Skip to main content
SpringerLink
Log in

Coronal plane alignment of the lower limbs in patients with unilateral developmental hip dislocation

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

We aimed to identify the coronal plane alignment of lower limbs in patients with unilateral developmental hip dislocation (UDHD) and observe the difference between Hartofilakidis type II and III.

Patients and methods

The radiographic data of 76 patients who met the inclusion criteria were retrospectively reviewed, including the hip-knee-ankle angle (HKA), mechanical lateral distal femoral angle (mLDFA), anatomical lateral distal femoral angle (aLDFA), mechanical proximal tibial angle (MPTA), and lateral distal tibial angle (LDTA).

Results

The valgus alignment on ipsilateral side was most frequently seen in both Hartofilakidis type II (51.3%) and type III groups (67.6%), whereas for the contralateral side, the neutral alignment in type II group (69.2%) and varus alignment in type III group (51.4%) were most commonly observed. Both the mLDFA and aLDFA of the ipsilateral side were significantly smaller than the contralateral side.

Conclusions

UDHD patients may present with lower limb malalignment on both sides. The ipsilateral valgus alignment is the most common deformity. On the contralateral side, Hartofilakidis type III patients may be more prone to be varus than type II patients. The lower limb malalignment and deformity of the ipsilateral distal femur should be considered during surgery involving hip, knee, or femur.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Hartofilakidis G, Stamos K, Karachalios T, Ioannidis TT, Zacharakis N (1996) Congenital hip disease in adults. Classification of acetabular deficiencies and operative treatment with acetabuloplasty combined with total hip arthroplasty. J Bone Joint Surg Am 78(5):683–692

    Article  CAS  PubMed  Google Scholar 

  2. Kosuge D, Yamada N, Azegami S, Achan P, Ramachandran M (2013) Management of developmental dysplasia of the hip in young adults: current concepts. Bone Joint J 95-B(6):732–737. https://doi.org/10.1302/0301-620X.95B6.31286

    Article  CAS  PubMed  Google Scholar 

  3. Hartofilakidis G, Yiannakopoulos CK, Babis GC (2008) The morphologic variations of low and high hip dislocation. Clin Orthop Relat Res 466(4):820–824. https://doi.org/10.1007/s11999-008-0131-9

    Article  PubMed  PubMed Central  Google Scholar 

  4. Yan F, Chen G, Yang L, He R, Gu L, Wang F (2014) A reduction technique of arthroplasty without subtrochanteric femoral shortening osteotomy for the treatment of developmental high dislocation of hip: a case series of 28 hips. J Arthroplast 29(12):2289–2293. https://doi.org/10.1016/j.arth.2013.11.016

    Article  Google Scholar 

  5. Imarisio D, Trecci A, Sabatini L, Uslenghi M, Leone C, Scagnelli R (2013) Cementless total hip replacement for severe developmental dysplasia of the hip: our experience in Crowe’s group IV. Musculoskelet Surg 97(1):25–30. https://doi.org/10.1007/s12306-012-0227-y

    Article  PubMed  Google Scholar 

  6. Crawford AH, Mehlman CT, Slovek RW (1999) The fate of untreated developmental dislocation of the hip: long-term follow-up of eleven patients. J Pediatr Orthop 19(5):641–644

    CAS  PubMed  Google Scholar 

  7. Wedge JH, Wasylenko MJ (1978) The natural history of congenital dislocation of the hip: a critical review. Clin Orthop Relat Res;(137):154–162

  8. Wedge JH, Wasylenko MJ (1979) The natural history of congenital disease of the hip. J Bone Joint Surg Br 61-B(3):334–338

    Article  CAS  PubMed  Google Scholar 

  9. Kandemir U, Yazici M, Alpaslan AM, Surat A (2002) Morphology of the knee in adult patients with neglected developmental dysplasia of the hip. J Bone Joint Surg Am 84-A(12):2249–2257

    Article  PubMed  Google Scholar 

  10. Sharma L, Song J, Felson DT, Cahue S, Shamiyeh E, Dunlop DD (2001) The role of knee alignment in disease progression and functional decline in knee osteoarthritis. JAMA 286(2):188–195

