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Luo S, Chen Y, Zhou W, Canavese F, Li L. Pioneering a chick embryo model to explore the intrauterine etiology of developmental dysplasia of the hip in oligohydramnios conditions. Osteoarthritis Cartilage 2024; 32:869-880. [PMID: 38588889 DOI: 10.1016/j.joca.2024.03.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 03/12/2024] [Accepted: 03/14/2024] [Indexed: 04/10/2024]
Abstract
OBJECTIVE To explore the impact of oligohydramnios on fetal movement and hip development, given its association with developmental dysplasia of the hip (DDH) but unclear mechanisms. METHODS Chick embryos were divided into four groups based on the severity of oligohydramnios induced by amniotic fluid aspiration (control, 0.2 mL, 0.4 mL, 0.6 mL). Fetal movement was assessed by detection of movement and quantification of residual amniotic fluid volume. Hip joint development was assessed by gross anatomic analysis, micro-computed tomography (micro-CT) for cartilage assessment, and histologic observation at multiple time points. In addition, a subset of embryos from the 0.4 mL aspirated group underwent saline reinfusion and subsequent evaluation. RESULTS Increasing volumes of aspirated amniotic fluid resulted in worsening of fetal movement restrictions (e.g., 0.4 mL aspirated and control group at E10: frequency difference -7.765 [95% CI: -9.125, -6.404]; amplitude difference -0.343 [95% CI: -0.588, -0.097]). The 0.4 mL aspirated group had significantly smaller hip measurements compared to controls, with reduced acetabular length (-0.418 [95% CI: -0.575, -0.261]) and width (-0.304 [95% CI: -0.491, -0.117]) at day E14.5. Histological analysis revealed a smaller femoral head (1.084 ± 0.264 cm) and shallower acetabulum (0.380 ± 0.106 cm) in the 0.4 mL group. Micro-CT showed cartilage matrix degeneration (13.6% [95% CI: 0.6%, 26.7%], P = 0.043 on E14.5). Saline reinfusion resulted in significant improvements in the femoral head to greater trochanter (0.578 [95% CI: 0.323, 0.833], P = 0.001). CONCLUSIONS Oligohydramnios can cause DDH by restricting fetal movement and disrupting hip morphogenesis in a time-dependent manner. Timely reversal of oligohydramnios during the fetal period may prevent DDH.
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Affiliation(s)
- Shaoting Luo
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110000, PR China
| | - Yufan Chen
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110000, PR China
| | - Weizheng Zhou
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110000, PR China
| | - Federico Canavese
- Department of Pediatric Orthopedic Surgery, Lille University Centre, Jeanne de Flandre Hospital, 59000 Lille, France
| | - Lianyong Li
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110000, PR China.
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Ozawa J, Kaneguchi A, Ezumi S, Maeno T, Iwazawa J, Minanimoto K, Ikeda A. Effects of hindlimb suspension on development of proximal and distal femur morphological abnormalities in growing rats. J Orthop Res 2023; 41:364-377. [PMID: 35488739 DOI: 10.1002/jor.25352] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 03/07/2022] [Accepted: 04/28/2022] [Indexed: 02/04/2023]
Abstract
Although morphological abnormalities of the femur are known predisposing factors for numerous musculoskeletal disorders, the etiology of these abnormalities is poorly understood. This study aimed to investigate whether femoral morphogenesis is affected by hindlimb suspension (HS) in growing rats. We used 41 four-week-old female rats in this study. In the HS groups, rats were suspended from their tails for 2, 4, and 8 weeks. Age-matched animals were used as controls. We examined morphological indices of the femur using three-dimensional reconstructed images from X-ray computed tomography. The femoral neck anteversion angle (AVA) was higher with growth in the experimental groups and did not differ in control groups. The AVAs in the HS groups were larger than controls at any time point. In the control groups, the trochlear angle (TA) was higher, rotating inward with growth, but did not differ in the HS groups. The TAs in the HS groups were smaller and rotated more outward compared with the control groups at any time point. The height ratios of the medial and lateral condyles (MC/LC), an asymmetry index, were larger in the HS groups compared to controls at any time point. There were strong relationships between proximal (AVA) and distal morphologies, such as the TA (Spearman's coefficient [rs ] = -0.80, p < 0.001) and MC/LC (rs = 0.79, p < 0.001). Our data suggest that sufficient physical activity in early life may protect against morphological femur abnormalities associated with hip and knee joint diseases.
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Affiliation(s)
- Junya Ozawa
- Major in Medical Engineering and Technology, Graduate School of Medical Technology and Health Welfare Sciences, Hiroshima International University, Higashi-Hiroshima, Hiroshima, Japan
| | - Akinori Kaneguchi
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Higashi-Hiroshima, Hiroshima, Japan
| | - Shun Ezumi
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Higashi-Hiroshima, Hiroshima, Japan
| | - Takuma Maeno
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Higashi-Hiroshima, Hiroshima, Japan
| | - Jukiya Iwazawa
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Higashi-Hiroshima, Hiroshima, Japan
| | - Kengo Minanimoto
- Major in Medical Engineering and Technology, Graduate School of Medical Technology and Health Welfare Sciences, Hiroshima International University, Higashi-Hiroshima, Hiroshima, Japan
| | - Airi Ikeda
- Major in Medical Engineering and Technology, Graduate School of Medical Technology and Health Welfare Sciences, Hiroshima International University, Higashi-Hiroshima, Hiroshima, Japan.,Department of Judo Therapy, Takarazuka University of Medical and Health Care, Takarazuka, Hyogo, Japan
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Oelen D, Kaiser P, Baumann T, Schmid R, Bühler C, Munkhuu B, Essig S. Accuracy of Trained Physicians is Inferior to Deep Learning-Based Algorithm for Determining Angles in Ultrasound of the Newborn Hip. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2022; 43:e49-e55. [PMID: 32767299 DOI: 10.1055/a-1177-0480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE Sonographic diagnosis of developmental dysplasia of the hip allows treatment with a flexion-abduction orthosis preventing hip luxation. Accurate determination of alpha and beta angles according to Graf is crucial for correct diagnosis. It is unclear if algorithms could predict the angles. We aimed to compare the accuracy for users and automation reporting root mean squared errors (RMSE). MATERIALS AND METHODS We used 303 306 ultrasound images of newborn hips collected between 2009 and 2016 in screening consultations. Trained physicians labelled every second image with alpha and beta angles during the consultations. A random subset of images was labeled with time and precision under lab conditions as ground truth. Automation predicted the two angles using a convolutional neural network (CNN). The analysis was focused on the alpha angle. RESULTS Three methods were implemented, each with a different abstraction of the problem: (1) CNNs that directly learn the angles without any post-processing steps; (2) CNNs that return the relevant landmarks in the image to identify the angles; (3) CNNs that return the base line, bony roof line, and the cartilage roof line which are necessary to calculate the angles. The RMSE between physicians and ground truth were found to be 7.1° for alpha. The best CNN architecture was (2) landmark detection. The RMSE between landmark detection and ground truth was 3.9° for alpha. CONCLUSION The accuracy of physicians in their daily routine is inferior to deep learning-based algorithms for determining angles in ultrasound of the newborn hip. Similar methods could be used to support physicians.
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Affiliation(s)
- David Oelen
- Biotechnologie & Physik, Supercomputing Systems, Zürich, Switzerland
| | - Pascal Kaiser
- Biotechnologie & Physik, Supercomputing Systems, Zürich, Switzerland
| | - Thomas Baumann
- Research Department, Institute of Primary and Community Care Lucerne, Luzern, Switzerland
| | - Raoul Schmid
- Praxis, Baarer Kinderarztpraxis, Baar, Switzerland
| | - Christof Bühler
- Biotechnologie & Physik, Supercomputing Systems, Zürich, Switzerland
| | - Bayalag Munkhuu
- National Center for Maternal and Child Health, Ulaanbaatar, Mongolia
| | - Stefan Essig
- Research Department, Institute of Primary and Community Care Lucerne, Luzern, Switzerland
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Wang S, Ji G, Li W, Tang S, Dong Z, Xu C, Chen X, Zhao C, Wang F. Can Traditional Straight-leg Swaddling Influence Developmental Dysplasia of the Femoral Trochlea? An In Vivo Study in Rats. Clin Orthop Relat Res 2022; 480:1804-1814. [PMID: 35486522 PMCID: PMC9384908 DOI: 10.1097/corr.0000000000002224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 04/08/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND It has been reported that trochlear dysplasia occurs very early in development, and environmental factors like swaddling may cause developmental dysplasia of the hip, which is associated with a shallower trochlear groove. However, to our knowledge, there are no definitive studies about the relationship between trochlear dysplasia and traditional straight-leg swaddling. QUESTIONS/PURPOSES Using a rat model of femoral trochlear dysplasia, we asked: Does straight-leg swaddling for 1 and 2 weeks in newborn Wistar rats alter the femoral trochlea with respect to (1) gross morphology, (2) histologic appearance, as well as (3) trochlear sulcus angle, width, and depth? METHODS Eighty-four newborn Wistar rats (44 females and 40 males) were divided into two equal groups: 42 in the unswaddled group and 42 in the swaddled group; each group was comprised of 22 females and 20 males. In the swaddled group, the rats were wrapped in surgical tape to maintain hip and knee extension to simulate traditional human straight-leg swaddling. To determine whether longer periods of swaddling were associated with more severe trochlear dysplasia, 21 rats in each group were euthanized at 1 and 2 weeks, respectively, and the gross morphology of the femoral trochlea was observed by one observer blinded to condition. Then hematoxylin and eosin staining of the femoral trochlea was performed and the distribution and number of the chondrocytes of the trochlear groove were viewed through a microscope. The trochlear sulcus angles, depth, and width were measured by an experienced technician blinded to condition. RESULTS By observing the gross morphology, we found that the trochlear groove in the swaddled group became qualitatively flatter compared with the unswaddled group at 1 week, and at 2 weeks, the trochlear groove became much shallower. At 1 and 2 weeks, histologic examinations showed obvious qualitative changes in the distribution and number of chondrocytes of the trochlear groove in the swaddled than in the unswaddled groups. In the swaddled group, trochlear dysplasia was more common at 2 weeks, occurring in 62% (26 of 42 [16 of 22 females and 10 of 22 males]) versus 33% (14 of 42 [8 of 22 females and 6 of 20 males]) at 1 week. At 1 week, the swaddled group showed more trochlear dysplasia compared with the unswaddled group as measured by angle of the trochlear groove (137° ± 6° versus 132°± 3.6°, mean difference 5° [95% confidence interval 2.9° to 7.2°]; p < 0.001), depth of the trochlear grove (0.28 ± 0.04 mm versus 0.31 ± 0.02 mm, mean difference 0.03 mm [95% CI 0.01 to 0.04]; p < 0.001). At 2 weeks, the swaddled group showed more severe trochlear dysplasia than at 1 week compared with the unswaddled group as measured by the angle of the trochlear groove (135° ± 6.0° versus 128° ± 4.8°, mean difference 7° [95% CI 5.7° to 10.4°]; p < 0.001), depth of the trochlear grove (0.32 ± 0.04 mm versus 0.36 ± 0.02 mm, mean difference 0.04 mm [95% CI 0.03 to 0.06]; p < 0.001). There was no difference in the width of the trochlear sulcus between the swaddled and the unswaddled groups at 1 week (1.29 ± 0.14 mm versus 1.30 ± 0.12 mm, mean difference 0.01 mm [95% CI -0.05 to 0.07]; p = 0.73) and 2 weeks (1.55 ± 0.12 mm versus 1.56 ± 0.12 mm, mean difference 0.01 mm [95% CI -0.05 to 0.07]; p = 0.70). CONCLUSION Our results indicate that traditional straight-leg swaddling could induce trochlear dysplasia in this model of newborn rats. With an increased swaddling time of 2 weeks, more severe trochlear dysplasia appeared in the swaddled group. CLINICAL RELEVANCE Our findings suggest that traditional straight-leg swaddling may impair trochlear development in the human neonate and lead to trochlear dysplasia in infants. We believe our animal model will be useful in future work to observe and study the change of cartilage and subchondral bone in each stage of the development of trochlear dysplasia and the change of mechanotransduction-associated proteins (such as, TRPV4/ Piezo1 and CollagenⅡ) in cartilage and subchondral osteocytes. It will also be helpful to further investigate the mechanism of developmental femoral trochlea dysplasia caused by biomechanical changes.
