MR-based Parameters as a Supplement to Radiographs in Managing Developmental Hip Dysplasia

김휘택,In-Bo Kim,Jong-Seo Lee, 대한정형외과학회 2011 Clinics in Orthopedic Surgery Vol.3 No.3

Background: Some dysplastic hips with favorable radiographic parameters fail to develop normally, suggesting that we shouldconsider cartilaginous or soft tissue structures for further information regarding the condition of the hip. The purpose of this studywas to provide a clear defi nition of concentric reduction in developmental dysplasia of the hip (DDH) based on magnetic resonanceimaging (MRI), and to determine how radiographic and MR-based parameters could be used together to treat dysplastic hips. Methods: We studied range of motion (ROM)-MRI of 25 patients with unilateral hip dysplasia (mean age at the time of MR imaging,44.1 months). Each ROM-MRI consisted of a set of bilateral hip scans in the following positions: neutral; abduction; abduction-internal rotation; abduction-internal rotation-fl exion; and adduction. Before MR scanning, the 25 patients received the followingprimary treatments: closed reduction (n = 15; at a mean age of 14.5 months); and open reduction (n = 10; at a mean age of 10.0months). The following new parameters appear to be useful in treating DDH: 1) the labral angle, the angle the labrum makes withthe acetabulum; 2) the uncorrected labral deformity (ULD), the “residual deformity” (defl ection of the labrum) when the affected labrumis freed from pressure in abduction; and 3) the zone of compressive force (ZCF), the region of the acetabulum through whichthe body weight acts on the femoral head. Results: A concentrically-reduced hip is one in which the labrum points downward in the neutral position, at the same angle asthat of the normal side; and in which the ZCF is zone 3, the inner acetabular zone as defi ned herein. The ULD and the ZCF may bedetermined precisely as we have done, or the physician may simply observe the changes in the orientation of the labrum and comparethe changes qualitatively to the unaffected side, and likewise for the medial joint space. Conclusions: Detailed analysis of the labrum as permitted by ROM-MRI, together with acetabular index and other parametersmeasured from radiographs, provides important information for physicians treating childhood hip dysplasia.

소아 고관절 질환(I): 발달성 고관절 이형성증의 진단 및 초기 치료

김휘택(Hui Taek Kim),박용건(Yong Geon Park) 대한정형외과학회 2020 대한정형외과학회지 Vol.55 No.5

소아 고관절 이형성증은 비구 또는 근위 대퇴골, 혹은 양쪽 모두를 포함하는 고관절의 부적절한 발달을 지칭하는 광범위한 개념이다. 초음파적 검사로 영아기의 고관절 탈구 진단이 간과되거나 수술적인 치료가 필요한 경우는 감소하고 있으나 모든 고관절 이형성증을 찾아내지는 못하고 있다. 아탈구가 없는 고관절 이형성증은 우연히 진단되며, 40대 이후 여자에서 퇴행성 관절염과 강한 연관성을 가진다. 아탈구를 동반한 고관절 이형성증은 아탈구의 정도에 따라 증상이 다양한 시기에 걸쳐 나타나며, 특히 여성에서 임신 중 발현되는 경우가 많다. 신생아에 대한 정확한 이학적 검사와 조기 치료는 이 질환의 양호한 결과를 위해 매우 중요하다. 진단의 간과를 막고 조기 치료의 기회를 제공하기 위해 저자는 고관절 이형성증이 의심스러운 2세 이하 영아 모두에게 고관절 검사를 추천한다. 본 연구에서는 고관절 이형성증의 진단 및 초기 치료에 대해 고찰해 보고자 한다. Developmental dysplasia of the hip broadly includes inadequate development of the hip joint involving the acetabulum or proximal femur, or both. Although ultrasonographic studies in neonates have greatly lowered the frequency of neglected or operatively treated cases, its sensitivity is less than desired. Hip dysplasia without subluxation is commonly diagnosed incidentally and strongly related to degenerative arthritis in females after the 4th decade. Hip dysplasia with subluxation shows symptoms through various periods, depending on its severity, especially for women with onset during pregnancy. A complete physical examination and early treatment for neonates are extremely important for obtaining satisfactory outcomes. To avoid underdiagnosis and to serve appropriate treatment on time, the authors recommend examining any suspicious hips in infants under two years of age. The study will discuss the diagnosis and primary treatment of developmental dysplasia of the hip.

