Predicting Rates of Angular Correction After Hemiepiphysiodesis in Patients With X-Linked Hypophosphatemic Rickets.

Purpose: Patients with X-linked hypophosphatemic rickets (XLH) often develop coronal plane knee deformities despite medical treatment. Hemiepiphysiodesis is an effective way to correct coronal plane knee deformities in skeletally immature patients, but a full understanding of the rate of angular correction after hemiepiphysiodesis in XLH patients, compared with idiopathic cases is lacking.

Methods: We retrospectively reviewed charts of 24 XLH patients and 37 control patients without metabolic bone disease who underwent hemiepiphysiodesis.

Is combined surgical dislocation and proximal femoral osteotomy a safe procedure for correction of complex hip deformities?

Complex deformities of the hip requiring intra-articular and proximal femoral correction are challenging with regard to surgical access and complication risk. Combined surgical dislocation and proximal femoral osteotomy (SD/PFO) is a surgical strategy that provides unrestricted access to the joint with the capability for adjunctive PFO. Although providing excellent surgical access, concerns over a potentially high risk of postoperative complications remain, and published information on the safety of this technique remain scarce.

Late Effects of Clubfoot Deformity in Adolescent and Young Adult Patients Whose Initial Treatment Was an Extensive Soft-tissue Release: Topic Review and Clinical Case Series.

Children with congenital clubfoot often have residual deformity, pain, and limited function in adolescence and young adulthood. These patients represent a heterogeneous group that often requires an individualized management strategy. This article reviews the available literature on this topic while proposing a descriptive classification system based on a review of patients at our institution who underwent surgery for problems related to previous clubfoot deformity during the period between January 1999 and January 2012.

Limb lengthening in the treatment of posteromedial bowing of the tibia.

Purpose: Posteromedial bowing of the tibia is an uncommon but recognized congenital lower extremity deformity in children that can lead to limb length discrepancy (LLD) and residual angulatory deformity. The purpose of this study is to report a series of children at a single institution with posteromedial bowing treated by lengthening.

Methods: A retrospective review was carried out at our institution identifying 16 patients who were treated with limb lengthening for posteromedial bowing of the tibia and followed to skeletal maturity.

Severe Hip Dysplasia in Skeletally Mature Patients With Spastic Cerebral Palsy: The Technique and Early Outcome of Comprehensive Surgical Correction (Including the Bernese PAO).

Background: Treatment of symptomatic hip dysplasia in skeletally mature patients with spastic cerebral palsy (CP) can be challenging. This study examines our technical experience with the Bernese periacetabular osteotomy (PAO) in combination with adjunctive procedures in the treatment of this complex hip deformity.

Methods: Sixteen consecutive patients (18 hips) with symptomatic CP hip dysplasia were treated with a PAO and variable adjunctive procedures and retrospectively reviewed.

Treatment of femoral fractures in children aged two to six.

Aims: Current American Academy of Orthopaedic Surgeons (AAOS) guidelines for treating femoral fractures in children aged two to six years recommend early spica casting although some individuals have recommended intramedullary stabilization in this age group. The purpose of this study was to compare the treatment and family burden of care of spica casting and flexible intramedullary nailing in this age group.

Methods: Patients aged two to six years old with acute, non-pathological femur fractures were prospectively enrolled at one of three tertiary children's hospitals.

Open Reduction and Internal Fixation for the Treatment of Symptomatic Osteochondritis Dissecans of the Femoral Head in Patients With Sequelae of Legg-Calvé-Perthes Disease.

Background: Osteochondritis dissecans (OCD) is estimated to occur in 2% to 7% of patients with Legg-Calvé-Perthes disease (LCPD). Unstable osteochondral fragments secondary to LCPD may produce mechanical symptoms requiring surgical intervention. Reattachment of the fragment with open reduction and internal fixation (ORIF) may provide good clinical outcomes.

Activity Level Maintenance at Midterm Follow-up Among Active Patients Undergoing Periacetabular Osteotomy.

Background: For active patients undergoing periacetabular osteotomy (PAO), returning to and maintaining a high level of activity postoperatively is a priority.

Purpose: To evaluate the maintenance of activity levels at midterm follow-up in active patients treated with PAO for symptomatic acetabular dysplasia.

