who had an anteverting PAO from 01 November 2010 to 31 December 2015. All patients were followed up clinically and radiologically. Functional scores were ascertained using pre- and postoperative iHOT-12 and EQ-5D. The effect of hypermobility, smoking status and body mass index (BMI) on outcome measures was evaluated. Results: 31 anteverting PAOs were performed on 27 consecutive patients. All patients were female. The mean age was 26.7 years (SD 6.7). The mean BMI was 25.8 kg/m2 (SD 5.1). 5 patients were smokers (16.1%) and 11 exhibited signs of generalised joint laxity. 23 hips had undergone prior hip arthroscopy and 1 patient had previous open FAI surgery. The minimum clinical follow-up was 2 years (mean 3.4 years; range 2–7 years). A crossover sign was present in all cases. The mean iHOT-12 score improved from 19.5 to 51 at 6 months, 64.5 at 1 year and 48 at 2 years following surgery ( p < 0.05) EQ-5D improved from 0.42 preoperatively to 0.76 at 6 months and 0.69 at 1 year following surgery ( p < 0.05). Conclusions: We have characterised functional acetabular retroversion syndrome (FARS) as a condition affecting young, active females which severe symptoms out of proportion to demonstrable radiographic pathology.

Good mid-term clinical results of a cemented dual mobility cup: a single-centre experience

2017 ◽  
Vol 28 (1) ◽  
pp. 59-62 ◽  
Author(s):  
Gregor Kavčič ◽  
Pika Mirt ◽  
Klemen Bedenčič
Keyword(s):  
Final Analysis ◽  
Clinical Results ◽  
Harris Hip Score ◽  
Consecutive Series ◽  
Dual Mobility Cup ◽  
Dual Mobility ◽  
Single Centre Experience ◽  
The Mean ◽  
Hip Arthroplasties

Introduction and methods: From January 2004 to December 2008, 188 total hip arthroplasties were performed using a cemented dual mobility cup. 174 patients were available for final analysis. Their mean age was 76.8 (range 54-98 years). The mean follow-up was 7.7 years (range 5-10 years). Results: There were no dislocations. Survivorship rates of the femoral and acetabular components were 100% at a minimum of 5 years. At the latest follow-up, the mean Harris Hip Score significantly increased from 31.6 (only arthritic patients) points preoperatively to 84.5 points. No patients had progressive osteolysis, component migration, or loosening on radiographs. 2 patients presented with periprosthetic fractures treated conservatively. 2 patients presented with infection treated without implant removal and 1 patient presented with transient femoral palsy. Conclusions: The results of this consecutive series confirmed the good performance of the cemented dual mobility cup at mean 7.7 years follow-up with no revision and no dislocations.

scholarly journals Periacetabular osteotomy with concomitant hip arthroscopy: A case series with 24 months minimum follow-up

Medwave ◽  
2020 ◽  
Vol 20 (11) ◽  
pp. e8082-e8082
Author(s):  
Cristian Barrientos ◽  
Julián Brañes ◽  
Rodrigo Olivares ◽  
Rodrigo Wulf ◽  
Álvaro Martinez ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Hip Arthroscopy ◽  
Periacetabular Osteotomy ◽  
Case Series ◽  
Resonance Imaging ◽  
Edge Angle ◽  
Center Edge ◽  
Lateral Center Edge Angle ◽  
Center Edge Angle

Purpose To describe patient-reported outcomes, radiological results, and revision to total hip replacement in patients with hip dysplasia that underwent periacetabular osteotomy as isolated treatment or concomitant with hip arthroscopy. Methods Case series study. Between 2014 and 2017, patients were included if they complained of hip pain and had a lateral center-edge angle ≤ of 20°. Exclusion criteria included an in-maturate skeleton, age of 40 or older, previous hip surgery, concomitant connective tissue related disease, and Tönnis osteoarthritis grade ≥ 1. All patients were studied before surgery with an anteroposterior pelvis radiograph, false-profile radiograph, and magnetic resonance imaging. Magnetic resonance imaging was used to assess intraarticular lesions, and if a labral or chondral injury was found, concomitant hip arthroscopy was performed. The non-parametric median test for paired data was used to compare radiological measures (anterior and lateral center-edge angle, Tönnis angle, and extrusion index) after and before surgery. Survival analysis was performed using revision to total hip arthroplasty as a failure. Kaplan Meier curve was estimated. The data were processed using Stata. Results A total of 15 consecutive patients were included; 14 (93%) were female patients. The median follow-up was 3.5 years (range, 2 to 8 years). The median age was 20 (range 13 to 32). Lateral center-edge angle, Tönnis angle, and extrusion index correction achieved statistical significance. Seven patients (47%) underwent concomitant hip arthroscopy; three of them (47%) were bilateral (10 hips). The labrum was repaired in six cases (60%). Three patients (15%) required revision with hip arthroplasty, and no hip arthroscopy-related complications are reported in this series. Conclusion To perform a hip arthroscopy concomitant with periacetabular osteotomy did not affect the acetabular correction. Nowadays, due to a lack of conclusive evidence, a case by case decision seems more appropriate to design a comprehensive treatment.

scholarly journals The Early Outcome Of the Bernese Periacetabular Osteotomy For Hip Dysplasia In Multiple Epiphyseal Dysplasia

2021 ◽  
Author(s):  
Yao-Yuan Chang ◽  
Chia-Che Lee ◽  
Sheng-Chieh Lin ◽  
Ken N Kuo ◽  
Kuan-Wen Wu ◽  
...  
Keyword(s):  
Femoral Head ◽  
Statistical Significance ◽  
Periacetabular Osteotomy ◽  
Hip Osteoarthritis ◽  
Multiple Epiphyseal Dysplasia ◽  
Harris Hip Score ◽  
Joint Preserving Surgery ◽  
The Mean ◽  
Epiphyseal Dysplasia

Abstract Background:Multiple epiphyseal dysplasia (MED) is a rare congenital bone dysplasia. Patients with MED develop secondary hip osteoarthritis as early as third to the fourth decade. Currently, there is no consensus on how to prevent or slow the process of secondary hip osteoarthritis.The Bernese periacetabular osteotomy is a joint preserving surgery to reshape acetabulum and extend coverage for the hip, however, there is no established evidence of the effectiveness for the MED hips.Patients and methods:A retrospective series of 6 hips in 3 patients with multiple epiphyseal dysplasia treated with the Bernese periacetabular osteotomy were reviewed. The average age at the time of surgery was 14.3 years (range: 11.4 to 17.2 y). Radiographic parameters were analyzed preoperatively and 1-year postoperatively. The hip function was evaluated by the Harris Hip Score (HHS) before and after surgery. Results:The mean follow-up time was 1.7 years. The mean LCEA increased from 3.8° to 47.1° (p = .02), ACEA increased from 7.3° to 35.1° (p = .02), and AI decreased from 27.8° to 14.6° (p=.04). The femoral head coverage ratio increased from 66.8% to 100% (p= .02). The procedure achieved femoral head medialization by decreasing central head distance from 86.7mm preoperatively to 82.7mm postoperatively, however, without statistical significance. (p = .699). The improvement of clinical outcomes by mean HHS was significant from 67.3 preoperatively to 86.7 postoperatively (p=0.05).Conclusion:Bernese PAO is a feasible option for treatment of the hip problems in MED patients. It reshapes acetabular and femoral morphology 3-dimensionally. In our study, the short-term follow-up results showed obvious functional and radiographic improvement. A long-term follow-up is necessary in the future.

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