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Sung-Jae Park, Sung-Jae Lee, Wen-Ming Chen, Jung-Hong Park, Yong-Soo Cho, Taejin Shin, Soon-Yong Kwon
Periacetabular osteotomy (PAO) is a complex surgical procedure to restore acetabular coverage in the dysplastic hip, and the amount of acetabular rotation during PAO plays a key role. Using computational simulations, this study assessed the optimal direction and amount of the acetabular rotation in three dimensions for a patient undergoing PAO. Anatomy-specific finite element (FE) models of the hip were constructed based on clinical CT images. The calculated acetabular rotation during PAO were 9.7°, 18°, and 4...
2018: Applied Bionics and Biomechanics
Daniel A Maranho, Kathryn A Williams, Michael B Millis, Young-Jo Kim, Eduardo N Novais
BACKGROUND: The treatment of hip dysplasia in patients with Down syndrome is challenging. We investigated the clinical, functional, and radiographic outcomes of periacetabular osteotomy (PAO) as well as factors associated with its failure at a minimum of 5 years of follow-up. METHODS: Between 1992 and 2011, 19 patients with Down syndrome (26 hips) underwent PAO at a mean age of 16.2 ± 4.7 years. Hip pain and function were assessed with use of the modified Harris hip score (HHS) and the Gross Motor Function Classification System (GMFCS)...
March 7, 2018: Journal of Bone and Joint Surgery. American Volume
Koichi Ogura, Michiro Susa, Hideo Morioka, Akihiko Matsumine, Takeshi Ishii, Kenichiro Hamada, Takafumi Ueda, Akira Kawai
BACKGROUND: We conducted a nationwide survey of prosthetic reconstruction using a constrained-type hip tumor prosthesis (C-THA) following resection of periacetabular tumors. METHODS: Eighty patients with periacetabular tumors underwent wide resection and prosthetic reconstruction using C-THA at JMOG-affiliated institutions (39 males and 41 females; mean age, 46.7 years; mean follow-up period, 65 months). Primary bone or soft tissue sarcoma accounted for 75% of the cases...
February 23, 2018: Journal of Surgical Oncology
D A Maranho, Y-J Kim, K A Williams, E N Novais
Purpose: To investigate the outcomes of an anteverting triple periacetabular osteotomy for the treatment of hip instability in skeletally immature patients with Down syndrome. Methods: We evaluated 16 patients (21 hips) with Down syndrome and hip instability who underwent an anteverting triple periacetabular osteotomy between 2007 and 2016. There were nine females and seven males with an average age of 7.4 years SD 2.0. We assessed the level of hip pain, gait ability and clinical stability at a minimum of one year after surgery...
February 1, 2018: Journal of Children's Orthopaedics
L Franken, F Thielemann, A Postler, S Blum, A Hartmann, K-P Günther, J Goronzy
INTRODUCTION: Periacetabular osteotomy (PAO) is an effective procedure in treatment of symptomatic hip dysplasia. To achieve a good outcome a strict patient selection has to be applied. The aim of this study was to evaluate the influence of patient age at surgery on clinical outcome. METHODS: In a prospective study 86 patients (106 hips) underwent clinical and radiographic follow-up at a mean time of 5 years (2.5-8.5 years) after PAO. Patient-related outcome measurements (PROMs: EQ-5D, WOMAC, OHS, GTO) were applied preoperatively as well as postoperatively and the deformity correction as well as development of osteoarthritis were evaluated...
February 12, 2018: Der Orthopäde
Andrea M Spiker, Kate R Gumersell, Ernest L Sink, Bryan T Kelly
In the realm of hip preservation, hip arthroscopy is often used to address intra-articular impingement pathology, whereas periacetabular osteotomy (PAO) is used to address dysplasia and instability. Indications to combine these 2 procedures include hip dysplasia and symptomatic instability with a concomitant symptomatic labral tear or the other symptomatic intra-articular pathology (i.e., loose body, chondral flap). The arthroscopic portion of the procedure allows repair of the injured labrum and close inspection of the hip joint, and the PAO addresses undercoverage and/or inappropriate version of the acetabulum...
October 2017: Arthroscopy Techniques
Songkiat Thanacharoenpanich, Matthew J Boyle, Robert F Murphy, Patricia E Miller, Michael B Millis, Young-Jo Kim, Yi-Meng Yen
Patients with developmental dysplasia of the hip (DDH) who undergo periacetabular osteotomy (PAO) often have labral tears. The objective of this retrospective study was to compare PAO alone with PAO combined with arthrotomy or arthroscopy in DDH patients who had a full-thickness labral tear on magnetic resonance imaging. In total, 47 hips in the PAO group (PAO) were compared with 60 hips in the PAO with concomitant arthrotomy or arthroscopy (PAO-A) with respect to Hip Disability and Osteoarthritis Outcome Score (HOOS), modified Harris Hip Score (mHHS), Visual Analog Scale (VAS), clinical and radiographic outcomes at a median of 29 months...
