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Radiographic characteristics of the hip joint in skeletally mature patients with multiple hereditary exostoses
Kazu Matsumoto1, Hiroyasu Ogawa2, Haruhiko Akiyama2
1Department of Orthopaedic Surgery, Graduate School of Medicine, Gifu University, 1-1, Yanagido, Gifu, 501-1194, Japan. mkazuu@gifu-u.ac.jp.
Insights
Skeletally mature patients with multiple hereditary exostoses (MHE) do not commonly show hip dysplasia. However, they exhibit femoral neck widening and coxa valga, influenced by osteochondroma.
Area of Science:
- Orthopedics
- Radiology
- Medical Imaging
Background:
- Multiple hereditary exostoses (MHE) is a genetic disorder characterized by the development of multiple osteochondromas.
- The hip joint, particularly the proximal femur, can be affected by MHE, leading to potential structural changes.
Purpose of the Study:
- To characterize the radiological features of the hips, focusing on the proximal femur, in skeletally mature patients with MHE.
- To compare hip joint morphology in MHE patients with a healthy control group.
Main Methods:
- Radiographic analysis of 100 hips from 50 MHE patients and 100 hips from age- and sex-matched controls.
- Evaluation of acetabular and proximal femur parameters: acetabular depth-width ratio (ADR), Sharp's angle, Wiberg's centre-edge angle (CEA), femoral neck-shaft angle (NSA), femoral neck width (FNW), and femoral head-neck ratio (FHNR).
Main Results:
- Osteochondromas were common on the medial femoral neck (79%) but rare on the femoral head (1%).
- No significant differences in ADR or Sharp's angle between MHE and control groups.
- Significant differences observed in CEA, FNW, FHNR, and NSA, with MHE patients showing wider femoral necks and a larger NSA (coxa valga).
Conclusions:
- Skeletally mature MHE patients typically do not present with pelvic hip dysplasia.
- Femoral neck widening and coxa valga are characteristic radiological findings in MHE.
- The presence of osteochondroma around the femoral neck influences the degree of valgus deformity, providing valuable insights for orthopedic surgeons.
Objective:
To elucidate the radiological characteristics of the hips, especially in proximal femur, of skeletally mature patients with multiple hereditary exostoses (MHE).
Materials And Methods:
Fifty eligible patients (100 hips) were included in the study and assigned to the MHE group. The control group included age- and sex-matched individuals, and the radiographs of 100 hips were used as controls. We examined the anatomical characteristics of the acetabulum and the proximal femur, including the acetabular depth-width ratio (ADR), Sharp's angle, femoral neck-shaft angle (NSA), Wiberg's centre-edge angle (CEA), femoral neck axis length (FNAL), femoral head diameter, (FHD), femoral neck width (FNW), femoral shaft width (FSW), femoral neck-shaft angle (NSA), and femoral head-neck ratio (FHNR = FHD/FNW). p value < 0.05 was considered significant.
Results:
Osteochondroma was frequently observed in the medial femoral neck (79%), but it was rarely found in the femoral head (1%). ADR and Sharp's angle were not significantly different between the MHE and control groups (p = 0.2056, p = 0.5025). CEA was significantly different between the two groups (p < 0.0001). FNW was significantly larger in the MHE group than in the control group (p < 0.0001). FHNR was significantly different between the two groups (p < 0.0001). NSA was significantly larger than the MHE group (141.8° ± 9.7° vs 129.5° ± 5.6°, p < 0.0001).
Conclusions:
Hip dysplasia in the pelvic side was not commonly observed in skeletally mature MHE patients. However, they showed femoral neck widening and coxa valga. The occurrence of osteochondroma around the femoral neck affects the degree of valgus deformity. These facts could be useful for orthopaedic surgeons treating MHE patients.
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