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late one. My name is, uh, eczema via on. I'm going to talk to you today about dystasia so many times with us and then or inviting me to get to stop. So I work and not only trust, and if you're wondering where it is, well, it's in the Northeast serving some a few might have visited the area already. It's a beautiful part of the country. To kill any points for today would be dysplasia is a very common condition. I'll go over how to reach diagnosis and understand the basic principles of managing this crazy. So many years ago, Harris was looking at the urology off the arthritis, and what he noted was that do Patty was two or three is extremely there for kicks in, actually have some evidence of a standard displays you in 40% femoral head abnormality, perhaps from establishing been done, which doctor wasn't a well despite. So when we talk about this, please here it really comes in various sizes and shapes. The fourth thing which comes to our mind, is a picture like this when the hip is completely dislocated, or have something like the second picture where there is an incongruent, but the more common they displace you, that least we hit. Presenting surgeon see would be the mild to moderate dysplastic. So with the others got to examples. Well, perhaps not benefit from a presenting said so hopefully Quintus, this place here it all depends on with radiologically Index. You using this particular study any symptomatic individuals deformed that almost 4% at some degree off the press, lazy in under the study, depending on the radiographic index, they found that the prevalence was any. We've been fighting that accent. What dysplasia was not related to self reported him be. So not all of those 10% patient had been. However, there was some relationship. We didn't have this place here on osteoarthritis. Imagine lost electricity to full off very eager students. Almost 10% would have some degree off this crazy. So really, this pathology that common but FBI and this plus displacing bean certainly not all need any form of treatment. Sort of. The reasons for this can be environmental factors. It can be because of spinal pelvic alignment rations or, of course, labeled in world with regards environment of factors. It is becoming a parent that hit me has been going and epidemic, especially in young females. It may well be related to the fact that this generation rooms, too, don't mean for it. You want one being getting sporting do it is we all want to do Martin's five years, whatever. We're capable. But what we ignore is that not everyone's here. Not everyone's joints are suitable for high level activities, so subtle abnormalities, which previously would have remained on recognized, become a problem. The spine dictates where the calluses imbalance between the source muscle in the back muscles well tell to the palace, either forward or backward, causing either subtle dysplasia become more obvious. Yeah, bases ending up with a retroverted in causing impingement. We really will understand that in patients that displaces the labrum has to compensate for the shallow socket so it becomes take. The contralateral junction is under a lot of pressure, lot of sheer force on the label and potentially there. If you remove the liver contact, stress increased back a 9% and it does being proposed. That liberal detachment is one of the key currents and otherwise well functioning. This class tickets knife label injury does not occur. The hip article Cartilage million in the true life at this picture that you can see is not uncommon on the liberal becomes calcified, especially after it there, it seems like a fracture. What did? Simply a nurse? A stab way. It's indicative of this lasted action of injury. This paper from me in clinic pretended of winning John's only war. It looked at the natural history of osteoarthritis in patients. Technically, is any been one. They had looked very, very graphic. And in DC's one of these was the lateral center jungle. It's I'll explain later, but the normal center it angle is between 25 to 40 degrees. So to lower the centrist angle, the created really the risk of progression, osteoarthritis or need to have a basement. Similarly, what defined waas that that the Lantus angle that's troubling index. The normal is 0 to 10 if it's creative and it's a great risk of progression osteoarthritis. So for every degree, decrease in central angle, the chance of having a hip replacement increase over 10% or so, especially if the centers angle is blocking the it decrease. So quite important, England. So yes, we're established that displaces common liver. There is perhaps on the key evens in the butt. Physiology or batter. Genesis offered with lazy on early detection is important, so hold your diagnosis easier. This patient typically present with the something around the hip area. We can have somebody after 2 30. Occasionally they have sores clicking occasional, their vitamin snapping to be aware of these, very rarely, the level complain off instability, but they will be typically strong. Family history when you examined the patient makes you do a good range of movement analysis. If the baby move to reduce clear that they had a loving osteoarthritis ruin apprehension tests that simply externally rotating the hip and extension, they might feel some degree of instability or discomfort in the entry part of the hip, you're more important. It's recess the patient in tone position to take the patient profile of the femur so that you can detect any imbalance in general patient on exhortation. Indeed, at the same time, look 40 Dorsen toward bold emitting, I would say extra, perhaps gives you most of the information MRI scan, especially for this place here, I will say, is very little unless you grew out OCR traders for me, the million Vest Asians X ray or a CT scan. When you're looking at X rays, make sure that the palaces where in terms off hormonal plain alignment sad still playing the abnormalities, looking, for example in abnormalities. To make sure the doctor performs the same shape, make sure that the distance between the symphysis and the coccyx is around an inch or so and the pelvis. The horizontal line is horizontal. Who, if you want to measure angles, yes, you have to draw or horizontal connecting the tear drops. Or, indeed, a skilled a positive on for 27. You draw a line along the weight bearing so has mentioned before. Normal is 5 to 10 decrease. And then this young girl, you can see that it's more than 10 degrees brought center. It's angle. Drop a nickel er from the center of the family head. There, another line through the center of the former head from the edge of that stuff. Normal is 25 to 35 degrees. You're in this case, it's introduced. Then you can also says that, um, head on the coverage. One of the best investigations CT scan, especially If you do a three D reconstruction, what are you looking at on the excess? Because much more smaller office who? It's important to understand the relationship between the anterior and the hospital if the Androgel is lateral, is compared to the postural it is across for that, it's indicated off, establish or if it's still media, then it's indicative of focal and displays you, for example, in this case. But clearly the pelvis is still too, because off the spinal abnormality this patient unusual measurements. One would say that