Aims. We evaluated the national and regional trends from 2013 to 2022, in the prevalence of Perthes’ disease among adolescent males in South Korea. Methods. This retrospective, nationwide, population-based study included a total of 3,166,669 Korean adolescent males examined at regional Military Manpower Administration (MMA) offices over ten years. Data from the MMA were retrospectively collected to measure the national and regional prevalence per 100,000 and 95% CI of Perthes’ disease according to the year (1 January 2013 to 31 December 2022) and history of pelvic and/or femoral osteotomy in South Korea. Spearman’s correlation analysis was performed to assess the relationship between the Perthes’ disease prevalence and several related factors. Results. The prevalence of Perthes’ disease showed a gradually increasing trend for a ten-year follow-up period from 2013 to 2022 with a mean of 71.17 (95% CI 61.82 to 80.52) per 100,000, ranging from 56.02 (95% CI 48.34 to 63.71) in 2013 to 77.53 (95% CI 67.94 to 87.11) in 2019. The proportion of patients with a Stulberg classification ≥ III ranged from 50.57% in 2015 to 80.08% in 2019, showing a gradually increasing trend. Following the trend for Perthes’ disease, an increase in the proportion of pelvic and/or femoral osteotomies was observed, whereas conservative treatment decreased in adolescent males. For a ten-year follow-up period, the prevalence of Perthes’ disease was highest in provinces, followed by the metropolitan area and Seoul. Conclusion. The prevalence of Perthes’ disease in adolescent males increased over time from 2013 to 2022. In particular, the trend in the prevalence of Perthes’ disease with incongruent hips was significantly associated with overweight and obesity rates among male adolescents with a very high level of correlation. Cite this article: Bone Joint J 2025;107-B(1):42–49

The December 2022 Children’s orthopaedics Roundup³⁶⁰ looks at: Immobilization of torus fractures of the wrist in children (FORCE): a randomized controlled equivalence trial in the UK; Minimally invasive method in treatment of idiopathic congenital vertical talus: recurrence is uncommon; “You’re O.K. Anaesthesia”: closed reduction of displaced paediatric forearm and wrist fractures in the office without anaesthesia; Trunk range of motion and patient outcomes after anterior vertebral body tethering versus posterior spinal fusion: comparison using computerized 3D motion capture technology; Selective dorsal rhizotomy for individuals with spastic cerebral palsy; Scheuermann’s kyphosis and posterior spinal fusion; All-pedicle-screw constructs in skeletally immature patients with severe idiopathic early-onset scoliosis; Proximal femoral screw hemiepiphysiodesis in children with cerebral palsy.

Aims

The main aims were to identify risk factors predictive of a radiolucent line (RLL) around the acetabular component with an interface bioactive bone cement (IBBC) technique in the first year after THA, and evaluate whether these risk factors influence the development of RLLs at five and ten years after THA.

Aims

The most important complication of treatment of developmental dysplasia of the hip (DDH) is avascular necrosis (AVN) of the femoral head, which can result in proximal femoral growth disturbances leading to pain, dysfunction, and eventually to early onset osteoarthritis. In this study, we aimed to identify morphological variants in hip joint development that are predictive of a poor outcome.

Aims

The goal of closed reduction (CR) in the treatment of developmental dysplasia of the hip (DDH) is to achieve and maintain concentricity of the femoral head in the acetabulum. However, concentric reduction is not immediately attainable in all hips and it remains controversial to what degree a non-concentric reduction is acceptable. This prospective study is aimed at investigating the dynamic evolution of the hip joint space after CR in DDH using MRI.

