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The underused hip in ipsilaterally orthotics-dependent children.

Sallam A, Ziegler CM, Jansson V, Heimkes B - J Child Orthop (2015)

Bottom Line: The results were analyzed and correlated with clinical findings, a common activity score and planimetric radiographic data.Kinetic gait analysis showed increased stride length (6.8 ± 3.7 cm), shortened stance phase (6.6 ± 1.6 %) and reduced forces transmitted to the ground (92.2 ± 34.3 N).The kinematic analysis showed increased hip abduction (14.0° ± 8.2°), while the pelvic obliquity was not significantly changed (0.01° ± 0.01°).

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany.

ABSTRACT

Background: The aim of this investigation is the development of primarily healthy hips in children who have required orthoses/protheses over the long term due to ipsilateral distally located deformities of the leg. These children show ipsilateral in-toeing gait and Duchenne's limping followed by a coxa valga antetorta and facultative hip decentration. A practical question is whether these hips are in danger of decompensation. An additional theoretical question is how the external shape and internal architecture changes if a primarily healthy hip is underused.

Methods: Ten children with healthy hips who are unilaterally long-term orthotics/prosthetics-dependent agreed to undergo an instrumental gait analysis. The results were analyzed and correlated with clinical findings, a common activity score and planimetric radiographic data.

Results: The intra-individual comparison revealed a number of significant changes in the hip of the deformed leg (p < 0.05). Clinically, the internal rotation was increased (15° ± 4.2°), while the external rotation was diminished (13° ± 1.3°). Radiologically, the projected caput-collum-diaphyseal angle, the lesser trochanter to articular surface distance and the head-shaft angle were increased by 11.1° ± 15.4°, 5.8 ± 4.2 mm and 11.9° ± 0.6°, respectively. Both the Sharp and acetabular angles were increased, the former by 3.6° ± 0.6° and the latter by 3.2° ± 0.6°. Kinetic gait analysis showed increased stride length (6.8 ± 3.7 cm), shortened stance phase (6.6 ± 1.6 %) and reduced forces transmitted to the ground (92.2 ± 34.3 N). The kinematic analysis showed increased hip abduction (14.0° ± 8.2°), while the pelvic obliquity was not significantly changed (0.01° ± 0.01°).

Conclusions: Duchenne's limp and lack of weight-bearing stress are the decisive pathogenic factors of the underused coxa valga and acetabular dysplasia. These changes follow the mechanobiological concept of "function modifies design", which means function influences external shape and internal architecture of bones and joints. As a practical consequence we recommend that one pelvic radiograph be performed as a precaution at the end of puberty of children with these conditions.

Level of evidence: Level II retrospective study.

No MeSH data available.


Related in: MedlinePlus

Femoral and acetabular geometry. Boxplot showing the projected angle between the femoral neck and diaphysis (caput collum diaphysis angle, pCCD), head–shaft angle (CF), Sharp–Ullmann angle and acetabular (AC) angle on the diseased and healthy sides. Four patients showed slight acetabular dysplasias according to Tönnis [21].
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Fig2: Femoral and acetabular geometry. Boxplot showing the projected angle between the femoral neck and diaphysis (caput collum diaphysis angle, pCCD), head–shaft angle (CF), Sharp–Ullmann angle and acetabular (AC) angle on the diseased and healthy sides. Four patients showed slight acetabular dysplasias according to Tönnis [21].

Mentions: Regarding the changes in the proximal femoral end, the pCCD angle (Fig. 2) was age dependent, with a significantly higher mean value on the diseased side (p < 0.001). When compared to the normal age- and gender-specific reference values [12], the observed values indicate a tendency to develop coxa valga (148.05° ± 11.04°) on the diseased side. The mean LTA was also significantly increased (p < 0.01) compared with the healthy side (8.07 ± 2.14 and 7.49 ± 1.72 cm, respectively). Additionally, the CF angle (Fig. 2), which indicates the horizontal orientation of the epiphyseal plate, was significantly higher (p < 0.001) on the diseased side (74.86° ± 8.79°) than on the healthy one (62.93° ± 8.19°).Fig. 2


The underused hip in ipsilaterally orthotics-dependent children.

