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Objective The aim of the present paper was to evaluate the results of one‐stage total hip arthroplasty (THA) for patients with bilateral Crowe type IV developmental dysplasia of the hip (DDH). Methods Data for 58 patients (116 hips) with bilateral Crowe type IV DDH who had one‐stage THA performed by the same surgeon during the period of April 2008 to February 2019 were retrospectively reviewed. The mean age of the patients was 37.3 years; 5 were men and 53 were women. All patients underwent THA through the posterolateral approach using the Pinnacle acetabular cup, a ceramic‐on‐ceramic bearing, and the modular S‐ROM stem. Subtrochanteric shortening osteotomy was performed on 86/116 hips. Intraoperative conditions were recorded. Radiographic and functional outcomes were evaluated, and complications were recorded. Results All patients were followed up for an average of 71.3 ± 37.6 months (range, 12–140). The mean operative time was 276.5 ± 57.9 min (range, 175–540). The mean intraoperative blood loss was 933.6 ± 400.8 mL (range, 300–2000). The mean transfusion requirement was 1778 ± 798.0 mL (range, 575–4550). The mean length of hospital stay was 8.6 ± 3.7 days (range, 5–22). At the final follow‐up, no loosening of acetabular and femoral components was observed. No osteolysis and heterotopic ossification occurred. The mean Harris hip scores were improved from 55.4 ± 14.3 preoperatively to 91.3 ± 4.2 postoperatively (P, The study demonstrates that one‐stage bilateral THA for bilateral Crowe type IV DDH is feasible and can effectively restore hip function.

OBJECTIVE: One of the most controversial issues in pediatric orthopedics is Developmental dysplasia of the hip (DDH). The timing of diagnosis and treatment are is the main goal to treat this condition successfully. Neglected cases that may remain undiagnosed until advancing age are still seen especially in developing countries. Delayed diagnosis and treatment with advancing age leads to more extensive surgery and cause low satisfactory rates. The aim of this study is to evaluate the effect of patients’ age on the results of single-stage treatment of Developmental Dysplasia of the Hip.MATERIAL AND METHODS: 23 patients (34 hips) treated in our hospital between 2004 and 2010 were included in the study. Single-stage treatment including open reduction, femoral shortening, and Salter’s innominate osteotomy was applied to patients whose mean age of surgery was 7.5 years. Radiological results were evaluated in terms of improvement in the acetabular index, in the acetabular angle and according to Severin’s classification, and Bucholz and Ogden’s avascular necrosis (AVN) classification at the final follow-up.RESULTS: The average follow-up period was 60 (range: 24 - 84) months. While the acetabular index was 39.7°±1.4° (range: 25°- 52°) preoperatively, it was measured as 21.8°±1.8° postoperatively. The mean amount of improvement in the acetabular angle was 17.9°±0.8°. According to Bucholz and Ogden’s classification, one patient (2.9%) had Type 1 AVN and one patient (2.9%) had Type 3 AVN. Radiologically, the success rate (85.7%) was significantly higher in children aged 8 years and younger (p = 0.008).CONCLUSIONS: According to the improvement in the acetabular index and Severin's radiological classification, successful results are obtained after a single-step treatment of DDH, which is treated in the 4-8 age range. However, the radiological results of children older than 8 years are worse than those under 8 years old., AMAÇ: Pediatrik ortopedide, tedavisi en tartışmalı konulardan biri, Gelişimsel Kalça Displazisidir (GKD). Tanı ve tedavi zamanlaması, bu durumu başarılı bir şekilde tedavi etmek için ana hedeftir. Özellikle gelişmekte olan ülkelerde ilerleyen yaşa kadar teşhis edilemeyen vakalar halen görülmektedir. Gecikmiş tanı ve tedavi , ilerleyen yaşla birlikte daha kapsamlı ameliyatlara yol açar ve düşük memnuniyet oranlarına neden olabilir. Bu çalışmanın amacı, Gelişimsel Kalça Displazisi’nin tek aşamalı tedavisinin sonuçlarına, hasta yaşının etkisini değerlendirmektir.GEREÇ VE YÖNTEM: 2004 ve 2010 yılları arasında hastanemizde tedavi edilen 23 hasta (34 kalça) çalışmaya dahil edildi. Ortalama ameliyat yaşları 7,5 olan hastalara açık redüksiyon, femoral kısaltma ve Salter innominate osteotomi’yi içeren tek basamaklı tedavi uygulandı. Radyolojik sonuçlar, asetabular indeksteki, asetabuler açıdaki ve Severin radyolojik sınıflamasına göre düzelme ve son takiplerindeki Bucholz ve Ogden avaskuler nekroz (AVN) sınıflamasına göre değerlendirildi.BULGULAR: Hastalarımızın ortalama takip süremiz 60 ay (24 ila 84 ay arası) idi. Asetabuler indeks, ameliyat öncesi 39.7°±1.4° (25° - 52° arası) iken ameliyat sonrası 21.8°±1.8° saptandı. Ameliyat sonrası çekilen pelvis grafilerinde ölçülen asetabuler açıda ortalama düzelme miktarı 17.9°±0.8° saptandı. Bucholz ve Ogden AVN sınıflamasına göre; 1 hastada Tip 1 (% 2.9) ve 1 hastada Tip 3 (% 2.9) AVN saptandı. Radyolojik olarak 8 yaş ve altındaki çocuklarda başarı oranı (85.7%) belirgin olarak yüksekti. (p =0.008)SONUÇ: Asetabuler indeks ve Severin’in radyolojik sınıflamasındaki düzelmeye göre, 4 - 8 yaş aralığında tedavi edilen GKD’nin tek basamaklı tedavisi sonrası başarılı sonuçlar elde edilir. Ancak 8 yaştan daha büyük çocukların radyolojik sonuçları 8 yaş altındakilere göre daha kötü sonuçlanmaktadır.

