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The acetabulum in Perthes' disease: a prospective study of 123 children.

Huhnstock S, Svenningsen S, Pripp AH, Terjesen T, Wiig O - J Child Orthop (2014)

Bottom Line: ADR values at diagnosis were associated with a more spherical femoral head at the 5-year follow-up [odds ratio (OR) 1.012, 95 % confidence interval (CI) 1.002-1.022, p = 0.016].None of the other acetabular parameters were significantly associated with the femoral head shape 5 years after diagnosis.Early dysplastic changes of the acetabulum were not associated with a poor radiological outcome 5 years after diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Orthopaedic Surgery, Oslo University Hospital, Rikshospitalet, 0027, Oslo, Norway, uxhuhs@ous-hf.no.

ABSTRACT

Purpose: We assessed the radiographic changes of the acetabulum during the course of Perthes' disease and investigated whether they were associated with femoral head sphericity 5 years after diagnosis.

Methods: We studied 123 children with unilateral Perthes' disease, femoral head necrosis more than 50 % and age at diagnosis 6 years or older. Pelvic radiographs were taken at onset, 1 year and 5 years after diagnosis. Sharp's angle, acetabular depth-to-width ratio (ADR) and lateral acetabular inclination were measured.

Results: Compared to the unaffected hips, the Perthes' hips developed significantly higher Sharp's angles (p < 0.001) and a higher proportion with an upward-sloping lateral acetabular margin (Perthes' hips: 49 %, unaffected hips 1 %). The mean ADR values were significantly lower on the affected side at all stages (p < 0.001). ADR values at diagnosis were associated with a more spherical femoral head at the 5-year follow-up [odds ratio (OR) 1.012, 95 % confidence interval (CI) 1.002-1.022, p = 0.016]. None of the other acetabular parameters were significantly associated with the femoral head shape 5 years after diagnosis.

Conclusion: The acetabulum developed an increasingly dysplastic shape in the course of Perthes' disease. Early dysplastic changes of the acetabulum were not associated with a poor radiological outcome 5 years after diagnosis. Routine measurement and monitoring of acetabular changes in plain radiographs were of little prognostic value and can, therefore, hardly be recommended in clinical practice.

No MeSH data available.


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Figure showing changes of the acetabular depth and width from the time of diagnosis to 5-year follow-up (x-axis). The y-axis shows the percentage change of the depth (dashed line) and width (solid line) relative to the unaffected acetabula (0 % reference)
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Fig3: Figure showing changes of the acetabular depth and width from the time of diagnosis to 5-year follow-up (x-axis). The y-axis shows the percentage change of the depth (dashed line) and width (solid line) relative to the unaffected acetabula (0 % reference)

Mentions: The mean ADR value of the affected hips at the time of diagnosis was significantly lower compared with the unaffected side (p < 0.001) (Table 1). This was due to both an increase of acetabular width (p < 0.001) and a slight decrease of depth (p < 0.001) (Fig. 3). We analysed the ADR at diagnosis separately according to each Waldenström radiographic phase. The mean ADR value of the affected hips in the initial phase was significantly lower compared with the unaffected side (287 vs. 302; p < 0.001).Fig. 3


The acetabulum in Perthes' disease: a prospective study of 123 children.

Huhnstock S, Svenningsen S, Pripp AH, Terjesen T, Wiig O - J Child Orthop (2014)

Figure showing changes of the acetabular depth and width from the time of diagnosis to 5-year follow-up (x-axis). The y-axis shows the percentage change of the depth (dashed line) and width (solid line) relative to the unaffected acetabula (0 % reference)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC4252266&req=5

Fig3: Figure showing changes of the acetabular depth and width from the time of diagnosis to 5-year follow-up (x-axis). The y-axis shows the percentage change of the depth (dashed line) and width (solid line) relative to the unaffected acetabula (0 % reference)
Mentions: The mean ADR value of the affected hips at the time of diagnosis was significantly lower compared with the unaffected side (p < 0.001) (Table 1). This was due to both an increase of acetabular width (p < 0.001) and a slight decrease of depth (p < 0.001) (Fig. 3). We analysed the ADR at diagnosis separately according to each Waldenström radiographic phase. The mean ADR value of the affected hips in the initial phase was significantly lower compared with the unaffected side (287 vs. 302; p < 0.001).Fig. 3

Bottom Line: ADR values at diagnosis were associated with a more spherical femoral head at the 5-year follow-up [odds ratio (OR) 1.012, 95 % confidence interval (CI) 1.002-1.022, p = 0.016].None of the other acetabular parameters were significantly associated with the femoral head shape 5 years after diagnosis.Early dysplastic changes of the acetabulum were not associated with a poor radiological outcome 5 years after diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Orthopaedic Surgery, Oslo University Hospital, Rikshospitalet, 0027, Oslo, Norway, uxhuhs@ous-hf.no.

ABSTRACT

Purpose: We assessed the radiographic changes of the acetabulum during the course of Perthes' disease and investigated whether they were associated with femoral head sphericity 5 years after diagnosis.

Methods: We studied 123 children with unilateral Perthes' disease, femoral head necrosis more than 50 % and age at diagnosis 6 years or older. Pelvic radiographs were taken at onset, 1 year and 5 years after diagnosis. Sharp's angle, acetabular depth-to-width ratio (ADR) and lateral acetabular inclination were measured.

Results: Compared to the unaffected hips, the Perthes' hips developed significantly higher Sharp's angles (p < 0.001) and a higher proportion with an upward-sloping lateral acetabular margin (Perthes' hips: 49 %, unaffected hips 1 %). The mean ADR values were significantly lower on the affected side at all stages (p < 0.001). ADR values at diagnosis were associated with a more spherical femoral head at the 5-year follow-up [odds ratio (OR) 1.012, 95 % confidence interval (CI) 1.002-1.022, p = 0.016]. None of the other acetabular parameters were significantly associated with the femoral head shape 5 years after diagnosis.

Conclusion: The acetabulum developed an increasingly dysplastic shape in the course of Perthes' disease. Early dysplastic changes of the acetabulum were not associated with a poor radiological outcome 5 years after diagnosis. Routine measurement and monitoring of acetabular changes in plain radiographs were of little prognostic value and can, therefore, hardly be recommended in clinical practice.

No MeSH data available.


Related in: MedlinePlus