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Part II

Part II. Amy L. McIntosh, MD Pediatric Orthopedic Surgeon Mayo Clinic Rochester, Minnesota. Hip. Similar cross sectional study performed at the NIH Clinical Center 51 patients Hip pain Radiographic analysis. Rose, PS: JPO 2001. Abnormal Morphology. Present in 1/3 rd of patients

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Part II

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  1. Part II Amy L. McIntosh, MD Pediatric Orthopedic Surgeon Mayo Clinic Rochester, Minnesota

  2. Hip • Similar cross sectional study performed at the NIH Clinical Center • 51 patients • Hip pain • Radiographic analysis Rose, PS: JPO 2001

  3. Abnormal Morphology • Present in 1/3rd of patients • Took many forms

  4. Protrusio Acetabuli (10%) • 10% of patients • Abnormal deepening of the hip socket

  5. Abnormal Neck-Shaft Alignment (23%) • Most commonly “valgus” alignment • Increased angle • Fewer patients with “varus” alignment • Decreased angle • Seen in 23% of patients

  6. Arthritis

  7. Hip Arthritis

  8. Hip Arthritis

  9. Hip Symptoms • Pain data gathered on all patients over age 5 • Chronic hip pain present in 63% of all patients • Present in 79% of adults • Statistically associated with • Increasing arthritis on x-rays • Increasing age

  10. Legg Calve Perthes (16%) • Loss of the blood supply to the immature femoral head • Occurs during youth or adolescence • Treat = surgical

  11. Implications of Hip Abnormalities • Assist in identifying and diagnosing Stickler Syndrome • Recognizes the burden of progressive arthritis in patients • Patients and doctors should be alert for Perthes

  12. Other Orthopedic Manifestations • Clubfeet • Genu valgum (knocked- knees)

  13. Clubfeet (3%)

  14. Intrauterine Ultrasound Diagnosis

  15. Ponsetti Treatment

  16. Genu Valgum (25%)

  17. Growth Modulation

  18. Orthopedic Treatment Options • Spine • General joint arthritis

  19. Treatment Options for Arthritis • A large percentage of patients with Stickler Syndrome will develop symptomatic arthritis • Relatively young age • Multiple joints involved

  20. Principles of Treatment Lifestyle Modifications Medical Treatments Reconstructive Surgery

  21. Lifestyle Modifications Prevalence of Obesity in the United States

  22. Obesity • Each extra pound adds 4 pounds across the knee joint and 3 across the hip in regular activities • Average person takes 2000-4000 steps per day • So… one pound extra puts an extra 8-16 tons of stress on the knees each day!

  23. Activity Choices

  24. But… • In patients with Stickler Syndrome, healthy weight and sensible decisions will mitigate but not eliminate joint symptoms

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