Objective: In developmental hip dysplasia (DDH) patients, the chronic dislocation of the femoral head with respect to the true acetabulum determines muscle contracture and atrophy, particularly of the abductor muscles, and leads to secondary osteoarthritis (OA) with severe motor dysfunction, pain and disability. The correct positioning when a total hip replacement (THR) is performed is fundamental to the recovery of gait function. Also, inadequate rehabilitation of the abductor muscles for pelvic stabilisation can be responsible for residual dysfunction. Consensus on a programme for abductor muscle strengthening in these patients is not currently available. The aim of this study was to evaluate the effectiveness of a specific program of exercises for strengthening the abductor muscles in these patients. Methods: A multicentre, prospective, randomised clinical trial was carried out in an outpatient rehabilitation setting on 103 patients given THR for DDH through a minimally-invasive anterolateral approach. Patients were randomly divided into a Study Group, including 46 patients, and a Control Group, including 57 patients. All patients underwent standard early postoperative rehabilitation. In addition, the Study Group were given an extra 2-week rehabilitation once full weight-bearing on the operated limb was allowed, aimed at strengthening the abductor muscles. All patients were evaluated preoperatively, and at about 3 and 6 months postoperatively. Clinical measures (lower limb-length differences, hip range of motion, abductor muscle strength), and functional measures (WOMAC, HHS, 10mt WT, SF-12) were taken. Results: Hip range of motion and functional outcome measures showed a progressive improvement at follow ups in both groups, significantly higher in the Study Group. In particular, abductor strength at 6 months post-op improved by 92.5% with respect to 35.7% in the Control Group. Conclusion: In addition to standard rehabilitation, a rehabilitation programme for strengthening the gluteal muscles in DDH patients who underwent THR determined an increase in muscle strength that improved functional performance and patient satisfaction.

Purpose The correlation between the degree of developmental hip dysplasia (DDH) measured on ultrasound images compared with that measured on radiographs is not clear. Most studies have compared ultrasonography (US) and radiographic images made at different times of follow-up. In this study the correlation between US images and radiographs of the hip made on the same day was evaluated. Methods US images and radiographs of both hips of 74 infants, who were treated for stable DDH, were reviewed in a retrospective study. Only infants who had an US examination and a radiograph on the same day were included. Results The correlation between α-angle of Graf and femoral head coverage on US was strong (p ≤ 0.0001). Weak correlations were found between the acetabular index of Tönnis on radiographs and α-angle of Graf on US (p = 0.049) and between acetabular index of Tönnis on radiographs and femoral head coverage of Morin on US (p = 0.100). Conclusion This study reports on the correlation between US and radiographic imaging outcomes, both made on the same day in patients for treatment and follow-up of DDH. Level of Evidence IV