Aims. When the present study was initiated, we changed the treatment for late-detected developmental dislocation of the hip (DDH) from several weeks of skin traction to markedly shorter traction time. The aim of this prospective study was to evaluate this change, with special emphasis on the rate of stable closed reduction according to patient age, the development of the acetabulum, and the outcome at skeletal maturity. Methods. From 1996 to 2005, 49 children (52 hips) were treated for late-detected DDH. Their mean age was 13.3 months (3 to 33) at reduction. Prereduction skin traction was used for a mean of 11 days (0 to 27). Gentle closed reduction under general anaesthesia was attempted in all the hips. Concurrent pelvic osteotomy was not performed. The hips were evaluated at one, three and five years after reduction, at age eight to ten years, and at skeletal maturity. Mean age at the last follow-up was 15.7 years (13 to 21). Results. Stable closed reduction was obtained in 36 hips (69%). Open reduction was more often necessary in patients ≥ 18 months of age at reduction (50%) compared with those under 18 months (24%). Residual hip dysplasia/subluxation occurred in 12 hips and was significantly associated with avascular necrosis (AVN) and with high acetabular index and low femoral head coverage the first years after reduction. Further surgery, mostly pelvic and femoral osteotomies to correct subluxation, was performed in eight hips (15%). The radiological outcome at skeletal maturity was satisfactory (Severin grades 1 or 2) in 43 hips (83%). Conclusions. Gentle closed reduction can be attempted in children up to three years of age, but is likely to be less successful in children aged over 18 months. There is a marked trend to spontaneous improvement of the acetabulum after reduction, even in patients aged over 18 months and therefore simultaneous pelvic osteotomy is not always necessary

Aims

The purpose of this study was to compare the prevalence of hip displacement and dislocation in a total population of children with cerebral palsy (CP) in Scotland before and after the initiation of a hip surveillance programme.

Aims

Our aim was to assess the effectiveness of a protocol involving a standardised closed reduction for the treatment of children with developmental dysplasia of the hip (DDH) in maintaining reduction and to report the mid-term results.

The aim was to assess the effect of caudal block on patients who have had proximal femoral &/or pelvic osteotomy compared to patients who have had epidural anaesthesia with regards to pain relief and hospital stay. We looked at two patient cohorts; epidural & caudal pain relief in aforementioned procedures. Interrogation of our clinical database (WinDip, BlueSpeir&clinical notes) identified 57 patients: 33 proximal femoral osteotomy, 13 pelvic osteotomy and 11 combined(25 Males 32 Females), aged 1–18 years-old between 2012–2014, in two institutions. A database of demographics, operative indications, associated procedures, analgesia and type of anaesthesia was constructed in relation to daily pain score and length of hospital stay. 39 patients had epidural anaesthesia, and 18 had caudal block. Cerebral palsy with unstable hips was the commonest indication(21), followed by dysplastic hip(10), Perthes disease(8) and other causes(18). The Face, Legs, Activity, Cry, Consolability(FLACC) scale was used to assess pain. Length of hospital stay in caudal block patients was 3.1 days(1–9), in epidural anaesthesia patients stay was 4.46 days(2–13). Paediatrics high dependency unit after an epidural was needed in 20(Average stay 3.4 days) compared to 1 who received caudal block. Caudal block FLACC pain score in the first 36 hours was 1.23(0–4) compared to 0.18(0–2) in patients who had an epidural. Caudal block is associated with less hospital stay and fewer admissions to the high dependency unit, it also provides adequate pain relief post osteotomies when compared to epidural, therefore could be performed at units lacking epidural facilities. A change in related practice however should be cautious and supported by further studies

We describe the clinical and radiological results of cementless primary total hip replacement (THR) in 25 patients (18 women and seven men; 30 THRs) with severe developmental dysplasia of the hip (DDH). Their mean age at surgery was 47 years (23 to 89). In all, 21 hips had Crowe type III dysplasia and nine had Crowe type IV. Cementless acetabular components with standard polyethylene liners were introduced as close to the level of the true acetabulum as possible. The modular cementless S-ROM femoral component was used with a low resection of the femoral neck.

A total of 21 patients (25 THRs) were available for review at a mean follow-up of 18.7 years (15.8 to 21.8). The mean modified Harris hip score improved from 46 points pre-operatively to 90 at final follow up (p < 0.001).

