Outcome of periacetabular osteotomy for the management of acetabular dysplasia: experience in an academic centre.

Periacetabular osteotomy (PAO) is a very effective reconstructive procedure for treatment of acetabular dysplasia. An orthopaedic paediatric surgeon and a reconstructive hip arthroplasty surgeon performed this procedure together in the early phase of their learning curve and then performed it individually. The early clinical and radiographic results of 85 consecutive PAOs performed in this academic orthopaedic unit were reviewed. The mean Merle-d\u27Aubigné score increased from 12.4 preoperatively to 16 at follow-up. Pre-operatively 73 hips were anteverted and 12 were neutral or retroverted. The mean angle of Wiberg improved from 5 degrees to 21 degrees (p \u3c 0.0001) in anteverted hips, and from 9 degrees to 30 degrees in neutral or retroverted hips. The mean angle of Lequesne and de Sèze improved from 6 degrees to 35 degrees (p \u3c 0.0001) in anteverted hips, and in neutral or retroverted hips from 9 degrees to 30 degrees (p \u3c 0.0001). The acetabular index improved from 26 degrees to 8 degrees (p \u3c 0.0001) in anteverted hips, and from 21 degrees to 7 degrees (p \u3c 0.0001) in neutral or retroverted hips. Over the 7 year period the blood loss and operative time improved from 2000 ml to 900 ml and 4 hours to 2 hours respectively. Four hips (four patients) required conversion to total hip replacement. The radiographic correction and improved clinical scores are similar to those in previous studies. This study shows a survival rate of 94% at 58 months following periacetabular osteotomy. The learning curve and the early results of this procedure performed in our academic unit are encouraging

Orthopedic management of the extremities in patients with Morquio A syndrome.

BackgroundMusculoskeletal involvement in Morquio A syndrome (mucopolysaccharidosis IVA; MPS IVA) contributes significantly to morbidity and mortality. While the spinal manifestations of the disorder have received considerable attention in the literature, there have been few reported studies to date to guide the management of the orthopedic problems associated with the lower and upper extremities.PurposeThe objective was to develop recommendations for the management of the extremities in patients with Morquio A syndrome.MethodsA group of specialists in orthopedics, pediatrics and genetics with experience in the management of Morquio A patients convened to review and discuss current clinical practices and to develop preliminary recommendations. Evidence from the literature was retrieved. Recommendations were further refined until consensus was reached.Results and conclusionsThis present article provides a detailed review and discussion of the lower and upper extremity deformities in Morquio A syndrome and presents recommendations for the assessment and treatment of these complications. Key issues, including the importance of early diagnosis and the implications of medical therapy, are also addressed. The recommendations herein represent an attempt to develop a uniform and practical approach to managing patients with Morquio A syndrome and improving their outcomes

Activity intensity, assistive devices and joint replacement influence predicted remodelling in the proximal femur

Bone morphology and density changes are commonly observed following joint replacement, and may contribute to the risks of implant loosening and periprosthetic fracture, and reduce the available bone stock for revision surgery. This study was presented in the “Bone and Cartilage Mechanobiology across the scales” WCCM symposium to review the development of remodelling prediction methods and to demonstrate simulation of adaptive bone remodelling around hip replacement femoral components, incorporating intrinsic (prosthesis) and extrinsic (activity and loading) factors.An iterative bone remodelling process was applied to finite element models of a femur implanted with a cementless THR (total hip replacement) and a hip resurfacing implant. Previously developed for a cemented THR implant, this modified process enabled the influence of pre- to postoperative changes in patient activity and joint loading to be evaluated. A control algorithm used identical pre- and postoperative conditions, and the predicted extents and temporal trends of remodelling were measured by generating virtual x-rays and DXA scans.The modified process improved qualitative and quantitative remodelling predictions for both the cementless THR and resurfacing implants, but demonstrated the sensitivity to DXA scan region definition and appropriate implant-bone position and sizing. Predicted remodelling in the intact femur in response to changed activity and loading demonstrated that in this simplified model, although the influence of the extrinsic effects were important, the mechanics of implantation were dominant. This study supports the application of predictive bone remodelling as one element in the range of physical and computational studies, which should be conducted in the pre-clinical evaluation of new prostheses

Description of Total Hip Replacement Case Series in Military Corp (Feb 2004- Feb 2006)

