Hip Dysplasia: Understanding and Treating Instability of the Native Hip

Foreword
Preface
Contents
Contributors
1: Aetiology of Hip Dysplasia: Genetic and Environmental Factors
	Introduction/Chapter Overview
	Disease Spectrum
		Definitions
			Heterogeneity in Definition of DDH
		Epidemiology
	Established Risk Factors for Development of DDH
		Exogenous Intrauterine Factors
			Breech Presentation
			Primiparity
			Birth Weight
			Oligohydramnios
			Mode of Delivery
			Multifoetal Pregnancy
			Associated “Packaging Disorders”
		Exogenous Extra-Uterine Factors
			Influence of Swaddling
		Endogenous Factors
			Female Gender
			Family History
			Metabolic
			Geography and Ethnicity
			Ligamentous Laxity and Connective Tissue Composition
	The Genetic Aetiology of Hip Dysplasia
		Heritability of DDH
		Genetic Mapping Methods
		Genetic Associations with DDH
	Summary/Conclusion
	References
2: Natural History of Residual Hip Dysplasia
	Introduction
	Development of Hip Symptoms
	Development of Radiographic Arthritis
	Progression to Total Hip Arthroplasty
	Areas of Controversy
	Conclusion
	References
3: Anatomical Description and Classification of Hip Dysplasia
	Classification of Hip Dysplasia
	Ultrasonography-Based Classification
	Plain X-Ray-Based Classification
		Tönnis Classification
		The International Hip Dysplasia Institute (IHDI) Group Classification
		Crowe, Eftekhar, Kerboul, and Hartofilikadis Classifications as a Function of Femoral Head Position
		Severin Classification
		Ottawa Comprehensive Classification for Acetabular Dysplasia
		The Tönnis Classification System for Radiographic Assessment of Hip Arthritis with Acetabular Dysplasia
	Conclusion
	References
4: Pathomechanics of the Dysplastic Hip
	Relationship Between Pathoanatomy and Pathomechanics
	Historical Context for the Etiology of Arthritis Development
	Kinematics, Kinetics, and Muscle Mechanics in the Dysplastic Hip
	Pathomechanics of Chondrolabral Loading in the Dysplastic Hip
	Future Directions and Open Research Questions
	References
5: Biomechanics of the Native Hip from Normal to Instability
	Introduction
	Functional Anatomy of the Capsule
	Capsular Contributions to Stability
	Effects of Capsulotomy and Repair
	Characterizing Instability
		Acetabular Coverage and Femoral Morphology
		Capsular Laxity
	Capsular Function After Acetabular Reorientation
	Summary
	References
6: Traditional Imaging: Plain X-Rays, Three-Dimensional CT, and MR Imaging in Development Dysplasia of the Hip
	Introduction
	Plain Radiograph Imaging of the Hip
	Technical Principles of Radiographic Imaging
		Conical Projection
		Film-Tube Distance
		Patient-Film Distance
		Centering and Alignment of the X-Ray Beam
		Pelvic Orientation
	Basic Plain Radiograph Imaging
		Anteroposterior (AP) Pelvis View
		Axial Cross-Table View
		Additional Plain Radiograph Imaging
		Functional Views
		Not Recommended Plain Radiographs
	Radiographic Parameters
		Acetabular Coverage
		Acetabular Depth
		Acetabular Orientation
	Femoral Anatomy
	Joint Congruency
	Effect of Pelvic Orientation on Radiographic Parameters
	Reference Values for Acetabular Under- and Overcoverage
	Classification of Development Dysplasia of the Hip: Crowe Classification
	CT Scans and 3D Reconstruction
	Outlook
	Magnetic Resonance Imaging (MRI) of the Hip
		MR Technique and Imaging Protocol
		MR Imaging in the Setting of Hip Dysplasia
	References
7: Advancing Imaging of the Hip: Cartilage
	Introduction
	Infrastructure for Cartilage Mapping
	MRI Requirements
	MRI Cartilage Mapping Techniques
	MR Image Post-Processing and Data Analysis
		Delayed Gadolinium-Enhanced MRI of Cartilage (dGEMRIC)
		dGEMRIC in Hip Dysplasia
		T2 Mapping
			T2 Mapping in Hip Dysplasia
		T2∗ Mapping
			T2∗ Mapping in Hip Dysplasia
		T1ρ Mapping
			T1ρ Mapping in Hip Dysplasia
	Conclusion and Outlook
	References
8: Non-Surgical Management of Pre-Arthritic Dysplastic Hip Pain
	Introduction
	Postural Correction, Activity Modification, and Patient Education