A total of 15 patients (17 THRs; 57%) underwent revision of the acetabular component at a mean of 14.6 years (7 to 20.8), all for osteolysis. Two patients (two THRs) had symptomatic loosening. No patient underwent femoral revision. Survival with revision of either component for any indication was 81% at 15 years (95% CI 60.1 to 92.3), with 21 patients at risk.

This technique may reduce the need for femoral osteotomy in severe DDH, while providing a good long-term functional result.

Cite this article: Bone Joint J 2014;96-B:1449–54.

The August 2013 Children’s orthopaedics Roundup³⁶⁰ looks at: a multilevel approach to equinus gait; whether screening leads to needless intervention; salvage of subcapital slipped epiphysis; growing prostheses for children’s oncology; flexible nailing revisited; ultrasound and the pink pulseless hand; and slipping forearm fractures.

Most centres in the United Kingdom adopt a selective screening programme for developmental dysplasia of the hip (DDH) based on repeated clinical examination and selective ultrasound examination. The Newborn Infant Physical Examination protocol implemented in 2008 recommends a first examination at birth and then a second and final examination at six to ten weeks of age. Due to concerns over an increase in late presentations we performed a retrospective review of our 15-year results to establish if late presentation increases treatment requirements. Of children presenting before six weeks of age, 84% were treated successfully with abduction bracing, whereas 86% of children presenting after ten months eventually required open reduction surgery. This equates to a 12-fold increase in relative risk of requiring open reduction following late presentation. Increasing age at presentation was associated with an increase in the number of surgical procedures, which are inevitably more extensive and complex, with a consequent increased in cost per patient. The implementation of an opportunistic examination at three to five months could help to reduce the unintended consequences of the Newborn Infant Physical Examination programme.

Cite this article: Bone Joint J 2013;95-B:846–50.

Introduction. Patients who are symptomatic with concurrent acetabular dysplasia and proximal femoral deformity may have Perthes disease. Osteotomies to correct both the acetabular and proximal femur deformities may optimise biomechanics and improve pain and function. In this study, we assessed the long-term results for such a combined procedure. Methods. We included patients who underwent concurrent pelvic and proximal femoral osteotomies by the senior surgeon (JNOH) with a minimum follow-up of 5 years. A modified triple pelvic interlocking osteotomy was performed to correct acetabular inclination and/or version with a concurrent proximal femoral osteotomy to correct valgus/varus and/or rotational alignment. We assessed functional scores, radiological paramenters, arthroplasty conversion rate, time interval before conversion to arthroplasty and other associated complications. Results. We identified 63 patients (64 hips) with a mean age of 29.2 years (range 14.3–51) at a mean follow-up of 10.1 years (range 5.1–18.5). The mean sourcil inclination postoperatively was 4.9. O. (range 1–12) compared to 24. O. (range 14.5–33) preoperatively. The mean Tonnis grade postoperatively was 2.2 (1–3) compared to 1.8 (range 1–2) preoperatively. At the last follow-up assessment, the mean Oxford Hip Score was 56 (range 60–47), Non-arthritic Hip Score was 71 (range 59–80) and UCLA activity score was 8 (range 5–10). There were 12 (18.8%) conversions to arthroplasty at a mean of 7.9 years (range 2.2–12.2) after surgery. Other associated complications include 1 sciatic nerve injury, 1 deep infection and 5 non-unions that required refixation. Discussion. Symptomatic acetabular dysplasia with concurrent proximal femoral deformity is difficult to treat. The use of combined pelvic and femoral osteotomies can optimise acetabular and femoral head alignment to improve pain and function with more than 4 out of 5 hips preserved at 10 years

