2024年12月 保髋进展 JCR Q3 区

Developmental dysplasia of the hip (DDH) is a prevalent developmental condition that necessitates early detection and treatment. Follow-up, as well as therapeutic decision-making in children younger than four years, is challenging because the center-edge (CE) angle of Wiberg is not reliable in this age group. The authors propose a modification of the CE angle (MCE) to achieve comparable reliability with the CE among children younger than four and set diagnostic thresholds for the diagnosis of DDH. 952 anteroposterior pelvic radiographs were retrospectively reviewed. The MCE is defined on X-ray pelvic overview images as the angle between the line connecting the epiphyseal joint center and the outer edge of the acetabulum, and perpendicular to the Hilgenreiner line. The MCE angle exhibited high sensitivity and specificity, as well as intrarater variability comparable to the CE among children younger and older than four years. The authors recommend cut-off values for the MCE angle; for children under four years old, the angle should be equal to or greater than 15 degrees; for those under eight years old, it should be equal to or greater than 20 degrees; and for those eight years old and older, it should be equal to or greater than 25 degrees. However, the MCE angle's reliability diminishes around the age of nine due to the curvature of the growth plate, which complicates accurate measurement. This study showed that the MCE angle can be used adequately in children under four years and could be used as a progression parameter to diagnose DDH.

Background Avascular necrosis (AVN) of the femoral head is a serious complication after surgical treatment of developmental dysplasia of the hip (DDH). The main objective of this study is to identify the incidence of AVN and to define AVN risk factors. The study also aims to identify the effects of AVN and other factors on final clinical and radiological outcomes. Methods All patients in the study were managed according to King Saud University protocol for surgical treatment of DDH. Occurrence of AVN was reported. All affected hips were evaluated clinically and radiologically after six and 12 months and at final follow-up. Significant variables from the univariate analysis were entered into multivariate regression models. Results A total of 131 patients were included in the study involving 189 hips with DDH. AVN was diagnosed postoperatively in 23 (12%) hips. In the multivariate regression analysis, the presence of AVN (p=0.002), prolonged casting (p=0.016) and the need for a second surgery (p=0.029) were strong determinants of unsatisfactory clinical outcomes. Worse radiological outcomes were significantly associated with the presence of AVN (p=0.002), previous trials of closed reduction (p=0.032) and the need for a second surgery (p=0.013). In the last multivariate regression model, a previous trial of closed reduction (p=0.001), absence of an ossified femoral head (OFH) (p=< 0.001), prolonged casting (p=0.038), and the need for second surgery (p=0) were strong risk factors for AVN. Conclusions The current study highlighted the factors responsible for AVN occurrence after open DDH reduction. The factors which are strong determinants of unsatisfactory clinical and radiological outcomes were identified. Overcoming these factors is mandatory to improve the results.

Femoroacetabular impingement (FAI) is a condition caused by abnormal contact between the femur head and the acetabulum, which damages the labrum and articular cartilage. While the prevalence and the type of impingement may vary across human groups, the variability among populations with short height or with a high prevalence of overweight has not yet been explored. Latin American studies have rarely been conducted in reference to this condition, including the Mayan and mestizo populations from the Yucatan Peninsula.

This study evaluates the impact of smoking on clinical outcomes following hip arthroscopy (HA) through a systematic review and meta-analysis.

Non-arthritic hip pain is a common presentation among the general population, with many possible contributing etiologies. While radiographs, computed tomography, and magnetic resonance imaging are all within the standard diagnostic workup, ultrasonography has emerged as a facile tool given its low cost, lack of radiation, and dynamic application. This article reviews the utility of ultrasound (US) in evaluation of non-arthritic hip pain and its ability to detect pathology both statically and dynamically in comparison and as an adjunct to standard imaging modalities.

Developmental dysplasia of the hip (DDH) is a prevalent developmental condition that necessitates early detection and treatment. Follow-up, as well as therapeutic decision-making in children younger than four years, is challenging because the center-edge (CE) angle of Wiberg is not reliable in this age group. The authors propose a modification of the CE angle (MCE) to achieve comparable reliability with the CE among children younger than four and set diagnostic thresholds for the diagnosis of DDH. 952 anteroposterior pelvic radiographs were retrospectively reviewed. The MCE is defined on X-ray pelvic overview images as the angle between the line connecting the epiphyseal joint center and the outer edge of the acetabulum, and perpendicular to the Hilgenreiner line. The MCE angle exhibited high sensitivity and specificity, as well as intrarater variability comparable to the CE among children younger and older than four years. The authors recommend cut-off values for the MCE angle; for children under four years old, the angle should be equal to or greater than 15 degrees; for those under eight years old, it should be equal to or greater than 20 degrees; and for those eight years old and older, it should be equal to or greater than 25 degrees. However, the MCE angle's reliability diminishes around the age of nine due to the curvature of the growth plate, which complicates accurate measurement. This study showed that the MCE angle can be used adequately in children under four years and could be used as a progression parameter to diagnose DDH.

As the field of hip preservation evolves, the diagnosis of borderline dysplasia (defined as a lateral center edge angle between 18°-25°) has shown itself to be one of the more challenging diagnoses to treat. As the nuances of acetabular coverage have come to light, the question of whether borderline hip dysplasia is best treated with isolated hip arthroscopy, periacetabular osteotomy, or whether a combined procedure is best, is now top of mind. The goal of these procedures is to not only improve patient symptoms, but to correct underlying pathology and ideally slow the development of hip osteoarthritis. The purpose of this review is to summarize the recent literature and clinical findings regarding both isolated hip arthroscopy and periacetabular osteotomy in the surgical management of borderline hip dysplasia.

We explored the value of contrast-enhanced ultrasound (CEUS) in evaluating femoral head (FH) perfusion, guiding interventions and follow-up for infants with developmental dysplasia of the hip (DDH) and septic arthritis of the hip (SAH). The aim was to provide robust evidence for clinical assessment.

Nonsteroidal anti-inflammatory drugs (NSAIDs) have analgesic effects on femoroacetabular impingement (FAI) patients undergoing hip arthroscopy surgery (HAS). However, the influence of medication time on the analgesic effect of NSAIDs is uncertain. This study aimed to compare the analgesic effect, joint function, quality of life (QoL), and patients' satisfaction between preoperative and postoperative NSAIDs in these patients.