	Analgesics, NSAIDs, and Oral Supplements
	Physical and Manual Therapy
	Orthotics and Assistive Devices
	Intra-Articular Hip Injections
	Orthobiologics, Regenerative Medicine, and Newer Therapies
		Emerging Therapeutics
		Stem Cell Treatment, Bone Marrow Aspiration Concentrate, and Lipoaspirate
		Tissue Engineering
		Rapid Prototyping and 3D Bioprinting
		Nanotechnology
	Summary
	References
9: Adjuvant Therapies in the Treatment of Pre-Arthritic Hip Disease
	Introduction
	Systemic Drug Use
	Intra-Articular Injection
		Corticosteroid
		Hyaluronic Acid
		Platelet-Rich Plasma (PRP)
			Leucocyte-Rich PRP
			Leucocyte-Poor PRP
		Bone Marrow Aspirate Concentrate
	Stem Cells
		Mesenchymal Stem Cells
			Bone Marrow-Derived MSCs
			Adipose-Derived MSCs
			Synovium-Derived MSCs
			Muscle-Derived MSCs
		Peripheral Blood-Derived Progenitor Cells
		Induced Pluripotent Stem Cells
	Growth Factors
		Applying Growth Factors
		Regulating Detrimental Growth Factors
			Regulating Vascular Endothelial Growth Factor (VEGF)
			Regulating Transforming Growth Factor (TGF)-β1 with Use of Losartan
	Conclusion
	References
10: Role and Indications of Hip Arthroscopy for Hip Dysplasia
	Introduction
	Biomechanics of the Dysplastic Hip
	Intra-Articular Pathology in the Dysplastic Hip
	Treatment Options
		Periacetabular Osteotomy
		Isolated Arthroscopic Treatment
		Combined Procedures
		Author’s Preferred Treatment
	Conclusion
	References
11: Proximal Femoral Osteotomy
	Introduction
	Indications
	Surgical Planning
	Implants
	Surgical Technique
		Surgical Technique: Osteotomy with a Proximal Femoral Locking Plate – May Be Utilized for Both Intertrochanteric and Subtrochanteric Osteotomies (Fig. 11.4)
		Surgical Technique: Intertrochanteric Osteotomy with Blade Plate (Fig. 11.5)
	Conclusion
	References
12: The Periacetabular Osteotomy
	Introduction
	History of PAO
	Indications
	Contraindications
	Presentation and Initial Evaluation
	Author’s Preferred Technique
		Anesthesia and Blood Loss
		Surgical Technique
		Postoperative Protocol
	Outcomes
	Risks and Complications
	Combined Hip Deformities and the Use of Adjuvant Surgeries
		Adjuvant Hip Arthroscopy
		Adjuvant Hip Arthrotomy
		Adjuvant Femoral Osteotomy
	Summary
	References
13: Other Pelvic Osteotomies
	Introduction
	Reconstructive Procedures
		Triple Pelvic Osteotomy
			Historical Background
		Clinical Indications
		Advantages of TPO
		Disadvantages of TPO
		Surgical Technique
			Steel’s Modification
			Tönnis’ Modification
			O’Hara’s Modification
		Surgical Complications
			Non-union
			Nerve Injury
			Vascular Injury
			Infection
			Other Complications
		Clinical Results
			Functional and Clinical Outcomes
			Radiological Outcomes
		Pearls and Pitfalls
	Augmentation (Salvage) Procedures
		Chiari Pelvic Osteotomy
			Historical Background
		Clinical Indications
		Advantages
		Disadvantages
		Surgical Technique
		Surgical Complications
		Clinical Results
			Functional and Clinical Outcomes
			Radiological Outcomes
		Pearls and Pitfalls
	Shelf Acetabuloplasty
		Historical Background
		Clinical Indications
		Advantages
		Disadvantages
		Surgical Technique
		Surgical Complications
		Clinical Results
			Functional and Clinical Outcomes
			Radiological Outcomes
		Pearls and Pitfalls
	Conclusion
	References
14: Joint Replacement in the Dysplastic Patient: Surgical Considerations and Techniques
	Introduction
	The Morphology of the Dysplastic Femur
	THR in the Setting of Hip Dysplasia: Surgical Management
		Crowe 1 Deformities
		Crowe 2 and 3 Deformities
		Crowe 4 Deformities
			Bony and Soft Tissue Morphology
				The Crowe 4 Acetabulum
				Crowe 4 Femoral Anatomy
			The Biomechanics of the Crowe 4 Hip
			Crowe 4 THR: Surgical Management
	Avoiding Nerve Injury During THR in the Dysplastic Hip
	Implant Selection
		Femoral Components for the Dysplastic Hip
	Do Not Forget the Ipsilateral Knee
		Special Considerations for Crowe 4 Cases
	Authors’ Preference
	References
Index