Segreto Frank A, Vasquez-Montes Dennis, Brown Avery E, Bortz Cole, Horn Samantha R, Diebo Bassel G, Zhou Peter L, Vira Shaleen, Baker Joseph F, Petrizzo Anthony M, Lafage Renaud, Lafage Virginie, Errico Thomas J, Passias Peter G
Department of Orthopaedics, NYU Medical Center-Orthopaedic Hospital, New York, NY, USA.
Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA.
J Orthop. 2018 Aug 15;15(3):874-877. doi: 10.1016/j.jor.2018.08.015. eCollection 2018 Sep.
Early Onset and Adolescent Idiopathic Scoliosis, relatively common diagnoses (∼3% general population), have been associated with developmental dysplasia of the hip (DDH); a more rare spectrum of anomalies related to the abnormal development of acetabulum, proximal femur, and hip joint. To the best of our knowledge, no high powered investigations have been performed in an attempt to assess incidence and associated risks of DDH in scoliosis patients.
The KID database was queried for ICD-9 codes from 2003 to 2012 pertaining to EOS (Congenital and Idiopathic <10y/o) and AIS patients. Descriptive analysis assessed patient demographics and yearly trends in hip dysplasia rates. EOS and AIS patients with hip dysplasia were isolated, and incidence of hospital admissions for associated anomalies (osteonecrosis, osteoarthritis, recurrent hip dislocation, hip ankylosis) and hip arthroplasty (total + partial) were investigated. Univariate analysis of hip pathology determined significant predictors of hip arthroplasty. Binary logistic regression analysis was used to determine the relationship between these predictors.
111,827 scoliosis patients (EOS: 25,747; AIS: 77,183) were included. AIS patients were older (15.2 vs 4.3), more female (64.2% vs 52.1%), had a higher CCI (0.84 vs 0.64), and less racially diverse (all p < 0.001). The incidence of hip dysplasia was 1.4% for AIS patients and 3.9% for EOS patients (p < 0.001). Of the AIS (n = 1073) and EOS (n = 1005) patients with hip dysplasia, 0.3% (p > 0.05 between groups) developed hip osteonecrosis, 0% of patients were coded as having a hip labral tear, hip ankylosis, and 0.6% (EOS: 0.2%; AIS: 0.9%, p = 0.025) developed hip osteoarthritis. AIS patients were more likely to have recurrent hip dislocations (35.4% vs 17.0%, p < 0.001), and both groups had similar primary hip arthroplasty rates (6.7% vs 5.4%, p = 0.118) and revision hip arthroplasty rates (0% vs 0.4%, p = 0.053). Hip osteoarthritis (OR: 13.43[5.21-34.66], p=<0.001) and older age (OR: 1.039[1.007-1.073], p = 0.017) were the only significant predictors of hip arthroplasty (p=<.001).
The incidence of hip dysplasia in EOS and AIS populations is higher than that of the general population. The rate of DDH was 3.9% and 1.8% for EOS and AIS, respectively. While the incidence of DDH is higher, associated anomalies of osteoarthritis, osteonecrosis, labral tears, and ankylosis appear to be a minimal risk for AIS and EOS patients with Hip Dysplasia.
早发性和青少年特发性脊柱侧凸是相对常见的诊断（约占总人口的3%），与髋关节发育不良（DDH）有关；DDH是一种更罕见的异常情况，与髋臼、股骨近端和髋关节的异常发育有关。据我们所知，尚未进行过大规模研究来评估脊柱侧凸患者中DDH的发病率及相关风险。
查询KID数据库中2003年至2012年与早发性脊柱侧凸（先天性和特发性<10岁）和青少年特发性脊柱侧凸患者相关的ICD - 9编码。描述性分析评估了患者的人口统计学特征以及髋关节发育不良率的年度趋势。分离出患有髋关节发育不良的早发性脊柱侧凸和青少年特发性脊柱侧凸患者，并调查相关异常（骨坏死、骨关节炎、复发性髋关节脱位、髋关节强直）的住院发生率以及髋关节置换术（全髋关节置换术+部分髋关节置换术）的情况。对髋关节病变进行单因素分析，确定髋关节置换术的显著预测因素。采用二元逻辑回归分析来确定这些预测因素之间的关系。
纳入了111,827例脊柱侧凸患者（早发性脊柱侧凸：25,747例；青少年特发性脊柱侧凸：77,183例）。青少年特发性脊柱侧凸患者年龄较大（15.2岁对4.3岁），女性比例更高（64.2%对52.1%），Charlson合并症指数更高（0.84对0.64），种族多样性更低（所有p<0.001）。青少年特发性脊柱侧凸患者髋关节发育不良的发生率为1.4%，早发性脊柱侧凸患者为3.9%（p<0.001）。在患有髋关节发育不良的青少年特发性脊柱侧凸（n = 1073）和早发性脊柱侧凸（n = 1005）患者中，0.3%（两组间p>0.05）发生了髋关节骨坏死，0%的患者被编码为有髋关节盂唇撕裂、髋关节强直，0.6%（早发性脊柱侧凸：0.2%；青少年特发性脊柱侧凸：0.9%，p = 0.025）发生了髋关节骨关节炎。青少年特发性脊柱侧凸患者更易发生复发性髋关节脱位（35.4%对17.0%，p<0.001），两组的初次髋关节置换术发生率相似（6.7%对5.4%，p = 0.118），翻修髋关节置换术发生率也相似（0%对0.4%，p = 0.053）。髋关节骨关节炎（比值比：13.43[5.21 - 34.66]，p<0.001）和年龄较大（比值比：1.039[1.007 - 1.073]，p = 0.017）是髋关节置换术的仅有的显著预测因素（p<0.001）。
早发性脊柱侧凸和青少年特发性脊柱侧凸人群中髋关节发育不良的发生率高于一般人群。早发性脊柱侧凸和青少年特发性脊柱侧凸患者中DDH的发生率分别为3.9%和1.8%。虽然DDH的发生率较高，但对于患有髋关节发育不良的青少年特发性脊柱侧凸和早发性脊柱侧凸患者，骨关节炎、骨坏死、盂唇撕裂和强直等相关异常的风险似乎极小。