Aims Developmental Dysplasia of the Hip (DDH) has been linked to high birth weight and packaging disorders, though the evidence is limited. This has implications on screening strategies. The aim of this study was to establish whether birth weight was truly associated with the incidence of DDH. Patients and Methods This cohort study analysed the birth weights of all babies born at our institution over a 24 month period, between 01/01/2017 and 01/01/2019. Babies with DDH and those without DDH were compared. Babies were excluded if born before 38 weeks, had incomplete data or were a non-singleton pregnancy. Sub-analysis was performed for DDH severity (dysplastic versus subluxed/dislocated hips), breech presentation, gestational age, gender and ethnicity. Statistical analysis was performed using SPSS. Results There were 10,113 babies born at our institution during the selected timeframe, of which 884 were excluded for prematurity, 336 for being non-singleton and 19 for incomplete data. This left 8874 for analysis, of which 95 babies had confirmed DDH. Both the Non-DDH and DDH data sets had normal distribution (Shapiro-Wilkes, p = 0.308 and 0.629, respectively), with mean birth weights of 3477.7 g with DDH and 3492.8 g without DDH. No difference in birth weight was found (Independent T test, p = 0.789). Females had a lower birth weight than males (3293.1 g versus 3416.6 g (p p = 0.068), nor between males with and without DDH (p = 0.513). There were no significant differences in birth weights even when only displaced hips were analysed (p = 0.543), nor according to breech presentation (p = 0.8). Longer gestation babies weighed more (p p = 0.64). Conclusion This study discredits the belief that DDH may be related to higher birth weight, thus casting doubt on the link to DDH being a packaging problem in utero. This, therefore, allows future research to prioritise the investigation of alternative aetiologies.

Periacetabular osteotomy (PAO) for pelvic fracture sequelae presents a challenge in hip preservation surgery due to a combination of complex conditions involving post-traumatic altered anatomy and technically demanding procedure, with high surgical risk involved. To address these challenging conditions and evade potential devastating complications, a combination of patient-specific template (PST) and electromagnetic navigation (EMN) guidance can be used to increase the safety of the procedure and the accuracy of the acetabular reorientation. Herein we report our experience utilizing a combined PST- and EMN-assisted bilateral PAO for staged correction of bilateral severe, injury-induced hip dysplasia. The presented case report describes a unique method of successful surgical treatment of severe, bilateral injury-induced hip dysplasia with combined 3-D printing technology (PST) and intra-operative electromagnetic computer-assisted navigation (EMN) aided technically demanding surgical procedure (PAO), which emphasizes the benefits of PST and EMN use in hip preservation surgery in patients with complex pathoanatomic circumstances.

Background To evaluate and quantify the intraoperative effect of capsulorrhaphy on the deep seating of femoral head within the acetabulum as measured by medial joint space, a surrogate measure of acetabular-head contact. Methods In order to determine the exact effect of capsulorrhaphy, we prospectively scrutinized a consecutive sample of 18 patients with unilateral dysplastic hips aging > 18 months and followed them for a period of at least 12 months. The procedure of open reduction is described in detail. Two pediatric orthopedists carried out the operations from August 2014 to January 2019 at a tertiary pediatric hospital. Intraoperatively, AP radiographs of the pelvis were obtained before and after capsulorrhaphy. The distance between the inferomedial edge of the proximal femoral metaphysis and the lateral edge of the obturator foramen was recorded. To determine if there were differences in medial joint space due to capsulorrhaphy, a generalized linear model was run on the study sample. All patients were followed for at least 12 months to determine the rate of re-dislocation. Results Mean age (±standard deviation) of the participants was 37.5 (±24.7) months. All cases underwent Salter osteotomy, 5 cases needed femoral shortening (27.8%) and none needed derotational osteotomy. Capsulorrhaphy lead to a statistically significant decrease in the mean medial joint space from 1.59 cm before (95% CI: 1.12–2.05) to 0.76 cm after (95% CI: 0.50–1.02) the capsulorrhaphy (P Conclusions Capsulorrhaphy, independently, of age was associated with a 1-cm decrease in the mean medial hip joint space and a more deeply seated femoral head. Furthermore, this study presents a successful experience with capsulorrhaphy to prevent hip instability.

Assuming that developmental hip dysplasia (DDH) is a genetically controlled disease, we made a hypothesis that an increased homozygosity level and genetic loads, among the patients with DDH, could be some kind of predisposition for the degree of illness expression. Using HRC-test (test for determination of homozygously recessive characteristics in humans) we analyzed presence, distribution, and individual combination of 20 selected genetically controlled morphophysiological traits among DDH patients (N=200) and controls (N=200). Among groups of DDH patients the increase in the degree of genetic homozygosity correlates with the degree of illness expression (dysplasia/subluxations-39%; luxations-45%). There is significant difference in mean HRC value between tested groups of patients with dysplasia/luxations (p