발달성 엉덩관절 이형성증으로 인한 엉덩관절 전치환술 후 로봇치료가 환자의 기능에 미치는 영향: 사례연구

김소영,박치복,김병근 대한물리치료과학회 2023 대한물리치료과학회지 Vol.30 No.1

Background: The advantages of robotic therapy have recently been attempted several times in the re- habilitation of total hip arthroplasty (THA) patients. Therefore, this study also aims to report a case of how robot therapy affects the function of THA patients due to developmental dysplasia of the hip (DDH). Design: Case Study. Method: This study used the A-B-A' design. Period A is before robotic therapy, period B is robotic therapy, and period A` is after robotic therapy. The subjects performed physical therapy and occupational therapy for five days each during the baseline period A and A`. In intervention period B, robotic therapy was performed for five days along with the baseline intervention. This study was conducted for a total of fifteen days. The subjects' sit to stand (STS), timed up and go (TUG), and 10 metre walk (10MW) were evaluated. Result:: STS and TUG were significantly improved in periods B and A' compared to period A (p<0.05), and STS was significantly improved in period A' com- pared to period B (p<0.05). 10MW showed no sig- nificant improvement in periods B and A' compared to period A. Conclusions: This study confirmed that robot therapy was an effective intervention in improving the function of women in their 30s who underwent THA due to DDH. In the future, a study comparing the control group should be performed.

Revision of Failed Open Reduction of Developmental Dysplasia of the Hip

Mohamed Mansour Elzohairy,Mohamed Mahmoud Elhefnawy,Hosam Mohamed Khairy 대한정형외과학회 2020 Clinics in Orthopedic Surgery Vol.12 No.4

Background: The most common causes of re-dislocation after open reduction are inadequate exposure and failure to release the obstructing soft tissues inside and around the hip. Methods: This clinical study included 33 consecutive children (34 hips) who underwent a revision surgery after failed open reduction of developmental dysplasia of the hip (DDH). Results: According to the McKay clinical criteria, the results were good in 28 cases (82.4%), fair in 4 cases (11.8%), and poor in 2 cases with re-dislocation (5.9%). Radiological results according to the modified Severin criteria were as follows: 28 hips (82.4%) were identified as category 2 (good), 4 hips (11.8%) category 4 (fair), and 2 hips (5.9%) category 5 (poor). Conclusions: Revision surgery for DDH is demanding and the long-term consequences are usually serious, but stable, concentric reduction should be obtained either at the first or second open reduction by addressing the causes of failure. Failed acetabulum remodeling and technical errors with inadequate soft-tissue release were the most common causes of failure in the primary operation. Based on the results, the outcome of revision surgery after failed open reduction for DDH was good.

Is the Iliac Wing Curved Inward in Patients with Developmental Dysplasia of the Hip?

Noriaki Sako,Nobuhiro Kaku,Hiroaki Tagomori,Hiroshi Tsumura 대한정형외과학회 2021 Clinics in Orthopedic Surgery Vol.13 No.4

Background: There is a paucity of studies on the iliac curvature in developmental dysplasia of the hip (DDH). Here, we examined the iliac curvature in DDH using three-dimensional computed tomography. Methods: We allocated cases with a center-edge angle of < 20° to the DDH group (55 cases) and cases with a center-edge angle of > 25° to the control group (57 cases) and measured the straight line (line A) between the anterior and posterior superior iliac spines. We examined which part of the iliac bone line A passes through and classified the results into 4 categories (type A, inside the iliac bone; type B, through the iliac bone; type C, outside the iliac bone; and type D, both inside and outside the iliac bone) to evaluate the iliac wing curvature. After measuring the area and internal surface of the iliac wing using line A, we examined the correlation between these values, the interspinous distance, the superior iliac angle, and the center-edge angle. Results: Distributions of the four types were compared between the two groups; there was no significant difference. The length of the portion of line A inside the ilium and the area formed by line A and the iliac wing, which shows the degree of iliac wing curvature, were not significantly different between the groups. There were no correlations between these values and the center-edge angle; however, there were weak positive correlations among the interspinous distance, the superior iliac angle, and the centeredge angle. Conclusions: The inward nature of the iliac bone in patients with DDH is mainly due to the internal rotation of the entire iliac bone and less likely due to the curvature of the iliac bone.

