Hip Joint Stability during and after Femoral Lengthening in Congenital Femoral Deficiency
Abstract
:1. Introduction
2. Materials and Methods
2.1. Material
2.2. Methods
3. Results
3.1. Hip Stability during Femoral Lengthening
3.2. Hip Stability after External Fixator Removal
3.3. Hip Joint Morphology as Risk Factor for Hip Instability
3.3.1. Initial Assessment
3.3.2. Before Lengthening Assessment
Shenton’s Line
Center-Edge Angle, Acetabular Inclination, Neck-Shaft Angle and Antetorsion
3.4. Parameters of Femoral Lengthening as Risk Factor for Hip Instability
3.5. Pelvic Osteotomy as a Risk Factor for Hip Instability
3.6. CT Analysis of Hip Instability Cases
3.7. Clinical Analysis of Hip Instability Cases
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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SUPERhip Prior to Lengthening | No SUPERhip Prior to Lengthening | Total (Percentage) | |
---|---|---|---|
Group characteristics | N = 20 | N = 13 | N = 33 (100) |
Gender | |||
male | 8 | 8 | 16 (48%) |
female | 12 | 5 | 17 (52%) |
Side of deformity | |||
left | 11 | 7 | 18 (55%) |
right | 9 | 6 | 15 (45%) |
Congenital Femoral Deficiency Paley type [2] | |||
1a1 | 5 | 11 | 16 (48%) |
1a2 | 2 | 0 | 2 (6%) |
1a3 | 13 | 2 | 15 (45%) |
Age at the time of hip reconstruction (years, range) | 4.3 (2.7–8.1) | ||
Age at the time of femoral lengthening (years, range) | 6.6 (4.3–12.3) | 9.6 (6.9–14.3) | 7.8 (4.3–14.3) |
Additional diagnosis of fibular hemimelia Achterman and Kalamchi type [21] | 14 | 10 | 24 (73%) |
1a | 8 | 6 | 14 (42%) |
1b | 2 | 2 | 4 (12%) |
2 | 4 | 2 | 6 (18%) |
Follow-up in months (mean, range) | |||
After SUPERhip | 70 (24–100) | ||
After end of femoral lengthening | 39 (11–73) | 39 (12–106) | 39 (11–106) |
Normal Proximal Femur Morphology N = 13 | Abnormal Proximal Femur Morphology N = 15 | Total N = 28 | |
---|---|---|---|
Hip instability number (%) | 1 (8%) | 5 (33%) | 6 (21%) |
Coxa Vara (NSA < 120 deg) | 0 (0%) | 11 (73%) | 11 (39%) |
Retrotorsion (<0 deg) | 0 (0%) | 7 (44%) | 7 (25%) |
Diminished antetorsion (<20 deg) | 0 (0%) | 8 (53%) | 8 (29%) |
Abnormal antetorsion (retro- or diminished) | 0 (0%) | 15 (100%) | 15 (54%) |
AI > 25 deg. | 0 (0%) | 5 (33%) | 5 (18%) |
CEA < 20 deg | 6 (46%) | 8 (53%) | 14 (50%) |
Instable Hip Joint N = 6 | Stable Hip Joint N = 22 | Total N = 28 | p | OR | |
---|---|---|---|---|---|
Coxa Vara (NSA < 120 deg) | 4 (66%) | 7 (32%) | 11 | p = 0.121 | 4.28 |
Retrotorsion (<0 deg) | 2 (33%) | 5 (23%) | 7 | p = 0.595 | 1.7 |
Diminished antetorsion (<20 deg) | 3 (50%) | 5 (23%) | 8 | p = 0.190 | 3.4 |
Abnormal antetorsion (<20 deg or <0 deg) | 5 (83%) | 10 (45%) | 15 | p = 0.099 | 6 |
AI > 25 deg | 1 (17%) | 4 (18%) | 5 | p = 0.932 | 0.9 |
CEA < 20 deg | 2 (33%) | 12 (55%) | 14 | p = 0.357 | 0.42 |
With Preparatory Surgery | Without Preparatory Surgery | ||||
---|---|---|---|---|---|
Initial Assessment (N = 22) Mean (SD) | Before Lengthening (N = 22) Mean (SD) | Initial vs. before Lengthening p | Before Lengthening (N = 11) Mean (SD) | Before Lengthening with vs. without Preparatory Surgery, p | |
Neck-Shaft Angle | 117.8 (26.7) | 133.5 (13.2) | p < 0.01 * | 136.2 (6.0) | p = 0.43 |
Antetorsion | 7.0 (15.7) | 31.8 (16.0) | p < 0.01 * | 28.5 (10.6) | p = 0.74 |
Acetabular Inclination | 20.0 (7.7) | 11.2 (4.3) | p < 0.01 * | 14.7 (5.0) | p < 0.05 * |
Center-Edge Angle | 18.9 (7.4) | 24.7 (4.5) | p < 0.01 * | 22.3 (6.3) | p = 0.17 |
Hip Joint Instability (N = 6) | Stable Hip Joint (N = 22) | |||
---|---|---|---|---|
Initial | Before Lengthening | Initial | Before Lengthening | |
Neck-Shaft Angle | 112.7 (10.8) | 124.9 (14.2) | 123.2 (4.9) | 134.1 (11.8), p = 0.11 |
