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Zhang Y, Weng L, Zhang G, Zhou H, Liu X, Cao Y. Arthroscopic debridement and reduction is an effective procedure for failed closed reduction in young children with developmental dislocation of the hip. INTERNATIONAL ORTHOPAEDICS 2024; 48:1401-1409. [PMID: 38478021 DOI: 10.1007/s00264-024-06140-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 03/02/2024] [Indexed: 05/08/2024]
Abstract
PURPOSE To assess the efficacy of arthroscopic debridement and reduction through two medial portals for the treatment of developmental dislocation of the hip (DDH) with failure of initial closed reduction and to explore key pathological structures obstructing reduction. METHODS Forty-eight children with 58 irreducible dislocated hips treated by arthroscopic reduction between January 2017 and December 2020 were retrospectively evaluated. Arthroscopic reduction was performed via two medial portals located in the superior and inferior adductor longus. All intra-articular obstacles were eliminated via arthroscopy, followed by manual reduction and spica cast immobilization. The surgical duration, extent of improvement in the safe zone, and extent of secondary surgical treatment were noted. All the children were followed up for > 24 months. Hip function and radiographic outcomes were evaluated. RESULTS All 58 hips showed safe zone improvement and concentric reduction after arthroscopic debridement. Hypertrophic ligamentum teres and thickened pulvinars were detected and resected in all hips. Constrictive capsules preventing reduction were observed in 15 hips, which needed to be further released. No inverted labrum was observed. Secondary surgery was performed in four hips with redislocation and seven hips with subluxation during follow-up. The remaining 47 hips (81.03%) maintained their reduction at the last follow-up. Excellent and good clinical outcomes were achieved in 95.74% of patients according to McKay's criteria. Two hips, three hips, and one hip were diagnosed with grade I, II, and III osteonecrosis of the femoral head, respectively. CONCLUSION This study demonstrated that arthroscopic debridement and reduction is a safe and feasible choice for treating irreducible DDH.
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Affiliation(s)
- Yuan Zhang
- Department of Orthopaedics, National Clinical Research Center for Child Health and Disorders; Ministry of Education Key Laboratory of Child Development and Disorders; Chongqing Key Laboratory of Pediatrics; Children's Hospital of Chongqing Medical University, 136 Zhongshan Er Road, Yuzhong District, Chongqing, 400014, People's Republic of China
| | - Liuqi Weng
- Department of Orthopaedics, National Clinical Research Center for Child Health and Disorders; Ministry of Education Key Laboratory of Child Development and Disorders; Chongqing Key Laboratory of Pediatrics; Children's Hospital of Chongqing Medical University, 136 Zhongshan Er Road, Yuzhong District, Chongqing, 400014, People's Republic of China
| | - Ge Zhang
- Department of Orthopaedics, National Clinical Research Center for Child Health and Disorders; Ministry of Education Key Laboratory of Child Development and Disorders; Chongqing Key Laboratory of Pediatrics; Children's Hospital of Chongqing Medical University, 136 Zhongshan Er Road, Yuzhong District, Chongqing, 400014, People's Republic of China
| | - Hai Zhou
- Department of Orthopaedics, National Clinical Research Center for Child Health and Disorders; Ministry of Education Key Laboratory of Child Development and Disorders; Chongqing Key Laboratory of Pediatrics; Children's Hospital of Chongqing Medical University, 136 Zhongshan Er Road, Yuzhong District, Chongqing, 400014, People's Republic of China
| | - Xing Liu
- Department of Orthopaedics, National Clinical Research Center for Child Health and Disorders; Ministry of Education Key Laboratory of Child Development and Disorders; Chongqing Key Laboratory of Pediatrics; Children's Hospital of Chongqing Medical University, 136 Zhongshan Er Road, Yuzhong District, Chongqing, 400014, People's Republic of China
| | - Yujiang Cao
- Department of Orthopaedics, National Clinical Research Center for Child Health and Disorders; Ministry of Education Key Laboratory of Child Development and Disorders; Chongqing Key Laboratory of Pediatrics; Children's Hospital of Chongqing Medical University, 136 Zhongshan Er Road, Yuzhong District, Chongqing, 400014, People's Republic of China.
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Hu X, Tan Q, Mei H, Mo S, Liu K. Research on anterior minimally invasive approach in the treatment of children with developmental dysplasia of the hip. BMC Musculoskelet Disord 2023; 24:482. [PMID: 37312176 DOI: 10.1186/s12891-023-06582-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 05/30/2023] [Indexed: 06/15/2023] Open
Abstract
OBJECTIVES To investigate the clinical efficacy and safety of open reduction through anterior minimally invasive approach in the treatment of children with developmental dysplasia of the hip. METHOD A total of 23 patients (25 hips) less than 2 years with developmental dysplasia of the hip treated by open reduction through anterior minimally invasive approach were treated in our hospital from August 2016 to March 2019. Through the anterior minimally invasive approach, we enter from the gap between sartorius muscle and tensor fasciae lata without cutting off rectus femoris muscle, which can effectively expose the joint capsule and reduce the damage to medial blood vessels and nerves. The operation time, incision length, intraoperative bleeding, hospital stay and surgical complications were observed. The progression of developmental dysplasia of the hip and avascular necrosis of the femoral head were evaluated by imaging examination. RESULT All patients were performed with follow-up visit for an average of 22 months. The average incision length was 2.5 cm, the average operation time was 26 min, the average intraoperative bleeding was 12ml, and the average hospital stay was 4.9 days. All patients received concentric reduction immediately after operation, and no re-dislocation occurred. At the last follow-up visit, the acetabular index was (25.8 ± 6.4°). During the follow-up visit, X-ray showed avascular necrosis of the femoral head in 4 hips (16%). CONCLUSION open reduction through anterior minimally invasive approach can achieve good clinical effect in the treatment of infantile developmental dysplasia of the hip.
