Search Results (110)

Background: We aimed to analyze various gait parameters before and after THA for patients with a highly dislocated hip to examine gait recovery and whether it is continued. Methods: This was a retrospective, single-center study. We enrolled 10 patients with a highly dislocated hip (10 hips) due to developmental dysplasia of the hip (DDH) or sequelae of septic arthritis of the hip (SSH). A spatio-temporal gait analysis was performed before THA with subtrochanteric osteotomy and one year after surgery for all patients, and 5 of them had a complete follow-up gait analysis at five years postoperatively. Demographics, clinical outcome, and radiological data were collected. Results: At one year postoperatively, the terminal double support (TDS) increased from 8.6% (4.3–12.6) to 11.3% (5.8–14.0) of the gait cycle (p = 0.02). The vertical ground reaction force (vGRF) increased from 0.96 N/BW (0.69–1.30) to 1.11 N/BW (0.95–1.31) for the first peak (p = 0.045) and from 0.87 N/BW (0.59–1.12) to 1.10 N/BW (1.00–1.30) for the second peak (p = 0.001). However, there was no improvement in any gait parameters at five years postoperatively compared to one year postoperatively. The mean HHS was 57.2 (43–67) before surgery and 79.6 (61–88) at the last follow-up (p = 0.001). The preoperative leg length discrepancy (LLD), which was 43.6 mm (18.2–71.6), and improved to 9.8 mm (2.1–22.1) after surgery. Conclusions: Improvements in stance-phase stability (TDS) and vertical ground reaction forces (vGRF) enhanced gait after THA in patients with highly dislocated hips; however, these gains were only observed until 1 year postoperatively, with no further improvement thereafter. Notably, the magnitude of improvement in TDS and vGRF may exceed that typically reported after THA for primary osteoarthritis. Full article

Background and Objectives: Developmental dysplasia of the hip (DDH) in children can result in long-term skeletal complications, including a reduced bone mineral density (BMD) and an increased risk of osteoporosis. This study aimed to evaluate BMD in children with DDH and to identify clinical, functional, and nutritional factors associated with reduced BMD. Materials and Methods: A cross-sectional study was conducted on 25 children aged 5–10 years with confirmed DDH. Bone mineral density was measured at the total body, subtotal, and lumbar spine using dual-energy X-ray absorptiometry (DXA), and Z-scores were calculated. Functional assessments included isometric muscle strength, weight-bearing symmetry, and physical activity measured via accelerometry. Demographic data and daily calcium intake were recorded. Correlation and multiple linear regression analyses were performed to determine predictors of BMD. Results: Most participants exhibited normal growth and mobility, with mild asymmetries in limb strength and length. The mean total BMD was within normative ranges, whereas the lumbar spine Z-score (−1.41 ± 1.72) was mildly reduced. BMD positively correlated with age, anthropometric measures, weight-bearing capacity, and calcium intake, and negatively correlated with a family history of osteoporosis. Multiple regression analysis identified the muscle strength symmetry index as the strongest independent predictor of BMD across all sites (subtotal Z-score: β = 1.000, p < 0.001; total Z-score: β = 0.425, p = 0.023; lumbar Z-score: β = 0.499, p = 0.014). Physical activity levels showed no significant associations with BMD. Conclusions: Children with DDH generally demonstrate preserved overall BMD; however, mild lumbar spine deficits may occur. Muscle strength symmetry appears to be the most influential modifiable factor for optimizing bone health in this population, highlighting the importance of targeted physiotherapy interventions. Full article

Ultrasound examination using the Graf method is widely applied for early detection of developmental dysplasia of the hip (DDH), but intra- and inter-operator variability remains a limitation. This study aimed to quantify operator variability in hip ultrasound assessments and to validate an AI-assisted system for automated α-angle measurement to improve reproducibility. Thirty participants of different experience levels, including trained clinicians, residents, and medical students, each performed six ultrasound scans on a standardized infant hip phantom. Examination time, iliac margin inclination, and α-angle measurements were analyzed to assess intra- and inter-operator variability. In parallel, an AI-based system was developed to automatically detect anatomical landmarks and calculate α-angles from static images and dynamic video sequences. Validation was conducted using the phantom model with a known α-angle of 70°. Clinicians achieved shorter examination times and higher reproducibility than residents and students, with manual measurements systematically underestimating the reference α-angle. Static AI produced closer estimates with greater variability, whereas dynamic AI achieved the highest accuracy (mean 69.2°) and consistency with narrower limits of agreement than manual measurements. These findings confirm substantial operator variability and demonstrate that AI-assisted dynamic ultrasound analysis can improve reproducibility and reliability in routine DDH screening. Full article