Study Design: Case series; Level of evidence, 4.

Complications associated with combined surgical hip dislocation and periacetabular osteotomy for complex hip deformities.

Surgical hip dislocation (SD) and periacetabular osteotomy (PAO) are well-described treatments for femoroacetabular impingement (FAI) and acetabular dysplasia, respectively. Occasionally, complex deformities require a combined SD/PAO; the morbidity of performing both procedures in a single stage has not been fully investigated. We performed a retrospective review of a consecutive group of patients undergoing combined SD/PAO to investigate the incidence and character of perioperative complications.

Development of the HOOS to Assess Patient-Reported Outcomes in Patients Undergoing Hip Preservation Procedures.

Background: The creation of a single patient-reported outcome (PRO) platform validated across hip preservation, osteoarthritis (OA), and total hip arthroplasty (THA) populations may reduce barriers and streamline the routine collection of PROs in clinical practice. As such, the purpose of this study was to determine if augmenting the Hip disability and Osteoarthritis Outcome Score-Joint Replacement (HOOS, JR) with additional HOOS questions would result in a PRO platform that could be used across a wider spectrum of hip patient populations.

Hypothesis: The HOOS, JR would demonstrate a notable ceiling effect, but by augmenting the HOOS, JR with additional HOOS questions, a responsive PRO platform could be created.

Determining Hinge Abduction in Legg-Calvé-Perthes Disease: Can We Reliably Make the Diagnosis?

Background: Although hinge abduction is recognized as an important finding in children with Legg-Calvé-Perthes disease, variable diagnostic criteria exist. The purpose of this study was (1) to test the interobserver and intraobserver agreement of the current definition of hinge abduction and (2) to develop consensus regarding key diagnostic features that could be used to improve our diagnostic criteria.

Methods: Four orthopaedic surgeons with subspecialty pediatric hip interest independently assessed 30 randomly ordered cases of Legg-Calvé-Perthes disease.

Descriptive Epidemiology of Acetabular Dysplasia: The Academic Network of Conservational Hip Outcomes Research (ANCHOR) Periacetabular Osteotomy.

Background: Periacetabular osteotomy (PAO) is an established treatment for symptomatic acetabular dysplasia, which is a well-recognized cause of hip pain, functional limitations, and secondary osteoarthritis. The purpose of this study was to describe the demographics of patients undergoing PAO, the baseline patient-reported outcome measures for this population, and the types of adjunctive procedures performed at the time of PAO surgery.

Methods: Demographics, disease characteristics, and patient-reported functional measures were prospectively collected from all patients who underwent PAO performed by 12 surgeons from 2008 to 2013.

Patient-Reported Outcomes of Periacetabular Osteotomy from the Prospective ANCHOR Cohort Study.

Background: Current literature describing the periacetabular osteotomy (PAO) is mostly limited to retrospective case series. Larger, prospective cohort studies are needed to provide better clinical evidence regarding this procedure. The goals of the current study were to (1) report minimum 2-year patient-reported outcomes (pain, hip function, activity, overall health, and quality of life), (2) investigate preoperative clinical and disease characteristics as predictors of clinical outcomes, and (3) report the rate of early failures and reoperations in patients undergoing contemporary PAO surgery.

Three Patterns of Acetabular Deficiency Are Common in Young Adult Patients With Acetabular Dysplasia.

Background: Detailed recognition of the three-dimensional (3-D) deformity in acetabular dysplasia is important to help guide correction at the time of reorientation during periacetabular osteotomy (PAO). Common plain radiographic parameters of acetabular dysplasia are limited in their ability to characterize acetabular deficiency precisely. The 3-D characterization of such deficiencies with low-dose CT may allow for more precise characterization.

Do Radiographic Parameters of Dysplasia Improve to Normal Ranges After Bernese Periacetabular Osteotomy?

Background: The goal of periacetabular osteotomy (PAO) is to improve the insufficient coverage of the femoral head and achieve joint stability without creating secondary femoroacetabular impingement. However, the complex tridimensional morphology of the dysplastic acetabulum presents a challenge to restoration of normal radiographic parameters. Accurate acetabular correction is important to achieve long-term function and pain improvement.

Knee Pain and Activity Outcomes After Femoral Derotation Osteotomy for Excessive Femoral Anteversion.

