Acetabular Global Insufficiency in Patients with Down Syndrome and Hip-Related Symptoms

Bulat, Evgeny; Maranho, Daniel A; Kalish, Leslie A.; Millis, Michael B.; Kim, Young-Jo; Novais, Eduardo N.

doi:10.2106/jbjs.17.00341

Cited by 12 publications

(20 citation statements)

References 23 publications

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“…4 A recent tomographic study using reformatted images through the anatomical axis of the femoral neck, showed no difference in the neck-shaft angle between patients with Down syndrome and matched-control individuals. 16 Recent evidence suggested that the acetabulum is retroverted in Down syndrome, leading to an insufficient posterior support to the femoral head. 9 , 12 , 16 One study described the posterior acetabular wall as deficient and aggravating the retroversion of the acetabulum, leading to further posterior hip instability.…”

Section: Discussionmentioning

confidence: 99%

“… 16 Recent evidence suggested that the acetabulum is retroverted in Down syndrome, leading to an insufficient posterior support to the femoral head. 9 , 12 , 16 One study described the posterior acetabular wall as deficient and aggravating the retroversion of the acetabulum, leading to further posterior hip instability. 14 A recent study reported a global insufficiency of the acetabulum in patients with Down syndrome and hip symptoms, and that the acetabulum is more retroverted and shallower compared with healthy individuals.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…14 A recent study reported a global insufficiency of the acetabulum in patients with Down syndrome and hip symptoms, and that the acetabulum is more retroverted and shallower compared with healthy individuals. 16 Considering that the main factors leading to instability are the morphology of the acetabulum and femur, it is intuitive to believe that combined femoral and pelvic osteotomies would successfully stabilize the Down syndrome hip. However, one study reported a higher rate of failure of femoral and pelvic osteotomy compared with a complete redirectional osteotomy of the acetabulum.…”

Section: Discussionmentioning

confidence: 99%

“…4,[9][10][11][12][13][14] Abnormalities of the femur including increased femoral anteversion and coxa valga have been reported and have been described as the rationale for treatment by femoral intertrochanteric osteotomy. 4,11,15 However, recent studies have shown that insufficient posterior acetabular coverage 14,16 and acetabular retroversion 9,16,17 play a major role in the aetiology of hip instability. Surgical treatment by a complete redirectional osteotomy of the acetabulum has been shown to provide stability in a higher proportion of patients when compared with femoral osteotomy alone or combined to incomplete pelvic osteotomies.…”

Section: Introductionmentioning

confidence: 99%

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Preliminary results of an anteverting triple periacetabular osteotomy for the treatment of hip instability in down syndrome

Maranho

Kim

Williams

et al. 2018

Journal of Children's Orthopaedics

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PurposeTo investigate the outcomes of an anteverting triple periacetabular osteotomy for the treatment of hip instability in skeletally immature patients with Down syndrome.MethodsWe evaluated 16 patients (21 hips) with Down syndrome and hip instability who underwent an anteverting triple periacetabular osteotomy between 2007 and 2016. There were nine females and seven males with an average age of 7.4 years SD 2.0. We assessed the level of hip pain, gait ability and clinical stability at a minimum of one year after surgery. Radiographic evaluation included pre- and postoperative lateral centre-edge angle (LCEA), Tönnis acetabular angle and extrusion index.ResultAfter an average follow-up of 4.1 years SD 2.6, 20 of 21 hips (95%) remained clinically stable. In all, 12 of 16 (75%) patients had a full gait without a major limp, but three patients (19%) had a persistent limp. Of the 21 procedures, one hip (5%) was considered a failure due to persistent instability. There was a mean increase of 18.3º SD 15.3º of the LCEA (p < 0.001); a mean decrease of 15.2º SD 11.6º (p < 0.001) for the Tönnis angle and the extrusion index had a mean decrease of 0.27 SD 0.20 (p < 0.001). The most common complications were minor and included nonunion of the pubis or ischium (24%) and stress fractures of the pubis and ischium (14%). Only one patient required unplanned surgery for the treatment of an infection; which was considered a major complication.ConclusionThe anteverting triple periacetabular osteotomy provided global deformity correction and achieved hip stability in 95% of the hips after a mean follow-up of 4.1 years.Level of EvidenceTherapeutic level IV.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Preliminary results of an anteverting triple periacetabular osteotomy for the treatment of hip instability in down syndrome

Maranho

Kim

Williams

et al. 2018

Journal of Children's Orthopaedics

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Effects of hindlimb suspension on development of proximal and distal femur morphological abnormalities in growing rats

Ozawa

Kaneguchi

Ezumi

et al. 2022

Journal Orthopaedic Research

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Although morphological abnormalities of the femur are known predisposing factors for numerous musculoskeletal disorders, the etiology of these abnormalities is poorly understood. This study aimed to investigate whether femoral morphogenesis is affected by hindlimb suspension (HS) in growing rats. We used 41 four‐week‐old female rats in this study. In the HS groups, rats were suspended from their tails for 2, 4, and 8 weeks. Age‐matched animals were used as controls. We examined morphological indices of the femur using three‐dimensional reconstructed images from X‐ray computed tomography. The femoral neck anteversion angle (AVA) was higher with growth in the experimental groups and did not differ in control groups. The AVAs in the HS groups were larger than controls at any time point. In the control groups, the trochlear angle (TA) was higher, rotating inward with growth, but did not differ in the HS groups. The TAs in the HS groups were smaller and rotated more outward compared with the control groups at any time point. The height ratios of the medial and lateral condyles (MC/LC), an asymmetry index, were larger in the HS groups compared to controls at any time point. There were strong relationships between proximal (AVA) and distal morphologies, such as the TA (Spearman's coefficient [rs] = −0.80, p < 0.001) and MC/LC (rs = 0.79, p < 0.001). Our data suggest that sufficient physical activity in early life may protect against morphological femur abnormalities associated with hip and knee joint diseases.

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Hip Problems in Children with Trisomy 21

Lea

Alshryda

Wedge

2019

The Pediatric and Adolescent Hip

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Acetabular Global Insufficiency in Patients with Down Syndrome and Hip-Related Symptoms

Abstract: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Cited by 12 publications

References 23 publications

Preliminary results of an anteverting triple periacetabular osteotomy for the treatment of hip instability in down syndrome

Preliminary results of an anteverting triple periacetabular osteotomy for the treatment of hip instability in down syndrome

Effects of hindlimb suspension on development of proximal and distal femur morphological abnormalities in growing rats

Hip Problems in Children with Trisomy 21

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