2025年4月 保髋进展 JCR Q4 区

The clinical diagnosis of developmental dysplasia of the hip (DDH) typically involves manually measuring key radiological angles-Center-Edge (CE), Tönnis, and Sharp angles-from pelvic radiographs, a process that is time-consuming and susceptible to variability. This study aims to develop an automated system that integrates these measurements to enhance the accuracy and consistency of DDH diagnosis. We developed an end-to-end deep learning model for keypoint detection that accurately identifies eight anatomical keypoints from pelvic radiographs, enabling the automated calculation of CE, Tönnis, and Sharp angles. To support the diagnostic decision, we introduced a novel data-driven scoring system that combines the information from all three angles into a comprehensive and explainable diagnostic output. The system demonstrated superior consistency in angle measurements compared to a cohort of eight moderately experienced orthopedists. The intraclass correlation coefficients for the CE, Tönnis, and Sharp angles were 0.957 (95% CI: 0.952-0.962), 0.942 (95% CI: 0.937-0.947), and 0.966 (95% CI: 0.964-0.968), respectively. The system achieved a diagnostic F1 score of 0.863 (95% CI: 0.851-0.876), significantly outperforming the orthopedist group (0.777, 95% CI: 0.737-0.817, [Formula: see text]), as well as using clinical diagnostic criteria for each angle individually ([Formula: see text]). The proposed system provides reliable and consistent automated measurements of radiological angles and an explainable diagnostic output for DDH, outperforming moderately experienced clinicians.Clinical impact: This AI-powered solution reduces the variability and potential errors of manual measurements, offering clinicians a more consistent and interpretable tool for DDH diagnosis.

This research investigates how trabecular patterns affect growth plate morphology, focusing on shape, trabecular patterns, and ossification bridges. By studying mechanical adaptations, we propose a new methodology to model endochondral growth and bone remodeling, applicable to clinical cases involving growth abnormalities or growth plate diseases.

Total hip arthroplasty (THA) for severe developmental dysplasia of the hip (DDH) is technically difficult because of the anatomical features of dysplasia, such as a hypoplastic and shallow acetabulum, narrow femoral canal, and soft tissue contractures. Subtrochanteric osteotomy (STO) is effective technique to reduce the risk of sciatic nerve palsy while placing the acetabular cup in an anatomical position during THA for severe DDH. Few studies have compared THA performed without STO to THA performed with STO. We performed a systematic literature review and single-arm meta-analysis to integrate the results of studies regarding THA with STO for severe DDH.

Periacetabular osteotomy (PAO) has shown favorable outcomes. The goal of this study was to conduct a systematic review to assess the reoperation rates and long-term patient-reported outcomes (PROs) of PAO for the treatment of hip dysplasia.

The aim of this study was to evaluate the clinical efficacy of 2 approaches to total hip arthroplasty-the direct anterior approach and the posterolateral approach-in the treatment of developmental dysplasia of the hip. A total of 201 patients who were hospitalized between 2018 and 2023 for this condition were included in the study. Of the total number of patients, 100 underwent the procedure via the direct anterior approach (study group), whereas 101 underwent total hip arthroplasty via the posterolateral approach (control group). A range of clinical and patient data was gathered, including the following: age, gender, body mass index, disease classification, symptom history, intraoperative blood loss, blood transfusion volume, incision length, operation time, hospital stay, visual analog scale score, Harris score, Barthel index, postoperative complications, follow-up time, leg length discrepancy, and femur offset difference. The lack of statistically significant variations in age, gender, body mass index, and symptom history among the 2 patient groups suggests that they were comparable. Nevertheless, notable disparities were observed between the groups with regard to the length of the surgical incision (P < .001) and intraoperative blood loss (P < .001). Significant differences (P < .001) were observed in the visual analog scale scores of the patients in the study group at 1 day (6.71 ± 0.46), 3 days (5.71 ± 0.46), and 1 week (0.96 ± 0.20) after surgery, in comparison with the control group (7.46 ± 0.51, 6.35 ± 0.49, 1.73 ± 0.67). In addition, notable distinctions were detected in the Harris score between the groups at the Harris score 3 months postsurgery (P < .001) and at the last follow-up (P = .012). Furthermore, noteworthy distinctions were observed in the study group regarding both preoperative and postoperative leg length discrepancy (P < .001), in addition to preoperative offset and postoperative offset (P < .001). The utilization of the direct anterior approach in total hip replacement presents several advantages, including reduced tissue damage, decreased pain, quicker postoperative functional recovery, reduced dislocation risk, and enhanced hip joint functionality. This approach is in accordance with the tenets of minimally invasive surgery and improved recovery protocols, rendering it a feasible option for the management of developmental dysplasia of the hip among individuals.