Background: Residual acetabular dysplasia is one of the main complications of developmental dysplasia of the hip (DDH). Without treatment, over time degenerative osteoarthritis of the joint will develop, inexorably leading to the need for joint replacement. Acetabular and/or femoral osteotomies do not avoid the appearance of osteoarthritis in a significant number of patients. The purpose of this study was to assess the possibility of provoking changes in the morphology of the acetabulum through selective epiphysiodesis of the extra-articular portion of the ilioischial arm of the triradiate cartilage, using a percutaneous cannulated screw with the guidance of an imaging intensifier in an experimental model in rabbits. Methods: In a pilot study, 3-week-old New Zealand rabbits (n = 20) were submitted to unilateral surgery of the hip while the contralateral hip of the same group was used as a control. Posterior epiphysiodesis to the triradiate cartilage of the acetabulum was performed by placement of a cannulated screw. The rabbits were followed-up until 18 weeks of life. Radiographic measurements of the hips were performed immediately postoperatively and at 12 weeks of life and before the rabbits were sacrificed at week 18. Three-dimensional computed tomography (3D-CT) scans were performed. Non-parametric tests for paired samples and the Wilcoxon test were used to compare the differences between group 1 and group 2. A p < 0.05 was considered significant. Results: The non-intervened hips showed that, when the rabbit matured, the acetabulum lost concavity and depth. When comparing the median differences of the angles evaluated at 12 weeks between groups, a statistically significant difference was found in all radiographic measurements: an increase in Wiberg’s angle but a decrease in acetabular index, acetabular angle of Sharp, acetabular depth index, and acetabular anteversion. Evaluating the operated hips at 12 and 18 weeks (three months after having removed the screw) using 3D-CT, we observed a rebound effect in the correction confirming that the effect obtained through selective epiphysiodesis did not cause the definitive closure of the cartilage. Conclusions: Selective growth arrest of the ilioischial arm of the triradiate cartilage (posterior epiphysiodesis) can alter growth and change the shape of the acetabulum in rabbits. A rebound effect was observed when the screw was removed, confirming that the technique did not provoke definitive closure of the physis. Level of evidence: Level-2, therapeutic study.
References
[1]
Morcuende, J.A., Meyer, M.D., Dolan, L.A. and Weinstein, S.L. (1997) Long Term Outcome after Open Reduction through an Anteromedial Approach for Congenital Dislocation of the Hip. Journal of Bone and Joint Surgery-American, 79, 810-817.
[2]
Ponseti, I.V. (1978) Growth and Development of the Acetabulum in the Normal Child. Anatomical, Histological, and Roentgenographic Studies. Journal of Bone and Joint Surgery-American, 60, 575-585.
[3]
Weinstein, S.L., Mubarak, S.J. and Wenger, D.R. (2004) Developmental Hip Dysplasia and Dislocation: Part I. Instructional Course Lectures, 53, 523-530.
[4]
Weinstein, S.L., Mubarak, S.J. and Wenger, D.R. (2004) Developmental Hip Dysplasia and Dislocation: Part II. Instructional Course Lectures, 53, 531-542.
[5]
Salter, R.B. (1961) Innominate Osteotomy in the Treatment of Congenital Hip Dislocation and Subluxation of the Hip. Journal of Bone and Joint Surgery-British, 43, 518-539.
[6]
Albinana, J., Dolan, L.A., Spratt, K.F., Morcuende, J., Meyer, M.D. and Weinstein, S.L. (2004) Acetabular Dysplasia after Treatment for Developmental Dysplasia of the Hip. Implications for Secondary Procedures. Journal of Bone and Joint Surgery-British, 86, 876-886. http://dx.doi.org/10.1302/0301-620X.86B6.14441
[7]
Engesaeter, L.B., Furnes, O. and Havelin, L.I. (2008) Developmental Dysplasia of the Hip-Good Results of Later Total hip Arthroplasty: 7135 Primary Total Hips Arthroplasties after Developmental Dysplasia of the Hip Compared with 59,774 Total Hips Arthroplasties in Idiopathic Coxarthrosis Followed for 0 to 15 Years in the Norwegian Arthroplasty Register. The Journal of Arthroplasty, 23, 235-240.