    Article  CAS  PubMed  Google Scholar 

  11. Tetsworth K, Paley D (1994) Malalignment and degenerative arthropathy. Orthop Clin North Am 25:367–377

    CAS  PubMed  Google Scholar 

  12. McKellop HA, Llinas A, Sarmiento A (1994) Effects of tibial malalignment on the knee and ankle. Orthop Clin North Am 25:415–423

    CAS  PubMed  Google Scholar 

  13. Bruns J, Volkmer M, Luessenhop S (1993) Pressure distribution at the knee joint. Arch Orthop Trauma Surg 133:12–19

    Article  Google Scholar 

  14. Someya S, Sonohata M, Ide S, Nagamine S, Tajima T, Mawatari M (2016) Lower limbs alignment in patients with a unilateral completely dislocated hip. Open Orthop J 10:448–456 eCollection 2016

    Article  PubMed  PubMed Central  Google Scholar 

  15. Zampogna B, Vasta S, Amendola A, Uribe-Echevarria Marbach B, Gao Y, Papalia R, Denaro V (2015) Assessing lower limb alignment: comparison of standard knee X-ray vs long leg view. Assessing lower limb alignment: comparison of standard knee X-ray vs long leg view. Iowa Orthop J 35:49–54

    PubMed  PubMed Central  Google Scholar 

  16. Cooke TD, Sled EA, Scudamore RA (2007) Frontal plane knee alignment: a call for standardized measurement. J Rheumatol 34(9):1796–1801

    PubMed  Google Scholar 

  17. Thienpont E, Schwab PE, Cornu O, Bellemans J, Victor J (2017) Bone morphotypes of the varus and valgus knee. Arch Orthop Trauma Surg 137(3):393–400. https://doi.org/10.1007/s00402-017-2626-x

    Article  CAS  PubMed  Google Scholar 

  18. Mullaji AB, Shetty GM, Lingaraju AP, Bhayde S (2013) Which factors increase risk of malalignment of the hip-knee-ankle axis in TKA? Clin Orthop Relat Res 471(1):134–141. https://doi.org/10.1007/s11999-012-2520-3

    Article  PubMed  Google Scholar 

  19. Ganz R, Slongo T, Siebenrock KA, Turchetto L, Leunig M (2012) Surgical technique: the capsular arthroplasty: a useful but abandoned procedure for young patients with developmental dysplasia of the hip. Clin Orthop Relat Res 470(11):2957–2967. https://doi.org/10.1007/s11999-012-2444-y

    Article  PubMed  PubMed Central  Google Scholar 

  20. Moreland JR, Bassett LW, Hanker GJ (1987) Radiographic analysis of the axial alignment of the lower extremity. J Bone Joint Surg Am 69:745–749

    Article  CAS  PubMed  Google Scholar 

  21. Cooke TD, Scudamore RA, Bryant JT, Sorbie C, Siu D, Fisher B (1991) A quantitative approach to radiography of the lower limb. Principles and applications. J Bone Joint Surg Br 73(5):715–720

    Article  CAS  PubMed  Google Scholar 

  22. Sabharwal S, Zhao C (2008) Assessment of lower limb alignment supine fluoroscopy compared with a standing full-length radiograph. J Bone Joint Surg Am 90(1):43–51. https://doi.org/10.2106/JBJS.F.01514

    Article  PubMed  Google Scholar 

  23. Cooke TD, Li J, Scudamore RA (1994) Radiographic assessment of bony contributions to knee deformity. Orthop Clin North Am 25:387–393

    CAS  PubMed  Google Scholar 

  24. Paley D (2003) Principles of deformity correction. Springer, New York

    Google Scholar 

  25. Cooke TDV, Scudamore A (2003) Healthy knee alignment and mechanics. In: Callaghan JJ, Rosenberg AG, Rubash HE et al (eds) The adult knee. Lippincott Williams & Wilkins, Philadelphia, pp 175–186

    Google Scholar 

  26. Hsu RW, Himeno S, Coventry MB, Chao EY (1990) Normal axial alignment of the lower extremity and load-bearing distribution at the knee. Clin Orthop Relat Res;(255):215–227