Developmental dysplasia of the hip (DDH) is a common neonatal musculoskeletal disorder. In Germany, sonographic screening is recommended at 1–10 days of life for neonates with specific risk factors. This study aims to determine reference values for early sonographic screening and to evaluate associated risk factors. Between 2007 and 2022, 3383 neonates (6766 hips) underwent hip ultrasound according to Graf. Of these, 967 neonates were screened universally (2007–2015) and 1900 based on predefined risk factors (2015–2022). DDH was defined as ≥type IIc, according to Graf. A subgroup of 20 neonates with borderline alpha angles (51–52°) was followed up after 3–6 weeks. The mean alpha angle was 61.2° ± 5.3° (range 50.5–71.9°), and beta angle 70.8° ± 8.6° (range 53.6–88.0°). DDH prevalence was 2.5% in the universal and 3.2% in the risk-based cohort (p = 0.350). Logistic regression revealed associations with abnormal birth presentation (OR = 3.09, p < 0.001) and female sex (OR = 3.77, p < 0.001), not with Cesarean section or familial predisposition. In the follow-up subgroup, all hips showed a sufficient maturation to an alpha angle of 61.0° (range 57–66°). This study provides reference values for early DDH screening and confirms abnormal birth presentation and female sex as relevant risk factors. Full article

Background: Developmental dysplasia of the hip (DDH), if not treated, can lead to osteoarthritis and disability. Ultrasound (US) is a primary screening method for the detection of DDH, but its interpretation remains highly operator-dependent. We propose a supervised machine learning (ML) image segmentation model for the automated recognition of anatomical structures in hip US images. Methods: We conducted a retrospective observational analysis based on a dataset of 10,767 hip US images from 311 patients. All images were annotated for eight key structures according to the Graf method and split into training (75.0%), validation (9.5%), and test (15.5%) sets. Model performance was assessed using the Intersection over Union (IoU) and Dice Similarity Coefficient (DSC). Results: The best-performing model was based on the SegNeXt architecture with an MSCAN_L backbone. The model achieved high segmentation accuracy (IoU; DSC) for chondro-osseous border (0.632; 0.774), femoral head (0.916; 0.956), labrum (0.625; 0.769), cartilaginous (0.672; 0.804), and bony roof (0.725; 0.841). The average Euclidean distance for point-based landmarks (bony rim and lower limb) was 4.8 and 4.5 pixels, respectively, and the baseline deflection angle was 1.7 degrees. Conclusions: This ML-based approach demonstrates promising accuracy and may enhance the reliability and accessibility of US-based DDH screening. Future applications could integrate real-time angle measurement and automated classification to support clinical decision-making. Full article

Background/Objectives: Developmental dysplasia of the hip (DDH) is one of the most common pediatric orthopedic disorders and warrants timely diagnosis and treatment to prevent long-term disability. This review identified, summarized, and assessed the quality of current European national guidelines for DDH screening and treatment. Methods: Guidelines were identified by contacting the national orthopedic societies from 46 European countries and retrieving the guidelines from a recent systematic review. Two researchers independently extracted data and assessed guideline quality using the AGREE II checklist. Interrater agreement was assessed using Cohen’s $\kappa$. Results: Nine European national DDH guidelines were identified, of which four were published in peer-reviewed scientific journals. All guidelines advised clinical examination and imaging as part of the DDH screening program, though screening approach and timing varied considerably. Four guidelines included treatment recommendations. The type of treatment (abduction treatment vs. active monitoring) and duration of long-term follow-up showed great variation. Guideline quality ranged from 16 to 92% (Cohen’s $\kappa$ = 0.62), with two out of nine guidelines rated “good quality” (>70%). Conclusions: European national DDH guidelines appear scarce and of varying quality and content. A coordinated European initiative is warranted to urge countries to develop evidence-based DDH guidelines using validated tools and to publish these guidelines in peer-reviewed journals, thereby advancing equal diagnosis and treatment for children with DDH. Full article