Background: Developmental hip dysplasia is diagnosed when the femoral head is not sufficiently covered by the acetabulum. Anterior and lateral cover deficiency is seen, as a result a dysplastic hip joint. Various incision modifications have been developed because of the muscle dissection and wide wound scar in Smith-Peterson incision, which was originally used in Bernese osteotomy. This study evaluates applicability of the modified Stoppa approach in the performance of Bernese periacetabular osteotomy (PAO). Materials and Methods: Ten hemipelvises of five donor cadavers were used. The transverse Stoppa incision was made 2 cm over the symphysis pubis for quadrilateral surface exposure and pubic and ischial bone osteotomies. The second skin incision, a few centimeters lateral to the original incision, was made along the tensor fascia lata. Iliac bone osteotomy was performed starting just above the rectus femoris insertion. The displacement of the osteotomy was measured clinically and radiographically. Results: The mean anterior coverage calculated with center-edge angle was improved from 22.8° ±2.8 (range 20° min–28° max) preoperatively to 44.1° ± 3.7 (range 36° min–48° max). The displacement of the osteotomy at the iliopectineal line calculated on the iliac inlet view radiographs was 22.1 ± 3.4 mm (range 15 mm min–26 mm max). The clinical amount of the anterior displacement on the cadavers was 17.8 ± 3.35 mm (range 11 mm–21 mm) and lateral displacement was 20.3 ± 3.23 mm (range 15 mm–24 mm). The amount of the posterior intact bone enlargement at the quadrilateral surface was 5.3 ± 0.48 mm. Conclusion: This less traumatic two-incision exposure is an adequate technique for Bernese PAO, allowing the bone to be cut under direct visual observation and reducing the need to use fluoroscopy.

[AIM]To determine if there was a seasonal variation in adults undergoing total hip arthroplasty for end stage hip disease due to osteoarthritis (OA) or sequelae of developmental dysplasia of the hip (DDH). [METHODS]The total hip registry from the author’s institution for the years 1969 to 2013 was reviewed. The month of birth, age, gender, and ethnicity was recorded. Differences between number of births observed and expected in the winter months (October through February) and non-winter mo (March through September) were analyzed with the χ2 test. Detailed temporal variation was mathematically assessed using cosinor analysis. [RESULTS]There were 7792 OA patients and 60 DDH patients who underwent total hip arthroplasty. There were more births than expected in the winter months for both the DDH (P < 0.0001) and OA (P = 0.0052) groups. Cosinor analyses demonstrated a peak date of birth on 1st October. [CONCLUSION]These data demonstrate an increased prevalence of DDH and OA in those patients born in winter.

Developmental dysplasia of the hip (DDH) is still one of the biggest orthopedic problems in the world. Global poverty and refugee crises have led to it becoming a greater issue even in developed nations. Early diagnosis and effective treatment of DDH are required to prevent the possibility of arthrosis, limb shortening, pelvic asymmetry, and vertebral scoliosis. In late cases, surgery is the only choice for correction. Direct radiography has been used for many years and continues to have an important role, though ultrasonography is the primary source for early postnatal screening. Although magnetic resonance imaging (MRI) has become an important modality to provide sectional imaging in many cases, in late-period dysplasia, computed tomography (CT) and three-dimensional (3D) CT are preferred because it can more effectively demonstrate the cortical bony structures. The aim of this review was to demonstrate the effectiveness of 3D CT and multiplanar reconstruction based on previous studies.

Purpose Treatment is easier and complications are less likely to occur if developmental dysplasia of the hip (DDH) is diagnosed early. In this study, we examined the early results of open reduction using a medial approach which we had modified for DDH and analyzed the success of this technique and the associated complication rates, with a focus on avascular necrosis (AVN). Methods This is an Institutional Review Board-approved retrospective review of all patients diagnosed with DDH and treated with a modified medial approach at a single institution from July 1999 to December 2010. The patients’ charts were analyzed for clinical and radiographic features. Results Fifty-five hips of 41 patients, all of whom were treated by open reduction using a modified medial approach due to DDH, were evaluated retrospectively. The mean age of the patients at surgery was 19 (range 11–28) months, and the average follow-up was 5.5 (range 3–9.5) years. AVN was the most important complication in terms of radiological outcomes as assessed according to the Kalamchi–McEwen classification. Radiologic results were excellent or good in 51 hips (92.7 %) and fair–plus in four (7.3 %). Type 1 temporary AVN was detected in only two hips (3.6 %), and the lesions had disappeared completely in the final control graphs of these two patients. A secondary intervention was needed for two hips (3.6 %) of the same patients who were operated on due to bilateral DDH. No other complications, such as infection, re-dislocation, or subluxation, were seen in the operated patients. Conclusions We believe that treatment for DDH using a modified medial approach during early childhood is an effective and reliable method with low AVN rates. As shown here, this method achieves great success in radiological and clinical outcomes after a minimum 3-year follow-up.

