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A Survey of Parents' and Carers' Perceptions of Parenting a Child With Developmental Dysplasia of the Hip. Pediatr Phys Ther 2022; 34:328-333. [PMID: 35639555 DOI: 10.1097/pep.0000000000000917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To explore parents' and carers' perceptions of parenting a child with developmental dysplasia of the hip (DDH). METHODS A retrospective analysis of a questionnaire of parents and carers of children with hip dysplasia. Data analysis was guided by qualitative content analysis. RESULTS There were 753 responses describing a range of parenting experiences. Three themes emerged: arduous parenting , detailed the parenting challenges, both practical and emotional posed by the management of DDH; insufficient understanding , described the social disconnection experienced by the respondents due to a lack of empathy from others; inconsistent guidance , encompassed respondents' reliance on health professionals for information and support, yet frustration at variability in the management of DDH. CONCLUSIONS Overall, having to care for a child with DDH has a negative effect on the practice of parenting. Health professionals can support parenting and provide consistent education to assist parents' understanding of the complex nature of DDH management. What this study adds to the evidence: Despite a good prognosis, the diagnosis of hip dysplasia has a negative effect on of parenting. Parents and carers of children with hip dysplasia rely on the support of health professionals but find the associated loss of parenting autonomy distressing.
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Salton RL, Carry P, Freeman T, Holmes K, Miller NH, Kohuth B, Burke D, Belton M, Murphy-Zane MS, Georgopoulos G. Twelve-week standard of care protocol longer than median time to normalization among IIc hips treated with Pavlik harness. J Pediatr Orthop B 2022; 31:313-318. [PMID: 35102060 DOI: 10.1097/bpb.0000000000000946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Best treatment protocols for infants with developmental dysplasia of the hip (DDH) are poorly defined. This study estimates the time to normalization among Graf IIc hips undergoing Pavlik harness treatment. Following institutional review board approval, patients referred for DDH evaluation at a pediatric institution between 2009 and 2018 (n = 1424 hips/712 patients) were identified. We isolated all Graf IIc hips that underwent Pavlik harness treatment (n = 132 hips/n = 106 patients). Demographic and outcome measures were collected. Normalization was defined as alpha angle greater than or equal to 60° and femoral head coverage greater than or equal to 50%. Kaplan-Meier and Cox proportional hazards regression analyses modeled time to normalization and identified factors associated with earlier normalization. Median time to normalization was 7.0 weeks. At 12 weeks standard treatment, 85.8% [95% confidence interval (CI): 80.2-91.9%] had normalized. Greater femoral head coverage [hazard ratio (HR) per 1% increase: 1.03; 95% CI: 1.01-1.05; P = 0.0068] and hip stability at treatment initiation (HR unstable vs. stable: 0.64; 95% CI: 0.44-0.93; P = 0.0192) were associated with longer time to normalization. Some patients may not need 12 weeks of Pavlik bracing, particularly those with stable presentation who normalize before week 12. Shorter treatment lengths offer benefit without sacrificing long-term outcomes. Findings reinforce growing evidence that femoral head coverage should be a more significant consideration during diagnosis and instability is a concerning finding on examination.
