Objectives: To explore factors affecting the efficacy of Bernese periacetabular osteotomy for the treatment of hip dysplasia.Methods: A retrospective study was conducted on 44 patients with hip dysplasia who underwent Bernese periacetabular osteotomy with a modified Smith-Peterson approach between January 2017 and November 2019. Among them, 40 were women and four were men. The average age was 31.2 AE 9.4. Preoperative and postoperative imaging parameters were measured. The acetabular top tilt angle, lateral central edge angle, acetabular abduction angle, femoral head extrusion index, sphericity index of femoral head, Shenton line, Tonnis grade of osteoarthritis, joint congruency, p/a ratio, acetabular anteversion angle, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale scores, and modified Harris hip score (MHHS) were observed. MHHS were divided into three clinically relevant categories: poor (<70 points), good (70-85 points), and excellent (86-91 points). Patient demographic data, as well as preoperative and postoperative radiographic parameters, were subjected to univariate logistic regression analysis. Multiple regression analysis was used to determine factors influencing postoperative MHHS. Results:The follow-up time was 1.0-3.9 years after surgery, with an average of 1.6 years. By the last follow-up, MHHS increased from 70 points before surgery to 91 points after surgery (P < 0.001), WOMAC pain score decreased from 4 points before surgery to 0 points after surgery (P < 0.001). WOMAC functional score decreased (Preoperative: 18.0 [4.0]; Postoperative: 4.0 [0], P = 0.004). Six patients had sensory disturbance of the lateral femoral cutaneous nerve, four of which recovered completely during follow-up. No other complications related to surgical approach, osteotomy, acetabular displacement, acetabular fixation, and postoperative stage were found. There was no significant vascular, nerve, or visceral injuries in any of the patients. On multiple regression analysis, the probability of the postoperative modified Harris hip score of a hip joint with a preoperative lateral center edge angle ≥4.5 being classified as excellent was six times that of angles <4.5 (Exp[β]: 6.249, 95% CI: 1.03-37.85, P = 0.046). Regression analysis of other factors found no significant correlation with postoperative functional scores. Conclusion:Overall functional scores post-PAO significantly improved, and pain symptoms were significantly reduced.Patients with a preoperative lateral center edge angle ≥4.5 had better joint function after surgery.
Objective To explore the influencing factors of age at onset of pain and severe pain in patients with Hartofilakidis type I developmental dysplasia of the hip (DDH). Methods A retrospective study of 83 patients with DDH treated at our hospital from January 2017 to June 2021 was conducted. The age at onset of pain, patients’ demographic data, and radiographic parameters were collected. Multiple linear regression was used to determine the influencing factors of age at onset of pain. Cox regression analysis was used to determine the influencing factors of severe pain attacks. Results According to the results of multiple linear regression analysis, when the distance between the medial femoral head and the ilioischial line increased by one millimetre, the age at onset of pain decreased by 1.7 years (β = − 1.738, 95% CI − 1.914–[− 1.561], p < 0.001). When the sharp angle increases by one degree, the age at onset of pain decreases by 0.3 years (β = − 0.334, 95% CI − 0.496–[− 0.171], p < 0.001). According to the results of the Cox regression analysis, for each additional degree of the lateral centre-edge angle (LCEA), the probability of severe pain was reduced by 5% (Exp [β]: = 0.947, 95% CI 0.898–0.999, p = 0.044). For each additional millimetre in the distance between the medial femoral head and the ilioischial line, the likelihood of severe pain increased by 2.4 times (Exp [β]: 2.417, 95% CI 1.653–3.533, p < 0.001). Conclusion Larger distances between the medial femoral head and the ilioischial line and sharp angle can lead to an earlier age at onset of pain in patients with DDH. Small LCEA and excessive distance between the medial femoral head and the ilioischial line are risk factors for severe pain.
ObjectiveTo investigate the influencing factors of functional recovery after high tibial osteotomy (HTO).MethodsA retrospective research was carried on 98 patients who underwent HTO between January 2018 and December 2020. In each case, the medial proximal tibial angle (MPTA), joint line convergence angle (JLCA), femoral tibial angle (FTA), hip-knee-ankle (HKA), weight bearing line (WBL) ratio of the knee joint, opening gap, opening angle, American knee society knee score (KSS), US Hospital for Special Surgery (HSS) score, Lysholm score, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were measured to determine postoperative function and influential factors of pain through logistic regression analysis.ResultsThe follow-up time was between 18 and 42 months after operation with an average of 27.66 ± 12.9 per month. Overall functional scores were significantly improved. The influencing factors that may affect the postoperative effect of HTO include age and preoperative WBL ratio of the knee joint (WBL%). After incorporating these two factors into the multivariate logistic regression analysis, for every 1 unit increase in the preoperative WBL%, the probability of postoperative HSS being superior is 1.06 times higher than before [Exp(β): 1.062, 95% CI: 1.01–1.1, p = 0.018]. For every year increase in age, the probability of an excellent HSS score after surgery was 0.84 times higher than that before surgery [Exp(β): 0.843, 95% CI: 0.718–0.989, p = 0.036]. Preoperative WBL% ≥ 14.37 was 17.4 times more likely to be rated as excellent postoperative HSS than that <14.37 [Exp(β): 17.406, 95% CI: 1.621–186.927, p = 0.018].ConclusionThe postoperative functional scores of the patients significantly improved. Patients with preoperative WBL% ≥ 14.37% had better function after surgery.
