Relationships among hip instability, iliofemoral ligament, and pain in patients with developmental dysplasia of the hip

Yusuke Fujiwara; Takeshi Shoji; Yuki Ota; Hideki Saka; Tadashi Inoue; Yuichi Kato; Junichi Sumii; Yuji Yasunaga; Nobuo Adachi

doi:10.1016/j.jos.2023.03.001

Relationships among hip instability, iliofemoral ligament, and pain in patients with developmental dysplasia of the hip

J Orthop Sci. 2023 Mar 15:S0949-2658(23)00072-6. doi: 10.1016/j.jos.2023.03.001. Online ahead of print.

Authors

Yusuke Fujiwara¹, Takeshi Shoji², Yuki Ota³, Hideki Saka⁴, Tadashi Inoue⁵, Yuichi Kato⁶, Junichi Sumii⁷, Yuji Yasunaga⁸, Nobuo Adachi⁹

Affiliations

¹ Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan. Electronic address: japaneseqwer6060@gmail.com.
² Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan. Electronic address: readymade_jpn@yahoo.co.jp.
³ Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan. Electronic address: dryki0321@gmail.com.
⁴ Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan. Electronic address: saka@hiroshima-u.ac.jp.
⁵ Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan. Electronic address: t.inoue610@gmail.com.
⁶ Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan. Electronic address: katoo1117@gmail.com.
⁷ Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan. Electronic address: merameranin0325@yahoo.co.jp.
⁸ Department of Orthopaedic Surgery, Hiroshima Prefectural Rehabilitation Center, 295-3 Taguchi, Saijo-town, Higashi-hiroshima, 739-0036, Japan. Electronic address: yasuyuji@hiroshima-wsc.jp.
⁹ Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan. Electronic address: nadachi@hiroshima-u.ac.jp.

PMID: 36931978
DOI: 10.1016/j.jos.2023.03.001

Abstract

Background: To evaluate the relationships among hip instability, pain, and morphology of the iliofemoral ligament (ILFL) in patients with developmental dysplasia of the hip (DDH) using ultrasonography (US).

Methods: We reviewed 86 patients (109 hips) with DDH (Group D), 40 patients (46 hips) with borderline hip dysplasia (BDDH) (Group B) and 20 patients (23 hips) without hip pain and bony abnormality (control group). Group D was classified into three subgroups-the severe (group SP), moderate (group MP), and none/mild (group NMP) hip pain groups-using the visual analogue scale (VAS). For evaluating hip instability and ILFL morphology, the distance between the anterior edge of the anterior inferior iliac spine (AIIS) and the horizontal line to the femoral head, and ILFL thickness were measured using US. The difference between the distance in the neutral position and Patrick position was calculated and defined as the femoral head translation distance (FTD).

Results: FTD and ILFL thickness in group D were significantly larger than those in the control group and group B (P < 0.05). There was a significant positive correlation between FTD and ILFL thickness in three groups (r = 0.57, P < 0.05; r = 0.55, P < 0.05; r = 0.62, P < 0.05, respectively). FTD and ILFL thickness in group SP were significantly larger than those in group NMP (P < 0.05). FTD and ILFL thickness in group D had significantly negative correlations with the lateral center edge (r = -0.54, P < 0.05; r = -0.40, P < 0.05, respectively) and vertical-center-anterior angle (r = -0.51, P < 0.05; r = -0.43, P < 0.05, respectively).

Conclusions: Acetabular bony deficiency, especially in the anterior and lateral region can result in antero-posterior hip instability, leading to thickened ILFL and hip pain, even in patients with BDDH. These findings may facilitate our understanding and treatment of patients with DDH. When hip instability is suspected, hip US examination may help confirm the diagnosis and assist in providing objective clinical diagnostic evidence.

Keywords: Borderline hip dysplasia; Developmental dysplasia of the hip ultrasonography; Hip instability hip pain; Iliofemoral ligament.

Published by Elsevier B.V.