Aim: The purpose of the study was to determine the prevalence, incidence, and etiology as well as the risk factors for developmental dysplasia of the hip in newborns in whom we performed ultrasonography for screening using Graff’s method in our clinic. Methods: We retrospectively evaluated 2632 hip ultrasonography records of 1316 babies performed between 2008 and 2013. We analyzed the questionnaires of the Turkish Pediatric Orthopaedic Society which were filled by the physician during examination. The babies were divided into two groups according to ultrasonographic hip angles as pathological and normal. Results: The study is made on 1316 babies [680 girls (51.6%), 636 boys (48.4%)]. The risk for developmental dysplasia of the hip was higher in girls, babies with a family history, babies with metatarsus adductus and those have been swaddled before. The mean gestational age and gestational weight was statistically significantly lower in the pathological group (p=0.0011). Conclusion: In our cross-sectional study, the incidence of developmental dysplasia of the hip was 0.5%. Female gender, positive family history of developmental dysplasia of the hip,metatarsus adductus and swaddling are still risk factors. Researching risk factors carefully, patient education and adding hip ultrasonograpy to newborn routine screening program are important measures in preventing developmental dysplasia of the hip.

Objectives: Here we present our results of Total Hip Arthroplasty (THA) in a series of patients with arthrosis due to Developmental Dysplasia of the Hip (DDH). We assessed the radiological features, clinical score, complications and survival rate. Methods: We retrospectively reviewed the records[for full text, please go to the a.m. URL], Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2017)

Background Developmental hip dysplasia (DDH) may lead to severe acetabular and femoral abnormalities that can render total hip arthroplasty (THA) challenging, especially in DDH patients with a small physique. Most conventional cemented or cementless femoral components are often difficult to implant in the narrow femoral canal and require slight version correction during surgery. The aim of this study was to present the mid-term results of THA in the treatment of DDH patients with a small physique using a cementless Wagner cone prosthesis (Zimmer®, US). Methods Between January 2006 and March 2010, we retrospectively reviewed 50 patients who were treated at our center. A total of 50 patients (52 hips; 45 women, five men; mean age 32.5 years; range 27 to 38 years) who underwent THA were observed. The mean femoral medullary canal dimension at the isthmus was 7.6 mm (range 6.0 to 8.7). According to the Crowe classification, 19 hips presented dysplasia of grade I, while 33 presented dysplasia of grade II. All patients were treated with THA using a cementless Wagner cone prosthesis. Clinical and radiologic evaluations were performed on all patients. Results The mean duration of follow-up was 7.7 years (range 5.4 to 10.5). The Harris hip score (HHS) improved from 63 ± 9 (range 55 to 70) pre-operatively to 92 ± 8 (range 88 to 100) at the last follow-up. The HHS at the most recent follow-up was excellent in 66% of patients (34 hips), good in 26% (14 hips), fair in 6% (3 hips), and poor in 2% (1 hip). Radiographic evaluation demonstrated excellent osteointegration of the implants. Stem subsidence was present in three stems, and the range of stem subsidence was 2 mm in two stems (3.9%) and 3 mm in one stem (1.9%). Femoral osteolysis was observed in nine hips (18%) in the proximal zones, and no distal osteolysis was noted. Heterotopic ossification was observed in three hips (5.8%); of these, two were classified as Brooker’s grade 1, and one was classified as Brooker’s grade 2 at the most recent follow-up. None of the implants were revised. Conclusions Based on the tapered shape and free setting of anteversion, the Wagner cone femoral stem facilitates its implantation in dysplastic hips. Therefore, this series of short stems with a smaller diameter can ensure safe implantation in narrow medullary canals, especially in young DDH patients with a small physique. Trial registration Registration Number: ChiCTR-ORC-17011181 . Reg Date: 2017-04-19 00:44:59 Retrospective registration

Patients with neglected developmental dysplasia (DDH) face with early osteoarthritis of the hip, limb length inequality and marked disability while total hip reconstruction is the only available choice. DDH has severe morphologic consequences, with distorted bony anatomy and soft tissue contractures around the hip. It is critical to evaluate patients thoroughly before surgery. Anatomic reconstruction at the level of true acetabulum with uncemented implant is the mainstay of treatment. This requires a subtrochanteric shortening osteotomy, which can be realised using different osteotomy and fixation options. Although a demanding technique with a high rate of related complications, once anatomic reconstruction of the hip is achieved, patients have a remarkably good functional capacity and implant survival during long follow-up periods. Cite this article: Atilla B. Reconstruction of neglected developmental dysplasia by total hip arthroplasty with subtrochanteric shortening osteotomy. EFORT Open Rev 2016;1:65–71. DOI: 10.1302/2058-5241.1.000026.