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Affiliation(s)
- Shengjie Wang
- Hebei Medical University, the Third Affiliated Hospital, Hebei, China
| | - Gang Ji
- Hebei Medical University, the Third Affiliated Hospital, Hebei, China
| | - Weifeng Li
- Hebei Medical University, the Third Affiliated Hospital, Hebei, China
| | - Shiyu Tang
- Hebei Medical University, the Third Affiliated Hospital, Hebei, China
| | - Zhenyue Dong
- Hebei Medical University, the Third Affiliated Hospital, Hebei, China
| | - Chenyue Xu
- Hebei Medical University, the Third Affiliated Hospital, Hebei, China
| | - Xiaobo Chen
- Hebei Medical University, the Third Affiliated Hospital, Hebei, China
| | - Chao Zhao
- Hebei Medical University, the Third Affiliated Hospital, Hebei, China
| | - Fei Wang
- Hebei Medical University, the Third Affiliated Hospital, Hebei, China
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Nakamura Y, Saitou M, Komura S, Matsumoto K, Ogawa H, Miyagawa T, Saitou T, Imamura T, Imai Y, Takayanagi H, Akiyama H. Reduced dynamic loads due to hip dislocation induce acetabular cartilage degeneration by IL-6 and MMP3 via the STAT3/periostin/NF-κB axis. Sci Rep 2022; 12:12207. [PMID: 35842459 PMCID: PMC9288549 DOI: 10.1038/s41598-022-16585-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/12/2022] [Indexed: 11/10/2022] Open
Abstract
Developmental dysplasia of the hip (DDH) is characterized by anatomical abnormalities of the hip joint, ranging from mild acetabular dysplasia to hip subluxation and eventually dislocation. The mechanism underlying the cartilage degeneration of the hip joints exposed to reduced dynamic loads due to hip dislocation remains unknown. We established a rodent hip dislocation (disarticulation; DA) model of DDH (DA-DDH rats and mice) by swaddling. Expression levels of periostin (Postn) and catabolic factors, such as interleukin-6 (IL-6) and matrix metalloproteinase 3 (Mmp3), increased and those of chondrogenic markers decreased in the acetabular cartilage of the DA-DDH models. Postn induced IL-6 and Mmp3 expression in chondrocytes through integrin αVβ3, focal adhesion kinase, Src, and nuclear factor-κB (NF-κB) signaling. The microgravity environment created by a random positioning machine induced Postn expression in chondrocytes through signal transducer and activator of transcription 3 (STAT3) signaling. IL-6 stimulated Postn expression via STAT3 signaling. Furthermore, cartilage degeneration was suppressed in the acetabulum of Postn−/− DA-DDH mice compared with that in the acetabulum of wild type DA-DDH mice. In summary, reduced dynamic loads due to hip dislocation induced acetabular cartilage degeneration via IL-6 and MMP3 through STAT3/periostin/NF-κB signaling in the rodent DA-DDH models.
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Affiliation(s)
- Yutaka Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Mitsuru Saitou
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Shingo Komura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Kazu Matsumoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Hiroyasu Ogawa
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Takaki Miyagawa
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Takashi Saitou
- Department of Molecular Medicine for Pathogenesis, Graduate School of Medicine, Ehime University, Toon, Ehime, 791-0295, Japan
| | - Takeshi Imamura
- Department of Molecular Medicine for Pathogenesis, Graduate School of Medicine, Ehime University, Toon, Ehime, 791-0295, Japan
| | - Yuuki Imai
- Division of Integrative Pathophysiology, Proteo-Science Center, Ehime University, Toon, Ehime, 791-0295, Japan
| | - Hiroshi Takayanagi
- Department of Immunology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Haruhiko Akiyama
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan.
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Ye T, Xue F, Hu H, He Z, Wang M, Yu Z, Zhao B, Chu L. Early Emergent and Progressive Aberrant Subchondral Bone Remodeling Coupled with Aggravated Cartilage Degeneration in Developmental Dysplasia of the Hip. Cartilage 2022; 13:19476035221098165. [PMID: 35549743 PMCID: PMC9251826 DOI: 10.1177/19476035221098165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Developmental dysplasia of the hip (DDH) is the most common skeletal development in children and could result in secondary osteoarthritis. This study aims to clarify the alternations of subchondral trabecular bone remodeling and microstructural properties during the development of DDH, and the potential influence of these alternations on the overlying cartilage degeneration and DDH progression. DESIGN Traditional straight-leg swaddling method was adopted to establish DDH model in newborn Sprague Dawley rats. Hip joint specimens from normal or DDH rats were used. Typical features of DDH in radiological examination were observed by x-ray analysis. Micro-computed tomography analysis was applied to evaluate the microstructural properties of subchondral bone at postnatal weeks 2, 4, and 6. Histological and immunohistochemical analyses were adopted to appraise subchondral bone remodeling activity and cartilage degeneration. The associations among subchondral bone, articular cartilage, and DDH severity were analyzed via multiple linear regression analysis. RESULTS Compared with control group, the subchondral bone in DDH group displayed a gradual trend of deteriorated microstructure and worsening biomechanical properties along with aberrant bone remodeling, which might be responsible for the inhibition of stress transmission from the articular cartilage to the subchondral bone and thus leading to the cartilage degeneration and accelerated DDH progression. CONCLUSIONS Our findings indicate that alternations of subchondral trabecular bone in a time-dependent manner could contribute to the DDH progression and the amelioration on subchondral bone might be a favorable therapeutic candidate for DDH.
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Affiliation(s)
- Teng Ye
- Department of Orthopedic Surgery,
Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai,
China
| | - Feng Xue
- Department of Orthopedic Surgery,
Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai,
China
| | - Hai Hu
- Department of Orthopedic Surgery,
Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai,
China
| | - Zihao He
- Shanghai Key Laboratory of Orthopedic
Implants, Department of Orthopedic Surgery, Shanghai Ninth People’s Hospital,
Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Minqi Wang
- Department of Bone and Joint Surgery,
Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai,
China
| | - Zhifeng Yu
- Shanghai Key Laboratory of Orthopedic
Implants, Department of Orthopedic Surgery, Shanghai Ninth People’s Hospital,
Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bizeng Zhao
- Department of Orthopedic Surgery,
Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai,
China
| | - Linyang Chu
- Department of Orthopedic Surgery,
Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai,
China,Linyang Chu, Department of Orthopedic
Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 600#
Yishan Road, Shanghai 200233, China.
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Zhou W, Luo W, Liu D, Canavese F, Li L, Zhao Q. Fluoride increases the susceptibility of developmental dysplasia of the hip via increasing capsular laxity triggered by cell apoptosis and oxidative stress in vivo and in vitro. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2022; 234:113408. [PMID: 35298972 DOI: 10.1016/j.ecoenv.2022.113408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 02/26/2022] [Accepted: 03/08/2022] [Indexed: 06/14/2023]
Abstract
The etiology of developmental dysplasia of the hip (DDH) is multifactorial, including breech presentation and hip capsular laxity. In particular, hip laxity is the main contributor to DDH by changing the ratio and distribution of collagens. Also, fluoride (F) affects collagens from various tissue besides bone and tooth. To investigate the association of DDH and excessive F intake, we conducted this research in lab on cell and animal model simultaneously. We established animal model of combination of DDH and F toxicity. The incidence of DDH in each group was calculated, and hip capsules were collected for testing histopathological and ultrastructural changes. The primary fibroblasts were further extracted from hip capsule and treated with F. The expression of collagen type I and III was both examined in vivo and in vitro, and the level of oxidative stress and apoptosis was also tested identically. We revealed that the incidence of DDH increased with F concentration. Furthermore, the oxidative stress and apoptosis levels of hip capsules and fibroblasts both increased after F exposure. Therefore, this study shows that excessive F intake increases susceptibility to DDH by altering hip capsular laxity in vivo and in vitro respectively. We believe that F might be a risk factor for DDH by increasing hip laxity induced by triggering fibroblast oxidative stress and apoptosis.
