An Unnoticed Femoral Condyle Deformity in Transverse Plane Is Associated With Knee Valgus in Patients With Unilateral Developmental Dysplasia of the Hip

Abstract

Objective: Patients with developmental dysplasia of the hip (DDH) are usually accompanied by knee valgus, and the previous studies mainly focused on the deformity of the knee in the coronal plane that led to knee valgus. In the transverse plane, the deformity of the femoral condyle had never been considered. This study aimed to analyze the transverse morphology of the femoral condyle in patients with unilateral DDH and explore the correlation between the morphology of the femoral condyle and lower limb alignment.

Methods: Sixty-seven patients (10 male and 57 female) with unilateral DDH in our center between May 2019 and March 2024 were retrospectively analyzed. Then, the lengths of each part of the femoral condyle were collected from CT, and the ratios of anterolateral condyle to anteromedial condyle (ALC/AMC), posterolateral condyle to posteromedial condyle (PLC/PMC), lateral condyle to medial condyle (LC/MC), anterolateral condyle to posterolateral condyle (ALC/PLC) and anteromedial condyle to posteromedial condyle (AMC/PMC) were calculated. Then, the patients were grouped by Crowe classification to further analyze the morphology of the distal femur condyle. The mechanical axis deviation (MAD) of the lower limbs was evaluated. The Pearson correlation coefficient was used to explore the correlation between knee valgus and the morphology of the femur condyle.

Result: Compared with the contralateral side, the ratio of ALC/PLC (p < 0.001) and the ratio of AMC/PMC (p = 0.031) in the ipsilateral side were significantly greater. Grouped by Crowe classification, the greater ratio of ALC/PLC (p < 0.001) in the ipsilateral side could be found in patients with Crowe III and IV DDH. The greater ratio of AMC/PMC (p = 0.003) was only found in patients with Crowe IV DDH. When the four Crowe type sides are compared with each other, the ratio of ALC/PLC in patients with Crowe III and IV DDH is greater than that of patients with Crowe I and II DDH (p = 0.005). The ratio of AMC/PMC in patients with Crowe IV DDH is greater than that of other Crowe type patients(p = 0.003). Besides, as the severity of DDH increases, the MAD increased, which was correlated with the ratio of the ALC/PLC (r = 0.609, p < 0.001) and the ratio of AMC/PMC (r = 0.229, p = 0.031).

Conclusion: Patients with unilateral high-riding DDH could present with an increased ratio of anterolateral condyle and posterolateral condyle on the ipsilateral side, which may be associated with the occurrence of knee valgus.Level III, prognostic study.

Keywords

DDH / femoral condyle / knee / knee valgus

References

[1] D. Kosuge, N. Yamada, S. Azegami, P. Achan, and M. Ramachandran, “Management of Developmental Dysplasia of the Hip in Young Adults: Current Concepts,” Bone & Joint Journal 95-b (2013): 732-737.

[2] D. G. Rosenbaum, S. Servaes, E. A. Bogner, D. Jaramillo, and D. N. Mintz, “MR Imaging in Postreduction Assessment of Developmental Dysplasia of the Hip: Goals and Obstacles,” Radiographics 36 (2016): 840-854.

[3] A. H. Crawford, C. T. Mehlman, and R. W. Slovek, “The Fate of Untreated Developmental Dislocation of the Hip: Long-Term Follow-Up of Eleven Patients,” Journal of Pediatric Orthopaedics 19 (1999): 641-644.

[4] J. H. Wedge and M. J. Wasylenko, “The Natural History of Congenital Dislocation of the Hip: A Critical Review,” Clinical Orthopaedics and Related Research 137 (1978): 154-162.

[5] J. H. Wedge and M. J. Wasylenko, “The Natural History of Congenital Disease of the Hip,” Journal of Bone and Joint Surgery. British Volume (London) 61-b (1979): 334-338.

[6] S. Someya, M. Sonohata, S. Ide, S. Nagamine, T. Tajima, and M. Mawatari, “Lower Limbs Alignment in Patients With a Unilateral Completely Dislocated Hip,” Open Orthopaedics Journal 10 (2016): 448-456.