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Affiliation(s)
- Reba L Salton
- Musculoskeletal Research Center, Orthopedics Institute, Children's Hospital Colorado
| | - Patrick Carry
- Musculoskeletal Research Center, Orthopedics Institute, Children's Hospital Colorado
- Department of Orthopedics, Anschutz Medical Campus, University of Colorado School of Medicine
| | - Tyler Freeman
- Department of Orthopedics, Anschutz Medical Campus, University of Colorado School of Medicine
| | - Kaley Holmes
- Musculoskeletal Research Center, Orthopedics Institute, Children's Hospital Colorado
| | - Nancy H Miller
- Department of Orthopedics, Anschutz Medical Campus, University of Colorado School of Medicine
- Department of Orthopedics, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Brian Kohuth
- Department of Orthopedics, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Deborah Burke
- Department of Orthopedics, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Matthew Belton
- Department of Orthopedics, Anschutz Medical Campus, University of Colorado School of Medicine
| | - Margaret Siobhan Murphy-Zane
- Department of Orthopedics, Anschutz Medical Campus, University of Colorado School of Medicine
- Department of Orthopedics, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Gaia Georgopoulos
- Department of Orthopedics, Anschutz Medical Campus, University of Colorado School of Medicine
- Department of Orthopedics, Children's Hospital Colorado, Aurora, Colorado, USA
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Radiographic Outcomes of Ganz versus Modified Triple Osteotomies in Femoral Head Medialization and Coverage in Acetabular Dysplasia. J Clin Med 2022; 11:jcm11071924. [PMID: 35407532 PMCID: PMC9000010 DOI: 10.3390/jcm11071924] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/27/2022] [Accepted: 03/28/2022] [Indexed: 02/04/2023] Open
Abstract
Variable techniques in periacetabular osteotomy have been formulated for the treatment of acetabular dysplasia. However, few studies have compared the radiographic outcomes between different osteotomy types. This study compared modified triple innominate (MTI) osteotomy and Ganz osteotomy with respect to radiographic outcomes. Patients receiving MTI osteotomies and Ganz osteotomies at any time between 2006 and 2018 in a tertiary medical centre were recruited. Only patients with unilateral osteotomies were recruited to eliminate potential influence from the contralateral hip following periacetabular osteotomy. Patients having hip-joint dislocation, receiving simultaneous proximal femoral osteotomy, or having fewer than 2 years of follow-up were excluded. The radiographic parameters of preoperative and postoperative anteroposterior radiographs of the pelvis were measured, and Sharp’s angle (SA), the lateral centre-edge angle (CE angle), the femoral head extrusion index (FHEI), and the centre-head distance discrepancy (CHDD) were included for comparison. Among 55 participants, 23 received MTI osteotomies and 32 received Ganz osteotomies. The mean age at which patients underwent surgery was 21.9 years in the Ganz osteotomy group and 21.1 years in the MTI group. The mean follow-up length was 2.5 years. The preoperative radiographic parameters between groups differed only slightly and nonsignificantly. Both groups exhibited significantly improved SA, LCEA, and FHEI after surgery. The Ganz osteotomy group exhibited more favourable postoperative FHEI (13.5 vs. 24.3, p < 0.0001), CHDD (3.7 vs. 11.5, p < 0.0001), Sharp angle (45.0 vs. 41.8, p = 0.0489) and CE angles (28.3 vs. 21.1, p = 0.029) compared with the MTI osteotomy group. Notably, CHDD became better and worse following Ganz and MTI osteotomies, respectively; this suggests that the femoral head is pushed laterally in modified triple osteotomy. With respect to femoral head coverage and the medialization of the femoral head, Ganz osteotomy exhibits more favourable corrections in postoperative radiographic parameters than does MTI osteotomy.
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Xu N, Xia B, Tao H, Sun K, Liu Q, Chen W, Wang D, Gao H, Guo Y, Liu Y, Gao J, Teng J, Li T, He Q, Wu Z. Epidemiological investigation and ultrasonic diagnosis of developmental dysplasia of the hip in Chinese infants: A large multi-center cohort study. Medicine (Baltimore) 2022; 101:e28320. [PMID: 35029175 PMCID: PMC8758026 DOI: 10.1097/md.0000000000028320] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 11/26/2021] [Indexed: 01/05/2023] Open
Abstract
Developmental dysplasia of the hip (DDH) is common among Chinese infants, but a lack of large-scale, multi-center epidemiological studies has made it difficult to characterize the risk factors associated with this disease.This multi-center cohort study included 19,833 Chinese infants aged 14 days to 6 months. A multi-center ultrasound protocol was used to diagnose hip abnormalities, and epidemiological data of the infants were collected through questionnaires. Categorical variables were expressed as percentages and compared using χ2 test. Multivariate analysis was performed through logistic regression.Of 19,833 infants, 345 had DDH (1.7%). DDH incidence was higher in female infants (n = 279) than in male infants (n = 66) (χ2 = 95.89, P < .05), and there were more left hip cases (n = 149) than right hip cases (n = 79) (χ2 = 12.49, P < .05). DDH incidence was statistically different amongst different age groups in months (χ2 = 451.71, P < .05), and it gradually decreased with age (P < .05). The prevalence of a positive DDH family history, breech presentation, oligohydramnios, swaddling style, and other musculoskeletal deformities was higher in the positive group than in the negative group (all P < .05). No significant differences were found in terms of delivery by cesarean section, multiple births, or premature birth between both groups.Family history, breech presentation, oligohydramnios, musculoskeletal deformities, and female sex are high-risk factors for DDH in Chinese infants. The incidence of DDH gradually decreases with age. The results of this study provide evidence for the epidemiology of infant DDH in China.