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Affiliation(s)
- Weizheng Zhou
- Department of Pediatric Orthopaedics, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang, Liaoning 110004, China
| | - Wenting Luo
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang, Liaoning 110004, China
| | - Dan Liu
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang, Liaoning 110004, China
| | - Federico Canavese
- Department of Pediatric Orthopedics, Lille University Center, Jeanne de Flandres Hospital, Avenue Eugène-Avinée, Lille 59037, France
| | - Lianyong Li
- Department of Pediatric Orthopaedics, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang, Liaoning 110004, China.
| | - Qun Zhao
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang, Liaoning 110004, China
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Li W, Wang S, Tang S, Dong Z, Wang F. What is the relationship between the breech presentation and femoral trochlear dysplasia? An experimental study of the breech presentation model in neonatal rats. BMC Musculoskelet Disord 2022; 23:60. [PMID: 35039030 PMCID: PMC8764757 DOI: 10.1186/s12891-022-05023-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 01/12/2022] [Indexed: 11/24/2022] Open
Abstract
Background The relationship between breech presentation and trochlear dysplasia has been confirmed. However, the pathological process of breech-related trochlear dysplasia remains unclear. This study aimed to establish an animal model to simulate breech presentation and to analyze the pathological process of the femoral trochlea. Materials and Methods One hundred and twenty neonatal rats were randomly assigned into a control group and two experimental groups that were swaddled (using surgical tape) to keep the hip flexed and knees extended to simulate human breech presentation for the 5 days (short Swaddling) and the 10 days (prolonged Swaddling) of life. Gross and cross-sectional observation, histological staining measurement in two experimental time points (5 and 10 days after birth) were conducted to evaluate the morphological changes of the femoral trochlea. Results The incidence of trochlear dysplasia increased with the Swaddling time. Rats in the prolonged Swaddling group had the high prevalence of trochlea dysplasia (52 of 60), followed by short Swaddling group (42 of 60). Gross and cross-sectional observation showed a shallower trochlea groove in two experimental groups. Histologicalstaining measurement indicated that the trochlear sulcus angle and trochlear sulcus depth were significantly different between the experimental group and the control group since day 5 and day 10. Conclusion In this model, breech presentation had an adverse effect on neonatal knees and could induce trochlear dysplasia. In addition, this study also showed that the more time in breech presentation, the more incidence of trochlear dysplasia.
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Affiliation(s)
- Weifeng Li
- Department of Joint Surgery, the Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Shengjie Wang
- Department of Joint Surgery, the Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Shiyu Tang
- Department of Joint Surgery, the Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Zhenyue Dong
- Department of Joint Surgery, the Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Fei Wang
- Department of Joint Surgery, the Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China.
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9
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Liu B, Hu X, Li L, Gao S. Morphological Development of the Hip in Normal Infants Under Six Months of Age by the Graf Ultrasound Method. Front Pediatr 2022; 10:914545. [PMID: 35615629 PMCID: PMC9126495 DOI: 10.3389/fped.2022.914545] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 04/15/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This large-sample observational study aims to analyze the morphological development of the hip joint in Chinese normal infants under 6 months of age by the Graf ultrasound method. METHODS The clinical and ultrasound data of infants who underwent early screening for developmental dysplasia of the hip (DDH) in the authors' clinic from January 2011 to December 2019 were analyzed retrospectively. The standard Graf method was used to measure the hip joint α angle, β angle and femoral head coverage (FHC). The infants with Graf type I or IIa hips were included in this study. All infants were grouped by age. FHC, α and β angles were compared among different study groups. RESULTS A total of 3,067 infants (6,134 hips) were included in the study. There were 1,164 males and 1,903 females with an average age of 77 days (1-180 days). The mean α angle was 62.4 ± 3.6° on the left and 63.2 ± 3.5° on the right (P < 0.001). The mean β angle was 55.6 ± 4.5° on the left and 54.8 ± 4.5° on the right (P < 0.001). The average FHC was 54.2 ± 4.6% and 54.8 ± 4.2%, accordingly (P < 0.001). The α angle and FHC of females was significantly smaller than that of males (P < 0.001). While the left β angle in females was slightly larger than males (P = 0.014), there were no significant differences in the right β angle between the two sexes (P = 0.150). During the first 3 postnatal months, the α angle and FHC increased while β angle decreased with age. However, the α and β angles and FHC were stable at a relatively constant level from the 4 to the 6th postnatal month. CONCLUSIONS The normal infant hip reveals progressive maturation during the first 3 months after birth, and then enters a plateau period during the 4 to 6th month. The development of hip joint in females and of the left side slightly lags behind that in males and of the right side, which is consistent with the observation that DDH is more common in females and on the left hips.
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Affiliation(s)
- Bing Liu
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiaoyun Hu
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Lianyong Li
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Shuxi Gao
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
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Ulziibat M, Munkhuu B, Bataa AE, Schmid R, Baumann T, Essig S. Traditional Mongolian swaddling and developmental dysplasia of the hip: a randomized controlled trial. BMC Pediatr 2021; 21:450. [PMID: 34641800 PMCID: PMC8513275 DOI: 10.1186/s12887-021-02910-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 09/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mongolian traditional swaddling of infants, where arms and legs are extended with a tight wrapping and hips are in adduction position, may lead to abnormal maturation and formation of the hip joint; and is a contributing factor for developmental dysplasia of the hip (DDH). This hypothesis was tested in this randomized controlled trial. METHODS Eighty newborns with one or two hips at risk of worsening to DDH (Graf Type 2a; physiologically immature hips) at birth were randomized into 2 groups at a tertiary hospital in Ulaanbaatar. The "swaddling" group (n = 40) was swaddled in the common traditional Mongolian method for a month while the "non-swaddling" group (n = 40) was instructed not to swaddle at all. All enrollees were followed up on monthly basis by hip ultrasound and treated with an abduction-flexion splint if necessary. The groups were compared on the rate of Graf's "non-Type 1" hips at follow-up controls as the primary outcome. Secondary outcomes were rate of DDH and time to discharge (Graf Type 1; healthy hips). In addition, correlation between the primary outcome and swaddling length in days and frequency of swaddling in hours per day were calculated. RESULTS Recruitment continued from September 2019 to March 2020 and follow-up data were completed in June 2020. We collected final outcome data in all 80 enrollees. Percentages of cases with non-Type 1 hip at any follow-up examination were 7.5% (3/40) in the non-swaddling group and 40% (16/40) in the swaddling group (p = 0.001). There was no DDH case in the non-swaddling group while there were 8 cases of DDH in the swaddling group. The mean time to discharge was 5.1 ± 0.3 weeks in the non-swaddling group and 8.4 ± 0.89 weeks in the swaddling group (p = 0.001). There is a correlation between the primary outcome and the swaddling frequency in hours per day (r = 0.81) and swaddling length in days (r = 0.43). CONCLUSIONS Mongolian traditional swaddling where legs are extended and hips are in extension and adduction position increases the risk for DDH. TRIAL REGISTRATION Retrospectively registered, ISRCTN11228572 .
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Affiliation(s)
- Munkhtulga Ulziibat
- Department of Health Sciences and Medicine, University of Lucerne, Luzern, Switzerland.
- National Center for Maternal and Child Health, Ulaanbaatar, Mongolia.
| | - Bayalag Munkhuu
- National Center for Maternal and Child Health, Ulaanbaatar, Mongolia
| | | | | | | | - Stefan Essig
- Center for Primary and Community Care, Department of Health Sciences and Medicine, University of Lucerne, Luzern, Switzerland
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Vaidya S, Aroojis A, Mehta R. Developmental Dysplasia of Hip and Post-natal Positioning: Role of Swaddling and Baby-Wearing. Indian J Orthop 2021; 55:1410-1416. [PMID: 35003533 PMCID: PMC8688658 DOI: 10.1007/s43465-021-00513-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 09/02/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Traditional swaddling, which implies restrictive immobilisation of the infant's lower limbs with the hips in forced extension and adduction, has been shown to be a risk factor for Developmental Dysplasia of Hip (DDH). METHODS We reviewed the literature regarding the correlation between DDH and post-natal positioning by swaddling and baby-wearing, to draw awareness of healthcare professionals towards an important risk factor for DDH that has often been overlooked. RESULTS There is overwhelming evidence in the literature, by both experimental and clinical studies, that proves the close association between improper post-natal positioning of the baby's hips in extension-adduction and an increased incidence of DDH. On the other hand, "hip safe" swaddling which allows unrestricted flexion-abduction movements of the infants' hips, and the use of baby-wearing devices which keep the lower limbs in an attitude of hip flexion-abduction and knee flexion, is optimal for hip development. Populations which practice these "hip-safe" techniques of infant immobilisation have a lower incidence of DDH as compared to those which practice restrictive immobilisation. Furthermore, populations which have adopted "hip-safe" positioning have demonstrated a significant decrease in the incidence of DDH. Understanding this association is vital, since this is a modifiable risk factor, rectification of which can decrease the incidence of DDH. CONCLUSION Policy makers and governments must design educational campaigns tailored to their respective populations to increase awareness regarding the benefits of "hip-safe" techniques of infant positioning, since this simple intervention has the potential of decreasing the incidence of DDH.
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Affiliation(s)
- Sandeep Vaidya
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Acharya Donde Marg, Mumbai, 40012 Maharashtra India
| | - Alaric Aroojis
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Acharya Donde Marg, Mumbai, 40012 Maharashtra India
| | - Rujuta Mehta
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Acharya Donde Marg, Mumbai, 40012 Maharashtra India
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Siddicky SF, Wang J, Rabenhorst B, Buchele L, Mannen EM. Exploring infant hip position and muscle activity in common baby gear and orthopedic devices. J Orthop Res 2021; 39:941-949. [PMID: 34566253 PMCID: PMC8462515 DOI: 10.1002/jor.24818] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 07/13/2020] [Indexed: 02/04/2023]
Abstract
Infant positioning in daily life may affect hip development. While neonatal animal studies indicate detrimental relationships between inactive lower extremities and hip development and dysplasia, no research has explored infant hip biomechanics experimentally. This study evaluated hip joint position and lower extremity muscle activity of healthy infants in common body positions, baby gear, and orthopedic devices used to treat hip dysplasia (the Pavlik harness and the Rhino cruiserabduction brace). Surface electromyography(EMG) and marker-based motion capture recorded lower extremity muscle activity and kinematics of 22 healthy full-term infants (4.2±1.6 months, 13M/9F) during five conditions: Pavlik harness, Rhino brace, inward-facing soft-structured baby carrier, held in arms facing inwards, and a standard car seat. Mean filtered EMG signal, time when muscles were active, and hip position (angles) were calculated. Compared to the Pavlik harness, infants exhibited similar adductor activity (but lower hamstring and gluteus maximus activity) in the Rhino abduction brace, similar adductor and gluteus maximus activity (but lower quadriceps and hamstring activity) in the baby carrier, similar but highly variable muscle activity in-arms, and significantly lower muscle activity in the car seat. Hip position was similar between the baby carrier and the Pavlik harness. This novel infant biomechanics study illustrates the potential benefits of using inward-facing soft-structured baby carriers for healthy hip development and highlights the potential negative impact of using supine-lying container-type devices such as car seats for prolonged periods of time. Further study is needed to understand the full picture of how body position impacts infant musculoskeletal development.
