Hip dysplasia is known to lead to premature osteoarthritis. Computational models of joint mechanics have documented elevated contact stresses in dysplastic hips, but elevated stress has not been directly associated with regional cartilage degeneration. The purpose of this study was to determine if a relationship exists between elevated contact stress and intra‐articular cartilage damage in patients with symptomatic dysplasia and femoroacetabular impingement. Discrete element analysis was used to compute hip contact stresses during the stance phase of walking gait for 15 patients diagnosed with acetabular dysplasia and femoral head‐neck offset deformity. Contact stresses were summed over the duration of the walking gait cycle and then scaled by patient age to obtain a measure of chronic cartilage contact stress exposure. Linear regression analysis was used to evaluate the relationship between contact stress exposure and cartilage damage in each of six acetabular subregions that had been evaluated arthroscopically for cartilage damage at the time of surgical intervention. A significant correlation (R2 = 0.423, p < 0.001) was identified between chondromalacia grade and chronic stress‐time exposure above both a 1 MPa damage threshold and a 2 MPa‐years accumulated damage threshold. Furthermore, an over‐exposure threshold of 15% regional contact area exceeding the 1 and 2 MPa‐years threshold values resulted in correct identification of cartilage damage in 83.3% (55/66) of the acetabular subregions loaded during gait. These results suggest corrective surgery to alleviate impingement and reduce chronic contact stress exposures below these damage‐inducing thresholds could mitigate further cartilage damage in patients with hip dysplasia.
Purpose: To perform a systematic review and meta-analysis of literature and to evaluate the relationship between abnormal femoral version and the development of hip osteoarthritis (OA). Methods: A systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, evaluating Level I and II studies. Included studies had to provide granular femoral version (FV) information. The severity of OA was ranked on the KellgreneLawrence (KL) scale. Excel version 1808 (Microsoft, Redmond, WA) was used to perform a student t test statistical analyses. Results: Our review identified 19 qualifying studiesd5 Level I and 14 Level II with 1,756 patients. Patients with FV above normal range (>14 ) had greater KL scores than patients with normal range FV (mean AE standard deviation; 3.37 AE 1.44 vs 2.05 AE 1.72, P < .05). Analysis of KL scores in patients with FV >24 (>1 standard deviation) versus patients with FV >14 but <24 also demonstrated a positive correlation between increasing FV and KL (4.00 AE 1.96 vs 2.34 AE 0). This was significant independent of the presence or absence of developmental dysplasia of the hip. Retroverted hips (FV<10 ) in the present study showed variable OA results upon analysis. Conclusions: The present review suggests that elevated FV may be a risk factor for more severe hip OA with or without the presence of concurrent dysplasia of the hip. The relative amount of increased anteversion appears positively correlated with severity of OA. Although femoral retroversion may impact hip mechanics, in this review it does not appear to strongly correlate with the development of OA. Level of Evidence: II: systematic review of Level I and II studies.
Arch anatomy often goes undocumented on preoperative imaging, yet children undergoing extended end-to-end repair with bovine arch anatomy are at a significantly increased risk of recoarctation. This may be due to a reduced clampable distance to facilitate repair. These results should be considered in the preoperative assessment, parental counseling, and surgical approach for children with discrete aortic coarctation.
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