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Affiliation(s)
- Na Xu
- Department of Ultrasound, The Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Bei Xia
- Department of Ultrasound, The Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Hongwei Tao
- Department of Ultrasound, The Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Ke Sun
- Department of Orthopedics, The Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Qinghua Liu
- Department of Ultrasound, The Qilu Children's Hospital of Shandong University, Jinan, Shandong, China
| | - Wenjuan Chen
- Department of Ultrasound, The Hunan Children's Hospital, Changsha, Hunan, China
| | - Dan Wang
- Department of Ultrasound, The Zhengzhou Children's Hospital, Zhengzhou, Henan, China
| | - Hong Gao
- Department of Ultrasound, The Kunming Children's Hospital, Kunming, Yunnan, China
| | - Yan Guo
- Department of Ultrasound, The Shanxi Children's Hospital, Taiyuan, Shanxi, China
| | - Yan Liu
- Department of Ultrasound, The Guizhou Women and Children's Hospital, Guiyang, Guizhou, China
| | - Jun Gao
- Department of Ultrasound, The Wuhan Women's and Children's Health Care Center (Wuhan Children's Hospital), Wuhan, Hubei, China
| | - Jianbo Teng
- Shandong Medical Imaging Research Institute, Jinan, Shandong, China
| | - Tianzi Li
- Department of Ultrasound, The Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Qiancheng He
- Department of Ultrasound, The Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Zhixia Wu
- Department of Ultrasound, The Shenzhen Children's Hospital, Shenzhen, Guangdong, China
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Lee WC, Chen TY, Hung LW, Wang TM, Chang CH, Lu TW. Increased Loading Rates During Gait Correlate With Morphology of Unaffected Hip in Juveniles With Treated Developmental Hip Dysplasia. Front Bioeng Biotechnol 2021; 9:704266. [PMID: 34368099 PMCID: PMC8335483 DOI: 10.3389/fbioe.2021.704266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 06/29/2021] [Indexed: 11/13/2022] Open
Abstract
Long-term follow-up studies on children with surgically treated developmental dysplasia of the hip (DDH) have shown that not only the affected side progresses to premature osteoarthritis, but the unaffected side may also suffer from insidious hip dysplasia or osteonecrosis. The current gait analysis study identified the loading and unloading rates of the ground reaction forces (GRF) and lower limb joint axial forces during gait, and their correlations with the hip morphology in twenty juvenile patients with surgically treated unilateral DDH during toddlerhood. In a gait laboratory, each subject walked at preferred speed on a 10-m walkway while the kinematics and the GRF were measured. Loading and unloading rates of the vertical GRF and the joint axial forces were obtained as the maximum instantaneous slope of these force curves. Radiographic measurements of the hips were taken, and the correlations between the morphological parameters and the loading and unloading rates were obtained. The patients showed greater-than-normal peak loading rates of the joint axial forces, and the loading rates on both the affected and unaffected sides were strongly correlated to the acetabular index on the unaffected side, which was also significantly correlated with the peak unloading rates on the affected side. These results suggest that apart from regular follow-up of the affected hip, routine assessment of the morphological changes and/or increased loading rates on the unaffected hip is also important for early identification of any signs of insidious hip dysplasia and risk of premature degeneration of the cartilage.