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Affiliation(s)
- Safeer F. Siddicky
- Department of Orthopaedic Surgery, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
- Mechanical and Biomedical Engineering Department, College of Engineering, Boise State University, Boise, ID
| | - Junsig Wang
- Department of Orthopaedic Surgery, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Brien Rabenhorst
- Department of Orthopaedic Surgery, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Lauren Buchele
- Department of Orthopaedic Surgery, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Erin M. Mannen
- Department of Orthopaedic Surgery, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
- Mechanical and Biomedical Engineering Department, College of Engineering, Boise State University, Boise, ID
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Pinto DA, Aroojis A, Mehta R. Swaddling Practices in an Indian Institution: Are they Hip-Safe? A Survey of Paediatricians, Nurses and Caregivers. Indian J Orthop 2020; 55:147-157. [PMID: 33569109 PMCID: PMC7851204 DOI: 10.1007/s43465-020-00188-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 06/25/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Traditional infant swaddling or binding with hips and knees extended is a known risk factor for Developmental Dysplasia of the Hip (DDH), while 'hip-safe swaddling' with hips and knees flexed is believed to eliminate this risk. We conducted a survey to determine the prevalent practices for infant swaddling in India; why mothers practice swaddling and who teaches them; and whether Paediatricians, nurses and caregivers are aware of hip-safe swaddling. METHODS Anonymous one-time surveys were conducted in three groups-Paediatricians, Nurses and caregivers - at a tertiary-care, urban based, paediatric and maternity hospital. RESULTS Forty-five paediatricians, 219 nurses and 100 caregivers were surveyed. Ninety percent caregivers practiced traditional swaddling, for on average 10.2 hours a day, starting soon after birth, up to 4.2 months of life. Traditional swaddling was advocated by 99% nurses and 53% Paediatricians. Reasons for swaddling included sleep, warmth and the misbelief that the child's legs would remain bowed if not bound straight; contrarily few mothers (8%) avoided swaddling out of superstition. Mothers learnt swaddling mainly from relatives (94%) and nurses (64%). Most nurses (70%) had learnt the practice during nursing training. Only 6.6% Paediatricians, 4% caregivers and 0% nurses were aware of 'hip-safe swaddling'. CONCLUSION Traditional swaddling of infants is a practice deeply rooted in India, born out of misbeliefs, and propagated by lack of awareness. Training in hip-safe swaddling targeted at nurses and Paediatricians would be an effective initial step in creating awareness among mothers and changing their practices.
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Affiliation(s)
- Deepika A. Pinto
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Acharya Donde Marg, Parel, Mumbai, 400012 Maharashtra India
| | - Alaric Aroojis
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Acharya Donde Marg, Parel, Mumbai, 400012 Maharashtra India
| | - Rujuta Mehta
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Acharya Donde Marg, Parel, Mumbai, 400012 Maharashtra India
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Wang CL, Zuo B, Li D, Zhu JF, Xiao F, Zhang XL, Chen XD. The long noncoding RNA H19 attenuates force-driven cartilage degeneration via miR-483-5p/Dusp5. Biochem Biophys Res Commun 2020; 529:210-217. [PMID: 32703413 DOI: 10.1016/j.bbrc.2020.05.180] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/25/2020] [Indexed: 02/04/2023]
Abstract
Developmental dysplasia of the hip (DDH) is a common hip disease characterized by abnormal development of the acetabulum and femoral head. In most cases, DDH ultimately leads to osteoarthritis. Anomalous biomechanical force plays an important role in cartilage degeneration in DDH. However, in addition to mechanical wear, the underlying molecular mechanisms in cartilage degeneration in DDH remain unclear. This study analyzed the effect of long noncoding RNA (lncRNA)-H19 on DDH cartilage degradation. To elucidate the specific role of lncRNA H19, we established an intermittent cyclic mechanical stress (ICMS) cell force model to simulate abnormal biomechanical environment in vitro. Then, the roles of lncRNA-H19 were also determined in vivo by establishing a model of swaddling DDH. We observed that patients with DDH possessed low levels of lncRNA-H19, COL2A1, and Aggrecan but high levels of MMP3 and Adamts5. The same results were also obtained in a DDH rat model. Furthermore, the data suggested that ICMS promoted cartilage degeneration and caused reorientation of the cytoskeleton, and lncRNA H19 helped inhibit cartilage degeneration. Bioinformatics analysis and lncRNA sequencing were performed, and luciferase assays showed that lncRNA H19 and Dusp5 are both direct targets of miR-483-5p. Moreover, Dups5 plays a negative role in ICMS-induced cartilage degradation by activating the Erk and p38 pathways. In vivo, lncRNA H19 had protective effects on the swaddling DDH model. These findings indicate that lncRNA-H19 played a positive role in cartilage degradation in DDH through the lncRNA H19/miR-483-5p/Dusp5 axis.
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Affiliation(s)
- Cheng-Long Wang
- Department of Orthopedic Surgery, Xin Hua Hospital Affiliated with Shanghai Jiao Tong University School of Medicine (SJTUSM), China
| | - Bin Zuo
- Department of Orthopedic Surgery, Xin Hua Hospital Affiliated with Shanghai Jiao Tong University School of Medicine (SJTUSM), China
| | - De Li
- Department of Orthopedic Surgery, Xin Hua Hospital Affiliated with Shanghai Jiao Tong University School of Medicine (SJTUSM), China
| | - Jun-Feng Zhu
- Department of Orthopedic Surgery, Xin Hua Hospital Affiliated with Shanghai Jiao Tong University School of Medicine (SJTUSM), China
| | - Fei Xiao
- Department of Orthopedic Surgery, Xin Hua Hospital Affiliated with Shanghai Jiao Tong University School of Medicine (SJTUSM), China
| | - Xiao-Ling Zhang
- Department of Orthopedic Surgery, Xin Hua Hospital Affiliated with Shanghai Jiao Tong University School of Medicine (SJTUSM), China.
| | - Xiao-Dong Chen
- Department of Orthopedic Surgery, Xin Hua Hospital Affiliated with Shanghai Jiao Tong University School of Medicine (SJTUSM), China.
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Luo W, Dong Y, Hu T, Liu D, Wei X, Ma W, Yuan Z, Zhao Q. 25(OH)D status and expression of miR-140 in the serum of patients with developmental dysplasia of the hip. Nutrition 2020; 81:110896. [PMID: 32739657 DOI: 10.1016/j.nut.2020.110896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/13/2020] [Accepted: 05/24/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Developmental dysplasia of the hip (DDH) is one of the most common orthopedic birth defects in newborn infants, for whom early detection and treatment are critical. MiR-140 plays an important role in bone development and was found to be regulated by vitamin D receptors in our previous study. This study aimed to investigate vitamin D status and miR-140 expression in the circulation of patients with orthopedic conditions, including DDH. METHODS The 25-hydroxyvitamin D (25[OH]D) status and miR-140 expression were determined in the serum of 120 patients with orthopedic conditions. Receiver operating characteristic curves were used to evaluate the potential diagnosis capability of 25(OH)D status and miR-140 expression in DDH. A DDH rat model was also used to verify miR-140 expression in vivo. RESULTS We found that most patients with orthopedic conditions have vitamin D insufficiency and deficiency, and patients with DDH are in the insufficiency range. MiR-140 was downregulated in the serum of patients with DDH patients and in the hip joints of rats with DDH. A panel of 25(OH)D and miR-140 showed robust performance in distinguishing DDH from controls. CONCLUSIONS Our results indicate that miR-140 may play an important role in DDH, with the potential capability of being a biomarker for the diagnosis of DDH.
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Affiliation(s)
- Wenting Luo
- Key Laboratory of Health Ministry for Congenital Malformation, Department of Pediatric Surgery, Shengjing Hospital, China Medical University, Shenyang, China
| | - Yaping Dong
- Key Laboratory of Health Ministry for Congenital Malformation, Department of Pediatric Surgery, Shengjing Hospital, China Medical University, Shenyang, China
| | - Tao Hu
- Key Laboratory of Health Ministry for Congenital Malformation, Department of Pediatric Surgery, Shengjing Hospital, China Medical University, Shenyang, China
| | - Dan Liu
- Key Laboratory of Health Ministry for Congenital Malformation, Department of Pediatric Surgery, Shengjing Hospital, China Medical University, Shenyang, China
| | - Xiaowei Wei
- Key Laboratory of Health Ministry for Congenital Malformation, Department of Pediatric Surgery, Shengjing Hospital, China Medical University, Shenyang, China
| | - Wei Ma
- Key Laboratory of Health Ministry for Congenital Malformation, Department of Pediatric Surgery, Shengjing Hospital, China Medical University, Shenyang, China
| | - Zhengwei Yuan
- Key Laboratory of Health Ministry for Congenital Malformation, Department of Pediatric Surgery, Shengjing Hospital, China Medical University, Shenyang, China
| | - Qun Zhao
- Key Laboratory of Health Ministry for Congenital Malformation, Department of Pediatric Surgery, Shengjing Hospital, China Medical University, Shenyang, China.
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Ji X, Liu T, Zhao S, Li J, Li L, Wang E. WISP-2, an upregulated gene in hip cartilage from the DDH model rats, induces chondrocyte apoptosis through PPARγ in vitro. FASEB J 2020; 34:4904-4917. [PMID: 32058630 DOI: 10.1096/fj.201901915r] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 12/29/2019] [Accepted: 01/20/2020] [Indexed: 12/17/2022]
Abstract
Chondrocyte apoptosis plays an important role in the developmental dysplasia of the hip (DDH) development. It has been found that WNT1 inducible signaling pathway protein 2 (WISP-2) and peroxisome proliferator-activated receptor γ (PPARγ) are involved in cell apoptosis. In this study, we performed the straight-leg swaddling DDH rat model and we found that cartilage degradation and chondrocyte apoptosis were remarkably increased in DDH rats in vivo. Moreover, we found that WISP-2 was upregulated in hip acetabular cartilage of DDH rats compared to control rats. Next, the effects of WISP-2 on chondrocyte apoptosis and its possible underlying mechanism were examined in vitro. The lentivirus-mediated gain- and loss-of-function experiments of WISP-2 and peroxisome proliferator-activated receptor γ (PPARγ) for cell viability and apoptosis were performed in primary rat chondrocytes. The results showed that the overexpression of WISP-2 induced chondrocyte apoptosis, and knockdown of WISP-2 could suppress the chondrocyte apoptosis induced by advanced glycation end products (AGE). Additionally, WISP-2 could negatively regulate the expression of PPARγ in chondrocytes. Moreover, the knockdown of PPARγ promoted chondrocyte apoptosis and overexpression of PPARγ abated the increased apoptosis and decreased cell viability of chondrocytes induced by WISP-2. This study demonstrated that WISP-2 might contribute to chondrocyte apoptosis of hip acetabular cartilage through regulating PPARγ expression and activation, which may play an important role in the development of DDH.
