0
Scientific Articles   |    
Instability of the Hip in Patients with Down SyndromeImproved Results with Complete Redirectional Acetabular Osteotomy
Wudbhav N. Sankar, MD1; Michael B. Millis, MD2; Young-Jo Kim, MD, PhD2
1 Division of Orthopaedic Surgery, 2nd floor, Wood Building, The Children's Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, PA 19104
2 Department of Orthopaedic Surgery, Hunnewell 225, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA 02115. E-mail address for Y.-j. Kim: young-jo.kim@childrens.harvard.edu
View Disclosures and Other Information
Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

  • Disclosure statement for author(s): PDF

Investigation performed at Children's Hospital Boston, Boston, Massachusetts

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2011 Oct 19;93(20):1924-1933. doi: 10.2106/JBJS.J.01806
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case

Abstract

Background: 

The treatment of hip instability in patients with Down syndrome is challenging, and the literature provides little data to guide treatment. The purpose of the present study was to evaluate our results with complete redirectional acetabular osteotomy and to compare these results with our experience with other procedures.

Methods: 

We retrospectively evaluated all patients with Down syndrome who underwent surgery for the treatment of gross hip instability or symptomatic acetabular dysplasia with or without subluxation. Medical records were reviewed for symptoms and demographic information. On the basis of the primary procedure, the patients were separated into Group A (periacetabular or triple osteotomy) or Group B (varus femoral osteotomy with or without incomplete acetabuloplasty [e.g., Dega osteotomy or shelf acetabuloplasty]). Preoperative and latest postoperative radiographs were used to compare the extrusion index, the lateral center-edge angle, the Tönnis angle, and the continuity of the Shenton line. Preoperative computed tomography (CT) scans were measured for acetabular version.

Results: 

We identified thirty-five hips (twenty-three patients), including twenty-five hips in Group A and ten in Group B. The mean age was 11.8 years, and the mean duration of follow-up was 5.3 years. Preoperatively, the acetabula were retroverted in both groups. Patients in Group A had worse initial hip pathology than those in Group B, as indicated by a higher mean extrusion index (50% compared with 33%; p = 0.06), a smaller center-edge angle (1° compared with 15°; p = 0.003), a larger Tönnis angle (21° compared with 10°; p = 0.001), and a smaller percentage of patients with an intact Shenton line (20% compared with 40%; p = 0.39). Most recent radiographs, however, showed superior results for Group A, including a lower mean extrusion index (10% compared with 29%; p < 0.0001), a larger center-edge angle (33° compared with 14°; p < 0.001), a smaller Tönnis angle (−1° compared with 10°; p < 0.001), and a larger percentage of patients with an intact Shenton line (88% compared with 70%; p = 0.32). Preoperatively, eighteen hips demonstrated gross instability: twelve were treated with either periacetabular osteotomy or triple innominate osteotomy, and all but one (92%) remained stable at the time of the latest follow-up. In contrast, six hips were treated with femoral osteotomy with or without incomplete acetabuloplasty, with only three (50%) remaining stable.

Conclusions: 

Complete redirectional acetabular osteotomies are successful for stabilizing the hip and for correcting acetabular dysplasia in patients with Down syndrome.

Level of Evidence: 

Level of Evidence: Therapeutic Level II. See Instructions to Authors for a complete description of levels of evidence.

Figures in this Article
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

     
    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org

    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe





    Related Content
    The Journal of Bone & Joint Surgery
    JBJS Case Connector
    Topic Collections
    Related Audio and Videos
    PubMed Articles
    Acetabular retroversion in Down syndrome. J Pediatr Orthop 2012 Apr-May;32(3):277-81.
    Management of hip instability in trisomy 21. J Pediatr Orthop 2013 Jul-Aug;33 Suppl 1():S33-8.
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    12/04/2013
    New York - Icahn School of Medicine at Mount Sinai
    02/28/2014
    District of Columbia (DC) - Children's National Medical Center
    12/31/2013
    S. Carolina - Department of Orthopaedic Surgery Medical Univerity of South Carlonina
    04/02/2014
    W. Virginia - Charleston Area Medical Center