Developmental dysplasia of the hip (DDH) is a congenital disorder influenced by genetic and epigenetic factors. This study aimed to elucidate the molecular pathogenesis of DDH through a comprehensive transcriptomic analysis, identifying differentially expressed genes (DEGs) and long non-coding RNAs (lncRNAs) in hip joint capsules from DDH patients and healthy controls. RNA sequencing data from 12 samples (6 DDH, 6 controls) were retrieved from the NCBI database. Functional annotation was performed using Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses via the DAVID tool. A protein–protein interaction (PPI) network of DEGs was constructed using STRING with medium confidence settings. Among 78,930 transcripts, 4.3% were significantly differentially expressed, according to DESeq2 analysis. A total of 3425 DEGs were identified (FDR < 0.05, |log2 FC| > 2), including 1008 upregulated and 2417 downregulated transcripts in DDH samples. Additionally, 1656 lncRNAs were detected among the DEGs. These findings enhance our understanding of the genetic and epigenetic landscape of DDH and highlight the involvement of key biological pathways such as cell cycle regulation and Wnt signaling. This study provides a foundation for future molecular research into the pathogenesis of DDH. Full article

Background and Objectives: Total hip arthroplasty (THA) following pelvic osteotomy for developmental dysplasia of the hip (DDH) is technically challenging due to altered acetabular morphology. This study aimed to compare radiographic cup position and perioperative characteristics of THA after three common pelvic osteotomies—periacetabular osteotomy (PAO), shelf procedure, and Chiari osteotomy—with primary THA in Crowe type I DDH. Methods: A retrospective review identified 25 hips that underwent conversion THA after pelvic osteotomy (PAO = 12, shelf = 8, Chiari = 5) and 25 primary THAs without prior osteotomy. One-to-one matching was performed based on sex (exact match), age (within 5 years), and BMI (within 2 kg/m²) without the use of propensity scores. Cup inclination, radiographic anteversion, center-edge (CE) angle, and cup height were measured on standardized anteroposterior radiographs (ICC = 0.91). Operative time, estimated blood loss, and use of bulk bone grafts or reinforcement rings were reviewed. One-way ANOVA with Dunnett’s post hoc test and chi-square test were used for statistical comparison. Results: Cup inclination, anteversion, and CE angle did not differ significantly among groups. Cup height was significantly greater in the PAO group than in controls (29.0 mm vs. 21.8 mm; p = 0.0075), indicating a more proximal hip center. The Chiari and shelf groups showed upward trends, though not significant. Mean operative time tended to be longer after PAO (123 min vs. 93 min; p = 0.078). Bulk bone grafts and reinforcement rings were more frequently required in the PAO group (17%; p = 0.036 vs. control), and occasionally in Chiari cases, but not in shelf or control groups. Conclusions: THA after PAO is associated with higher cup placement and greater need for reconstructive devices, indicating increased technical complexity. In contrast, shelf and Chiari conversions more closely resemble primary THA. Preoperative planning should consider hip center translation and bone-stock restoration in post-osteotomy THA. Full article

Background: Residual deficits after early treatment of developmental dysplasia of the hip (DDH) using osteotomy often led to asymmetrical gait deviations with increased repetitive rates of ground reaction force (GRF) in both hips, resulting in a higher risk of early osteoarthritis. This study investigated lower limb inter-joint coordination and swing foot control during level walking in adolescents with early-treated unilateral DDH. Methods: Eleven female adolescents treated early for DDH using Pemberton osteotomy were compared with 11 age-matched healthy controls. The joint angles and angular velocities of the hip, knee, and ankle were measured, and the corresponding phase angles and continuous relative phase (CRP) for hip–knee and knee–ankle coordination were obtained. The variability of inter-joint coordination was quantified using the deviation phase values obtained as the time-averaged standard deviations of the CRP curves over multiple trials. Results: The DDH group exhibited a flexed posture with increased variability in knee–ankle coordination of the affected limb throughout the gait cycle compared to the control group. In contrast, the unaffected limb compensated for the kinematic alterations of the affected limb with reduced peak angular velocities but increased knee–ankle CRP over double-limb support and trajectory variability over the swing phase. Conclusions: The identified changes in inter-joint coordination in adolescents with early treated DDH provide a plausible explanation for the previously reported increased GRF loading rates in the unaffected limb, a risk factor of premature OA. Full article