January 2018: Journal of Hip Preservation Surgery
Jason J Shin, Darren L de Sa, Jeremy M Burnham, Craig S Mauro
With increased knowledge and understanding of hip pathology, hip arthroscopy is rapidly becoming a popular treatment option for young patients with hip pain. Despite improved clinical and radiographic outcomes with arthroscopic treatment, some patients may have ongoing pain and less than satisfactory outcomes. While the reasons leading to failed hip arthroscopy are multifactorial, patient selection, surgical technique and rehabilitation all play a role. Patients with failed hip arthroscopy should undergo a thorough history and physical examination, as well as indicated imaging...
January 2018: Journal of Hip Preservation Surgery
Joel Wells, Perry Schoenecker, Stephen Duncan, Charles W Goss, Kayla Thomason, John C Clohisy
BACKGROUND: The Bernese periacetabular osteotomy (PAO) is an alternative to arthroplasty for treating symptomatic acetabular dysplasia, but there have been few studies on the intermediate-term outcomes of this procedure. In the present study, we assessed intermediate-term hip survival and patient-reported outcomes of PAO used to treat symptomatic acetabular dysplasia. METHODS: From July 1994 to August 2008, 238 hips (206 patients) were treated with PAO. Sixty-two had a diagnosis other than classic acetabular dysplasia, and 22 were lost to follow-up...
February 7, 2018: Journal of Bone and Joint Surgery. American Volume
Andrew J Bryan, Kirsten Poehling-Monaghan, Aaron J Krych, Bruce A Levy, Robert T Trousdale, Rafael J Sierra
The purpose of this study was to compare a group of dysplastic hips treated successfully with hip arthroscopy with a group of dysplastic hips treated unsuccessfully with hip arthroscopy to determine (1) preoperative patient characteristics and radiographic parameters and (2) intraoperative findings and treatment associated with outcome. The authors retrospectively reviewed a prospective database of 20 adult patients (17 female, 3 male) with hip dysplasia who underwent primary hip arthroscopy between January 2009 and February 2013...
January 25, 2018: Orthopedics
Morteza Kalhor, Kaveh Gharanizadeh, Paulo Rego, Michael Leunig, Reinhold Ganz
OBJECTIVES: The purpose of this study was to report (1) a different but specific pattern of impingement in hips involved with valgus slipped capital femoral epiphysis (valgus SCFE) and (2) the results of surgical treatment using intracapsular realignment techniques. DESIGN: Case series. SETTING: Multiple academic centers. PATIENTS: Six patients with 8 involved hips referred for valgus alignment of proximal femoral epiphysis (valgus SCFE)...
February 2018: Journal of Orthopaedic Trauma
Jody Litrenta, Brian Mu, Victor Ortiz-Declet, Austin W Chen, Itay Perets, Benjamin G Domb
PURPOSE: To compare patient-reported outcomes, progression of radiographic arthritis, revision rates, and complications for hips with acetabular retroversion treated by open versus arthroscopic methods. METHODS: The PubMed and EMBASE databases were searched in August 2016 for literature on the open and arthroscopic techniques using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) method. All studies published in the English language that focused on the surgical treatment of femoroacetabular impingement caused by retroversion were included...
January 17, 2018: Arthroscopy: the Journal of Arthroscopic & related Surgery
Zhiye Du, Shun Tang, Rongli Yang, Xiaodong Tang, Tao Ji, Wei Guo
BACKGROUND: Hip dislocation is a major complication of total femoral prosthetic reconstruction (TFR) after femoral tumor resection. Hip dislocation can occur because of inadequate functional abductor musculature, inadequate hip capsule repair, or a long lever arm after total femur replacement. To eliminate the negative effects of these factors on the risk of hip dislocation, the use of artificial ligaments may help to increase the stability of the hip joint. We aimed to determine whether application of an artificial ligament would improve limb function and active range of movement (ROM) after TFR...
December 27, 2017: Journal of Arthroplasty
Karen Boretsky, Maria A Hernandez, Elizabeth Eastburn, Cornelius Sullivan
BACKGROUND: The clinical reliability and reproducibility of ultrasound-guided lumbar plexus blocks is not established in pediatric populations. We present the results of a combined nerve stimulation ultrasound-guided lumbar plexus block using the vertebral body, transverse process, and psoas muscle as landmarks on a transverse lumbar paravertebral sonogram with mid-axillary transducer placement, "shamrock method," in children and adolescents. AIMS: Our primary objective was to determine the rate of achieving sensory changes in the lumbar plexus distribution...