Purpose Debate currently exists regarding the economic viability for screening for developmental dysplasia of the hip in infants. Methods A prospective study of infant hip dysplasia over the period of 1998–2008 (36,960 live births) was performed to determine treatment complexity and associated costs of disease detection and hospital treatment, related to the age at presentation and treatment modality. The involved screening programme utilised universal clinical screening of all infants and selective ultrasound screening of at-risk infants. Results One hundred and seventy-nine infants (4.8/1,000) presented with hip dysplasia. Thirty-four infants presented late (> 3 months of age) and required closed or open reduction. One hundred and forty-five infants presented at < 3 months of age, 14 of whom failed early Pavlik harness treatment. A detailed cost analysis revealed: 131 early presenters with successful management in a Pavlik harness at a cost of £601/child; 34 late presenters who required surgery (36 hips, 19 closed/17 open reductions, one revision procedure) at a cost of £4,352/child; and 14 early presenters with failed management in a Pavlik harness requiring more protracted surgery (18 hips, four closed/14 open reductions, seven revision procedures) at a cost of £7,052/child. Conclusions Late detection causes increased treatment complexity and a sevenfold increase in the short-term costs of treatment, compared to early detection and successful management in a Pavlik harness. Discussion Improved strategies are needed for the 10 % of early presenting infants who fail Pavlik harness treatment and require the most complex and costly interventions.

Introduction Developmental hip dysplasia represents the most common deformation of locomotor system in children. Developmental modulation of the hip is expressed during first year of life which is important for early diagnosis and treatment. Therefore, in the practice, it is very important to set a diagnosis early with application of simple and convenient methods (ultrasound) in order to achieve fast and efficient therapeutical effect and avoid permanent disability. Aim The aim of this paper is to point out the increase of prematurely born infants and their survival thanks to the development of Unit for Intensive Neonatal Care at the Pediatric Clinics in Sarajevo. Material and methods Clinical investigation included 150 infants (77 girls and 73 boys) in whom the developmental hip dysplasia was diagnosed with clinical exam, ultrasound exam and x-ray of the hips. The exams were done in period of January 2012 to August 2014. Results Two groups of patients were formed. The first one consisted of premature infants, total number of 75 (34 girls and 41 boys), with developmental hip dysplasia that was diagnosed at the first exam at the Ultrasound unit of the Pediatric clinics and at the Intensive Neonatal Care Unit of the Pediatric Clinics in Sarajevo. Second (control) group consistsed of patients-on term infants who had diagnosed one of developmental hip dysplasia, total of 75 (43 girls and 32 boys) during first exam in the Ultrasound unit of the Pediatric clinics in Sarajevo. Conclusion The frequency of premature birth is between 5 and 10% of all labors and demonstrates increasing trend. We suggest ultrasound examination of hips in each newborn, term or premature, at the age of 6 weeks after birth.

Developmental hip dysplasia (DDH) greatly contributes to occurrence of severe hip osteoarthritis (OA) in adulthood, but the association between the two is not a perfect one. Both conditions are known to have a strong genetic component. Transforming growth factor β1 (TGF-β1) and interleukin-6 (IL-6) are two pro- inflammatory cytokines included in pathogenesis of OA, bone remodeling and development of bone and joint tissues. TGF-β1 gene has a polymorphic site in the signal sequence ((29)T→C) and "C allele carriage" is associated with higher circulating TGF-β1 levels. IL-6 gene has several polymorphic sites in the promoter region including -572T→C transition associated with higher circulating IL-6 levels. As a preliminary investigation on possible association between these polymorphisms and severe adult hip OA secondary to DDH, 28 consecutive patients and 20 healthy controls were genotyped at these loci. With adjustment for sex, "C allele carriage" in the TGF-β1 signal sequence and CC genotype ("transition homozygous") at locus -572 in the IL-6 promoter were each associated with severe OA secondary to DDH (OR=13.4, p=0.016 and OR=6.2, p=0.024, respectively). The combination of these genotypes was particularly strongly associated with the disease (OR=11.1, p

Introduction The aim of our study was to evaluate changes in collodiaphyseal, Hilgenreiner and Wiberg’s centre-edge angle values in different age groups of children before and after surgical correction of developmental dysplasia of the hip. Material and methods We evaluated 78 children with developmental hip dysplasia treated at University Children’s Hospital in Belgrade during a 10-year period. Three age groups were analysed: the first group younger than 24 months of life, the second group between 25 and 48 months, and the third group older than 48 months of life. Three angles were evaluated separately before and after surgical correction: collodiaphyseal angle, Hilgenreiner angle and Wiberg’s centre-edge angle. Results We found a highly statistically significant difference (p < 0.001) before and after the operation for collodiaphyseal and Hilgenreiner angle in the first and second age group, while there was a statistically significant difference (p < 0.05) in the third age group. Regarding Wiberg’s centre-edge angle, there was a highly statistically significant difference (p < 0.001) in all age groups. One way ANOVA revealed a highly statistically significant difference (p < 0.001) for collodiaphyseal and Hilgenreiner angle in age groups before the operation, while after surgery such a trend remained for Hilgenreiner angle. Regarding collodiaphyseal and Wiberg’s centre-edge angle in the period after correction, there was no statistical difference (p > 0.05) between age groups of the participants. Conclusions Our findings demonstrate that age of participants is in correlation with correction of values for collodiaphyseal angle, Hilgenreiner angle and Wiberg’s centre-edge angle in surgically treated children diagnosed with developmental dysplasia of the hip.