Background/Objectives: Developmental dysplasia of the hip (DDH) affects 1–3% of newborns and requires early detection for optimal outcomes. DDH involves abnormal acetabular–femoral congruence between the acetabulum and femoral head, resulting from either shallow acetabular development or delayed femoral ossification of the femoral head. We evaluated the ossification nucleus of the femoral head (ONFH) to determine prevalence, radiographic timing, and associations with perinatal factors. Methods: We analyzed 100 pelvic radiographs of infants between 90 and 150 days of age. Participants were selected by convenience sampling, based on inclusion criteria. We identified the presence of ONFH and measured biometric parameters, morphology, and anatomical location. Sociodemographic and perinatal data were collected from the participating infants. Results: The prevalence of ONFH was 33%, and the mean age at visualization was 104 days. The presence of ONFH was correlated with birth weight (p = 0.011), discharge weight (p = 0.005), and weight at 1 month (p = 0.034). In our study, female sex (p = 0.004) was associated with a 4.966-fold higher odds of ONFH prevalence compared to males. Conclusions: This study provides relevant evidence regarding the prevalence, morphology, and characteristics of ONFH. Few studies report this information on ONFH in different populations. The optimal timing for radiographic visualization of ONFH in infants remains undefined, but the appearance of the ONFH was concentrated around 104 days of life. The novel association between weight and ONFH provides new insights into DDH. This provides new insights for DDH screening. This association warrants further research for the early detection of DDH. Full article

Background: The increasing incidence of revision total hip arthroplasties (rTHAs), particularly due to failure of the acetabular components and severe bone loss, necessitates reliable surgical solutions. Iliac stemmed cups (ISCs) have emerged as effective options for managing complex pelvic defects, including Paprosky type 3A and 3B acetabular defects, severe developmental dysplasia, and selected pelvic discontinuities. This review examines the historical evolution, clinical indications, and outcomes associated with ISCs. Methods: This narrative review analyzed the historical and recent literature concerning various ISC designs. We critically assessed clinical outcomes, complication rates, and implant survival from 13 key studies. Results: ISCs have progressed significantly from initial monobloc designs to contemporary modular configurations, substantially enhancing surgical versatility and biomechanical stability. Clinical outcomes varied with reported complications such as infection, dislocation, mechanical failure, and aseptic loosening ranging from 10% to over 30%. Newer modular implants like the Sansone cup have demonstrated improved outcomes, with complication rates below 10% and five-year survival rates exceeding 95%. Conclusions: ISCs are reliable and versatile implants, particularly suited to address significant pelvic bone deficiencies. Optimal surgical techniques and careful implant selection remain essential to minimize complications and achieve favorable long-term functional outcomes, making these implants valuable tools in complex hip arthroplasty. Full article

(1) Background: This publication focuses on processes that disrupt the proper development of the hip. Four pathomechanisms underlying human developmental defects are described in the literature, i.e., dysplasia, malformation, disruption, and deformity. In the case of hip development, arguably the greatest challenge involves confusion between dysplasia and deformity, which often leads to misdiagnosis, incorrect nomenclature, and incorrectly chosen treatment. (2) Methods: A review of the scientific literature was performed. (3) Results: The paper presents a description of hip joint development disorders in the context of their pathomechanisms. An attempt was made to answer the question of whether these disorders are rooted in a primary disorder of tissue growth, resulting in incorrect anatomy, or are the result of anatomical deformations with secondary modifications in tissue structures—of a degenerative or adaptive nature—based on Delpech–Hueter–Volkmann growth and remodeling laws. In addition, the emphasis is placed on the presence of so-called clinically and diagnostically mute cases. We suggest augmenting diagnostic procedures with genetic tests to increase the sensitivity of screening. (4) Conclusions: Based on the arguments, a new division of developmental hip disorders is proposed. Full article

