Search Results (118)

Background/Objectives: The prevalence of developmental dysplasia of the hip (DDH) in adolescent idiopathic scoliosis (AIS) remains unclear, partly because of differences in diagnostic criteria and measurement accuracy. Additionally, spinopelvic alignment and skeletal maturation may affect radiographic assessment of acetabular morphology in patients with AIS. This study aimed to clarify the prevalence of DDH in Japanese patients with AIS using standardized radiographic assessment and to compare conventional and age-adjusted diagnostic criteria for DDH. Methods: This cross-sectional study included 602 Japanese patients aged 10–18 years with AIS. Patients with inadequate radiographs, including those with pelvic rotation and lateral inclination, were excluded to improve measurement accuracy. DDH was defined using two criteria: (1) conventional (lateral center-edge angle <20°) and (2) age-adjusted thresholds (<15° for <15 years and <18° for ≥15 years). Radiographic parameters were compared between patients with and without DDH. A multivariate logistic regression analysis was performed to identify factors independently associated with DDH. Results: The prevalence of DDH in AIS was 5.6% (34/602) using the conventional criterion and 1.5% (9/602) using the age-adjusted criteria. Patients with DDH showed significantly lower acetabular coverage, with a lower lateral center-edge angle and acetabular head index and higher Sharp and Tönnis angles than those without DDH (all p < 0.01). No significant difference in the main curve Cobb angle was observed between the groups. A younger age was independently associated with DDH, whereas sex and the main curve Cobb angle were not. Conclusions: The prevalence of DDH in Japanese patients with AIS varies substantially depending on the diagnostic criteria. Standardized radiographic evaluation with exclusion of pelvic rotation provides a reliable estimate. These findings highlight the importance of evaluating acetabular morphology on standing whole-spine radiographs in patients with AIS while considering skeletal maturation and spinopelvic alignment. Full article

Developmental dysplasia of the hip (DDH) is a common musculoskeletal disorder in infancy, and early detection is essential for optimal clinical outcomes. Radiographic assessment is traditionally based on angular measurements, which may be limited by variability in landmark identification and do not fully capture the complex morphology of the hip joint. In this study, we investigate whether geometric features derived from the hip joint articulation space can be used to differentiate between normal and dysplastic hips in infant radiographs. Pelvic X-ray images from infants (mean age 4.5 ± 0.83 months) were analyzed, and custom segmentation masks were developed to isolate the joint space region. A total of 99 geometric and radiomic features were extracted and evaluated using statistical analysis and supervised machine learning methods. Multiple features demonstrated strong discriminative power between normal and DDH (p < 0.001), with shape and spatial distribution characteristics showing the highest relevance. Classification models achieved an F1-score of approximately 80% on the full dataset. Notably, patient age was identified as a significant confounding factor, and analysis on an age-matched subset improved classification performance to 94% accuracy and 93% recall. These findings suggest that geometric characterization of the hip joint space provides a promising and interpretable framework for DDH detection. The results also highlight the importance of age-stratified analysis in pediatric imaging. Further validation on larger and more diverse datasets is required to assess clinical applicability. Full article

Background: Surgical management of adult patients with post-dysplastic coxarthrosis using total hip arthroplasty is technically demanding and carries an increased risk of complications. In cases of high iliac dislocation classified as Crowe type IV, restoring the acetabular component to the anatomical hip centre often requires femoral shortening osteotomy to enable safe reduction in the prosthetic joint. Nevertheless, long-term evidence on functional outcomes and prosthesis survival with this approach is limited. Methods: A retrospective cohort study included 19 patients with 22 cases of Crowe type IV post-dysplastic hip osteoarthritis treated with uncemented total hip arthroplasty (Pinnacle/S-ROM, DePuy, Warsaw, IN, USA) combined with transverse subtrochanteric femoral shortening osteotomy. Patients underwent serial clinical follow-up, including assessment of range of motion, measurement of limb-length discrepancy, and functional evaluation using the Harris Hip Score and the WOMAC questionnaire. Radiological assessment included evaluation of osteotomy union, implant positioning, and osteolysis on standardized radiographs. Vertical distances of the centre of rotation (CR), the tip of the greater trochanter (GT), and the tip of the lesser trochanter (LT) from both reference lines were measured bilaterally, and inter-side differences were calculated. The reference lines consisted of the line connecting the inferior margins of the ischial bones and the teardrop (TD) line. Results: All osteotomies united at a mean of 5.57 months, with a mean follow-up of 129 months. Mean limb-length discrepancy decreased from 5.27 cm to 1.5 cm, and mean hip flexion improved from 82.9° to 106°. Functional outcomes improved significantly, with mean WOMAC increasing from 55.4 to 80.1 (p < 0.001) and mean Harris Hip Score from 49.8 to 84.66 at up to 3 years of follow-up (p < 0.001). Osteotomy length correlated strongly with lesser trochanter–teardrop distance (p = 0.00000048). Complications included distal femoral fissure (27.3%) and revision (18%), with no infection or permanent neurological deficit. Conclusions: Total hip arthroplasty combined with subtrochanteric femoral shortening osteotomy for Crowe type IV post-dysplastic hip osteoarthritis appears to be a feasible and effective procedure in an experienced centre, providing reliable osteotomy healing and significant early functional improvement that is sustained over time. Limb-length discrepancy was reduced and satisfactory biomechanical restoration was achieved, with an acceptable complication profile and implant survival of 81.3% at long-term follow-up. The LT–TD parameter was identified as a potential predictor of osteotomy length, enabling the proposal of a preoperative planning equation. However, given the limited sample size and lack of validation, these findings should be interpreted cautiously. Further studies are needed to confirm their broader applicability. Full article

