CEMİL ERTÜRK, Sezen KOÇARSLAN, Halil BÜYÜKDOĞAN, MEHMET AKİF ALTAY

Investigation of sensory nerve endings in pulvinar, ligamentum teres, and hip joint capsule: A prospective immunohistochemical study of 36 cases with developmental hip dysplasia

Objective: The aim of this study was to immunohistochemically identify and characterize the presence of sensory nerve endings (SNEs) inpulvinar, ligamentum teres (LT), and hip joint capsule (HJC) of children with developmental dysplasia of the hip (DDH).Methods: Pulvinar, LT, and HJC specimens were obtained from 38 hips of 36 children (31 girls, five boys; mean age=49 months; agerange=18-132 months) during open reduction surgery for DDH. All specimens underwent subsequent routine tissue processing (formalinfixation and paraffin embedding). To determine tissue morphology, haematoxylin and eosin staining was used. SNEs were analyzed immunohistochemically using a mouse monoclonal antibody against S-100 Beta Protein based on the classification of Freeman and Wyke including four types of SNEs including mechanoreceptors: type I Ruffini corpuscles, type II Pacini corpuscles, type III Golgi organs, and type IVaunmyelinated free nerve endings (FNEs). Additionally, children were sorted into three groups based on their age at the time of surgery: Group1 (age 5 years; 9 hips of 8 children).Results: Although no Type I, II, or III SNEs were identified in any specimen, type IVa mechanoreceptor (FNEs) was immunohistochemicallycharacterized in 13 (34%) pulvinar, 19 (50%) LT, and 16 (42%) HJC specimens. The total density of FNEs was 3.31±5.70)/50 mm2 (range 0-21)in pulvinar specimens, 3.18 ± 5.92)/50 mm2 (range 0–24) in HJC specimens, and 4.51±6.61/50 mm2 (range 0-22) in LT specimens. Furthermore, the operated side, gender, and the number of FNEs in specimens did not differ significantly among the age groups (p>0.05 for all), andthe number of FNEs was not significantly correlated with age, gender, or the operated side (p>0.05 for all).Conclusion: Evidence from this study revealed that pulvinar, LT, and HJC include only FNEs, which play a role in pain sensation, amongmechanoreceptors. Surgical excision of these tissues may not cause a significant loss of sensory function in the hip joint of children withDDH.Level of Evidence: Level II, Therapeutic Study

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