Aims: Developmental dysplasia of the hip (DDH) describes a pathological relationship between the femoral head and acetabulum. Periacetabular osteotomy (PAO) may be used to treat this condition. The aim of this study was to evaluate the results of PAO in adolescents and adults with persistent DDH. Methods: Patients were divided into four groups: A, adolescents who had not undergone surgery for DDH in childhood (25 hips); B, adolescents who had undergone surgery for DDH in childhood (20 hips); C, adults with DDH who had not undergone previous surgery (80 hips); and D, a control group of patients with healthy hips (70 hips). The radiological evaluation of digital anteroposterior views of hips included the Wiberg angle (centre-edge angle (CEA)), femoral head cover (FHC), medialization, distalization, and the ilioischial angle. Clinical assessment involved the Harris Hip Score (HHS) and gluteal muscle performance assessment. Results: Significant improvements in radiological parameters were achieved in all measurements in all groups (p < 0.05). The greatest improvement was in CEA (mean of 19° (17.2° to 22.3°) in Group B), medialization (mean of 3 mm (0.9 to 5.2) in Group C), distalization (mean of 6 mm (3.5 to 8.2) in Group B), FHC (mean of 17% (12.7% to 21.2%) in Group B), and ilioischial angle (mean of 5° (2.3° to 8.1°) in Group B). There were significant improvements in the mean HHS and gluteal muscle performance scores postoperatively in all three groups. Conclusion: The greatest correction of radiological parameters and clinical outcomes was found in patients who had undergone hip surgery in childhood. Although the surgical treatment of DDH in childhood makes subsequent hip surgery more difficult due to scarring, adhesions, and altered anatomy, it requires less correction of the deformity and has a beneficial effect on the outcome of PAO in adolescence and early adulthood. Cite this article: Bone Joint J 2022;104-B(7):775–780.

Background and Objectives: Successful treatment of severe trauma and fractures of the long bones with successful healing and bone union is still a significant challenge for surgeons. Unfortunately, up to 10% of long-bone fractures develop bone healing disorders. The aim of this study was to evaluate the results of treating bone defects with different etiologies in the upper and lower extremities using the induced membrane technique. Materials and Methods: We prospectively evaluated the radiological and clinical outcomes of 45 patients with severe bone defects treated with the induced membrane technique during the period from May 2021 to October 2023. The time to bone defect regeneration, size of the bone defect, and the cost of treatment were evaluated. Functional outcomes were assessed using the Disabilities of the Arm Shoulder and Hand (DASH) scale, SF-36, and the Lower Limb Functional Index (LLFI). Results: The mean follow-up time was 31 months (12–35). There were 20 patients with upper extremity bone defects and 25 with lower extremity bone defects. The mean defect length was 7.9 cm for the upper extremity (3.5–18) and 5.3 cm for the lower extremity (3–11). The mean times to achieve bone union and remodeling were 6.0 months (3–12) and 9 months (3–13) for the upper and lower limbs, respectively. Clinical evaluation at the end of treatment (achieving bone union) showed statistically significant improvements in the DASH, SF-36, and LLFI scales for pre- and postoperative outcomes. There was no statistical significance in the SF-36 clinical scale scores after surgical treatment compared to reconstructive treatment of upper and lower extremity bone defects. Results: The presented reconstructive approach to the treatment of bone defects and healing disorders and extensive analysis demonstrate the effectiveness of the induced membrane technique in a short follow-up period, with a relatively high level of patient comfort and good clinical results in the treatment of severe bone defects with particularly infectious etiologies.