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Affiliation(s)
- Wei-Chun Lee
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan.,Department of Pediatric Orthopedics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tsan-Yang Chen
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Li-Wei Hung
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan.,Department of Orthopedics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Ting-Ming Wang
- Department of Orthopedic Surgery, School of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chia-Hsieh Chang
- Department of Pediatric Orthopedics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tung-Wu Lu
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan.,Department of Orthopedic Surgery, School of Medicine, National Taiwan University, Taipei, Taiwan
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Merckaert SR, Zambelli PY, Edd SN, Daniele S, Brigitte J. Mid- and long-term outcome of Salter's, Pemberton's and Dega's osteotomy for treatment of developmental dysplasia of the hip: a systematic review and meta-analysis. Hip Int 2021; 31:444-455. [PMID: 32678678 DOI: 10.1177/1120700020942866] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Early diagnosis and early treatment have become the gold standard for management of developmental dysplasia of the hip. Surgery is required in case of failed initial treatment. Innominate pelvic osteotomy of Salter (SIO), Pemberton's pericapsular osteotomy (PPO) and Dega's acetabuloplasty (DA) are among the most used procedures.We performed a systematic review and meta-analysis of the past 57 years in order to assess the mid- and long-term outcome of these techniques. METHODS Studies met inclusion criteria if they: (1) reported at least 5 cases treated by 1 of the abovementioned surgical techniques; (2) included children aged between 1 and 8 years; (3) surgical indication was late detected DDH or a failed initial treatment; (4) presented a minimal follow-up of 24 months; (5) reported the radiological score of Severin and/or the clinical score of McKay.Clinical and radiological outcomes were dichotomised into favourable and unfavourable outcome and weighted summary rates were determined using meta-analysis models. RESULTS From a total of 7391 articles, 48 level of evidence grade IV articles were included in our review. A total of 2143 cases with a mean follow up of 112.4 months were included.Pooled Severin score indicated a statistically better outcome for PPO and DA compared to SIO (p = 0.0003 and p = 0.002, respectively). By dichotomising the results in favourable and unfavourable outcome, PPO showed the best results (p = 0.0002 vs. SIO, p = 0.01 vs. DA).Pooled McKay score showed a statistically better outcome for PPO and DA compared to SIO (p < 0.0001 and p = 0.03, respectively) as well as better outcomes for PPO compared to DA (p = 0.01). By dichotomising the results in favourable and unfavourable, PPO showed the best results. CONCLUSIONS Even if our review demonstrates slightly better radiological and clinical results with the PPO, the currently available and limited data do not allow for clear recommendation towards one of these techniques.
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Affiliation(s)
- Sophie R Merckaert
- Department of Paediatric Orthopaedic Surgery, Children's Hospital, Centre Hospitalier Universitaire Vaudois (CHUV) Lausanne, Switzerland
| | - Pierre-Yves Zambelli
- Department of Paediatric Orthopaedic Surgery, Children's Hospital, Centre Hospitalier Universitaire Vaudois (CHUV) Lausanne, Switzerland
| | - Shannon N Edd
- Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Department of Musculoskeletal Medicine (DAL), Swiss BioMotion Lab, Lausanne, Switzerland
| | - Starnoni Daniele
- Department of Neurosurgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Jolles Brigitte
- Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Department of Musculoskeletal Medicine (DAL), Swiss BioMotion Lab, Lausanne, Switzerland.,Institute of Micro Engineering, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
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Longo UG, Papalia R, De Salvatore S, Ruzzini L, Piergentili I, Oggiano L, Costici PF, Denaro V. Developmental Hip Dysplasia: An Epidemiological Nationwide Study in Italy from 2001 to 2016. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126589. [PMID: 34207407 PMCID: PMC8296454 DOI: 10.3390/ijerph18126589] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/12/2021] [Accepted: 06/14/2021] [Indexed: 01/11/2023]
Abstract
Developmental Dysplasia of the Hip (DDH) includes a broad spectrum of hip abnormalities. DDH requires early diagnosis and treatment; however, no international consensus on screening protocol and treatment is provided in the literature. Epidemiological studies are helpful to understand the national variation of a specific surgical procedure and compare it with that of other countries. Data provided by different countries could allow researchers to provide international guidelines for DDH screening and treatment. Limited data are reported regarding trends of hospitalization for DDH, and no public database is available. The purpose of this study was to estimate annual admissions for DDH in Italian patients from 2001 to 2016, based on the hospitalization reports. Data of this study were collected from the National Hospital Discharge Reports (SDO) reported at the Italian Ministry of Health. Descriptive statistical analyses were performed. From 2001 to 2016, 3103 hospitalizations for DDH were recorded in Italy, with a mean incidence of 2.33 (per 100,000 young inhabitants). Females of the 0–4 years old group represented the majority of patients hospitalized for DDH.