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Affiliation(s)
- Xianglu Ji
- Department of Hand and Foot Surgery, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China
| | - Tianjing Liu
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China
| | - Shuyi Zhao
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China
| | - Jianjun Li
- Department of Traumatic Orthopedics, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China
| | - Lianyong Li
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China
| | - Enbo Wang
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China
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Pavlik Harness initiation on Barlow positive hips: Can we wait? J Orthop 2019; 16:378-381. [PMID: 31065214 DOI: 10.1016/j.jor.2019.03.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 02/05/2019] [Accepted: 03/20/2019] [Indexed: 10/27/2022] Open
Abstract
We investigated if infants with a Barlow positive hip(s) have natural hip stabilization and can thus avoid Pavlik Harness (PH) treatment. We conducted a chart review for infants who presented within two weeks of life, had a Barlow positive hip, and were deferred treatment. Of the thirty infants, eighteen were treated with PH at 4-6 weeks or 12 weeks due to persistent dysplasia. Twelve infants avoided PH entirely. There were zero cases of PH failure. Parents can be counseled that deferring treatment until at least 4-6 weeks of age might avoid treatment altogether without an increased risk of harness failure.
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Oka K, Murase T, Tanaka H, Kawabata H. The morphologic change of the elbow with flexion contracture in upper obstetric brachial plexus palsy. J Shoulder Elbow Surg 2019; 28:1764-1770. [PMID: 31043347 DOI: 10.1016/j.jse.2019.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 02/04/2019] [Accepted: 02/15/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Contracture of the elbow after obstetric brachial plexus palsy (OBPP) is well known; however, details of the 3-dimensional (3D) morphologic changes in the elbow joint in OBPP have not been clarified. This study aimed to clarify the 3D morphologic changes in the elbow joint by focusing on the distal humerus with flexion contracture in upper OBPP. We tested the hypothesis that the shape of the distal humerus with flexion contracture in upper OBPP is hypoplastic in the trochlea, capitellum, and olecranon fossa. METHODS We retrospectively studied 20 patients with elbow flexion contracture and residual OBPP. The approximate radius of the distal humerus, the shortest distance between the olecranon and coronoid fossa, and the size of the olecranon fossa were measured and compared between the affected and normal sides using 3D bone models to assess the distal humerus morphology. RESULTS The average radius of the distal humerus was smaller on the affected side than on the normal side. Furthermore, the average distance between the olecranon and coronoid fossa was greater and the average size of the olecranon fossa was smaller on the affected side than on the normal side. The size of the distal humerus was significantly smaller and the olecranon fossa was significantly shallower on the affected side. CONCLUSIONS Consistent with our original hypothesis, the distal humerus with flexion contracture in upper OBPP was hypoplastic. The shallow olecranon fossa might prevent full extension of the elbow even though soft tissue contracture release is performed. We recommend evaluation of the morphology of the olecranon fossa to determine the treatment plan for elbow flexion contracture with OBPP.
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Affiliation(s)
- Kunihiro Oka
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Japan.
| | - Tsuyoshi Murase
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Hiroyuki Tanaka
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Hidehiko Kawabata
- Department of Orthopaedic Surgery, Osaka Rehabilitation Hospital for Children, Osaka, Japan
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Abstract
BACKGROUND Developmental dysplasia of the hip is effectively treated with a Pavlik harness (PH) within the first 6 months of life. Over 80% of unstable hips in the newborn period will naturally stabilize by 2 months of age. If there is no difference in the effectiveness of initiating PH treatment at 1 week compared with 4 weeks of age, waiting may allow the hips to naturally stabilize and avoid treatment. The purpose of this study is to evaluate whether the timing of PH implementation influences its effectiveness in the treatment of developmental dysplasia of the hip. METHODS A retrospective review was conducted between 2004 and 2010. Patients were included if PH therapy was prescribed for hip instability or dislocation at or before 6 months of age. PH failure was defined as requiring any operative procedure for definitive management. Groups were divided based on the age at which the PH was initiated-group1=<30 days, group 2=30 to 60 days, group 3=>60 days. RESULTS A total of 176 children were included with 38 (21.6%) failing PH treatment. The mean age at PH initiation was 1.3 months (SD=1.3) in the successfully treated children and 1.4 months (SD=1.2) in the failures (P=0.77). There was no difference in the failure rates by age with group 1=19.1% (18/94), group 2=22.5% (9/40), and group 3=26.2% (11/42) (P=0.87). There was no statistical difference with respect to sex or breech positioning in the success or failure groups; however, there was a higher percentage of bilateral involvement in the failure group (P=0.04). CONCLUSIONS Patients who had PH initiation before 30 days of age were no more or less likely to fail than when PH was initiated after 30 days of age. Parents can be counseled that waiting until after 30 days of age is appropriate before PH implementation. By avoiding swaddling during this period, the hips may stabilize without treatment and allow for more parental-infant bonding before implementation of PH. LEVEL OF EVIDENCE Level III-therapeutic, case control study.
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Fontecha C, Coma Muñoz A, Catala Muñoz A. Evaluation by ultrasound of the hips of babies carried in baby carriers. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019. [DOI: 10.1016/j.recote.2019.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Exploración ecográfica de las caderas del bebé en mochilas de porteo. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019; 63:289-294. [DOI: 10.1016/j.recot.2019.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/12/2019] [Accepted: 02/13/2019] [Indexed: 11/22/2022] Open
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Ömeroğlu H, Akceylan A, Köse N. Associations between risk factors and developmental dysplasia of the hip and ultrasonographic hip type: a retrospective case control study. J Child Orthop 2019; 13:161-166. [PMID: 30996740 PMCID: PMC6442512 DOI: 10.1302/1863-2548.13.180174] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE We aimed to revisit the correlation between the previously defined risk factors and the occurrence of developmental dysplasia of the hip (DDH) and to assess the influence of these factors on the ultrasonographic type of hip dysplasia according to the Graf's classification in patients with DDH. METHODS Data of healthy infants (mean age 33 days) who had bilateral mature (normal) hips (Graf type I) were compared with the data of infants (mean age 105 days) who were treated by abduction brace due to unilateral or bilateral DDH (Graf type IIa- and worse hips). RESULTS Infants with at least one risk factor had a significantly higher rate of DDH than those with no risk factors (p < 0.001). Likewise, infants with more than one risk factor had a significantly higher rate of DDH than those with only one risk factor (p = 0.008). Family history, breech presentation and swaddling were found to be the three significant risk factors related to the development of DDH. Family history, swaddling and oligohydramnios were found to be the three significant risk factors correlated with a higher rate of unstable/decentred hip(s) (Graf types D/III/IV) in patients with DDH. CONCLUSION The risk of DDH significantly increases in infants who have more than one risk factor for DDH. Positive family history and postnatal traditional swaddling are the two main factors both in the aetiology of DDH and in development of a more severe hip dysplasia in patients with DDH. Besides, breech presentation increases the risk of development of DDH and oligohydramnios leads to development of a more severe hip dysplasia in patients with DDH. By introducing these four variables as 'absolute risk factors for DDH' to the selective newborn hip screening programmes, the sensitivity and specificity of these programmes may be optimized and the risk of delayed diagnosis may be lessened. LEVEL OF EVIDENCE Level III prognostic study.
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Affiliation(s)
- H. Ömeroğlu
- TOBB University of Economics and Technology, Faculty of Medicine, Department of Orthopaedics and Traumatology, Ankara, Turkey, Correspondence should be sent to Prof. Dr. Hakan Ömerog˘lu, TOBB University of Economics and Technology Hospital, Yas¸am Caddesi No: 5, Sög˘ütözü, Ankara, Turkey. E-mail:
| | - A. Akceylan
- Ministry of Health Aks¸ehir State Hospital, Clinics of Orthopaedics and Traumatology, Konya, Turkey
| | - N. Köse
- University of Eskis¸ehir Osmangazi, Faculty of Medicine, Department of Orthopaedics and Traumatology, Eskis¸ehir, Turkey
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Onay T, Gumustas SA, Cagirmaz T, Aydemir AN, Orak MM. Do the risk factors for developmental dysplasia of the hip differ according to gender? A look from another perspective. J Paediatr Child Health 2019; 55:168-174. [PMID: 30069945 DOI: 10.1111/jpc.14143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 05/21/2018] [Accepted: 06/28/2018] [Indexed: 11/28/2022]
Abstract
AIM The aim of the present study was to examine if there were gender differences in risk factors in 4415 infants who were evaluated through a physical examination and hip ultrasonography (USG). METHODS Physical examination of the hip and hip USG were performed on 4415 infants by the same paediatric orthopaedics specialist. Barlow and Ortolani tests were performed together with the evaluation for the limitation of abduction. Ultrasonographic hip examination was performed according to the Graf technique. The birth records of all the infants were examined, and anamneses (genetic disease, maternal age, delivery type, swaddling, multiple pregnancies, duration of gestation period, gravida, birthweight, breech presentation, oligohydramnios and family history) were obtained from the families. Any accompanying musculoskeletal (torticollis, pes equinovarus, congenital knee dislocation) abnormality was recorded. RESULTS Pathological hip was determined in 149 (3.37%) of 4415 infants. In males, gestational week, family history, breech presentation, swaddling, congenital knee dislocation and limited abduction were observed to be significant for the presence of developmental dysplasia of the hip (DDH). In females, significant factors for the presence of DDH were determined to include birthweight, gestational week, breech presentation, multiple pregnancy, accompanying oligohydramnios, torticollis, pes equinovarus and limited abduction. CONCLUSION Risk factors for DDH can differ according to gender.
