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    Analysis of a radiographic assessment method of acetabular cover in developmental dysplasia of the hip
    (Springer-Verlag, 2002) Ömeroglu, H; Agus, H; Bicimoglu, A; Tümer, Y
    The aim of this study was to analyse a radiographic assessment method of acetabular cover (Ogata et al.) in developmental dysplasia of the hip (131314). Intraobserver and interobserver reliabilities of the method were found to be 'substantial' (agreement ratio 85%, kappa coefficient 0.76) and 'moderate' (agreement ratio 71%, kappa coefficient 0.54), respectively. The percentage of hips considered pathological was significantly higher following the use of the acetabular roof shape classification system (15%) than following the measurement of the centre-edge (CE) angle of Wiberg (3%) in the same hips (p = 0.000). The average CE angle of Ogata values of types 1&2, 3 and 4 acetabula were significantly different, whereas the CE angle of Wiberg ones were not. It was concluded that this classification system was a reliable and reproducible radiological indicator for reflecting the acetabular cover. A careful assessment is needed in types 3 and 4 acetabula, because the use of classical angle measurements on plain radiographs such as the CE angle of Wiberg may carry the risk of overestimation of the radiological hip anatomy in such hips.
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    Measurement of center-edge angle in developmental dysplasia of the hip
    (Springer-Verlag, 2002) Ömeroglu, H; Biçimoglu, A; Agus, H; Tümer, Y
    Objective: To analyse in detail the two methods for the measurement of the center-edge (CE) angle in developmental dysplasia of the hip (DDH) in children and adolescents. Design: Four observers independently interpreted the radiographs of 51 surgically treated and 15 unaffected hips on two occasions. CE angle was measured by using two methods: classic (Wiberg) and refined (Ogata et al.). Intraobserver and interobserver variations of both methods were calculated and the effect of age and treatment type on the two measurement methods were analysed. Results: Following 528 measurements in 66 hips, the mean classic CE angle was 28.2degrees and the mean refined CE angle, 19.9degrees. The classic CE angle had nearly 1degrees less intraobserver and interobserver variation than the refined CE angle. Classic angle measurements were obviously higher than refined ones in the hips of children under 9 years of age and in hips in which an innominate osteotomy had been performed. Conclusion: Although CE angle of Wiberg, which is an important radiographic indicator, has an adequate level of reliability and reproducibility it may not reflect the true lateral femoral head coverage in some cases.
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    Six years of experience with a new surgical algorithm in developmental dysplasia of the hip in children under 18 months of age
    (Lippincott Williams & Wilkins, 2003) Biçimoglu, A; Agus, H; Ömeroglu, H; Tümer, Y
    One hundred thirty-seven developmentally dysplastic hips of 107 children with a mean age of I I months were treated by the same surgical algorithm. Following iliopsoas and adductor longus tenotomies by the Ferguson posteromedial approach, the operation was ended in case of arthrographically documented concentric reduction (Tonnis grade I reduction) and an open reduction was performed in case of nonanatomic arthrographic reduction (Tonnis grade 2 or 3 reduction). Mean follow-up was 4.2 years. The need for open reduction increased in preoperatively dislocated hips that were proximally displaced according to the Tonnis classification. Somewhat better latest acetabular index values were seen in hips having lower preoperative dislocation grades that were surgically treated before the age of 12 months. Rates of avascular necrosis of the femoral head, redislocation, and secondary operation were 13%, 1%, and 2%, respectively. The authors concluded that although mid-term results of this new surgical algorithm in developmental dysplasia of the hip was satisfactory in infants younger than 18 months of age, long-term follow-up is needed for better understanding of its use.