Background: Developmental dysplasia of the hip (DDH) is the most common musculoskeletal condition in infants, and it is routinely managed with abduction orthoses. Despite high treatment success rates, concerns persist regarding potential delays in motor milestone acquisition. This meta-analysis evaluates the impact of orthotic treatment in children with DDH on early motor development. Methods: PubMed, Web of Science, and Embase were screened from inception to 17 February 2025. The review followed PRISMA guidelines. Risk of bias was assessed using the ROBINS-I tool V2 and visualized with the ROBVIS application. Mean differences in motor milestone achievement timepoints were compared in months between the intervention and control groups using a random effects meta-analysis model. A meta-regression was conducted to explore potential moderators of effect size. The protocol was prospectively registered in PROSPERO (ID: CRD42025648186). Results: Four studies, including 952 children, were analyzed—335 were treated for DDH with abduction orthoses, and 617 were healthy controls. Pavlik harness was used in three studies (n = 235), while the Koszla brace was used in one study (n = 100). Children in the orthosis group began walking approximately 0.55 months later than healthy controls (95% CI: 0.40 to 0.70). Sitting was also delayed by 1.11 months (95% CI: 0.76 to 1.47). No significant difference was found for crawling. Conclusions: The use of abduction orthoses may result in a slight, clinically marginal delay in achieving motor milestones, such as sitting and unaided walking. However, given that untreated DDH can lead to severe functional limitations, early intervention with orthoses remains a justified and safe standard of care. Full article

Background: Developmental dysplasia of the hip (DDH) is a common orthopedic disorder characterized by abnormal development of the hip joint, which can lead to pain, instability, and early-onset osteoarthritis if left untreated. Its etiology is multifactorial, involving both genetic and environmental factors. Methods: This study investigated the association between selected single-nucleotide polymorphisms (SNPs) related to joint and bone development and the occurrence of DDH. It assessed potential copy number variations (CNVs) in key skeletal genes using MLPA. A total of 125 individuals were examined, including 43 patients with DDH and 82 healthy controls. Six SNPs were genotyped using real-time PCR with TaqMan assays: TGFB1 (rs1800470), CX3CR1 (rs3732378, rs3732379), GDF5 (rs143384), COL1A1 (rs113647555), and MMP24 (rs12479765). Allele and genotype distributions were compared between cases and controls, and CNVs in COL1A1, COL2A1, LRP5, DKK1, FZD4, and NDP genes were analyzed using Multiplex Ligation-Dependent Probe Amplification. Results: Among the examined variants, only GDF5 rs143384 showed a nominally significant association with DDH (p = 0.040), with the A allele more common in affected individuals. However, after correcting for multiple testing, this result no longer remained significant. No significant associations were detected for TGFB1, CX3CR1, COL1A1, or MMP24. Although CX3CR1 rs3732378 allele frequencies differed slightly from international reference data, no link to DDH was confirmed. Conclusions: MLPA analysis did not identify pathogenic CNVs in the analyzed loci, which indicates that the studied genes have no association with DDH in the Slovak population. Similarly, SNPs in the studied genes yielded no significant results, apart from rs143384 in GDF5, which requires further investigation to confirm our findings. Full article