The aim of this study was to retrospectively evaluate the effectiveness of corrective osteotomies in lower limb axis disorders at different levels of non-idiopathic (post traumatic, developmental, post-septic) etiology. A total of 50 patients were divided into three groups: A—thigh segment alignment disorder (24 patients); B—tibia segment alignment disorder (18 patients); C—thigh and tibia segment alignment disorder (8 patients). Radiological evaluation of digital lower limb postural X-ray was performed laterally and for AP, and included mLPFA, mLDFA, MAD, CORA coronal and sagittal plane parameters for the femur segment and mMPTA, mLDTA, MAD, CORA coronal and sagittal plane for the tibia segment. Clinical assessment was based on the LLFI. The mean follow-up was 55.8 months (12–86). Improvements in the radiological parameters and statistical significance were achieved for all measurements in all groups (p < 0.05). The most common plane of deformation was the coronal plane (varus/valgus), followed by the transverse (rotational) and sagittal planes (procurvatum/recurvatum). In this study, we examined 29 post-traumatic deformities and 21 other etiologies. Improvements in the LLFI score performance after corrective osteotomies were observed in all three groups. Corrective osteotomies are a safe and useful but challenging method of preserving joints in cases of post-traumatic, developmental or post-septic lower limb alignment disorders.

The aim of this study was to evaluate the results of surgical treatment of developmental dysplasia of the hip (DDH) with periacetabular osteotomy (PAO) and determine the values of radiological parameters that would allow us to obtain an optimal clinical result. Radiological evaluation included determining the center-edge angle (CEA), medialization, distalization, femoral head coverage (FHC), and ilioischial angle as measured on a standardized AP radiograph of the hip joints. Clinical evaluation was based on the HHS, WOMAC, Merle d’Aubigne–Postel scales and Hip Lag Sign. The results of PAO presented decreased medialization (mean 3.4 mm), distalization (mean 3.5 mm), and ilioischial angle (mean 2.7°); improvement in femoral head bone cover; an increased CEA (mean 16.3°) and FHC (mean 15.2%); clinically increased HHS (mean 22 points) and M. Postel–d’Aubigne (mean 3.5 points) scores; and a decrease in WOMAC (mean 24%). HLS improved in 67% of patients after surgery. Qualification of patients with DDH for PAO should be based on the following values of three parameters: CEA < 26°, FHC < 75%, and ilioischial angle >85.9°. To achieve better clinical results, it is necessary to increase the average CEA value by 11° and the average FHC by 11% and reduce the average ilioischial angle by 3°.

Background: Residual hip dysplasia is one of the factors contributing to early hip joint osteoarthritis. The main problems caused by residual dysplasia are pain and instability of the hip joint caused by the lack of sufficient bony covering of the femoral head. The aim of this work was to radiologically assess the configuration change of a dysplastic hip joint after surgical treatment using the Bernese periacetabular osteotomy procedure.Methods: We assessed the radiological parameters of patients with hip dysplasia treated by Bernense periacetabular osteotomy by performing a digital antero-posterior pelvis X-ray: central edge angle and femoral head coverage, medialization, distalization and ilio-ischial angle parameters. For normally distributed parameters, we used Student’s t-test; for parameters without a normal distribution, we used the Wilcoxon signed-rank test. Correlations were assessed according to a normal distribution using the Pearson and Spearman method.Results: For all parameters, we observed statistically significant differences in the measurements of dysplastic hip joints before and after the surgery. We also observed a statistically significant difference between the structure of dysplastic hip joints prior to the surgery and healthy hip joints from the control group based on all radiological parameters. The resulting medialization was 2.68 mm, distalization was 3.65 mm, and the ilio-ischial angle was changed by 2.62°. There was also an improvement in the femoral head bony covering: CEA by 17.61° and FHC by 16.46%.Conclusions: Based on all the radiological parameters, we presented the difference between healthy and dysplastic hip joints. Learning the parameter values that are used to describe dysplastic hip joints will allow us to improve the imaging of the condition and will also allow for better planning and proper qualification of patients for surgical treatment of hip joint dysplasia.Trial registration: Consent of the bioethics commission Medical Centre of Postgraduate Education 83/PB/2015 18.11.2015 Warsaw