Medical Student Research Fellowship for Summer 2008

Mentor: Karl Rathjen, M.D.
Department: Orthopaedic Surgery
Room number: TSRH, 2222 Welborn St., Dallas, TX 75219
Mail Code:
Phone number: 214-559-7555
E-mail: Karl.Rathjen@tsrh.org
Project title: Long Term Functional and Radiographic Outcome of Developmental Dysplasia of the Hip

Human subjects IRB approved project number (where applicable): 102006-053

Animal subjects IRB approved project number (where applicable):

Project Type: Prospective patient-based research.

Brief Description of Project: Specific Aims: The aim of this study is to develop a reliable, reproducible and valid radiographic classification for DDH regardless of treatment by correlating existing radiographic measurement with validated functional outcome measures. Steps to achieve this include:

1) Establish adequate inter- and intra- reliability for the radiographic measurements. This will be accomplished by having 6 different surgeons record all the radiographic measurements on 20-30 different radiographs (that represent an appropriately diverse sample of outcomes) on two separate occasions.

2) Once we have recorded all health-related quality of life information and radiographic measurements, statistical analysis will be done to identify which combination of radiographic measurements correlate best with the health-related quality of life.

3) Validity over time (ie. to demonstrate whether patients with a poor radiographic score deteriorate more than those with a better radiographic score) will be assessed by a followup assessment (utilizing both radiographs and quality of life outcome measures) 10 years after the initial assessment.

Study Design: All patients 18 years of age and older treated for idiopathic DDH at Texas Scottish Rite Hospital for Children (TSRH) who have reached skeletal maturity will be included in this study. We will review the clinical and radiographic records of all patients with the diagnosis of idiopathic DDH. All patients will be asked to return to TSRH for a follow up radiographic examination, including the administration of Health Related Quality of Life (HRQL) questionnaires. Target accrual number is 400 patients.

The radiographic exam will include a standing anteroposterior (AP) pelvic radiograph and a false profile lateral radiograph of the acetabulum. These are the standard radiographs obtained for all patients undergoing an evaluation for DDH at TSRH. The radiographic measurements to be analyzed will include the lateral and ventral center edge angles, femoral head extrusion index, acetabular index, lateral subluxation, superior (vertical) subluxation, peak-to-edge distance, cross over sign, posterior wall sign and Shenton's line.

Previous Research Activities or Publications with Medical Students:

2007 - Cuyler Dear and Terri Griffith worked on preliminary chart reviews for this same study. No publications since study is still underway.

2006 - Mustafa Alibhai - Recurrence Rate Following Curettage and Bone Grafting of Aneurysmal Bone Cysts of the Extremities. - no publications

2005 - Zachary Vest - Long Term Following Removal of Posterior Spinal Implants

Rathjen, KE, M Wood, A McClung, Z Vest. Clinical and Radiographic Results After Implant Removal in Idiopathic Scoliosis. Spine. (In press)

2004 - Heath McCullough - Outcome of Open Reduction for Treatment of DDH in the Older Child - no publications