Morphological analysis of the knee joint in patients with hip dysplasia
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KNEE
Morphological analysis of the knee joint in patients with hip dysplasia Huiwu Li • Xinhua Qu • You Wang Kerong Dai • Zhenan Zhu
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Received: 3 February 2012 / Accepted: 5 October 2012 Ó Springer-Verlag Berlin Heidelberg 2012
Abstract Purpose The purpose of this study was to investigate the morphological changes of the knee in patients with untreated developmental dysplasia of the hip. Methods Morphological analysis of 150 knee joints in 75 patients with developmental dysplasia of the hip was performed by examining computed tomographic (CT) images. Of these patients, 36 had unilateral developmental dysplasia of the hip and 39 had bilateral developmental dysplasia of the hip. Therefore, 36 hips were normal, and 114 hips were dislocated. CT images ranged from the iliac crest to 2 cm inferior to the tibial tuberosity. Results Compared with the knees in patients with normal hips, the femoral condyles in patients with dislocated hips were smaller and exhibited greater medial and lateral condylar asymmetry. The anterior femoral condylar angle of the femur was increased, as was the groove angle, while the trochlear groove was shallower in patients with dislocated hips. Furthermore, the lateral patella shift was reduced and the patellar tilt angle was increased in patients with dislocated hips compared with patients with normal hips. The extent of changes in these variables differed with the degree of dislocation. However, the posterior condylar angle of the femur was not affected by the degree of dislocation. Conclusion These findings suggest that developmental dysplasia of the hip is associated with morphological
H. Li X. Qu Y. Wang K. Dai Z. Zhu (&) Department of Orthopaedics, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 639 Zhizaoju Road, Shanghai 200011, People’s Republic of China e-mail: [email protected]
changes in the knee joint. These changes should be considered during hip and knee surgery. Level of evidence Prospective study, Level II. Keywords Hip dysplasia Morphological analysis Knee joint Computed tomography
Introduction Developmental dysplasia of the hip (DDH) is the most common condition that leads to secondary osteoarthritis of the hip [3, 24, 32]. Many studies have examined the morphology of the acetabulum and the proximal femur in patients with DDH [15, 18, 27, 33, 34]. The hip joint is located at the junction of the axial and appendicular skeleton. As a result, the structural changes associated with DDH are not confined to the hip joint. Indeed, the structural changes can affect both the axial and the appendicular skeleton [7, 23, 36, 38, 39]. It has been proposed that abnormalities of the hip affect the growth plates of the distal end of the femur and the proximal end of the tibia, resulting in valgus deformity of the knee [36, 38]. Furthermore, keen pain has also been reported in patients with DDH, irrespective of whether they have undergone total hip arthroplasty (THA) or not [35, 39]. Notably, the incidence of DDH is highest in
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