A new functional Hip Scoring System compatible with Asian Lifestyle

doi: https://doi.org/10.12669/pjms.38.3.5758 
How to cite this:Junaid J, Bhatti A. A new functional Hip Scoring System compatible with Asian Lifestyle. Pak J Med Sci. 2022;38(3):442-444. doi: https://doi.org/10.12669/pjms.38.3.5758 
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The goals of treatment in children with hip problems are to create normal anatomy of the proximal femur and acetabulum and maintain that anatomy to allow normal development of hip function. With experience and greater understanding of the outcomes, surgical recommendations frequently change. These surgeries are complicated, and the outcome has a direct correlation with experience. 1 4 McKay, Trevor, and Modified MacKay criteria and modified Harris hip score are the most frequently used methods. The parameter used by these methods include, presence of pain, limp, stability in the supine position, Trendelenburg sign, deformity, ROM, functional limitations, and endurance. The functional limitation evaluated includes "as described by the patient" that "partially limited or severely limited". 5 These functional limitations or types of functions have never been categorized or explained before.
All these systems have been designed with needs of western lifestyle in mind. Whereas the eastern (Asian) population have some unique sitting habits to sit on floor with positions of Squat (Crouch Sitting), Palthi (Cross leg sitting) and Tashahhud (Kneeling) as shown in Fig. A-C, that has never been addressed in these methods of evaluation. These sitting postures in Asian lifestyle are accustomed and used every day for eating, prayers, work on floor and maintain bowel habits. To adopt these postures, place a huge exertional demand on postoperative hip is required, along with a good stability, balanced muscle power, supple pain free hip, knee, and trunk. The currently available scoring systems reveal significant limitations to evaluate patients' endurance and ability to attain these exertional activities, commonly practiced every day in eastern lifestyle and need of the day for children for assimilation into society and not feeling like an outlier. Failure to achieve those postures produce a significant emotional and psycho-social burden to the parents, patient, and community. 3 Henceforth, it is thus a need of time to do develop a method, that better suits to evaluate patient's limitation to achieve postures of Squat, Palthi and Tashahhud. Bhatti A et al introduced a new system that evaluate post-surgical reduction of DDH while patients perform their accustomed  The limitations exhibited by patients while adopting these postures are documented, recorded in video, and photographed. The video recording and photography without physical contact of the evaluator, significantly improve compliance of the patient, save time of concerned surgeon. The video can also be recorded easily at home by the parents, that provide a bias free, remote evaluation for a long-term follow-up and research.
The BFHS is recommended to be used after a minimum one-year post-operative duration. The duration that is mandatorily required to get back pain free, supple mobile hip joint with remodeling of articular surfaces, and relief of stiffness. By this time patient regain muscle strength, stability, and balance to have an endurance to perform these exertional activities. The effective use of BFHS after a year and quarterly thereafter helps in confidence build-up amongst parents and surgeon, with a real time demonstration of progressive development of hip/hips.
A pilot study of comparison between "outcome of Bhatti's vs Mackay & Ferguson scoring system" in post-surgical reduction of DDH 3 revealed comparatively similar results in terms of presence of pain, limp, Trendelenburg sign and endurance. Whereas BFSS was found superior scoring system to evaluate functional limitations of Asian lifestyle, having better compliance, less time consuming, reliability and accuracy better than MacKay & Ferguson with kapa value 100.0.
Moreover, the combination of BFHS with Severin's radiological classification 8 provides a comprehensive progressive clinico-radiological evaluation of the paediatric post-surgical hip/hips (Fig.A-E). That is significantly compatible with Eastern (Asian) lifestyle as well.

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