the centers angle is normal. Establish index is normal. But if you look at them through all of the statins, which one? The right side. It's quite media on. When you get a CT scan, you can see especially Focalin display. See yes, look at the entry. The Postwar. Get a CT scan. When you getting a CT scan, make sure includes to me so you can measure the family wash in, and most people also actually include the ankle to assess the proportion. We keep index used in the pediatric circles proposing the pediatric cycles, and that made me. But it's also a applied in adults. If you combine the family. That stuff reversion. If it's more than 60 degrees, it indicates cigarette and stuff. Pretty normal is 36 degrees. So, yes, this place is common diagnosis dysplasia. You have to examine the patient. Oh, and prone position. Look for some really worsened abnormalities. Look at the X rays closely. Look at the relationship between the enter in the Postwar. Get a CT scan. The next phase is holding minus these patients. Management depends entirely on whether it's purely establish a problem. Or is there a family problem itself? We might have a family had s first image, many to address. They might have some reverse initials, which we need to be. Uh, it just is make sure the hip is congruent. Before hoping for presenting safe, which is a significant arthritis, I would suggest being better off with the hip replaced asymptomatic patients. Most of us would not be actually. So the question is, can we truly order the natural history off hip? Spacey So this 21 year old can prevent the degeneration from progressing. So by the end of 34 years, this it was clearly completely arthritic sort of treatment off the ceiling about pasta be it cost me, which can be triple Buchard. Scary are Scipio is probably the most well described most Children in, which is what I'll concentrate on. Femoral osteotomy is an option for from reversion of normality clear their travel from rostrata that can be done as well, depending on the pathology of the femur on probation really is a good option in patients in arthritis. So hip are. Trust me doesn't true. The people with severe dysplasia if you perform the hip, are trust to be be high biliary. It's got a tractor, though, thinking off repairing the labrum so that everything will kill, be not have pain. But unless you deal with the cause of the labor there, it won't look. And it has been shown that this catastrophic failure, if you try to do a part of us to be and people had severe dysplasia, maybe in Borland's plastic that it's centered. I'm looking 2025. You may want to address the condition, or you may want process that for the before proceeding with the meal, those cases it can be justified yes, from reading. This study has come up, which has proposed a traffic light system, Um, in terms off the civility of distress and whether part So come and drink it. Sort of the basic principal lost art me Well, you won't be improved. The family had cover. So from there go there. You can see the family had it better covered after no stroke case me, that would be possible unless you do from last year. So the aim is to increase the contact area. Prove the congress see refused contact stress. In the end, you're dressed or by mechanics going to move the damaged article carton away from repairing want So the normal articular cartilage becomes very and then it that would look, offload the damn a scarlet and probably helping the cartilage degeneration. Boonies view is the most well described osteo me for hip dysplasia here. It's a very powerful lost your me. It allows the last correction. The postural color is left in that, and that helps similar guns off weight bearing forces going along the coast, recalling and then the piece has been possibly rehabilitated sooner. So those two columns entire large collections possible hour. Technically, it's more demanding, and it allows John utilization. It would be ideal so in the past. Muscle approaches we use, but it's all changed. You can do it using a my escrow. It's well describe the literature. We also shown that the complications and outcome off the peers dependent on the surgical approach on in the current AM I support is the complication rate is much lower than what the systematic review his social. So this paper compared am I supposed to withstand, really inquire bruised the arteries to use on found that it not only reduced blood loss and transitional common, um, in in Duration city, but also helping with the joints. So I would it certainly reduce. Start to introduce is rate, which is a serious complication to have to joint. So I will read. You can see the blue. It's in understanding. I didn't one approach and then my support much better on the daughter, so volatile it did feel that might be your related operation selection on the same paper that shown that people would create a degree of degeneration with experience that form on the force away. So because ms is why it's clearly, um, I support is much better, More appealing medication, you know, Big shout out for the no not blasting hip registry it published. It's Seventh and Report, not along with more than 1000 your patients entered from across the country, clearly shows that 12 months out comes in truth with all the sores that we should be cautious in terms of, uh, doing it in patients who older than 40 45. And the study from Japan had shown that all the five years people older than 40 fine equally well as compared with the people younger than 40. But beyond that, at 10, 15, 20 years of sorrows, thank you for three s years and established technique, good long term results have been established, and 20 and 30 year olds a published has been shown that the five year survival is 96% daniel 90%. So, actually, in keeping with some joint places that we have and my own personal stories yes, more than 500 cases but Norvasc in June of injury blood transfusion rate has reduced the time. It's fairly 67% now bases do need some sort of trouble. Prophylactic agent. Despite that, they can develop billion DVT stress. Facture is an unrecognized under reported complication, especially of the pasta column. It got naming on the surgeon only to be slightly very off it. In terms of outcome, all the data is entered into the no, no, plus the hip registry. We have our own registry, which tracks and out comes over bit of time. So you can see in the last 10 years you're in here, though outcomes actually tend to improve after until between, it does come in stable. So, Bill, because good function results but resume it long term survival is low complication. Really? Yeah, especially the my support. Just don't open the patient's election. Then on an ideal 100 someone was less than 30 years of age, it nasty arthritis. And you can expect the 90% survival 20 years for these patients. So I'm back to the learning points. Yes, dysplasia is common labor. There is one of the key, even. And perhaps diagnosing these before liberty or as soon as the labor that happens is important. Before osteoarthtitis develops gums of diagnosis to examine the patient and prone position. Look at the trend. The postural relationship on the x ray. Look at the CT scan. Make sure you measure the Femara Bush management options. Not everyone needs an operation, but some benefit from you or femoral started or injury. A combination basis. Election. This is excellent. Thank you much.