[7] U. Kandemir, M. Yazici, A. M. Alpaslan, and A. Surat, “Morphology of the Knee in Adult Patients With Neglected Developmental Dysplasia of the Hip,” Journal of Bone and Joint Surgery. American Volume 84 (2002): 2249-2257.

[8] H. Li, X. Qu, Y. Wang, K. Dai, and Z. Zhu, “Morphological Analysis of the Knee Joint in Patients With Hip Dysplasia,” Knee Surgery, Sports Traumatology, Arthroscopy 21 (2013): 2081-2088.

[9] T. D. Cooke, R. A. Scudamore, J. T. Bryant, C. Sorbie, D. Siu, and B. Fisher, “A Quantitative Approach to Radiography of the Lower Limb. Principles and Applications,” Journal of Bone and Joint Surgery. British Volume (London) 73 (1991): 715-720.

[10] S. Sabharwal and C. Zhao, “Assessment of Lower Limb Alignment: Supine Fluoroscopy Compared With a Standing Full-Length Radiograph,” Journal of Bone and Joint Surgery. American Volume 90 (2008): 43-51.

[11] A. Tanavalee, P. Yuktanandana, and C. Ngarmukos, “Surgical Epicondylar Axis vs Anatomical Epicondylar Axis for Rotational Alignment of the Femoral Component in Total Knee Arthroplasty,” Journal of the Medical Association of Thailand = Chotmaihet Thang Phaet 84, no. Suppl 1 (2001): S401-S408.

[12] G. Yang, Y. Dai, C. Dong, et al., “Distal Femoral Morphological Dysplasia Is Correlated With Increased Femoral Torsion in Patients With Trochlear Dysplasia and Patellar Instability,” Bone & Joint Journal 102-b (2020): 868-873.

[13] M. Lahner, N. L. Jahnke, S. Zirke, et al., “The Deviation of the Mechanical Leg Axis Correlates With an Increased Hip Alpha Angle and Could Be a Predictor of Femoroacetabular Impingement,” International Orthopaedics 38 (2014): 19-25.

[14] G. Meermans, A. Malik, J. Witt, and F. Haddad, “Preoperative Radiographic Assessment of Limb-Length Discrepancy in Total Hip Arthroplasty,” Clinical Orthopaedics and Related Research 469 (2011): 1677-1682.

[15] J. Sun, L. Guo, M. Ni, et al., “Changes in Distribution of Lower Limb Alignment After Total Hip Arthroplasty for Crowe IV Developmental Dysplasia of the Hip,” Therapeutics and Clinical Risk Management 17 (2021): 389-396.

[16] Q. Li, M. Kadhim, L. Zhang, X. Cheng, Q. Zhao, and L. Li, “Knee Joint Changes in Patients With Neglected Developmental Hip Dysplasia: A Prospective Case-Control Study,” Knee 21 (2014): 1072-1076.

[17] Y. Tokuhara, Y. Kadoya, M. Kim, M. Shoundou, T. Kanno, and T. Masuda, “Anterior Knee Pain After Total Hip Arthroplasty in Developmental Dysplasia,” Journal of Arthroplasty 26 (2011): 955-960.

[18] S. J. Guo, Y. X. Zhou, D. J. Yang, and X. C. Yang, “Lower-Limb Valgus Deformity Associated With Developmental Hip Dysplasia,” Chinese Medical Journal 125 (2012): 3956-3960.

[19] B. Hu, L. Sang, D. Gao, Y. Wu, H. Zhang, and D. Luo, “Patella Alignment Abnormality in Patients With Developmental Dysplasia of the Hip,” Journal of Orthopaedic Surgery (Hong Kong) 27 (2019): 2309499019854039.

[20] W. Fan, L. D. Angibaud, A. Y. Jung, et al., “Gap Balancing Throughout the Arc of Motion With Navigated TKA and a Novel Force-Controlled Distractor: A Review of the First 273 Cases,” Journal of Arthroplasty 38 (2023): S246-S252.

RIGHTS & PERMISSIONS

2025 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.