[8]
Bucholz, R.W., Ezaki, M. and Ogden, J.A. (1982) Injury to the Acetabular Triradiate Physeal Cartilage. Journal of Bone and Joint Surgery-American, 64, 600-609.
[9]
Scuderi, G. and Bronson, M.J. (1978) Triradiate Cartilage Injury. Report of Two Cases and Review of the Literature. Clinical Orthopaedics and Related Research, No. 217, 179-189.
[10]
Los roedores de laboratorio como modelos de enfermedades humanas. Manual de genética de roedores de laboratorio. Ed-Panamericana., 263-297.
[11]
Hilgenreiner, H. (1986) Hingenreiner on Congenital Hip Dislocation. JPO, 6, 207, Fig. 1.
[12]
Sharp, I.K. (1961) Acetabular Dysplasia. The Acetabular Angle. Journal of Bone and Joint Surgery, 43B, 268-272.
[13]
Wiberg, G. (1939) Studies on Dysplastic Acetabula and Congenital Subluxation of the Hip Joint with Special References to the Complication of OSteoarthritis. Acta Chirurgica Scandinavica, 83, 58.
[14]
Cooperman, D.R., Wallensten, R. and Stulberg, S.D. (1983) Acetabular Dysplasia in the Adult. Clinical Orthopaedics and Related Research, 175, 79-85.
[15]
Daysal, G.A., Goker, B., Gonen, E., Demirag, M.D., Haznedaroglu, S., Ozturk, M.A. and Block, J.A. (2007) The Relationship between Hip Joint Space Width, Center Edge Angle and Acetabular Depth. Osteoarthritis and Cartilage, 15, 1446-1451. http://dx.doi.org/10.1016/j.joca.2007.05.016
[16]
Seinsheimer, F. and Sledge, C. (1981) Parameters of Longitudinal Growth Rate in Rabbit Epiphyseal Growth Plates. The Journal of Bone & Joint Surgery, 63, 627-630.
[17]
Shaw, N. and Lacey, E. (1975) The Influence of Corticosteroids on the Normal and Papain Treated Epiphyseal Growth Plate in the Rabbit. The Journal of Bone & Joint Surgery, 57, 228-233.
[18]
Páez, J., Hennessey Montilla, R., Armando Amador, J. and Martínez, C. (2006) Efecto de la oxitetraciclina sobre el cartílago articular. Revista Colombiana de Ortopedia y Traumatología, 20, 48-54.
[19]
Chen, I.H., Kuo, K.N. and Lubicky, J.P. (1994) Prognosticating Factors Inacetabular Development Following Reduction of Developmental Dysplasia of the Hip. Journal of Pediatric Orthopaedics, 14, 3-8. http://dx.doi.org/10.1097/01241398-199401000-00002
[20]
Lindstrom, J.R., Ponseti, I.V. and Wenger, D.R. (1979) Acetabular Developmental after Reduction in Congenital Dislocation of the Hip. The Journal of Bone & Joint Surgery, 61, 112-118.
[21]
Tonnis, D. (1987) Displasia Congénita y la luxación de cadera en ninos y adultos. Springer, Berlín.
[22]
Weintroub, S., Green, I., Terdiman, R. and Weissman, S.L. (1979) Growthand Development of Congenitally Dislocated Hips Reduced Inearly Infancy. The Journal of Bone & Joint Surgery, 61, 125-130.
[23]
Gepstein, R., Weiss, R.E. and Hallel, T. (1984) Acetabular Dysplasia and Hip Dislocation after Selective Premature Fusion of the Triradiate Cartilage: An Experimental Study in Rabbits. The Journal of Bone & Joint Surgery, 66, 334-336.