  27. Bonner TJ, Eardley WG, Patterson P, Gregg PJ (2011) The effect of post-operative mechanical axis alignment on the survival of primary total knee replacements after a follow-up of 15 years. J Bone Joint Surg Br 93(9):1217–1222. https://doi.org/10.1302/0301-620X.93B9.26573

    Article  CAS  PubMed  Google Scholar 

  28. Chao EY, Neluheni EV, Hsu RW, Paley D (1994) Biomechanics of malalignment. Orthop Clin North Am 25:379–386

    CAS  PubMed  Google Scholar 

  29. Cooke D, Scudamore A, Li J, Wyss U, Bryant T, Costigan P (1997) Axial lower-limb alignment: comparison of knee geometry in normal volunteers and osteoarthritis patients. Osteoarthr Cartil 5:39–47

    Article  CAS  PubMed  Google Scholar 

  30. Murphy SB, Simon SR, Kijewski PK, Wilkinson RH, Griscom NT (1987) Femoral anteversion. J Bone Joint Surg Am 69(8):1169–1176

    Article  CAS  PubMed  Google Scholar 

  31. Kuklo TR, Potter BK, O'Brien MF, Schroeder TM, Lenke LG, Polly DW Jr, Spinal Deformity Study Group (2005) Reliability analysis for digital adolescent idiopathic scoliosis measurements. J Spinal Disord Tech 18:152–159

    Article  PubMed  Google Scholar 

  32. Meermans G, Malik A, Witt J, Haddad F (2011) Preoperative radiographic assessment of limb-length discrepancy in total hip arthroplasty. Clin Orthop Relat Res 469(6):1677–1682. https://doi.org/10.1007/s11999-010-1588-x

    Article  PubMed  Google Scholar 

  33. Smyth EH (1980) Windswept deformity. J Bone Joint Surg Br 62-B(2):166–167

    Article  CAS  PubMed  Google Scholar 

  34. Li Q, Kadhim M, Zhang L, Cheng X, Zhao Q, Li L (2014) Knee joint changes in patients with neglected developmental hip dysplasia: a prospective case-control study. Knee 21(6):1072–1076. https://doi.org/10.1016/j.knee.2014.08.012

    Article  PubMed  Google Scholar 

  35. Li H, Qu X, Wang Y, Dai K, Zhu Z (2013) Morphological analysis of the knee joint in patients with hip dysplasia. Knee Surg Sports Traumatol Arthrosc 21(9):2081–2088. https://doi.org/10.1007/s00167-012-2242-9

    Article  PubMed  Google Scholar 

  36. Teitge RA (2012) Does lower limb torsion matter? Tech Knee Surg 11(3):137–146

    Article  Google Scholar 

  37. Vanwanseele B, Parker D, Coolican M (2009) Frontal knee alignment: three-dimensional marker positions and clinical assessment. Clin Orthop Relat Res 467(2):504–509. https://doi.org/10.1007/s11999-008-0545-4

    Article  PubMed  Google Scholar 

  38. Tanamas S, Hanna FS, Cicuttini FM, Wluka AE, Berry P, Urquhart DM (2009) Does knee malalignment increase the risk of development and progression of knee osteoarthritis? A systematic review. Arthritis Rheum 61(4):459–467. https://doi.org/10.1002/art.24336

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Medical School of Chinese People’s Liberation Army, 28 Fuxing Road, Haidian District, Beijing, 100853, China

    Zhendong Zhang

  2. Department of Orthopaedics, The First Affiliated Hospital of Chinese People’s Liberation Army General Hospital, 51 Fucheng Road, Haidian District, Beijing, 100048, China

    Zhendong Zhang, Hong Zhang, Dianzhong Luo, Hui Cheng, Kai Xiao & Shuxun Hou

Authors
  1. Zhendong Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hong Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dianzhong Luo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hui Cheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kai Xiao
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Shuxun Hou
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shuxun Hou.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

We received the ethics committee review board approval from our institution before the initiation of this study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhang, Z., Zhang, H., Luo, D. et al. Coronal plane alignment of the lower limbs in patients with unilateral developmental hip dislocation. International Orthopaedics (SICOT) 42, 2761–2769 (2018). https://doi.org/10.1007/s00264-018-3813-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-018-3813-2

Keywords

Search

Navigation