Background: Total hip arthroplasty (THA) remains the standard treatment for advanced osteoarthritis, including for complex deformities. Innovations such as spherical screw-in acetabular components aim to enhance fixation and long-term outcomes. This study evaluated the long-term clinical and radiographic outcomes of cementless THA using such implants. Methods: A retrospective analysis was conducted on 277 patients (293 hips) who underwent THA with a screw-in acetabular cup (Aesculap/BBraun SC, Tuttlingen, Germany) and Antega femoral stem between 2005 and 2024. Patients were evaluated using the modified Merle d’Aubigné and Postel (MAP) score, Visual Analog Scale (VAS), and radiographic classifications, with implant survival assessed via Kaplan–Meier analysis. Results: The mean follow-up was 13.8 years. At the final follow-up, 58.7% of hips achieved excellent MAP scores, and mean VAS pain scores improved from 7.1 to 1.8 (p < 0.05). Implant positioning was within the Lewinnek safe zone in 77.1% of cases. Revision was required in 6.1% of hips, mostly due to aseptic loosening. The five- and ten-year survival rates were 98.3% and 94.0%, respectively. Conclusions: Spherical screw-in acetabular cups provide durable fixation and satisfactory long-term outcomes in THA, particularly for dysplastic hips, supporting their continued use with careful surgical techniques. Full article

Background: This study aims to demonstrate the challenges during the treatment of patients with osteoarthritis due to the development of dysplasia, which can be faced by surgeons who treat patients with THA. Our objective is to present our findings from a comparison of patients who underwent total hip arthroplasty (THA) for osteoarthritis secondary to developmental dysplasia of the hip (DDH), with or without a prior periacetabular osteotomy (PAO). Methods: We divided patients into two groups. Group A was adolescents who underwent periacetabular osteotomy and further THA in the orthopedic center (29 hips), and Group B was adolescents who underwent THA without PAO but suffered from DDH (24 hips). We measured blood loss, cup size, cup positioning, cup coverage, inclination and anteversion of the cup, duration of surgery, clinical scores, time of hospitalization, and the presence of ossification. Results: The mHHS score demonstrated significant differences (group A: 89 points vs. group B: 91 points; p = 0.03). The blood loss was expressed in the difference in Hb concentration preoperatively and on the 3rd postoperative day, which was higher by 0.85 mg/dL in group A (group A: 4.4 mg/dl vs. group B: 3.55 mg/dL; p = 0.004). Also, the value of HCT on the 3rd postoperative day was significantly lower in group A (group A: 27% vs. group B: 29.5%; p = 0.02). Radiological measurements showed a statistically significant difference in the Brooker scale (p = 0.005). Thirteen patients from group A after THA expressed first-grade ossifications or higher, and two patients from group B had first- and second-grade ossifications. Furthermore, a notably larger distalization was observed after the PAO procedure compared to those who underwent the procedure without PAO previously (79 mm [IQR = 73–83 mm] vs. 74.5 mm [IQR = 69–77 mm]; p = 0.004). Conclusions: Patients reported lower mHHS results, a higher risk of heterotopic ossifications, prosthesis head distalization, and more significant blood loss during the perioperative period after THA in patients who underwent PAO compared to those without a previously performed osteotomy. Full article

Developmental dysplasia of the hip (DDH) is a multifactorial and polygenic abnormal hip joint development, with a prognosis influenced by environmental and genetic factors, potentially leading to complete dislocation. Growth differentiation factor 5 is a signaling molecule, encoded by a polymorphic gene (GDF5), promoting the development, repair, and maintenance of bone, cartilage, and other synovial joint tissues. The GDF5 rs143384 G>A polymorphism affects GDF5 expression and may be associated with a susceptibility to DDH. The aim of this study was to determine the frequency of the GDF5 rs143384 polymorphism in Brazilian individuals and its influence on the development of DDH. This case–control study included 50 DDH cases and 150 controls without hip disease. Genotyping was performed by real-time PCR using the TaqMan system. The GDF5 AA variant genotype frequency was significantly higher in DDH cases (32%) compared to controls (14%, p-value = 0.01) and showed a marginal association with disease risk (OR = 1.47; CI 95% = 0.96–2.26). The GDF5 rs143384 polymorphism could be useful in identifying individuals at risk, guiding personalized treatment strategies, and contributing to diagnosis and clinical management. Full article