Antetorsion | 6.55 (22.0) | 31.6 (20.2) | 14.2 (19.8) | 29.9 (13.4) |
Acetabular Inclination | 16.5 (7.1) | 11.7 (5.5) | 17.7 (6.6) | 12.8 (5.4) |
Center-Edge Angle | 23.4 (6.5) | 26.1 (4.4) | 20.4 (7.6) | 23.7 (5.5) |
Instable Hip Joint N = 6 | Stable Hip Joint N = 22 | Total N = 28 | p | OR | |
---|---|---|---|---|---|
Coxa Vara (NSA < 120 deg) | 3 (50%) | 2 (9%) | 5 | p < 0.05 * | 10 |
Retrotorsion (<0 deg) | 0 (0%) | 0 (0%) | 0 | ||
Diminished antetorsion (<20 deg) | 2 (33%) | 5 (23%) | 7 | p = 0.59 | |
Abnormal antetorsion (<20 deg or <0 deg) | 2 (33%) | 5 (23%) | 7 | p = 0.59 | |
AI > 25 deg | 0 (0%) | 0 (0%) | 0 | ||
CEA < 20 deg | 0 (0%) | 7 (32%) | 7 |
Instable Hip Joint N = 6 (6 Lengthenings) | Stable Hip Joint N = 22 (24 Lengthenings) | p | Total N = 28 (30 Lengthenings) | |
---|---|---|---|---|
Lengthening (cm) | 6.4 (1.0) | 5.5 (1.4) | p = 0.17 | 5.7 (1.4) |
Lengthening (%) | 28.2 (0.1) | 21.4 (0.1) | p = 0.08 | 22.8 (0.1) |
Shorter to healthy femur ratio before lengthening | 0.76 (0.08) | 0.81 (0.08) | p = 0.14 | 0.80 (0.08) |
Shorter to healthy femur ratio after lengthening | 0.92 (0.07) | 0.95 (0.08) | p = 0.43 | 0.94 (0.08) |
Ex-Fix Index (days/cm) | 35.6 (5.3) | 42.4 (23.1) | p = 0.85 | 41.1 (20.9) |
Ex-Fix duration (in days) | 227 (37) | 209 (35) | p = 0.30 | 212 (35) |
CFD Side | Healthy Femur | p | |
---|---|---|---|
AIa | 16.2 (9.0) | 6.5 (2.7) | p < 0.01 * |
AIm | 22.4 (3.9) | 6.7 (3.1) | p < 0.01 * |
AIp | 28.3 (5.6) | 9.9 (2.1) | p < 0.01 * |
Acetabular Anteversion | 10.5 (11.5) | 11.1 (6.0) | p = 0.81 |
Axial Acetabular Inclination | 106.7 (26.0) | 109.1 (13.0) | p = 0.83 |
Difference between AI in anterior and posterior part of acetabulum | 11.1 (6.1) | 3.0 (3.4) | p < 0.01 * |
Case | Hip Joint Initial Morphology | Hip Preparatory Surgery | Complications after Hip Preparatory Surgery | External Fixator Type for Lengthening | Mean Lengthening (%) | Lengthening Complications | When Instability Was Diagnosed (Days after External Fixator Removal) |
---|---|---|---|---|---|---|---|
1 | Normal | SUPERhip | no | Monolateral | 23.2% | no | 184 days |
2 | Diminished antetorsion | SUPERhip | no | Monolateral | 21.2% | Femoral fracture after frame removal | 801 days |
3 | Coxa Vara, Diminished antetorsion | SUPERhip + Dega | no | Monolateral | 39.7% | no | 127 days |
4 | Coxa Vara, Retrotorsion | SUPERhip + Dega | no | Monolateral | 40.2% | no | 509 days |
5 | Coxa Vara, Retrotorsion | PFO + Dega | Plate aseptic loosening, treated with plate replacement and fixation. | Monolateral | 16.8% | no | 752 days |
6 | Coxa Vara, Diminished antetorsion | PFO + Dega | Plate aseptic loosening, treated with plate replacement and fixation. | Circular | 27.8% | Femoral fracture after prophylactic nail removal | 1447 days |
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Tschurl, J.; Shadi, M.; Kotwicki, T. Hip Joint Stability during and after Femoral Lengthening in Congenital Femoral Deficiency. Children 2024, 11, 500. https://doi.org/10.3390/children11040500
Tschurl J, Shadi M, Kotwicki T. Hip Joint Stability during and after Femoral Lengthening in Congenital Femoral Deficiency. Children. 2024; 11(4):500. https://doi.org/10.3390/children11040500
Chicago/Turabian StyleTschurl, Jędrzej, Milud Shadi, and Tomasz Kotwicki. 2024. "Hip Joint Stability during and after Femoral Lengthening in Congenital Femoral Deficiency" Children 11, no. 4: 500. https://doi.org/10.3390/children11040500
APA StyleTschurl, J., Shadi, M., & Kotwicki, T. (2024). Hip Joint Stability during and after Femoral Lengthening in Congenital Femoral Deficiency. Children, 11(4), 500. https://doi.org/10.3390/children11040500