Background Today's society is much more mobile than in the past. This increased mobility has resulted in different marriage/parenting groups. We wished to study the demographics of developmental dysplasia of the hip (DDH) in our area and compare/contrast our findings with those in the literature and specifically look for new findings compared to previous studies. Methods A retrospective review of all children with DDH from 2003 through 2012 was performed. The age at first visit, gestational age, pregnancy number, gender, race, and family history of DDH was collected. Statistical significance was a p-value < 0.05. Results There were 424 children (363 girls, 61 boys). Ethnicity was White in 80.8 %, Hispanic in 13.8 %, Black in 4.0 %, and Indo-Malay and Indo-Mediterranean in 0.7 % each; 66.8 % were unilateral; 14.2 % had a positive family history. The average gestational age was 38.1 weeks; 94.4 % were full term. The child was vertex presentation in 67.6 % and breech in 32.4 %; 52.8 % were delivered vaginally and 47.2 % by Cesarean section. The child was the first-born in 48.3 %. When compared to the birth statistics of our state, there was a higher proportion of Whites and Hispanics with DDH, and a lower, but not inconsequential, proportion of Blacks ( p = 0.0018). Conclusion Mixing of gene pools and infant carrying methods (lack of swaddling or marked abduction) occurring with societal change likely explains the higher than expected proportion of DDH amongst those of Hispanic ethnicity and a lower than expected, but not rare, proportion in those of African ancestry. Level of evidence Level IV—retrospective case series.

Aim: The aim of this prospective study was to evaluate the outcome of open reduction and Tönnis acetabuloplasty as the first method of treating developmental dysplasia of the hip (DDH) in children in early childhood at walking age. Materials and methods: Between 2005 and 2009, 34 hips of 34 children were operated on with the aforementioned method. Mean age was 25.6 (range 12-44) months, and mean follow-up was 3.6 years. During the follow-up period,the hips were evaluated using the acetabular index and for development of avascular necrosis and redislocation. Functional evaluation was also conducted. Results: Clinically, 97.3 % of patients had excellent and good results. The acetabular angle decreased from 45 preoperatively to 21 early postoperatively and at the last follow-up had improved to 18. In two hips, type 2 avascular necrosis developed. Hip instability was not observed, and no additional surgery was performed. Conclusion: Tönnis acetabuloplasty is a powerful tool to increase primary stability of the hip when acetabular coverage is inadequate in DDH. Besides its acute correction ability, when performed properly, it has no unwanted effects on acetabular growth. As an isolated procedure or as a part of combined open reduction and/or femoral osteotomy, Tönnis type acetabuloplasty is a safe and effective method. © 2012 The Japanese Orthopaedic Association.

Together with standard total hip arthroplasty (THA), total hip arthroplasty in hip dysplasia and hip dislocation cases has also increased in our country. In this study short and long term evaluation of total hip arthroplasty cases secondary to osteoarthritis following Crowe type III and IV developmental dysplasia of the hip (DDH) has been evaluated. In Ondokuz Mayis University Medical Faculty Department of Orthopaedics and Traumatology we have retrospectively evaluated 78 THA patients presenting with high dislocation between May 2000 and May 2008. Out of 65 patients seventy-eight hips were assessed in the study. One of the patients was male and remaining 64 patients were females. Thirty-four (43.6%) patients were operated from their right hips, while 44 (56.4%) patients were operated from their left hips. Mean follow up time was 49.5 months (10–105 months). Seventy-eight hips were operated using posterolateral approach. Patients were postop¬eratively evaluated in 1st, 5th, 3rd, 5th, 6th and 12th months and once for the subsequent year. Clinical Harris scale and radiological Callaghan and Engh criteria were used to evaluate the results. Results were evaluated both clinically and radiologically. Twenty-two (28.2%) of the 78 hips were determined to be Crowe type III and 56 (71.8%) of them were type IV. Mean value of limb length deficiency before operation was 3.29 cm (distribution 0–7.5 cm, ± 2.06), in the final control it was determined to be 0.84 cm (distribution 0–2 cm, ±0.89). Trochanteric osteotomy was performed for 41 (52.5%) hips and sub trochanteric osteotomy was performed for 21 (%26.9) hips. In these osteotomized hips acetabulum was moved to its plausible location. Shortening was not performed in 16 (20.5%) patients. Mean value for distance of greater trochanter–minor trochanter was 49.20 mm. (31–65mm, ± 6.5). In 21 (26.9%) of the patients autograft taken from femoral head was put on to superolateral of acetabulum. Acetabular covering was 20-35%, and the median value was 30 (20-35) %. In 10 (12.8%) of the 62 osteotomized hips non-union was detected. In 7 patients (8.9%) there was late dislocation (except one). Preoperative mean Harris score was 41.9 (± 8.9) while postoperative mean Harris score was 88.9 (± 9.5). According to these results, 69 (69.7%) of the cases were excellent, 22 (22.2%) were very good, 6 (6.1%) were good and 2 (2%) were average. Results of total hip arthroplasties following developmental dysplasia or dislocation of hip are quite good. When examining the complaints leading to losses in PO Harris score, it has been found out that holding the handrails while climbing up the stairs as well as wearing shoes and socks have been detected to be the factors resulting in most decreases in the score. On the other hand, it has apparently been showed that in all the criteria including pain, walking, activity, deformity and latitude of motion which are the general basis of Harris evaluation schedule, point increase that is recovery has been determined in PO period. J. Exp. Clin. Med., 2012; 29:33-37