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Affiliation(s)
- Tolga Onay
- Department of Orthopaedics and Traumatology, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Seyit A Gumustas
- Department of Orthopaedics and Traumatology, Lutfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - Talat Cagirmaz
- Department of Orthopaedics and Traumatology, Lutfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - Ahmet N Aydemir
- Department of Orthopaedics and Traumatology, Pamukkale University School of Medicine, Denizli, Turkey
| | - Mehmet M Orak
- Department of Orthopaedics and Traumatology, Lutfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey
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Killian ML, Locke RC, James MG, Atkins PR, Anderson AE, Clohisy JC. Novel model for the induction of postnatal murine hip deformity. J Orthop Res 2019; 37:151-160. [PMID: 30259572 PMCID: PMC6393179 DOI: 10.1002/jor.24146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 09/12/2018] [Indexed: 02/04/2023]
Abstract
Acetabular dysplasia is a common, multi-etiological, pre-osteoarthritic (OA) feature that can lead to pain and instability of the young adult hip. Despite the clinical significance of acetabular dysplasia, there is a paucity of small animal models to investigate structural and functional changes that mediate morphology of the dysplastic hip and drive the subsequent OA cascade. Utilizing a novel murine model developed in our laboratory, this study investigated the role of surgically induced unilateral instability of the postnatal hip on the initiation and progression of acetabular dysplasia and impingement up to 8-weeks post-injury. C57BL6 mice were used to develop titrated levels of hip instability (i.e., mild, moderate, and severe instabillity or femoral head resection) at weaning. Joint shape, acetabular coverage, histomorphology, and statistical shape modeling were used to assess quality of the hip following 8 weeks of destabilization. Acetabular coverage was reduced following severe, but not moderate, instability. Moderate instability induced lateralization of the femur without dislocation, whereas severe instability led to complete dislocation and pseudoacetabulae formation. Mild instability did not result in morphological changes to the hip. Removal of the femoral head led to reduced hip joint space volume. These data support the notion that hip instability, driven by mechanical loss-of-function of soft connective tissue, can induce morphometric changes in the growing mouse hip. This work developed a new mouse model to study hip health in the murine adolescent hip and is a useful tool for investigating the mechanical and structural adaptations to hip instability during growth. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
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Affiliation(s)
- Megan L. Killian
- Department of Biomedical Engineering, University of Delaware, 5 Innovation Way, Suite 200, Newark, Delaware 19716,,Department of Orthopaedic Surgery, Washington University School of Medicine, 425 S. Euclid Avenue, Saint Louis, Missouri 63110
| | - Ryan C. Locke
- Department of Biomedical Engineering, University of Delaware, 5 Innovation Way, Suite 200, Newark, Delaware 19716
| | - Michael G. James
- Department of Orthopaedic Surgery, Washington University School of Medicine, 425 S. Euclid Avenue, Saint Louis, Missouri 63110
| | - Penny R. Atkins
- Department of Bioengineering, University of Utah, James LeVoy Sorenson Molecular Biotechnology Building, 36 S. Wasatch Drive, Rm. 3100, Salt Lake City, Utah 84112,,Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, Utah 84108
| | - Andrew E. Anderson
- Department of Bioengineering, University of Utah, James LeVoy Sorenson Molecular Biotechnology Building, 36 S. Wasatch Drive, Rm. 3100, Salt Lake City, Utah 84112,,Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, Utah 84108
| | - John C. Clohisy
- Department of Orthopaedic Surgery, Washington University School of Medicine, 425 S. Euclid Avenue, Saint Louis, Missouri 63110
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Chen Y, Lv H, Li L, Wang E, Zhang L, Zhao Q. Expression of PAPP-A2 and IGF Pathway-Related Proteins in the Hip Joint of Normal Rat and Those with Developmental Dysplasia of the Hip. Int J Endocrinol 2019; 2019:7691531. [PMID: 30915115 PMCID: PMC6402211 DOI: 10.1155/2019/7691531] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 12/16/2018] [Accepted: 01/02/2019] [Indexed: 01/21/2023] Open
Abstract
Developmental dysplasia of the hip (DDH) is one of the major causes of child disability and early osteoarthritis. Genetic factors play an important role, but which still remain unclear. Pregnancy-associated plasma protein-A2 (PAPP-A2), a special hydrolase of insulin-like growth factor binding protein-5 (IGFBP-5), has been confirmed to be associated with DDH by previous studies. The aim of this study was firstly, to investigate the expression of PAPP-A2 and insulin-like growth factor (IGF) pathway-related proteins in normal rat's hip joints; secondly, to compare the variations of those proteins between DDH model rats and normal ones. The DDH model was established by swaddling the rat's hind legs in hip adduction and extension position. The hip joints were collected for expression study of fetal rats, normal newborn rats, and DDH model rats. Positive expression of PAPP-A2 and IGF pathway-related proteins was observed in all the hip joints of growing-stage rats. Ultimately, IGF1 was downregulated; insulin-like growth factor 1 receptor (IGF1R) showed an opposite trend in DDH rats when compared with normal group. The PAPP-A2 and IGF pathway-associated proteins may also be involved in the development of the rat's hip joint, which bring the foundation for further revealing the pathogenic mechanism of DDH.
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Affiliation(s)
- Yufan Chen
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang City 110004, China
| | - Haixiang Lv
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang City 110004, China
| | - Lianyong Li
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang City 110004, China
| | - Enbo Wang
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang City 110004, China
| | - Lijun Zhang
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang City 110004, China
| | - Qun Zhao
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang City 110004, China
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Charlton SL, Schoo A, Walters L. Early dynamic ultrasound for neonatal hip instability: implications for rural Australia. BMC Pediatr 2017; 17:82. [PMID: 28320362 PMCID: PMC5359877 DOI: 10.1186/s12887-017-0830-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 03/08/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neonatal instability of the hip (NIH), where the femoral head can move away from the acetabulum, in the first weeks of life, is an important risk factor for developmental dysplasia of the hip (DDH). In rural areas in Australia, there is a recent trend to increased late diagnosis of DDH. Clinical screening of infant hips, a common practice in Australia, is experience dependent. Best practice early screening techniques are still debated with different techniques and timing used internationally. This systematic review examines early dynamic ultrasound (eDUS) screening for hip instability in the first 6 weeks after birth, and the early interventions informed by these findings and considers the findings for the context of rural Australia. METHODS The Cochrane Library, Medline, CINAHL and PEDro were searched for original research or systematic reviews, and clinical studies 1998 to 2015 involving dynamic ultrasound. Critical Appraisal Skills Programme tools were used to appraise the studies. RESULT Nineteen studies were included. Early Dynamic Ultrasound (DUS) is consistently described as a reliable assessment of NIH. Early DUS is recommended for risk factors including geographical areas of high prevalence. Approaches to early intervention of hips with excessive movement are somewhat discipline-related and include: primary prevention (advice), secondary prevention (abduction supports), and conservative management (removable splints). CONCLUSIONS In the context of increased prevalence of DDH in rural Australia, contemporary evidence suggests that introduction of early DUS could provide rural infants with more effective screening than clinical examination alone. Targeted early advice about posturing and simple removable supports to abduct infant hips could prevent some cases of DDH in rural Australia.
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Affiliation(s)
- Susan L Charlton
- Flinders Rural Health South Australia, Flinders University, Vivienne st, Mount Gambier, 5290, South Australia.
| | - Adrian Schoo
- Flinders Rural Health South Australia, Flinders University, Vivienne st, Mount Gambier, 5290, South Australia
| | - Lucie Walters
- Flinders Rural Health South Australia, Flinders University, Vivienne st, Mount Gambier, 5290, South Australia
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27
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Feng WJ, Wang H, Shen C, Zhu JF, Chen XD. Severe cartilage degeneration in patients with developmental dysplasia of the hip. IUBMB Life 2017; 69:179-187. [PMID: 28185391 DOI: 10.1002/iub.1606] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 01/03/2017] [Indexed: 01/24/2023]
Abstract
Developmental dysplasia of the hip (DDH) is a developmental disorder that has long-term chronic pain and limited hip joint mobility as major pathological characteristics. This study aims to access the association between the development of DDH and cartilage metabolic disorders. Cartilage tissue samples were acquired from patients with DDH, osteoarthritis (OA) and femoral neck fracture. The proteoglycan level was evaluated by safranin O-fast green, toluidine blue and hematoxylin-eosin (HE) staining. The levels of collagen-II (Col-II), collagen-X (Col-X) and metal matrix proteinase-13 (MMP-13) were evaluated by immunohistochemistry (IHC) and Western blotting analysis. The morphologic evaluation of cartilage was conducted by transmission electron microscopy (TEM). Quantitative real-time polymerase chain reaction (qRT-PCR) was performed to detect the mRNA level of aggrecan, Col-II, Col-X and MMP-13. The aggrecan level in the cartilage matrix was significantly decreased in DDH patients by safranin O-fast green and toluidine blue staining in comparison with that in the OA and control groups. In contrast with the OA group, the Col-II expression was reduced while the MMP-13 expression increased in DDH patients, as shown by IHC and Western blotting analysis. The collagenous fibrils in cartilage of DDH patients appeared significantly sparse and disordered in the TEM analysis. In DDH patients, the mRNA expression levels of Col-II and aggrecan were markedly reduced, while the mRNA expression of Col-X was markedly increased, compared with the OA patients. There is severe articular cartilage degeneration in DDH patients. This observation provides us with new insight into cartilage metabolic regulation in DDH. © 2017 IUBMB Life, 69(3):179-187, 2017.
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Affiliation(s)
- Wei-Jia Feng
- Department of Orthopedic Surgery, Xin Hua Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hui Wang
- Department of Orthopedic Surgery, Xin Hua Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Chao Shen
- Department of Orthopedic Surgery, Xin Hua Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jun-Feng Zhu
- Department of Orthopedic Surgery, Xin Hua Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiao-Dong Chen
- Department of Orthopedic Surgery, Xin Hua Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
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28
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Pollet V, Percy V, Prior HJ. Relative Risk and Incidence for Developmental Dysplasia of the Hip. J Pediatr 2017; 181:202-207. [PMID: 27866823 DOI: 10.1016/j.jpeds.2016.10.017] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 08/23/2016] [Accepted: 10/05/2016] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To determine the incidence and associated risk factors of developmental dysplasia of the hip (DDH) in a modern population without universal screening. STUDY DESIGN Children with DDH were identified from the Manitoba Centre for Health Policy's Data Repository by the use of International Classification of Diseases diagnosis codes as well as physician billing tariffs for surgical procedures for DDH for all children born between 1995 and 2012. To identify the outpatient-treated patients, ultrasound scans and radiographic imaging for DDH were reviewed for 2004-2012. Overall incidence was calculated on the basis of birth rate for the province per year. Relative risks of sex, first born, breech position, clubfoot deformity, multiple gestations, as well as regional health areas were analyzed with χ2 tests. RESULTS We identified 1716 cases of DDH of 258 499 newborns. The incidence of DDH was calculated at 6.6/1000 newborns. Late-presenting DDH was detected in 2.2/1000 newborns. Female first-born children, clubfoot deformity, and breech position were associated significantly with an increased risk. Children with DDH born in rural areas of the Northern and Central part of Manitoba presented at a later age than those who are born in the urban areas (P < .0001) CONCLUSION: This study shows the need for improved early detection and awareness at well-baby clinics of risk factors and regional differences for DDH.