Total hip arthroplasty (THA) is a widely performed procedure that significantly enhances patients’ quality of life. However, nerve injury remains a concerning complication, with an incidence ranging from 0.6% to 3.7%, depending on patient and surgical variables. This narrative review provides a comprehensive overview of nerve injuries associated with THA, focusing on etiology, risk factors, clinical manifestations, prevention, and treatment strategies. The most affected nerves include the sciatic, femoral, lateral femoral cutaneous (LFCN), superior gluteal, and obturator nerves. Anatomical factors such as developmental hip dysplasia (DDH), limb length discrepancy, and aberrant nerve courses, along with patient-specific conditions like female sex, obesity, and pre-existing spinal disorders, increase the risk of nerve damage. Surgical complexity, revision procedures, and surgeon experience also influence injury likelihood. Clinical manifestations range from sensory disturbances to motor deficits including foot drop, Trendelenburg gait, or impaired knee extension, depending on the nerve involved. Diagnosis is primarily clinical, supported by electrophysiological studies and imaging when needed. Prevention hinges on careful preoperative planning, appropriate surgical approach selection, meticulous intraoperative technique, and attention to limb positioning. Treatment is typically conservative, involving pain control, physical therapy, and neurostimulation. In refractory or severe cases, interventions such as nerve decompression, repair, or tendon transfer may be considered. Pharmacological agents including vitamin B12, tacrolimus, and melatonin show potential in promoting nerve regeneration. Although most nerve injuries resolve spontaneously or with conservative measures, some cases may result in long-term deficits. Understanding the mechanisms, risk factors, and management strategies is essential to mitigating complications and optimizing functional outcomes in patients undergoing THA. Full article

Background: Developmental dysplasia of the hip (DDH) encompasses a spectrum of neonatal hip abnormalities that, if not detected and treated early, may lead to long-term orthopedic sequelae. Universal ultrasound screening using Graf’s method has been proposed to improve early diagnosis, though its implementation remains heterogeneous in Italy. Objectives: This study aimed to describe the outcomes of a universal ultrasound screening program for DDH conducted in a first-level birth center in northern Italy, evaluating DDH incidence, risk factors, management outcomes, and program feasibility. Methods: A prospective observational study was conducted from February 2024 to October 2025 at the Ivrea birth center (Piedmont region, Italy). All consecutive live-born infants (n = 904) underwent hip ultrasound according to Graf’s method, between 0 and 11 weeks of age. Hips were classified as type I (normal), type IIa (physiologically immature), or type IIb–IV (pathological). Infants with type IIa hips were re-evaluated after 2–4 weeks; those with type IIb or worse were referred to pediatric orthopedics. Results: Of 1808 hips examined, 92% were Graf type I and 8% type IIa. After follow-up, 93% of type IIa hips matured spontaneously. Pathological DDH (Graf IIb or worse) was diagnosed in 8 infants (0.88%), of whom 75% were female; 50% had no identifiable risk factors. All affected infants were treated with harness before 12 weeks of age, with complete recovery and no late diagnoses. No infant required surgical treatment. Conclusions: Universal ultrasound screening for DDH was feasible and effective in a first-level birth center, ensuring early diagnosis and absence of late-presenting cases. These findings support universal screening as a safe and equitable approach to reduce DDH-related morbidity and align with national recommendations for standardized early detection programs. Full article

This study focuses on an individual from the southeastern area of the Roman Suburbium in Late Antiquity (3rd–5th centuries CE), whose skeleton was found in a multiple burial alongside five others. Osteological and CT imaging analyses revealed a significant developmental defect in the left hip, characterized by a shallow, flattened acetabulum and a hypoplastic or aplastic femoral head, with no evidence of infection or postmortem alteration. This rare condition provides a compelling case study demonstrating the effectiveness of an integrated diagnostic approach combining traditional osteology with advanced imaging techniques. Despite prior research into orthopedic pathologies in Roman Imperial and Late Antique populations, no comparable cases have been documented, highlighting a notable gap in the bioarchaeological literature regarding congenital skeletal defects. This case contributes to a broader understanding of disability in ancient communities and raises important questions about social recognition and support for individuals with physical impairments in the past. However, limitations exist due to the absence of certain skeletal elements, which restricts a full assessment of compensatory biomechanical adaptations, such as load redistribution through the trunk or upper limbs. Nevertheless, the findings underscore the growing importance of refining diagnostic standards to better identify and interpret evidence of disability in historical populations. Full article

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