The aims of total hip replacement include alleviation of pain and restoration of movement. This procedure is being carried for decades out side Sudan. This case series unicentric descriptive study, presents the description of the protocol in the military corp. hospital and description of early results of this experience .The questionnaire based study was undertaken to document the pre-op findings, intra-op protocol and post-op complications. Thirty four THR (Thirty two patients) were done over a period of 24 months, 25 Males and 9 females. Radigraphically, 10 were trauma, 14 AVN, 15 OA, 2 loose THR, and 3 were protrusi acetabuli. All patients with trauma had pre-op shortening .All patients received LMW heparin (Tinazaparin) as prophylaxis, none of them developed DVT . Two patients had dislocations, one was revision THR and the other one was done by junior surgeon. None of the patients developed post-op infection. One hip showed evidence of loosing. It was revision of THR. Sub group of 10 hips had post op shortening. All of them were having shortening secondarily to trauma. 4 Hips had lengthening post operatively. One patient died immediately post-op, the surgery was revision of hip and was the only patient who received general anesthesia on top of spinal anesthesia due to long procedure. The study concluded that, with such limited experience over twenty four months of treating thirty four hips the results of THR is quite promising with the conditions and staff we have, providing that more and more surgeons enrolled in arthroplasty training scheme

Acetabular revision with freeze-dried irradiated and chemically treated allograft: a minimum 5-year follow-up of 17 cases

We reviewed the results of 17 consecutive revision total hip arthroplasties performed with the use of freeze-dried irradiated bone allograft in 15 patients. These allografts were used in conjunction with five Kerboull rings, two steel meshes and ten cemented isolated cups. All the patients have had a follow-up of at least 5years. The patients were evaluated clinically and radiographically. No revisions were necessary and X-rays confirmed partial or total ingrowth of the allografts. In acetabular revision surgery, hip reconstruction can be successfully treated by freeze-dried irradiated and chemically treated allografts. Additional studies with longer term follow-up are necessary to confirm this outcom

Complications, Conversion, and Secondary Procedures Following Minimally Invasive Periacetabular Osteotomy: A Single-Surgeon Case Series

\ua9 2025 The AuthorsBackground: The introduction of minimally invasive periacetabular osteotomy (PAO) has reduced complications, allowing a broader range of patients to be considered for the procedure. This study aimed to identify patient-specific risk factors for poor outcomes. Methods: This retrospective case series (n = 513) used data from a local hip registration registry. Isolated PAOs with at least 1-year follow-up were included. Electronic records were reviewed to extract demographics and variables. The primary outcome was complication rate, with secondary outcomes including secondary procedures and conversion to total hip arthroplasty. Logistic regression was performed to correlate independent variables to outcomes, and Kaplan-Meier analysis assessed the survival of the native hip and cumulative complication risk. Results: Complication rate was 6.2%. Higher body mass index (BMI), smoking, T\uf6nnis grade 2, and increasing age were associated with higher odds of complications (P < .05). The nonunion rate was 4.3%; higher BMI and age linked to increased risk (P < .05). 10.9% of patients required a secondary procedure and cumulative risk for secondary procedures at 5 years was 11.4% and at 10 years was 17.2%. BMI correlated with the need for secondary procedures (P = .001). 3.7% (n = 19) required conversion to total hip arthroplasty with a mean time to conversion of 4.6 years \ub12.04. The 5- and 10-year survival rates were 96.3 and 92.7%, respectively. Conclusions: Minimally invasive PAO has acceptable rates of complication and conversion at mid-term follow-up. Age, BMI, smoking status, and T\uf6nnis grade 2 are associated with inferior outcomes. Knowledge of patient-specific risk factors can help in decision-making, expectation setting, and perioperative interventions

Update on pediatric hip imaging

Hip disorders are common in children. Prompt diagnosis and treatment are important because of the potential complications. Symptoms are frequently nonspecific, and clinical examination can be difficult and unreliable, especially in smaller children. Therefore, imaging can be valuable. Radiography and ultrasound remain the initial imaging modalities of choice. Increasingly, magnetic resonance imaging is obtained for assessing the pediatric hip, although the long imaging time and need for sedation may limit its use in daily practice. Because of the exposure to ionizing radiation, the use of computed tomography and bone scintigraphy in children is limited to selected cases. Pediatric hip pathology varies depending on patient age. This article provides an overview of common hip pathologies in children including congenital and developmental pathologies, trauma, infectious processes, inflammatory disease, and neoplasm. The age of the child, history, and clinical examination are essential to narrow down the differential diagnosis and subsequent selection of the appropriate imaging modality