Objective: In this study, our aim was to determine the prevalence of untreated hip dislocation and subluxation in Turkey.Methods: Pelvic radiographs of 4,947 children, aged between 6 months and 14 years, taken for non-orthopedic purposes were requested from 23 provinces around the country. 3,723 radiographs met the study criteria and were evaluated. Dislocated and subluxated hips were identified according to the relationship of femoral head using Perkin’s line and quadrants.Results: Thirty-five hips in 22 children were found to be dislocated or subluxated. The prevalence rate was calculated as 5.9‰.Conclusion: Despite appearing to have decreased when compared to limited regional prevalence studies, hip dislocation and subluxation prevalence is still unacceptably high. More extensile work should be done to avoid external factors in the etiology of developmental dysplasia of the hip and to organize screening programs in newborns., Amaç: Çalışmamızda ülkemizdeki tedavi edilmemiş kalça çıkığı ve subluksasyon sıklığının belirlenmesi amaçlanmıştır. Çalışma planı: Ülke genelinde 23 ilden, 6 ay-14 yaş arası 4,947 çocuğa ait, ortopedi dışı nedenlerle çekilmiş kalça grafileri istendi. Gelen grafilerden çalışma kriterlerine uygun olan 3,723’ü değerlendirmeye alındı. Çıkık ve sublukse kalçalar Perkin kadranı baz alınarak femur başıyla olan ilişkilerine göre tanımlandı. Bulgular: Yirmi iki çocuğun 35 kalçasının çıkık veya sublukse olduğu görüldü. Sıklık oranı ‰5.9 oranında hesaplandı. Çıkarımlar: Ülkemizde, kalça çıkığı ve subluksasyon sıklığı, daha önce yapılmış sınırlı bölge çalışmalarına göre azalmış gibi görünse de, hala ciddi oranda yüksek seyretmektedir. Yenidoğanlarda tarama çalışmalarının organize bir hale getirilip, Gelişimsel kalça displazisinin etiyolojisindeki çevresel faktörlerin engellenmesi için daha yaygın önlemler alınmalıdır.

Acetabular and femoral abnormalities make total hip arthroplasty in developmental hip dysplasia a challenging procedure. We present details of long-term follow-up of a series of patients affected by developmental hip dysplasia treated with total hip arthroplasty using a cementless tapered stem.Thirty-five hips in 20 patients (18 women and 2 men) aged between 44 and 60 years (mean 51 years) were observed. Clinical evaluation was conducted using the Harris Hip Score (HHS). Radiographic evaluation consisted in standard anteroposterior and axial view radiographs of the hip. According to Crowe's classification, 25 hips had grade 2 and 10 hips grade 3 dysplasia. All patients were treated with total hip arthroplasty using a cementless tapered stem (Wagner Cone Prosthesis™). After surgery the patients were clinically and radiographically evaluated at 1, 2, 3, 6 and 12 months and annually thereafter. The average follow-up was 12 years (range 10–14 years).The average HHS was 57±7 (range 45–66) preoperatively, 90±7 (range 81–100) 12 months after surgery and 90±6 (range 83–100) at last follow-up. Radiographic evaluation demonstrated excellent osseointegration of the implants in most cases. Signs of bone resorption were present in 5 hips, but no evidence of loosening was observed and none of the implants have been revised.The tapered stem achieved adequate stability and orientation, and may be a suitable option for total hip arthroplasty for arthritis following developmental hip dysplasia.