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Affiliation(s)
- Umile Giuseppe Longo
- Department of Orthopedic and Trauma Surgery, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (R.P.); (S.D.S.); (I.P.); (V.D.)
- Correspondence: ; Tel.: +39-06-225411613; Fax: +39-06-225411638
| | - Rocco Papalia
- Department of Orthopedic and Trauma Surgery, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (R.P.); (S.D.S.); (I.P.); (V.D.)
| | - Sergio De Salvatore
- Department of Orthopedic and Trauma Surgery, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (R.P.); (S.D.S.); (I.P.); (V.D.)
| | - Laura Ruzzini
- Orthopedic Unit, Department of Surgery, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (L.R.); (L.O.); (P.F.C.)
| | - Ilaria Piergentili
- Department of Orthopedic and Trauma Surgery, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (R.P.); (S.D.S.); (I.P.); (V.D.)
| | - Leonardo Oggiano
- Orthopedic Unit, Department of Surgery, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (L.R.); (L.O.); (P.F.C.)
| | - Pier Francesco Costici
- Orthopedic Unit, Department of Surgery, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (L.R.); (L.O.); (P.F.C.)
| | - Vincenzo Denaro
- Department of Orthopedic and Trauma Surgery, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (R.P.); (S.D.S.); (I.P.); (V.D.)
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St George J, Kulkarni V, Bellemore M, Little DG, Birke O. Importance of early diagnosis for developmental dysplasia of the hip: A 5-year radiological outcome study comparing the effect of early and late diagnosis. J Paediatr Child Health 2021; 57:41-45. [PMID: 32772467 DOI: 10.1111/jpc.15111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 06/25/2020] [Accepted: 07/15/2020] [Indexed: 01/18/2023]
Abstract
AIM Australia utilises a selective ultrasound screening programme. The rate of late diagnosis of developmental dysplasia of the hip (DDH) in Australia is increasing. The aim of this study is to quantify the treatment required and compare the 5-year radiological outcomes between early and late diagnosis in children with DDH with frank dislocation. METHODS We performed a case-matched control study of children with frank DDH dislocations from 2000 to 2010 comparing three groups: children with an early diagnosis successfully treated in a Pavlik harness (SP), children with an early diagnosis who failed Pavlik harness treatment (FP) and children with a late diagnosis (LD). Minimum follow-up was 4 years. RESULTS A total of 115 hips were included. Patients in the LD group required significantly more open reductions (P < 0.001), acetabular osteotomies (P < 0.001) and femoral osteotomies (P < 0.001). LD was also associated with significantly higher rates of growth disturbance at 46.3%, compared to 20.6% in the FP group and 5% in the SP group (P < 0.001). Overall, there were excellent radiological outcomes in 58.5% of the LD group compared to 79.4% in the FP group and 100% in the SP group. CONCLUSION In Australia, high rates of LD in DDH persist in the context of selective ultrasound screening. While good radiological outcomes are achievable, a significantly greater level of surgical intervention is required and this is associated with significantly higher rates of growth disturbance. Optimisation of screening in Australia is vital.