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Affiliation(s)
- Virginie Pollet
- Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands.
| | - Vanessa Percy
- Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Heather J Prior
- Manitoba Centre for Health Policy, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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29
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Abstract
Developmental dysplasia of the hip (DDH) encompasses a wide spectrum of clinical severity, from mild developmental abnormalities to frank dislocation. Clinical hip instability occurs in 1% to 2% of full-term infants, and up to 15% have hip instability or hip immaturity detectable by imaging studies. Hip dysplasia is the most common cause of hip arthritis in women younger than 40 years and accounts for 5% to 10% of all total hip replacements in the United States. Newborn and periodic screening have been practiced for decades, because DDH is clinically silent during the first year of life, can be treated more effectively if detected early, and can have severe consequences if left untreated. However, screening programs and techniques are not uniform, and there is little evidence-based literature to support current practice, leading to controversy. Recent literature shows that many mild forms of DDH resolve without treatment, and there is a lack of agreement on ultrasonographic diagnostic criteria for DDH as a disease versus developmental variations. The American Academy of Pediatrics has not published any policy statements on DDH since its 2000 clinical practice guideline and accompanying technical report. Developments since then include a controversial US Preventive Services Task Force "inconclusive" determination regarding usefulness of DDH screening, several prospective studies supporting observation over treatment of minor ultrasonographic hip variations, and a recent evidence-based clinical practice guideline from the American Academy of Orthopaedic Surgeons on the detection and management of DDH in infants 0 to 6 months of age. The purpose of this clinical report was to provide literature-based updated direction for the clinician in screening and referral for DDH, with the primary goal of preventing and/or detecting a dislocated hip by 6 to 12 months of age in an otherwise healthy child, understanding that no screening program has eliminated late development or presentation of a dislocated hip and that the diagnosis and treatment of milder forms of hip dysplasia remain controversial.
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Abstract
BACKGROUND The purpose of this single-examination pilot study was to confirm the ability to perform hip sonography while swaddled and to ascertain whether the various swaddling techniques influenced hip position and dynamics. METHODS Dynamic sonography was used to evaluate 30 infants in both swaddled and unswaddled positions who were being seen in clinic for suspected or documented developmental dysplasia of the hip. A "treatment group" of 16 infants (32 hips) treated in a Pavlik harness and a "nontreatment group" of 14 untreated infants (28 hips) were studied.Criteria for comparing sonographic results between swaddled and unswaddled hip positions included femoral head position, instability, and range-of-motion restriction. RESULTS Tight swaddling with a blanket was applied in 11 "nontreatment group" cases (20 hips; in 2 cases, only 1 hip studied) and produced limited flexion and abduction. One unstable left hip dislocated when tightly swaddled. Safe swaddling technique in 12 cases (24 hips) showed no limitation of flexion and abduction of the legs and no change in stability by sonography. Commercial swaddling products appeared to mildly restrict leg motion in 14 hips, but there was no change in hip position in the "nontreatment group." However, the commercial swaddling products changed the hip position in 3 Pavlik harness cases. CONCLUSIONS Swaddling techniques that allow a free range of leg motion may not affect hip stability in normal infants or those being treated with Pavlik harness. Swaddling with restricted leg motion increases potential for hip instability. Tight swaddling dislocated 1 unstable hip, and commercial swaddling products judged to apply only mild restriction of leg motion negatively impacted 3 cases being treated for developmental dysplasia of the hip with Pavlik harness. On the basis of this pilot study, we advise caution when swaddling infants, especially with techniques that restrict leg motion. Further study of the long-term effects of swaddling is warranted. LEVEL OF EVIDENCE Level II.
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Studer K, Williams N, Antoniou G, Gibson C, Scott H, Scheil WK, Foster BK, Cundy PJ. Increase in late diagnosed developmental dysplasia of the hip in South Australia: risk factors, proposed solutions. Med J Aust 2016; 204:240. [DOI: 10.5694/mja15.01082] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 01/21/2016] [Indexed: 11/17/2022]
Affiliation(s)
| | - Nicole Williams
- Women's and Children's Hospital, Adelaide, SA
- University of Adelaide Centre for Orthopaedic and Trauma Research, Adelaide, SA
| | | | - Catherine Gibson
- South Australian Birth Defects Register, Women's and Children's Hospital, Adelaide, SA
| | - Heather Scott
- South Australian Birth Defects Register, Women's and Children's Hospital, Adelaide, SA
| | - Wendy K Scheil
- Pregnancy Outcomes Statistics Unit, SA Health, Adelaide, SA
| | - Bruce K Foster
- Women's and Children's Hospital, Adelaide, SA
- University of Adelaide Centre for Orthopaedic and Trauma Research, Adelaide, SA
| | - Peter J Cundy
- Women's and Children's Hospital, Adelaide, SA
- University of Adelaide Centre for Orthopaedic and Trauma Research, Adelaide, SA
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Kotlarsky P, Haber R, Bialik V, Eidelman M. Developmental dysplasia of the hip: What has changed in the last 20 years? World J Orthop 2015; 6:886-901. [PMID: 26716085 PMCID: PMC4686436 DOI: 10.5312/wjo.v6.i11.886] [Citation(s) in RCA: 183] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 08/23/2015] [Accepted: 10/13/2015] [Indexed: 02/06/2023] Open
Abstract
Developmental dysplasia of the hip (DDH) describes the spectrum of structural abnormalities that involve the growing hip. Early diagnosis and treatment is critical to provide the best possible functional outcome. Persistence of hip dysplasia into adolescence and adulthood may result in abnormal gait, decreased strength and increased rate of degenerative hip and knee joint disease. Despite efforts to recognize and treat all cases of DDH soon after birth, diagnosis is delayed in some children, and outcomes deteriorate with increasing delay of presentation. Different screening programs for DDH were implicated. The suspicion is raised based on a physical examination soon after birth. Radiography and ultrasonography are used to confirm the diagnosis. The role of other imaging modalities, such as magnetic resonance imaging, is still undetermined; however, extensive research is underway on this subject. Treatment depends on the age of the patient and the reducibility of the hip joint. At an early age and up to 6 mo, the main treatment is an abduction brace like the Pavlik harness. If this fails, closed reduction and spica casting is usually done. After the age of 18 mo, treatment usually consists of open reduction and hip reconstruction surgery. Various treatment protocols have been proposed. We summarize the current practice for detection and treatment of DDH, emphasizing updates in screening and treatment during the last two decades.
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Back-carrying infants to prevent developmental hip dysplasia and its sequelae: is a new public health initiative needed? J Pediatr Orthop 2015; 35:57-61. [PMID: 24942071 DOI: 10.1097/bpo.0000000000000234] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Developmental dysplasia of the hip (DDH) is rarely encountered in the native sub-Saharan African population. We present a retrospective review of the incidence of symptomatic DDH in Malawi and a systematic review of the role of back-carrying as a potential influence of prevalence in this population group. METHODS We retrospectively reviewed the diagnosis and management of all infants seen at the Beit CURE International Hospital, Malawi and its mobile clinics, from November 2002 to September 2012. In addition, methodical review of the literature using the Preferred Reporting Items for Systematic Reviews and Meta-analyses checklist and algorithm was performed. RESULTS A total of 40,683 children aged less than 16 years were managed at our institute over a 10-year period, of which 9842 children underwent surgery. No infant presented with, or underwent surgical intervention, for symptomatic DDH. CONCLUSIONS The majority of mothers in Malawi back-carry their infants during the first 2 to 24 months of life, in a position that is similar to that of the Pavlik harness. We believe this to be the prime reason for the low incidence of DDH in the country. In addition, there is established evidence indicating that swaddling, the opposite position to back-carrying, causes an increase in the incidence of DDH. There is a need for the establishment of a large clinical trial into back-carrying and prevention of DDH in non-African population groups. LEVEL OF EVIDENCE Level II.
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Schwend RM, Shaw BA, Segal LS. Evaluation and treatment of developmental hip dysplasia in the newborn and infant. Pediatr Clin North Am 2014; 61:1095-107. [PMID: 25439013 DOI: 10.1016/j.pcl.2014.08.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Developmental dysplasia of the hip (DDH) encompasses a spectrum of physical and imaging findings. The child's hip will not develop normally if it remains unstable and anatomically abnormal by walking age. Therefore, careful physical examination of all infants to diagnosis and treat significant DDH is critical to provide the best possible functional outcome. Regardless of the practice setting, all health professionals who care for newborns and infants should be trained to evaluate the infant hip for instability and to provide appropriate and early conservative treatment or referral.