[24]
Isiklar, Z.U., Kandemir, U., Ucar, D.H. and Tumer, Y. (2006) Is Concomitantbone Surgery Necessary at the Time of Open Reduction Indevelopmental Dislocation of the Hip in Children 12-18. Journal of Pediatric Orthopedics. Part B, 15, 23-27. http://dx.doi.org/10.1097/01202412-200601000-00005
[25]
Hallel, T. and Salvati, E.A. (1977) Premature Closure of the Triradiate Cartilage: A Case Report and Animal Experiment. Clinical Orthopaedics and Related Research, 124, 278-281. http://dx.doi.org/10.1097/00003086-197705000-00038
[26]
Shapiro, F., Koide, S. and Glimcher, M.J. (1993) Cell Origin and Differentiation in the Repair of Full-Thickness Defects of Articular Cartilage. The Journal of Bone & Joint Surgery, 75, 532-553
[27]
Kim, H.W., Morcuende, J.A., Dolan, L.A. and Weinstein, S.L. (2000) Acetabular Development in Developmental Dysplasia of Thehip Complicated by Lateral Growth Disturbance of the Capital Femoral Epiphysis. The Journal of Bone & Joint Surgery, 82, 1692-1700.
[28]
Bicimoglu, A., Agus, H., Omeroglu, H. and Tumer, Y. (2003) Six Years of Experience with a New Surgical Algorithm in Developmental Dysplasia of the Hip in Children under 18 months of Age. Journal of Pediatric Orthopaedics, 23, 693-698.
[29]
Luhmann, S.J., Bassett, G.S., Gordon, J.E., Schootman, M. and Schoenecker, P.L. (2003) Reduction of a Dislocation of the Hip Due to Developmental Dysplasia, Implications for the Need for Future Surgery. The Journal of Bone & Joint Surgery, 85, 239-243.
[30]
Delgado-Baeza, E., Sanz-Laguna, A. and Miralles-Flores, C. (1991) Experimental Trauma of the Triradiate Epiphysis of the Acetabulum and Hip Dysplasia. International Orthopaedics, 15, 335-339. http://dx.doi.org/10.1007/BF00186873
[31]
Delgado Baeza, E., Gil Garay, E., Serrada Hierro, A., Davidson, W.M. and Miralles Flores, C. (1988) Experimental Acetabular Dysplasia Associated with a Lesion of Iliopubic Limb of the Triradiate Cartilage. Clinical Orthopaedics and Related Research, 234, 75-81. http://dx.doi.org/10.1097/00003086-198809000-00016
[32]
Kuba, A. (1986) Growth Disturbance of the Acetabulum by Damage to the Triradiate Cartilage of Rabbits. Nihon Seikeigeka Gakkai Zasshi, 60, 215-225
[33]
Peterson, H.A. and Robertson, R.C. (1997) Premature Partial Closure of the Triradiate Cartilage Treated with Excision of a Physical Osseous Bar. Case Report with a Fourteen-Year Follow-Up. The Journal of Bone & Joint Surgery, 79, 767-770.
[34]
Luis Moraleda, M.D., Javier Albinana, M.D. and Francisco Forriol, M.D. (2013) Selective Epiphysiodesis of the Triradiate Cartilage for Treatment of Residual Experimental Acetabular Dysplasia. Journal of Pediatric Orthopaedics, 33, 821-828. http://dx.doi.org/10.1097/BPO.0b013e31829b2f3f
[35]
Hernández, S. (2006) El modelo animal en las investigaciones biomédicas. Biomedicina, 2, 252-256.
[36]
Agus, H., Kalenderer, O., Bicimoglu, A. and Tümer, A. (2006) Can Percutaneous Epiphysodesis of Medial Proximal Femur Physis Be Effective for Treatment. 25th European Paediatric Orthopaedeic Society Abstract Book, Dresden, 5-8 April 2006, 5-75.
[37]
Ucar, D.H., Isiklar, Z.U., Stanitski, C.L., Kandemir, U. and Tumer, Y. (2004) Open Reduction through a Medial Approach in Developmental Dislocation of the Hip: A Follow-Up Study to Skeletal Maturity. Journal of Pediatric Orthopaedics, 24, 493-500. http://dx.doi.org/10.1097/01241398-200409000-00008