Background: Excessive femoral anteversion is a developmental condition that can become symptomatic into adolescence and manifest as anterior knee pain, tripping, and or problems with sports. Femoral derotational osteotomy about an antegrade intramedullary nail (IMN) is an accepted option to treat this condition. This is the first report of the clinical and functional outcomes of treatment of excessive anteversion with femoral derotational osteotomy stabilized with an IMN.

Femoral Deformity May Be More Predictive of Hip Range of Motion Than Severity of Acetabular Disease in Patients With Acetabular Dysplasia: An Analysis of the ANCHOR Cohort.

Background: It is generally believed that acetabular dysplasia (AD) is associated with increased hip range of motion (ROM). The purpose of this study was to investigate the associations between dysplasia severity and hip ROM in a large multicenter cohort.

Methods: A prospective registry of patients undergoing periacetabular osteotomy for symptomatic AD by 1 of 13 surgeons was used to analyze 1,051 patients (mean age, 26 ± 10 years).

Labral morphologic characteristics in patients with symptomatic acetabular dysplasia.

Background: The morphologic characteristics of the labrum in patients with symptomatic acetabular dysplasia have been described to some extent in smaller retrospective series, but the need remains to further define these disease characteristics and their importance as a diagnostic feature of hip instability.

Purpose: To (1) characterize the morphologic characteristics of the labrum in patients with symptomatic acetabular dysplasia and (2) test the relationships between specific labral variants, severity of dysplasia, and duration of symptoms.

Study Design: Cross-sectional study; Level of evidence, 3.

Does Tranexamic Acid Reduce Blood Loss and Transfusion Requirements Associated With the Periacetabular Osteotomy?

Background: Tranexamic acid (TXA) has shown safety and efficacy in reducing blood loss associated with various surgical procedures. However, to our knowledge there are no studies evaluating the effect of TXA on blood loss and transfusion requirements associated with periacetabular osteotomy (PAO).

Questions/purposes: The main purpose of this study is to determine whether TXA reduces blood loss and transfusion use in patients undergoing PAO for symptomatic acetabular dysplasia.

Are there sex-dependent differences in acetabular dysplasia characteristics?

Background: Many patients who undergo periacetabular osteotomy (PAO) for symptomatic acetabular dysplasia experience decreased pain and improved function, yet some experience inadequate clinical improvement. The etiologies of treatment failure have not been completely defined, and sex-dependent disease characteristics that may be associated with less pain relief are not understood.

Question/purposes: We sought to determine whether there were clinically important sex-specific differences between male and female patients undergoing PAO for acetabular dysplasia in terms of (1) clinical parameters (anthropomorphic traits and hip scores), (2) radiographic findings, and (3) intraoperative findings at the time of PAO, in particular findings potentially associated with femoroacetabular impingement (FAI) such as chondromalacia at the head-neck junction, impingement trough, or reduced head-neck offset.

Does surgical hip dislocation and periacetabular osteotomy improve pain in patients with Perthes-like deformities and acetabular dysplasia?

Background: Patients with symptomatic residual Perthes-like deformities may present with a combination of structural abnormalities including a large aspheric femoral head, short and wide femoral neck, high greater trochanter, and acetabular dysplasia. Sometimes, the hip is further compromised by concurrent symptomatic femoroacetabular impingement (FAI) (proximal femoral deformities) and structural instability (acetabular dysplasia).

Questions/purposes: We therefore sought to characterize (1) the intraoperative findings; (2) radiographic correction; and (3) early patient-reported outcomes, complications, and failures of treating complex Perthes-like hip deformities with combined surgical dislocation and periacetabular osteotomy (PAO).

Does previous pelvic osteotomy compromise the results of periacetabular osteotomy surgery?

Background: As the Bernese periacetabular osteotomy (PAO) has grown in popularity, specific indications and the results in patients treated for those indications need to be evaluated. Currently, although many patients undergo PAO after having had prior pelvic osteotomy, there is limited information regarding the efficacy of the PAO in these patients.

Questions/purposes: The purpose of this study was to compare the (1) early pain, function, activity, and quality of life outcomes; (2) radiographic correction; and (3) major complications and failures between patients who underwent PAO after prior pelvic reconstruction versus those who had a PAO without prior surgery.