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Affiliation(s)
- Justine St George
- Department of Orthopaedics, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Vinay Kulkarni
- Department of Orthopaedics, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Michael Bellemore
- Department of Orthopaedics, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - David G Little
- Department of Orthopaedics, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Oliver Birke
- Department of Orthopaedics, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
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Wakely L, Easey P, Leys J, Johnston C. Exploring the Lived Experience of Parenting a Child with Developmental Dysplasia of the Hip. Phys Occup Ther Pediatr 2021; 41:503-514. [PMID: 33557686 DOI: 10.1080/01942638.2020.1867694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Aim: Parenting a child with a health issue such as hip dysplasia (DDH) can be complicated and stressful. We aimed to explore in depth, the lived experience of parenting a child with DDH.Methods: Guided by phenomenology of practice, six mothers and one father of children with DDH were engaged in semi-structured interviews about their parenting experiences. Data were audio-recorded, transcribed verbatim and analyzed thematically.Results: Two themes emerged. Surrendering the parenting prerogative, which described participants' accounts of losing parenting autonomy while needing to rely on others to meet the needs of their child. The second theme; Struggling to adjust day-to-day, described the impact that DDH had on parenting and how participants struggled daily to meet the needs of their child.Conclusion: The management of DDH impacted both the emotional and practical aspects of parenting. Health professionals are ideally placed to support the parenting of children with DDH, but need to understand the parents' particular needs to provide this support empathetically.
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Affiliation(s)
- Luke Wakely
- University of Newcastle Department of Rural Health, Tamworth, Australia
| | - Pollyanna Easey
- Discipline of Physiotherapy, The University of Newcastle, Callaghan, Australia
| | - Jacqueline Leys
- University of Newcastle Department of Rural Health, Tamworth, Australia
| | - Catherine Johnston
- Discipline of Physiotherapy, The University of Newcastle, Callaghan, Australia
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Yang Y, Porter D, Zhao L, Zhao X, Yang X, Chen S. How to judge pelvic malposition when assessing acetabular index in children? Three simple parameters can determine acceptability. J Orthop Surg Res 2020; 15:12. [PMID: 31941521 PMCID: PMC6964075 DOI: 10.1186/s13018-020-1543-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 01/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The acetabular index (AI) is the most commonly used parameter for diagnosing hip dysplasia. Pelvic malposition can result in misinterpretation of AI measurement especially in younger children. We aimed to investigate the correlation between pelvic orientation and acetabular index (AI) by using digital reconstructed radiographs (DRRs) and identify reliable parameters predictive of pelvic orientation on plain radiographs. METHODS We retrospectively identified 33 children (52 hips) who received dual source CT examinations. Virtual pelvic models were reconstructed after scanning. After orientating in the standard neutral position, the models were rotated and tilted around corresponding axes. DRRs were generated at every 3° during the process. The acetabular index, the horizontal diameter (Dh) and vertical diameter (Dv) of bilateral obturator foramina, the vertical distance (h) between upper border of pubic symphysis, and Hilgenreiner's line were measured on each DRR by two independent observers. Rotation index (Rr = right Dh/left Dh), tilt index (Rt = h/Dv), intra-observer error, and inter-observer error of AI were calculated. RESULTS For tilt and rotation up to 12.0°, AI increased with anterior tilt and decreased with posterior tilt. And for rotation, it increased on the side toward which the pelvis rotated and decreased on the opposite side. AI varied dramatically if angulation exceeded 6.0°. Malposition below this limit demonstrated the intra- and inter-observer errors were ± 2.0° and ± 3.0° respectively and caused no significant effect on AI measurement. CONCLUSIONS For children up to age 6 years, an acceptable pelvic plain radiograph can be determined when Rt is approximately between 0.9 and 1.4 and Rr between 0.7 and 1.5. For the first time, we have identified parameters derived from a group of subjects which can predict this degree of malposition. The parameters obturator diameters (Dh), obturator height (Dv), and distance (h) between symphysis and Hilgengreiner's line can be feasibly measured on X-ray and employed in clinical practice to assess the acceptability of the pediatric pelvic radiograph prior to measurement of the AI.