Background and purpose There are recognized surgical indications for Bernese periacetabular osteotomy (PAO), but the degree of postoperative functional recovery is significantly different through clinical observation and follow-up. Therefore, it is necessary to do a preoperative evaluation. This study aims to screen the factors influencing functional recovery after PAO and construct a predictive nomogram.Patients and methods: Retrospective data were collected between December 2016 and March 2022 at The First Affiliated Hospital of Shandong First Medical University, including demographic data and imaging materials of patients undergoing PAO. The least absolute shrinkage and selection operator regression was used to screen the influencing factors, and then multivariate logistic regression analysis was employed to construct a predictive nomogram for predicting functional recovery after PAO.Result The influencing factors of functional recovery after PAO were screened out, namely the preoperative distance from the innermost surface of the femoral head to the ilioischial line, surgical approach, preoperative acetabular depth, and preoperative Calve line continuity. A nomogram model was established using these significant predictors. The receiver-operating characteristic curve was drawn, and the area under the curve was calculated to be 0.864. The calibration curve showed that the constructed nomogram model was well calibrated. There was sufficient consistency between the observed and estimated prediction probabilities to indicate that the clinical prediction model had high accuracy.Conclusion This predictive nomogram can identify the patients most suitable for PAO and can be used to guide the selection of surgical patients and surgical approaches.
ObjectiveTo introduce a surgical technique (the “Y” line technique) that will control leg length discrepancy (LLD) after total hip arthroplasty and to observe its effectiveness and influencing factors.MethodsAccording to the inclusion and exclusion criteria, a total of 350 patients were selected in this study; 134 patients in whom used the “Y” line technique was used to control lower limb length were included in Group A and 166 patients treated with freehand methods to control lower limb length were included in Group B. A total of 50 patients in whom the standard anteroposterior x-ray of bilateral hips was taken preoperatively and in whom the “Y” line technique was used during the operation were included in Group C.ResultsThe postoperative LLD of Group A was 4.74 mm (3.93), that of Group B was 5.85 mm (4.60), and that of Group C was 2 mm (1.00)—the difference was statistically significant (p < 0.001). There were significant statistical differences when comparisons were made between any two groups (p < 0.01). The distribution of postoperative LLD in Group A was better than that in Group B, and this factor was better in Group C than in Group A—the difference was statistically significant (p < 0.001). Severe unequal length rates of the lower extremities (LLD > 10 mm) were 5.97% (8/134) in Group A, 14.3% (24/166) in Group B, and 0% (0/50) in Group C—the difference was statistically significant (p < 0.001). There were significant differences between Group A and Group B and between Group B and Group C (p < 0.05), but there was no significant difference between Group A and Group C (p = 0.078).ConclusionThe “Y” line technique, which does not increase the operating time and patient cost, can effectively reduce postoperative LLD. Insufficient internal rotation of the healthy lower extremity and the low projection position in the preoperative anteroposterior x-ray of the bilateral hips were important factors affecting the accuracy of the “Y” line technique.
Objective: To introduce a surgical technique (the ‘Y’ line technique) which is to control the leg length discrepancy (LLD) after total hip arthroplasty.Methods: A total of 350 patients were selected; 134 patients who were used the ‘Y’ line technique to control lower limb length were included in Group A and 166 patients treated with free hand methods to control lower limb length were included in Group B. 50 patients who were taken standard anteroposterior X-ray of bilateral hips preoperatively and used the ‘Y’ line technique during the operation were included in Group C. Results: The postoperative LLD of the three groups was statistically significant (p < 0.001). There were significant differences statistically in comparison between any two groups (P<0.01). Severe unequal length rates of the lower extremities (LLD > 10 mm) were 5.97% (8/134) in Group A, 14.3% (24/166) in Group B and 0% (0/50) in Group C – the difference was statistically significant (p < 0.001). There were significant differences between Group A and Group B, Group B and Group C (P < 0.05), but there was no significant difference between Group A and Group C (P = 0.078).Conclusion: The ‘Y’ line technique, which does not increase the operation time, can effectively reduce postoperative LLD. Insufficient internal rotation of the healthy lower extremity and the low projection position in the preoperative anteroposterior X-ray of bilateral hips were important factors affecting the accuracy of the ‘Y’ line technique.
Objective To explore the influencing factors of pain onset age and severe pain in patients with Hartofilakidis type I developmental dysplasia of the hip (DDH). Methods A retrospective study of 83 patients with DDH treated at our hospital from January 2017 to June 2021 was conducted. The pain onset age, patients’ demographic data, and radiographic parameters were collected. Multiple linear regression was used to determine the influencing factors of pain onset age. Cox regression analysis was used to determine the influencing factors of severe pain attacks. Results According to the results of multiple linear regression analysis, when the distance between the medial femoral head and the ilioischial line increased by one unit, the pain onset age decreased by 1.7 years (β = − 1.738, 95% CI: − 1.914–[–1.561], p < 0.001). When the sharp angle increases by one unit, the pain onset age decreases by 0.3 years (β = − 0.334, 95% CI: − 0.496–[–0.171], p < 0.001). According to the results of the Cox regression analysis, for every unit increase of the lateral centre-edge angle (LCEA), the probability of severe pain decreased to 95% of the original (Exp [β]: = 1.090, 95% CI: 0.898–0.999, p = 0.04). For every unit increase in the distance between the medial femoral head and the ilioischial line, the likelihood of severe pain is 2.4 times higher than that of the original (Exp [β]: 2.417, 95% CI: 1.653–3.533, p < 0.001). Conclusion Larger distances between the medial femoral head and the ilioischial line and sharp angle can lead to an earlier pain onset age in patients with DDH. Small LCEA and excessive distance between the medial femoral head and the ilioischial line are risk factors for severe pain.
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