Introduction. Patients who are symptomatic with concurrent acetabular dysplasia and proximal femoral deformity may have Perthes disease. Osteotomies to correct both the acetabular and proximal femur deformities may optimise biomechanics and improve pain and function. In this study, we assessed the long-term results for such a combined procedure. Methods. We included patients who underwent concurrent pelvic and proximal femoral osteotomies by the senior surgeon (JNOH) with a minimum follow-up of 5 years. A modified triple pelvic interlocking osteotomy was performed to correct acetabular inclination and/or version with a concurrent proximal femoral osteotomy to correct valgus/varus and/or rotational alignment. We assessed functional scores, radiological paramenters, arthroplasty conversion rate, time interval before conversion to arthroplasty and other associated complications. Results. We identified 63 patients (64 hips) with a mean age of 29.2 years (range 14.3–51) at a mean follow-up of 10.1 years (range 5.1–18.5). The mean sourcil inclination postoperatively was 4.9. O. (range 1–12) compared to 24. O. (range 14.5–33) preoperatively. The mean Tonnis grade postoperatively was 2.2 (1–3) compared to 1.8 (range 1–2) preoperatively. At the last follow-up assessment, the mean Oxford Hip Score was 56 (range 60–47), Non-arthritic Hip Score was 71 (range 59–80) and UCLA activity score was 8 (range 5–10). There were 12 (18.8%) conversions to arthroplasty at a mean of 7.9 years (range 2.2–12.2) after surgery. Other associated complications include 1 sciatic nerve injury, 1 deep infection and 5 non-unions that required refixation. Discussion. Symptomatic acetabular dysplasia with concurrent proximal femoral deformity is difficult to treat. The use of combined pelvic and femoral osteotomies can optimise acetabular and femoral head alignment to improve pain and function with more than 4 out of 5 hips preserved at 10 years

Background. Several risk factors for the development of osteonecrosis following treatment of developmental dislocated hip have been reported. The need for further research with a large-enough sample size including statistical adjustment of confounders was demanded. The purpose of the present study was to find reliable predictors of osteonecrosis in patients managed for developmental dislocation of the hip. Methods. A retrospective cohort study of children, who have been hospitalized at our department between January 1998 and February 2007 with a developmental dislocation of the hip, was completed. Sixty-four patients satisfied the criteria for inclusion. Three groups according to age and treatment were identified. Group A and B included patients treated with closed or open reductions aged less than twelve months. Patients of group C were past walking age at the time of reduction and were treated by open reduction combined with concomitant pelvic and femoral osteotomies. The average duration of follow-up for all patients was 6.8 years. Logistic regression analysis was conducted to identify predictors for the development of osteonecrosis. Results. The overall rate of osteonecrosis in group A and B was 27.4% compared to 88.2% in patients of group C. After pooling of all data, no protective effect of the ossific nucleus of the femoral head on the development of osteonecrosis was found (p = 0.14). Additionally, an increase of surgical procedures in children of group C could not be demonstrated (p = 0.17). By using logistic regression analysis the type of reduction and secondary reconstructive procedure due to residual acetabular dysplasia could be identified as predictors for the development of osteonecrosis. Conclusions. Open reduction combined with concomitant osteotomies and secondary reconstructive interventions due to residual acetabular dysplasia increase the risk for osteonecrosis in the treatment of the developmental dislocated hip. Therefore, we advocate early reduction of the dislocated hip in the first year of life to avoid the need for concomitant osteotomies combined with open reduction. Level of Evidence. Prognostic study, level II-1 (retrospective study)

The April 2012 Children’s orthopaedics Roundup³⁶⁰ looks at osteonecrosis of the femoral head and surgery for dysplasia, femoral head blood flow during surgery, femoroacetabular impingement and sport in adolescence, the Drehmann sign, a predictive algorithm for septic arthritis, ACL reconstruction and arthrofibrosis in children, spinal cord monitoring for those less than four years old, arthroereisis for the flexible flat foot, fixing the displaced lateral humeral fracture, and mobile phones and inclinometer applications