Sallam A, Ziegler CM, Jansson V, Heimkes B - J Child Orthop (2015)

Femoral and acetabular geometry. Boxplot showing the projected angle between the femoral neck and diaphysis (caput collum diaphysis angle, pCCD), head–shaft angle (CF), Sharp–Ullmann angle and acetabular (AC) angle on the diseased and healthy sides. Four patients showed slight acetabular dysplasias according to Tönnis [21].
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4549347&req=5

Fig2: Femoral and acetabular geometry. Boxplot showing the projected angle between the femoral neck and diaphysis (caput collum diaphysis angle, pCCD), head–shaft angle (CF), Sharp–Ullmann angle and acetabular (AC) angle on the diseased and healthy sides. Four patients showed slight acetabular dysplasias according to Tönnis [21].
Mentions: Regarding the changes in the proximal femoral end, the pCCD angle (Fig. 2) was age dependent, with a significantly higher mean value on the diseased side (p < 0.001). When compared to the normal age- and gender-specific reference values [12], the observed values indicate a tendency to develop coxa valga (148.05° ± 11.04°) on the diseased side. The mean LTA was also significantly increased (p < 0.01) compared with the healthy side (8.07 ± 2.14 and 7.49 ± 1.72 cm, respectively). Additionally, the CF angle (Fig. 2), which indicates the horizontal orientation of the epiphyseal plate, was significantly higher (p < 0.001) on the diseased side (74.86° ± 8.79°) than on the healthy one (62.93° ± 8.19°).Fig. 2

Bottom Line: The results were analyzed and correlated with clinical findings, a common activity score and planimetric radiographic data.Kinetic gait analysis showed increased stride length (6.8 ± 3.7 cm), shortened stance phase (6.6 ± 1.6 %) and reduced forces transmitted to the ground (92.2 ± 34.3 N).The kinematic analysis showed increased hip abduction (14.0° ± 8.2°), while the pelvic obliquity was not significantly changed (0.01° ± 0.01°).

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany.

ABSTRACT

Background: The aim of this investigation is the development of primarily healthy hips in children who have required orthoses/protheses over the long term due to ipsilateral distally located deformities of the leg. These children show ipsilateral in-toeing gait and Duchenne's limping followed by a coxa valga antetorta and facultative hip decentration. A practical question is whether these hips are in danger of decompensation. An additional theoretical question is how the external shape and internal architecture changes if a primarily healthy hip is underused.

Methods: Ten children with healthy hips who are unilaterally long-term orthotics/prosthetics-dependent agreed to undergo an instrumental gait analysis. The results were analyzed and correlated with clinical findings, a common activity score and planimetric radiographic data.

Results: The intra-individual comparison revealed a number of significant changes in the hip of the deformed leg (p < 0.05). Clinically, the internal rotation was increased (15° ± 4.2°), while the external rotation was diminished (13° ± 1.3°). Radiologically, the projected caput-collum-diaphyseal angle, the lesser trochanter to articular surface distance and the head-shaft angle were increased by 11.1° ± 15.4°, 5.8 ± 4.2 mm and 11.9° ± 0.6°, respectively. Both the Sharp and acetabular angles were increased, the former by 3.6° ± 0.6° and the latter by 3.2° ± 0.6°. Kinetic gait analysis showed increased stride length (6.8 ± 3.7 cm), shortened stance phase (6.6 ± 1.6 %) and reduced forces transmitted to the ground (92.2 ± 34.3 N). The kinematic analysis showed increased hip abduction (14.0° ± 8.2°), while the pelvic obliquity was not significantly changed (0.01° ± 0.01°).

Conclusions: Duchenne's limp and lack of weight-bearing stress are the decisive pathogenic factors of the underused coxa valga and acetabular dysplasia. These changes follow the mechanobiological concept of "function modifies design", which means function influences external shape and internal architecture of bones and joints. As a practical consequence we recommend that one pelvic radiograph be performed as a precaution at the end of puberty of children with these conditions.

Level of evidence: Level II retrospective study.

No MeSH data available.


Related in: MedlinePlus