January 23, 2018: Paediatric Anaesthesia
Cale A Jacobs, Michael R Peabody, Stephen T Duncan, Ryan D Muchow, Ryan M Nunley, John C Clohisy, Paul E Beaule, Young Jo Kim, Michael B Millis, David A Podeszwa, Perry L Schoenecker, Rafael J Sierra, Ernest L Sink, Daniel J Sucato, Robert T Trousdale, Ira Zaltz
BACKGROUND: The creation of a single patient-reported outcome (PRO) platform validated across hip preservation, osteoarthritis (OA), and total hip arthroplasty (THA) populations may reduce barriers and streamline the routine collection of PROs in clinical practice. As such, the purpose of this study was to determine if augmenting the Hip disability and Osteoarthritis Outcome Score-Joint Replacement (HOOS, JR) with additional HOOS questions would result in a PRO platform that could be used across a wider spectrum of hip patient populations...
January 1, 2018: American Journal of Sports Medicine
J W Thomas Byrd, John C Clohisy, Young-Jo Kim, F Winston Gwathmey, Kay S Jones, Michael B Millis
Hip problems due to dysplasia are commonly associated with female athletes in sports demanding supraphysiologic motion, such as ballet, gymnastics and figure skating. However, hip problems are rarely mentioned among wrestlers, a male sport in which flexibility is advantageous. Dysplasia may have a mostly unrecognized prevalence among wrestlers that can lead to problems and benefit from reorientation periacetabular osteotomy (PAO). Study design in this research is Level 4 evidence case reports. Three consecutive intercollegiate wrestlers ages 20, 21 and 22 years underwent PAO for dysplasia and are reported...
December 2017: Journal of Hip Preservation Surgery
Christoph E Albers, Piet Rogers, Nicholas Wambeek, Sufian S Ahmad, Piers J Yates, Gareth H Prosser
Redirective, periacetabular osteotomies (PAO) represent a group of surgical procedures for treatment of developmental dysplasia of the hip (DDH) in skeletally mature and immature patients. The ultimate goal of all procedures is to reduce symptoms, improve function and delay or prevent progression of osteoarthritis. During the last two decades, the understanding of the underlying pathomechanisms has continuously evolved. This is mainly attributable to the development of the femoroacetabular impingement concept that has increased the awareness of the underlying three-dimensional complexity associated with DDH...
December 2017: Journal of Hip Preservation Surgery
Michael Leunig, Jonathan M Vigdorchik, Aidin Eslam Pour, Silvia Willi-Dähn, Reinhold Ganz
CASE: A large surgical correction was required for severe hip dysplasia, which was associated with a delayed-onset sciatic nerve injury in an adolescent patient. A cortical bone spur on the outside of the acetabular fragment produced an indirect injury that became symptomatic during mobilization of the patient. CONCLUSION: The risk of direct injury to the sciatic nerve during a periacetabular osteotomy is quite low when the osteotomy is executed in extension with abduction of the hip and flexion of the knee to reduce tension on the sciatic nerve...
January 2017: JBJS Case Connector
Diogo Lino Moura, Rúben Fonseca, João Freitas, António Figueiredo, José Casanova
Chondrosarcoma is a malignant cartilage-forming neoplasm. It is difficult to treat because of resistance to both chemotherapy and radiation, making wide local excision the only treatment. This report presents an active, 43 year-old man who was diagnosed with recurrent clear cell chondrosarcoma of the proximal left femur, previously reconstructed with a total hip prosthesis, extending to the weight-bearing dome of the acetabulum. Cancer staging study revealed no signs of tumor dissemination at distance. Given the excellent functional status of the patient, the authors performed a Enneking-Dunham type periacetabular pelvic resection and resected en bloc, with the total hip prosthesis including 22 cm of the femur and a portion of the hip abductor apparatus...
November 2017: Revista Brasileira de Ortopedia
Ayumi Matsunaga, Shunsuke Akiho, Koichi Kinoshita, Masatoshi Naito, Takuaki Yamamoto
PURPOSE: Curved periacetabular osteotomy (CPO) has been developed for the treatment of acetabular dysplasia. While several studies have reported its good clinical results, the complications of CPO include delayed union and nonunion of the superior pubic ramus. The purpose of this study is to investigate the prevalence of delayed union of the pubis one year after CPO, and to determine the risk factors for this complication. METHODS: The study examined 113 hips that underwent CPO between 2008 and 2012...
December 5, 2017: International Orthopaedics
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