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      Joint kinematics and kinetics during walking and running in 32 patients with hip dysplasia 1 year after periacetabular osteotomy

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          Abstract

          Background and purpose —

          Hip dysplasia can be treated with periacetabular osteotomy (PAO). We compared joint angles and joint moments during walking and running in young adults with hip dysplasia prior to and 6 and 12 months after PAO with those in healthy controls.

          Patients and methods —

          Joint kinematics and kinetics were recorded using a 3-D motion capture system. The pre- and postoperative gait characteristics quantified as the peak hip extension angle and the peak joint moment of hip flexion were compared in 23 patients with hip dysplasia (18–53 years old). Similarly, the gait patterns of the patients were compared with those of 32 controls (18–54 years old).

          Results —

          During walking, the peak hip extension angle and the peak hip flexion moment were significantly smaller at baseline in the patients than in the healthy controls. The peak hip flexion moment increased 6 and 12 months after PAO relative to baseline during walking, and 6 months after PAO relative to baseline during running. For running, the improvement did not reach statistical significance at 12 months. In addition, the peak hip extension angle during walking increased 12 months after PAO, though not statistically significantly. There were no statistically significant differences in peak hip extension angle and peak hip flexion moment between the patients and the healthy controls after 12 months.

          Interpretation —

          Walking and running characteristics improved after PAO in patients with symptomatic hip dysplasia, although gait modifications were still present 12 months postoperatively.

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          Most cited references25

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          A new periacetabular osteotomy for the treatment of hip dysplasias. Technique and preliminary results.

          A new periacetabular osteotomy of the pelvis has been used for the treatment of residual hip dysplasias in adolescents and adults. The identification of the joint capsule is performed through a Smith-Petersen approach, which also permits all osteotomies to be performed about the acetabulum. This osteotomy does not change the diameter of the true pelvis, but allows an extensive acetabular reorientation including medial and lateral displacement. Preparations and injections of the vessels of the hip joint on cadavers have shown that the osteotomized fragment perfusion after correction is sufficient. Because the posterior pillar stays mechanically intact the acetabular fragment can be stabilized sufficiently using two screws. This stability allows patients to partially bear weight after osteotomy without immobilization. Since 1984, 75 periacetabular osteotomies of the hip have been performed. The corrections are 31 degrees for the vertical center-edge (VCE) angle of Wiberg and 26 degrees for the corresponding angle of Lequesne and de Seze in the sagittal plane. Complications have included two intraarticular osteotomies, a femoral nerve palsy that resolved, one nonunion, and ectopic bone formation in four patients prior to the prophylactic use of indomethacin. Thirteen patients required screw removal. There was no evidence of vascular impairment of the osteotomized fragment.
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            Psychometric properties of patient-reported outcome measures for hip arthroscopic surgery.

            Patient-reported outcomes (PROs) are considered the gold standard when evaluating outcomes in a surgical population. While the psychometric properties of some PROs have been tested, the properties of newer PROs in patients undergoing hip arthroscopic surgery remain somewhat unknown. To evaluate the reliability, validity, responsiveness, and interpretability of 5 PROs (Copenhagen Hip and Groin Outcome Score [HAGOS], Hip Disability and Osteoarthritis Outcome Score [HOOS], Hip Outcome Score [HOS], International Hip Outcome Tool [iHOT-33], and Modified Harris Hip Score [MHHS]) in a population undergoing hip arthroscopic surgery and also to provide a recommendation of the best PROs in patients undergoing hip arthroscopic surgery. Cohort study (diagnosis); Level of evidence, 2. Study participants were adults (mean age, 37 ± 11 years) who had undergone hip arthroscopic surgery 12 to 24 months previously and pain-free, healthy age-matched controls (mean age, 35 ± 11 years). Baseline characteristics including age, height, weight, waist girth, physical activity, and occupation were collected for both groups. The hip arthroscopic surgery group completed the 5 PRO questionnaires on 3 occasions, while the healthy control group completed the PRO questionnaires on 1 occasion. The reliability (test-retest reliability [intraclass correlation coefficient, or ICC] and minimal detectable change [MDC]), validity (construct validity, ability to detect a difference between groups, acceptability including floor and ceiling effects), responsiveness, and interpretability (minimal important change [MIC]) of each measure were calculated. The test-retest reliability of PROs was excellent (ICC, 0.91-0.97), with an MDC of <20%. The HOOS, HAGOS, and iHOT-33 had acceptable content validity. All PROs demonstrated construct validity and were able to detect a difference between the hip arthroscopic surgery and control groups. No measures demonstrated a floor effect; however, the MHHS and subscales relating to activities of daily living of the HOOS, HOS, and HAGOS demonstrated a ceiling effect. The HOOS, iHOT-33, and MHHS demonstrated adequate responsiveness, and the MIC for all measures was <11 points of a possible 100 points. The PROs of the HOOS and iHOT-33 demonstrate psychometric properties that may enable researchers and clinicians to use them with confidence in a population undergoing hip arthroscopic surgery. The psychometric properties of the MHHS, HOS, and some subscales of the HAGOS are reduced, and these PROs may be less valuable in this group.
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              The prognosis in untreated dysplasia of the hip. A study of radiographic factors that predict the outcome.

              To help to determine the natural history of residual dysplasia of the hip after skeletal maturity, we followed the status of the contralateral hip in 286 patients who had had a total hip replacement for osteoarthrosis secondary to dysplasia. The initial radiographic findings in seventy-four patients in whom advanced osteoarthrosis later developed in the contralateral hip were compared with those in forty-three patients who had reached the age of sixty-five years without having had severe osteoarthrosis. No patient in whom the hip functioned well until the age of sixty-five years had had a center-edge angle of less than 16 degrees, an acetabular index of depth to width of less than 38 per cent, an acetabular index of the weight-bearing zone of more than 15 degrees, uncovering of the femoral head of more than 31 per cent, or an acetabulum in which the most proximal point of the dome had been at the lateral edge (zero peak-to-edge distance).
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                Author and article information

                Journal
                Acta Orthop
                Acta Orthop
                ORT
                Acta Orthopaedica
                Informa Healthcare
                1745-3674
                1745-3682
                December 2014
                19 November 2014
                : 85
                : 6
                : 592-599
                Affiliations
                1Department of Physiotherapy and Occupational Therapy , Aarhus University Hospital
                2Department of Sports Science , Aarhus University
                3Department of Orthopaedic Surgery , Aarhus University Hospital, Aarhus, Denmark
                Author notes
                Article
                ORT_A_960167_O
                10.3109/17453674.2014.960167
                4259030
                25191933
                bb3b39a4-ebb2-4e7f-92df-415f90ed48e8
                Copyright: © Nordic Orthopaedic Federation

                This is an open-access article distributed under the terms of the CC-BY-NC-ND 3.0 License which permits users to download and share the article for non-commercial purposes, so long as the article is reproduced in the whole without changes, and provided the original source is credited.

                History
                : 01 September 2014
                : 18 July 2014
                Categories
                Hip

                Orthopedics
                Orthopedics

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