Introduction: We describe the successful treatment of advanced Perthes’ disease in 5 patients using a combined pelvic and femoral osteotomy. To our knowledge, there are no reports in orthopaedic literature describing simultaneous pelvic and femoral osteotomy as treatment for healed Perthes disease. Method: There were 4 males and 1 female, age range 10 years to 18 years (mean 13 years). All five patients were rated as Stulberg IV. We used a Tonnis pelvic osteotomy and a 20° valgus femoral osteotomy. Clinical parameters, measured pre and post operatively, included range of movement, Harris hip and pain scores (patient and parent perception of pain on an analogue scoring system). Results: The mean improvement in Harris hip score was 30 points and the mean reduction in pain score was 6. Range of movement was not affected. Complications included one case of non-union of the femoral osteotomy, successfully treated by open reduction and internal fixation with bone graft. Conclusions: Simultaneous pelvic and femoral osteotomy may improve symptoms and function in symptomatic patients with healed Stulberg IV Perthes disease

Expecting the low wear property and the longevity, since October 1998, we have been using the alumina on alumina bearing for the hip arthroplasty. Until July 2008, for dysplastic 1078 hips we have implanted the bearing couple. Among them, we evaluated 86 hips in 79 patients (male 3, female 76) with the primary arthroplasty, Spongiosa Metal II Total Hip System (GHE: ESKA implants, Lübeck, Germany/Biolox Forte. ®. : Ceramtec AG, Plochingen, Germany), osteoarthritis secondary to developmental dysplasia, age 60 or below, and a minimum of five years follow-up. The preoperative diagnosis included the failed pelvic and/or femoral osteotomy, avascular necrosis after DDH, dislocation, and subdislocation. The average age at the surgery was 53 (27 to 60). The average of follow-up period was 6.3 (4.6 to 9.1) years. The implants have a macro-porous structure on the surface. To set the metal shell in the intended position, the sclerotic lesion was adequately resected by the chisels and then we used the acetabulum reamers. Otherwise the sclerotic lesion would prevent the reamer to go into the suitable direction. We reamed the acetabulum until the lamina interna to use the maximum size of the metal shell (i.e. to use the liner as thick as possible) and at the same time for the medialization of the hip center. To avoid impingement, the osteophyte was resected without hesitating. We added the adductor tenotomy for 19 hips, the extensive release of the flexor tendons (including the quadriceps origin, the sartroius origin, and the gluteus maximus insertion) for three hips, and the release of the extensor insertion (the gluteus maximus) for two hips, and the release of the flexor insertion (the iliopsoas) for two hips. The hip score was improved in all patients. The average amount of the hip score was 59 before the surgery and was 90 at the final follow-up. A positive Trendelenburg sign was observed in 53 hips (62%) before the surgery and 12 hips (14%) at the final follow-up. We had no revision, no bearing failure (alumina fracture or excessive wear), no dislocation, and no squeaking in these patients. The average inclination angle of the cup was 41 (29 to 49) degrees. The average anteversion angle of the cup was 19 (13 to 27) degrees. No patient required the revision surgery. At the final follow-up, all implants were stable. In the acetabulum, the radio-lucent line was observed in two hips (2%) (zone I). In the femur the line was observed in 13 hips (15%). All lines existed in the proximal femur. There was no cystic osteolytic lesion. The prevalence of these periprosthetic reactions was less than those in the same type implant with the polyethylene on alumina bearing. Some authors alerted that the alumina on alumina articulation should only be applied in when the optimized implant orientation is obtained so as to prevent the impingement and dislocation. Fortunately the alignment in this study was within the safe zone. However, we must always be very careful of the joint alignment, range of motion, and the muscle tension during the surgery to avoid the bearing failure, as setting an adequate alignment and obtaining a firm uncemented fixation of the cup is relatively difficult in dysplastic hips. From this view point, Spongiosa Metal II cup suits the use of the alumina on alumina bearing especially for dysplastic hips