One-stage Hip Reconstruction for Developmental Hip Dysplasia in Children over 8 Years of Age

Irfan Qadir,Saeed Ahmad,Atiq uz Zaman,Chirag Muhammad Khan,Shahzad Ahmad,Amer Aziz 대한고관절학회 2018 Hip and Pelvis Vol.30 No.4

Purpose: This study was performed to assess the clinical and radiological outcomes following one-stage hip reconstruction, consisting of open reduction femoral shortening and pelvic osteotomy, for neglected developmental dislocation of the hip (DDH). Materials and Methods: This is a retrospective analysis of 77 hips in 65 patients (46 females and 19 males; 12 had bilateral dislocations), operated at a Ghurki Trust Teaching Hospital in Pakistan between 2013 and 2015. The average age at surgery was 11.02±3.43 years. According to the Tönnis classification, there were 10, 14, 22, and 31 patients in grades 1, 2, 3, and 4, respectively. The pelvic procedure utilized in this study was triple osteotomy (47 hips) followed by double and Salter osteotomy (18 and 12 hips, respectively). Postoperative evaluations were conducted using the modified MacKay’s scoring system (functional outcomes) and Severin’s scoring method (radiological assessment). Results: Postoperatively, there were 38 (49.4%), 19 (24.7%), 14 (18.2%), and 6 (7.8%) hips in Severin grade I, II, III and IV, respectively. According to the modified McKay criteria, there were 22 hips (28.6%) in excellent condition, 44 (57.1%) in good condition, 9 (11.7%) in fair condition and 2 (2.6%) in poor condition. Both patients with poor outcomes had an unstable, painful hip with evidence of avascular necrosis of the femoral head. Conclusion: Based on the results presented here, we recommend the single stage procedure of open reduction, femoral shortening and pelvic osteotomy for treatment of DDH in older children with good to excellent functional and radiological outcomes.

Disparity between Clinical and Ultrasound Examinations in Neonatal Hip Screening

Bong Soo Kyung,Soon Hyuck Lee,Woong Kyo Jeong,Si Young Park 대한정형외과학회 2016 Clinics in Orthopedic Surgery Vol.8 No.2

Background: For early detection of developmental dysplasia of the hip (DDH), neonatal hip screening using clinical examination and/or ultrasound has been recommended. Although there have been many studies on the reliability of both screening techniques, there is still controversy in the screening strategies; clinical vs. selective or universal ultrasound screening. To determine the screening strategy, we assessed the agreement among the methods; clinical examination by an experienced pediatric orthopedic surgeon, sonographic morphology, and sonographic stability. Methods: From January 2004 to June 2009, a single experienced pediatric orthopedic surgeon performed clinical hip screenings for 2,686 infants in the neonatal unit and 43 infants who were referred due to impressions of hip dysplasia before 3 months of age. Among them, 156 clinically unstable or high-risk babies selectively received bilateral hip ultrasound examinations performed by the same surgeon using the modified Graf method. The results were analyzed statistically to detect any correlations between the clinical and sonographic findings. Results: Although a single experienced orthopedic surgeon conducted all examinations, we detected only a limited relationship between the results of clinical and ultrasound examinations. Ninety-three percent of the clinically subluxatable hips were normal or immature based on static ultrasound examination, and 74% of dislocating hips and 67% of limited abduction hips presented with the morphology below Graf IIa. A total of 80% of clinically subluxatable, 42% of dislocating and 67% of limited abduction hips appeared stable or exhibited minor instability on dynamic ultrasound examination. About 7% of clinically normal hips were abnormal upon ultrasound examination; 5% showed major instability and 3% showed dysplasia above Graf IIc. Clinical stability had small coefficients between ultrasound examinations; 0.39 for sonographic stability and 0.37 for sonographic morphology. Between sonographic stability and morphology, although 71% of hips with major instability showed normal or immature morphology according to static ultrasound examination, the coefficient was as high as 0.64. Conclusions: Discrepancies between clinical and ultrasound examinations were present even if almost all of the exams were performed by a single experienced pediatric orthopedic surgeon. In relation to screening for DDH, it is recommended that both sonographic morphology and stability be checked in addition to clinical examination.