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Affiliation(s)
- Richard M Schwend
- Orthopaedics and Pediatrics, UMKC, KUMC Director of Research Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108, USA
| | - Brian A Shaw
- Orthopaedic Surgery, University of Colorado School of Medicine, Children's Hospital Colorado and Memorial Health System, Colorado Springs, 4125 Briargate Parkway, Suite 100, Colorado Springs, CO 80920, USA.
| | - Lee S Segal
- Department of Orthopaedics, University of Wisconsin Hospital and Clinics, University of Wisconsin, 1685 Highland Avenue, Room 6170-110, Madison, WI 53705-2281, USA
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35
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Fu M, Liu J, Huang G, Huang Z, Zhang Z, Wu P, Wang B, Yang Z, Liao W. Impaired ossification coupled with accelerated cartilage degeneration in developmental dysplasia of the hip: evidences from μCT arthrography in a rat model. BMC Musculoskelet Disord 2014; 15:339. [PMID: 25294293 PMCID: PMC4289046 DOI: 10.1186/1471-2474-15-339] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 09/29/2014] [Indexed: 12/14/2022] Open
Abstract
Background Developmental dysplasia of the hip (DDH) always leads to cartilage degeneration and osteoarthritis of the hip joint. However, the diagnosis of early cartilage degeneration in DDH is still a clinical challenge. This study aims to investigate the dynamic changes of bone and cartilage in the hip of a rat model of DDH and to explore the potential application of microcomputed tomography (μCT) arthrography to detect early cartilage degeneration in DDH. Methods Newborn Wistar rats were used to induce DDH by hindlimb swaddling. The bone and cartilage of the hip in model and control group were analyzed by μCT arthrography and histology examination at postnatal day 10, week 4, 6 and 8. Results Hip dysplasia developed with age, became obvious at postnatal week 6 and further progressed at week 8. μCT analysis showed that bone mineral density (BMD) and bone volume density (bone volume over total volume, BV/TV) of the femoral head and neck region (FHNR) in model group were both significantly lower than those in control group, and they increased dramatically from postnatal week 4 to week 6 but maintained at a similar level at week 8. Contrast-enhanced μCT (CE-μCT) arthrography and histology data showed age-dependent increase in cartilage attenuation (CA) and decrease in safranin O staining intensity (SI) in model group, respectively. Moreover, the model group revealed remarkably higher CA and lower SI than control group, respectively. In addition, significant changes of CA and SI were both observed from postnatal week 6 to week 8 in model group. A strong linear correlation (r2 = 0.789, P <0.001) was found between CA and SI in model group. Furthermore, BMD was negatively correlated with SI (t = -2.683, P <0.05), whereas specific bone surface (bone surface over bone volume, BS/BV) was positively correlated with SI (t =4.501, P <0.01), in model group. Conclusions Impaired ossification coupled with continuous loss of sGAG in cartilage matrix was found in the dysplasia hip during the disease progression of DDH. Cartilage degeneration in the dysplasia hip may occur early at childhood, accelerated with age and become irreversible at young adult stage. All these abnormal changes could be quantitatively assessed by μCT arthrography. Electronic supplementary material The online version of this article (doi:10.1186/1471-2474-15-339) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ming Fu
- Department of Joint Surgery, First Affiliated Hospital of Sun Yat-sen University, No, 58 Zhongshan 2nd road, Guangzhou 510080, China.
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Blatt SH. To swaddle, or not to swaddle? Paleoepidemiology of developmental dysplasia of the hip and the swaddling dilemma among the indigenous populations of North America. Am J Hum Biol 2014; 27:116-28. [PMID: 25223754 DOI: 10.1002/ajhb.22622] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 07/28/2014] [Accepted: 08/20/2014] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Clinical prevalence of developmental dysplasia of the hip (DDH) is high among modern indigenous populations of North America, yet no systematic study of the paleoepidemiology of this group exists. This study discusses the skeletal criteria, epidemiology, pathophysiology, and risk factors of DDH. A range of cases of DDH from an archaeological Native American population are described and the clinical and prehistoric prevalence of DDH among indigenous populations of North America are calculated and discussed within a biocultural perspective. METHODS Pelves of 390 adults from the Late Prehistoric (1490 B.P. ± 70) Buffalo site, West Virginia, were examined for DDH. Morphology of true and false acetabula was classified and other changes of the pelvis, lower limb, and spine were noted along with cranial deformation, providing evidence of infant restriction. Prevalence of DDH among living and archaeological indigenous peoples of North America were calculated and compared. Cranial deformation was assessed as evidence for swaddling. RESULTS DDH was identified in 18 adults from Buffalo, resulting in a minimum prevalence of 46.15 per 1,000, within the range reported in modern indigenous groups in North America. Most, but not all, of the DDH cases were associated with cranial deformation, but not all cases of cranial deformation were associated with DDH. CONCLUSIONS The etiology of DDH suggests that components of both genetic predisposition and swaddling practices have combined to create a high-risk environment for the development of DDH, contributing to high prevalence within archaeological populations, like Buffalo, and modern Indigenous groups of North America.
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Affiliation(s)
- Samantha H Blatt
- Department of Anthropology, Boise State University, Boise, Idaho, 83725-1950
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Nowlan NC, Chandaria V, Sharpe J. Immobilized chicks as a model system for early-onset developmental dysplasia of the hip. J Orthop Res 2014; 32:777-85. [PMID: 24590854 DOI: 10.1002/jor.22606] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 02/03/2014] [Indexed: 02/04/2023]
Abstract
We have almost no understanding of how our joints take on their range of distinctive shapes, despite the clinical relevance of joint morphogenesis to postnatal skeletal malformations such as developmental dysplasia of the hip (DDH). In this study, we investigate the role of spontaneous prenatal movements in joint morphogenesis using pharmacological immobilization of developing chicks, and assess the system as a suitable model for early-onset hip dysplasia. We show that, prior to joint cavitation, the lack of dynamic muscle contractions has little impact on the shape of the hip joint. However, after the timepoint at which cavitation occurs, a dramatic effect on hip joint morphogenesis was observed. Effects in the immobilized chicks included flattening of the proximal femur, abnormal orientation of the pelvis relative to the femur and abnormal placement and coverage of the acetabulum. Although many clinical case studies have identified reduced or restricted movement as a risk factor for DDH, this study provides the first experimental evidence of the role of prenatal movements in early hip joint development. We propose that the immobilized chick embryo serves as a suitable model system for the type of early-onset DDH which arises due to neuromuscular conditions such as spinal muscular atrophy.
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Affiliation(s)
- Niamh C Nowlan
- EMBL-CRG Systems Biology Program, Centre for Genomic Regulation, UPF, Dr. Aiguader 88, 08003, Barcelona, Spain; Department of Bioengineering, Imperial College London, London, United Kingdom
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Cemented versus Uncemented Oxford Unicompartmental Knee Arthroplasty: Is There a Difference? Adv Orthop 2013; 2013:245915. [PMID: 24383006 PMCID: PMC3872020 DOI: 10.1155/2013/245915] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Accepted: 11/05/2013] [Indexed: 11/18/2022] Open
Abstract
Purpose. The use of uncemented unicompartmental knee prostheses has recently increased. However, few studies on the outcomes of uncemented unicompartmental knee prostheses have been performed. The purpose of this study was to compare the outcomes of cemented and uncemented Oxford unicompartmental knee arthroplasty. Materials and Methods. This retrospective observational study evaluated the clinical and radiological outcomes of 263 medial Oxford unicompartmental prostheses (141 cemented, 122 uncemented) implanted in 235 patients. The mean follow-up was 42 months in the cemented group and 30 months in the uncemented group. Results. At the last follow-up, there were no significant differences in the clinical results or survival rates between the two groups. However, the operation time in the uncemented unicompartmental knee arthroplasty group was shorter than that in the cemented unicompartmental knee arthroplasty group. In addition, the cost of uncemented arthroplasty was greater. Conclusion. Despite the successful midterm results in the uncemented unicompartmental knee arthroplasty group, a longer follow-up period is required to determine the best fixation mode.
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Blatt SH. Joined at the hip? A paleoepidemiological study of developmental dysplasia of the hip and its relation to swaddling practices among indigenous peoples of North America. Am J Hum Biol 2013; 25:821-34. [PMID: 24123551 DOI: 10.1002/ajhb.22458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Revised: 08/29/2013] [Accepted: 08/30/2013] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES Clinical prevalence of developmental dysplasia of the hip (DDH) is the highest among modern indigenous populations of North America, yet no systematic study of the paleoepidemiology of this group exists. This study discusses the skeletal criteria, epidemiology, pathophysiology, and risk factors for DDH. A range of cases of DDH from an archaeological Native American population are described, and the clinical and prehistoric prevalence of DDH among indigenous populations of North America are calculated and discussed within a biocultural perspective. METHODS Pelves of 390 adults from the Late Prehistoric (1490 BP ± 70) Buffalo site, West Virginia were examined for DDH. Morphology of true and false acetabula was classified and other changes of the pelvis, lower limb, and spine were noted along with cranial deformation, providing evidence of infant restriction. Prevalence of DDH among living and archaeological indigenous peoples of North America were calculated and compared. RESULTS DDH was identified in eighteen adults from Buffalo, resulting in a prevalence of 46.15, within the range reported in modern indigenous groups in North America. However, there is a significant difference between the DDH prevalence in prehistory and today in the target population. CONCLUSIONS Indigenous peoples of North America have the highest reported global prevalence of DDH today and in prehistory. The etiology of DDH suggests that components of both genetic predisposition and swaddling practices have combined to create a high-risk environment for the development of DDH, contributing to its high prevalence within archaeological populations, like Buffalo, and modern Native American/Aboriginal groups within North America.
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Affiliation(s)
- Samantha H Blatt
- Department of Anthropology, Boise State University, Boise, Idaho, 83725-1950
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Zhao D, Rao W, Zhao L, Liu J, Chen Y, Shen P, Du Q, Li L. Is it worthwhile to screen the hip in infants born with clubfeet? INTERNATIONAL ORTHOPAEDICS 2013; 37:2415-20. [PMID: 24005238 DOI: 10.1007/s00264-013-2073-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 08/06/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE There is some disagreement about whether idiopathic congenital talipes equinovarus (CTEV) increases the risk of neonatal developmental dysplasia of the hip (DDH). This study aimed to investigate the incidence of DDH in our infants with idiopathic CTEV. METHODS We conducted an observational cohort study over a three-year period to assess the relationship between idiopathic CTEV and DDH. All neonates younger than six weeks with idiopathic CTEV who were treated in our medical centre were admitted to this study. Each subject underwent hip ultrasound examination using the Graf method at the age of six weeks. DDH was diagnosed when a hip was type IIa(-) or worse according to the Graf classification of sonographic hip type. RESULTS A total of 184 patients were diagnosed with idiopathic CTEV and underwent hip sonography. In total, seven hips of five individuals underwent treatment (four girls and one boy). The results indicated that 2.7% of babies (five of 184) with idiopathic CTEV had DDH. However, we did not find any statistically significant difference (p = 0.5776) in the Pirani scores between the DDH group and group with normal hips. CONCLUSIONS This study revealed that the idiopathic CTEV group had a greater incidence of DDH in comparison with the general population. It is recommended that hip sonography be undertaken particularly in patients with idiopathic CTEV.
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Affiliation(s)
- Dahang Zhao
- Department of Paediatric Orthopaedics, Xin-Hua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, No. 1665, Kongjiang Road, Shanghai, 200092, China,
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Affiliation(s)
- Harish S Hosalkar
- Department of Orthopedic Surgery, Rady Children's Hospital San Diego, University of California San Diego, 3030 Children's Way, Suite 410, San Diego, CA 92123, USA.
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Are Consanguineous Marriage and Swaddling the Risk Factors of Developmental Dysplasia of the Hip? J Membr Biol 2012; 246:115-9. [DOI: 10.1007/s00232-012-9509-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 10/10/2012] [Indexed: 10/27/2022]
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