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Affiliation(s)
- Yi Yang
- Department of Pediatric Orthopaedics, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, No.3333, Binsheng Road, Hangzhou, 310052, China.,Department of Pediatric Orthopaedics, XinHua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, No. 1665, Kongjiang Road, Shanghai, 200092, China
| | - Daniel Porter
- Department of Orthopaedic Surgery, First Hospital of Tsinghua University, No. 6 JiuXianQiao No. 2 St, Chaoyang District, Beijing, 100016, China
| | - Li Zhao
- Department of Pediatric Orthopaedics, XinHua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, No. 1665, Kongjiang Road, Shanghai, 200092, China. .,Ying-Hua Medical Group of Children's Bone and Joint Healthcare, Room 16-3103, Lane 133 Linping Road, Hongkou District, Shanghai, 200086, China.
| | - Xiang Zhao
- Department of Pediatric Orthopaedics, XinHua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, No. 1665, Kongjiang Road, Shanghai, 200092, China
| | - Xuan Yang
- Department of Pediatric Orthopaedics, XinHua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, No. 1665, Kongjiang Road, Shanghai, 200092, China
| | - Suxian Chen
- Department of Radiology, XinHua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, No. 1665, Kongjiang Road, Shanghai, 200092, China
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11
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Merckaert SR, Pierzchala K, Bregou A, Zambelli PY. Residual hip dysplasia in children: osseous and cartilaginous acetabular angles to guide further treatment-a pilot study. J Orthop Surg Res 2019; 14:379. [PMID: 31752955 PMCID: PMC6868726 DOI: 10.1186/s13018-019-1441-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 10/31/2019] [Indexed: 01/23/2023] Open
Abstract
PURPOSE In case of residual hip dysplasia (RHD) in children, pelvic radiographs are sometimes insufficient to precisely evaluate the entire coverage of the femoral head, when trying to decide on the need for further reconstructive procedures. METHODS This study retrospectively compares the bony and the cartilaginous acetabular angle of Hilgenreiner (HTE) of 60 paediatric hips on pelvic MRI separated in two groups. Group 1 included 31 hips with RHD defined by a bony HTE > 20°. Group 2 included 27 hips with a HTE < 20°. They were compared by introducing a new ratio calculated from the square of cartilaginous HTE above the bony HTE on frontal MRI. The normal upper limit for this acetabular angle ratio was extrapolated from the published normal values of cartilaginous HTE and bony HTE in children. RESULTS The acetabular angle ratio was statistically significantly increased in the hips with RHD with a mean value of 7.1 ± 4.7 compared to the hips in the control group presenting a mean value of 2.1 ± 1.9 (p < 0.00001). CONCLUSIONS This newly introduced ratio seems to be a helpful tool to orientate the further treatment in children presenting borderline RHD.
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Affiliation(s)
- Sophie Rosa Merckaert
- Department of Women and Child's Care, Unit of Pediatric Orthopedics, Centre Hospitalier Universitaire Vaudois, CHUV, Lausanne, Switzerland.
| | | | - Aline Bregou
- Department of Women and Child's Care, Unit of Pediatric Orthopedics, Centre Hospitalier Universitaire Vaudois, CHUV, Lausanne, Switzerland
| | - Pierre-Yves Zambelli
- Department of Women and Child's Care, Unit of Pediatric Orthopedics, Centre Hospitalier Universitaire Vaudois, CHUV, Lausanne, Switzerland
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12
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Mureşan S, Mărginean MO, Voidăzan S, Vlasa I, Sîntean I. Musculoskeletal ultrasound: a useful tool for diagnosis of hip developmental dysplasia: One single-center experience. Medicine (Baltimore) 2019; 98:e14081. [PMID: 30633215 PMCID: PMC6336624 DOI: 10.1097/md.0000000000014081] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/17/2018] [Accepted: 12/18/2018] [Indexed: 11/27/2022] Open
Abstract
Developmental dysplasia of the hip (DDH) is one of the most common congenital abnormalities of the musculoskeletal apparatus in newborns. The aim of this study was to analyze the contribution of ultrasonography in the detection of DDH in newborns and infants, identifying the regional incidence of this pathology in the central area of Romania, emphasizing the risk factors that underlie DDH etiopathogenicity.This article represents a retrospective study of 847 newborns and infants examined in the Imagistic Department of a medical center from the central area of Romania, between January 1 and December 31, 2016. The ultrasound examinations were performed for the bilateral coxofemoral joints, using the method and technique described by Graf. For subjects born in the same medical center, data regarding mother's age, birth weights, and type of delivery (natural vs. caesarian section) were statistically analyzed.In our study group, the frequency of ultrasound diagnosis obtained from the examinations of right and left hips showed that the most frequent stage was type IA, and the rarest stage was III. The IA stage of right coxofemoral joints (87.3%) was higher than in the left coxofemoral joints (87.2%). The incidence of hip dysplasia (type III) diagnosed with ultrasound examinations in subjects from the central area of Romania was 0.2% (0.1% in both hips and 0.1% for the left coxofemoral joint).The musculoskeletal ultrasound examination is effective in early detection of hip dysplasia. The implementation of national and regional programs that promote indications, risk factors, and the screening age for DDH in both rural and urban areas could be a step forward in the early diagnosis of hip dysplasia for newborns and infants. The low incidence of DDH from our study group is not able to identify the role of advanced age of the mother, high birth weight of the newborn, or caesarean section as risk factors involved in the etiology of hip dysplasia. The implementation of national and regional programs that promote the musculoskeletal ultrasound as a screening imagistic investigation for DDH, in both rural and urban areas, could be a step forward in the early diagnosis of hip dysplasia for newborns and infants.