현성 하지 부동 영아에서의 고관절 선별 검사

정호진(Ho Jin Jung),장우영(Woo Young Jang),조일엽(Il Youp Cho),이순혁(Soon-Hyuck Lee) 대한정형외과학회 2017 대한정형외과학회지 Vol.52 No.3

목적: 본 연구에서 현성 하지 부동으로 발달성 고관절 이형성증(developmental dysplasia of the hip, DDH)을 감별 진단하기 위해 의뢰된 영아들에서 태아기 자세성 변형의 양상을 조사해보고 이러한 태아기 자세성 변형이 DDH와 어떤 연관성이 있는지 알아보고자 하였다. 대상 및 방법: 후향적 연구로, 2013년 3월부터 2015년 3월까지 현성 하지 부동으로 DDH가 의심되어 외래에 내원한 영아 150명의 의무기록과 영상의학적 검사를 조사하였다. 결과: 현성 하지 부동은 좌측 하지가 짧은 경우가(n=86, 57.3%) 많았으며, 62명(41.3%)에서 사두증, 124명(82.7%)에서 체부 만곡이 관찰되었다. 여아의 경우 생식기 방향을 통해 간접적으로 유추하여 평가한 골반 경사(pelvic obliquity)가 62명(63.3%)에서 관찰되었다. 고관절 진찰에서 이상 소견을 보이지 않은 139명에서는 DDH가 발견되지 않았으며, 고관절 진찰에서 이상 소견을 보인 11명 중에 6명에서 DDH로 진단되었다. 결론: 태아기 자세성 변형과의 동반 여부에 상관없이, 고관절 진찰에서 이상 소견이 있는 영아에서만 DDH가 진단되었다. 따라서 일차 DDH 선별 검사 시에 고관절 진찰을 함께 시행함으로써 DDH의 추정 진단에 대해 도움을 줄 수 있음을 염두해 두어야 한다. Purpose: This study aimed to investigate the clinical features of congenital postural deformities and lower extremity asymmetry with respect to the presence of developmental dysplasia of the hip (DDH) in infants with a discrepancy of the limb length referred for suspected DDH. Materials and Methods: We retrospectively reviewed the medical records and radiographs of 150 infants who visited Korea University Anam Hospital Orthopedic Clinic for suspected DDH between March 2013 and March 2015. Results: There were greater numbers of infants with a shorter lower extremity on the left side (n=86, 57.3%) than the right. Plagiocephaly was present in 62 infants and trunk curvature in 124 infants (82.7%). Pelvic tilting—indirectly assessed by a skewed direction of the external genitalia in female infants—was present in 62 infants (63.3%). None of the 139 infants with normal physical examination of the hip were diagnosed with DDH. Of those 11 infants with abnormal findings from the hip physical examination, a total of 6 infants were diagnosed with DDH. Conclusion: Regardless of the associated findings of congenital postural deformation, all infants diagnosed with DDH had abnormal findings from the physical examination of the hip joint. Thus, we conclude that the hip examination is important as the primary clinical screening in aiding the diagnosis of DDH.

발달성 고관절 이형성증 환자에 발생된 고도의 탈구에 대한 전자하부 단축 절골술을 통한 인공고관절 치환

박명식,서동주,박종혁,오상수,황병연 대한고관절학회 2004 Hip and Pelvis Vol.16 No.1

Crowe IV 선천성 고관절 탈구 환자에서 전자하 단축 절골술과 동반하여 시행한 무시멘트 고관절 전치환술

문경호 ( Kyoung Ho Moon ),박현우 ( Hyun Woo Park ),이정윤 ( Jung Youn Lee ) 대한고관절학회 1998 Hip and Pelvis Vol.10 No.2

Hip dysplasia in its end stage may require arthroplasty, and the pathological anatomy of chronically dislocated hips makes reconstruction far more difficult in them than in most cases. Total hip arthroplasty with subtrochanteric shortening osteotomy was performed on five Crowe VI developmental dysplasia of the hip in four women. The clinical and radiological results of this operative technique were excellent in short term follow-up. This operative technique is useful method in Crowe VI developmental dysplasia of the hip for correcting the leg length discrepancy without permanent neurologic deficit.