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.
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.
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
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.
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
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
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.
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
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
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.
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.
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.
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
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
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.
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
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.
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