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Affiliation(s)
- Xiongke Hu
- Department of Pediatric Orthopedics, Hunan Children's Hospital, Pediatric Academy of University of South China, No.86, Ziyuan Road, Yuhua District, Changsha, 410000, Hunan Province, China
- Hunan Provincial Key Laboratory of Pediatric Orthopedics, Changsha, 410008, Hunan, China
| | - Qian Tan
- Department of Pediatric Orthopedics, Hunan Children's Hospital, Pediatric Academy of University of South China, No.86, Ziyuan Road, Yuhua District, Changsha, 410000, Hunan Province, China
- Hunan Provincial Key Laboratory of Pediatric Orthopedics, Changsha, 410008, Hunan, China
| | - Haibo Mei
- Department of Pediatric Orthopedics, Hunan Children's Hospital, Pediatric Academy of University of South China, No.86, Ziyuan Road, Yuhua District, Changsha, 410000, Hunan Province, China
- Hunan Provincial Key Laboratory of Pediatric Orthopedics, Changsha, 410008, Hunan, China
| | - Shasha Mo
- Department of Pediatric Orthopedics, Hunan Children's Hospital, Pediatric Academy of University of South China, No.86, Ziyuan Road, Yuhua District, Changsha, 410000, Hunan Province, China
| | - Kun Liu
- Department of Pediatric Orthopedics, Hunan Children's Hospital, Pediatric Academy of University of South China, No.86, Ziyuan Road, Yuhua District, Changsha, 410000, Hunan Province, China.
- Hunan Provincial Key Laboratory of Pediatric Orthopedics, Changsha, 410008, Hunan, China.
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Kiani SN, Gornitzky AL, Matheney TH, Schaeffer EK, Mulpuri K, Shah HH, Yihua G, Upasani V, Aroojis A, Krishnamoorthy V, Sankar WN. A Prospective, Multicenter Study of Developmental Dysplasia of the Hip: What Can Patients Expect After Open Reduction? J Pediatr Orthop 2023; 43:279-285. [PMID: 36882887 DOI: 10.1097/bpo.0000000000002383] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
BACKGROUND Although there are several predominantly single-center case series in the literature, relatively little prospectively collected data exist regarding the outcomes of open hip reduction (OR) for infantile developmental dysplasia of the hip (DDH). The purpose of this prospective, multi-center study was to determine the outcomes after OR in a diverse patient population. METHODS The prospectively collected database of an international multicenter study group was queried for all patients treated with OR for DDH. Minimum follow-up was 1 year. Proximal femoral growth disturbance (PFGD) was defined by consensus review using Salter's criteria. Persistent acetabular dysplasia was defined as an acetabular index >90th percentile for age. Statistical analyses were performed to compare preoperative and operative characteristics that predicted re-dislocation, PFGD, and residual acetabular dysplasia. RESULTS A cohort of 232 hips (195 patients) was identified; median age at OR was 19 months (interquartile range 13 to 28) and median follow-up length was 21 months (interquartile range 16 to 32). Re-dislocation occurred in 7% of hips (n=16/228). The majority (81%; n=13/16) occurred in the first year after initial OR. Excluding patients with repeat dislocation, 94.5% of hips were IHDI 1 at most recent follow-up. On the basis of strict radiographic review, some degree of PFGD was present in 44% of hips (n=101/230) at most recent follow-up. Seventy-eight hips (55%) demonstrated residual dysplasia compared with established normative data. Hips that had a pelvic osteotomy at index surgery had about half the rate of residual dysplasia (39%; n=32/82) versus those without a pelvic osteotomy with at least 2 years follow-up (78%; n=46/59). CONCLUSIONS In the largest prospective, multicenter study to date, OR for infantile DDH was associated with a 7% risk of re-dislocation, 44% risk of PFGD, and 55% risk of residual acetabular dysplasia at short term follow-up. The incidence of these adverse outcomes is higher than previous reports. Patients treated with concomitant pelvic osteotomy had lower rates of residual dysplasia. These prospectively collected, multicenter data provide better generalizable information to improve family education and appropriately set expectations. LEVEL OF EVIDENCE Level II, prospective comparative study.
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Affiliation(s)
- Sara N Kiani
- Department of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Alex L Gornitzky
- Department of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | | | - Emily K Schaeffer
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
| | - Kishore Mulpuri
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
| | - Hitesh H Shah
- Department of Orthopaedics, Kasturba Medical College, Manipal, Karnataka
| | - Ge Yihua
- Department of Orthopaedics, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra
| | - Vidyadhar Upasani
- Department of Orthopaedics, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - Alaric Aroojis
- Department of Orthopaedics, Shanghai Children's Medical Center, Shanghai, China
| | | | - Wudbhav N Sankar
- Department of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
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Ciftci S, Aydın BK. Letter to the editor regarding "Is capsulorrhaphy a necessary step during open reduction of developmental dysplasia of the hip? A randomized controlled trial". INTERNATIONAL ORTHOPAEDICS 2022; 46:1207. [PMID: 35234999 DOI: 10.1007/s00264-022-05360-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 10/19/2022]
Affiliation(s)
- Sadettin Ciftci
- Faculty of Medicine, Department of Orthopaedics and Traumatology, Selcuk University, Alaeddin Keykubat Campus, 42100, Selcuklu, Konya, Turkey.
| | - Bahattin Kerem Aydın
- Faculty of Medicine, Department of Orthopaedics and Traumatology, Selcuk University, Alaeddin Keykubat Campus, 42100, Selcuklu, Konya, Turkey
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