Free clinical trials for osteoarthritis of the hip

The most important measurements are detailed in Figure 6 and Table 1.ДЄcetabular depth value under 250 characterizes the dysplastic hip.

Values under 2вЂ‰mm are consistent with joint space narrowing. In the adult hip, normal joint space ranges from 3 to 5вЂ‰mm and must be uniform. It is not present at birth but gradually develops due to pressure of the femoral head. Its medial aspect corresponds to the inner cortex of the pelvis and the lateral edge with the acetabular notch and the anteroinferior portion of the quadrilateral plate. The teardrop represents a summation of shadows. A more severe condition is protrusio acetabuli, diagnosed when the femoral head overlaps or overpasses the ilioischial line ( Figure 5). Therefore, this as an isolate criterion is not enough to make the diagnosis of pincer-type impingement. Nevertheless, coxa profunda had been found in 76% of asymptomatic hips, mainly in women. When the acetabular floor overlaps or overpasses the ilioischial line, the diagnosis of coxa profunda can be made. In normal conditions the floor of the acetabular fossa is lateral to the ilioischial line by 2вЂ‰mm in men and 1вЂ‰mm in women. It is part of the posterior column of the acetabulum.ДЄcetabular Floor. The ilioischial line of KГ¶hler begins at the medial border of the iliac wing and extends along the medial border of the ischium to end at the ischial tuberosity. It conforms to the inner margin of the pelvic ring and it is part of the anterior column of the acetabulum. Iliopectineal or iliopubic line is formed by the arcuate line of the ilium and the superior border of the superior pubic ramus up to the pubic symphysis. In the adult hip there are important landmarks to be recognized on plain film radiographs ( Figure 5):

Group B hips in children who are less than 8 years at the time of onset have a very favorable outcome unrelated to the treatment, whereas Group C hips in children of all ages usually have poor outcome unrelated to the treatment.

Patients who are over the age of 8 years at the time of onset and have a hip in the lateral pillar B group or B/C border group have a better outcome with surgical treatment than they do with conservative treatment. Group B/C is considered when the loss of lateral pillar height is at 50%. In Group A, which has a better prognosis, there are no loss of height in the lateral third of the femoral head and little density changes in Group B, there is lucency and lateral height loss of less than 50% and in Group C, the most severe form, there is more than 50% loss of lateral height. Herring or lateral pillar classifications and the patient's age strongly correlate with the outcome. Classification of its severity can be assessed by radiographs. Most cases of Legg-CalvГ©-Perthes disease (LCPD) develop between the ages of 4 and 10 years ( Figure 3). Differences greater than 1.5вЂ‰mm between the two sides are considered abnormal. The medial articular joint space is measured between the medial border of the femoral head or neck (when epiphysis is not ossified) and the acetabular platform. The most useful lines and angles that can be drawn in the pediatric pelvis assessing DDH are shown in Figure 2. Because eccentric position or delayed appearance of the ossific nucleus is a common finding in DDH, a new radiographic classification system has been developed by the International Hip Dysplasia Institute (IHDI), which uses the mid-point of the proximal femoral metaphysis as a reference landmark. It relies on the presence of the femoral head ossification center. The TГ¶nnis method is the most widely used radiographic system to classify DDH. Дespite the widespread of ultrasound, pelvis radiographs are still frequently used to diagnose and/or monitor DDH or for assessing other congenital conditions or bone tumors. The range of normal values is from 90 to 135В° and is related to the infant's age. Lines are drawn from the highest point of the ischium to the most prominent point of the symphysis, joining at the inside of the pelvis. The symphysis os-ischium angle of TГ¶nnis evaluates the pelvic position in the sagittal plane. In neutral rotation the ratio is 1 but is considered to be acceptable when it is between 0.56 and 1.8. TГ¶nnis introduced a quotient of pelvic rotation by dividing the horizontal diameter of the obturator foramen of the right side and that of the left. Reliability of measurements increases if indicators of pelvic alignment are taken into account. Radiographs of infants should be obtained with the pelvis in neutral position with the lower limbs held in neutral rotation and slight flexion.

Free clinical trials for osteoarthritis of the hip