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Affiliation(s)
| | | | - Septimiu Voidăzan
- Epidemiology Department, University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureş
| | - Ionuţ Vlasa
- Gynecological Clinic No. 1, Emergency County Hospital Târgu Mureş
| | - Ioana Sîntean
- University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureş, Târgu Mureş, Romania
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13
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Al-Essa RS, Aljahdali FH, Alkhilaiwi RM, Philip W, Jawadi AH, Khoshhal KI. Diagnosis and treatment of developmental dysplasia of the hip: A current practice of paediatric orthopaedic surgeons. J Orthop Surg (Hong Kong) 2018; 25:2309499017717197. [PMID: 28659058 DOI: 10.1177/2309499017717197] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Developmental dysplasia of the hip (DDH) is one of the prevalent musculoskeletal conditions in young adults and is a leading cause of hip osteoarthrosis in this age group. The optimum age for surgical intervention when needed is not well established in the literature and the lack of management guidelines and standard practice of DDH leads to different practices worldwide. This study aims to investigate the current practice of paediatric orthopaedic surgeons in diagnosing and treating DDH worldwide and identify points of agreement and disagreement. METHODS A cross-sectional study utilizing an online questionnaire was designed to examine the different points of view and current practice of paediatric orthopaedic surgeons worldwide regarding DDH diagnosis and treatment. RESULTS Ninety-one surgeons responded, with an overall response of 45.5%. The vast majority of respondents use ultrasonography in children less than 3 months of age and pelvic radiography in over 3 months to diagnose DDH. Pavlik harness is the most popular DDH treatment for children younger than 6 months. For older children, closed reduction with hip spica cast is the most preferable treatment. The maximum duration of first-line treatment has a broad range. The treatment of bilateral DDH varies widely among surgeons. CONCLUSION This study shows clearly that paediatric orthopaedic surgeons do not agree on the diagnosis and treatment protocol of DDH, hence different approaches to this common disease are practised. The lack of an international guideline should motivate paediatric orthopaedic surgeons to discuss and formulate a uniform and evidence-based protocol for the diagnosis and treatment of DDH.
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Affiliation(s)
- Rakan S Al-Essa
- 1 College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Fares H Aljahdali
- 1 College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Rakan M Alkhilaiwi
- 1 College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Winnie Philip
- 2 College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
| | - Ayman H Jawadi
- 3 Pediatric Orthopedic Surgery Division, King Saud Bin Abdulaziz University for Health Science (KSAU-HS), Riyadh, Saudi Arabia
| | - Khalid I Khoshhal
- 4 Department of Orthopedic Surgery, College of Medicine, Taibah University, AlmadinahAlmunawwarah, Saudi Arabia
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Cai Z, Li L, Zhang L, Ji S, Zhao Q. Dynamic long leg casting fixation for treating 12- to 18-month-old infants with developmental dysplasia of the hip. J Int Med Res 2016; 45:272-281. [PMID: 28222640 PMCID: PMC5536605 DOI: 10.1177/0300060516675110] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To evaluate the effect of dynamic long leg casting in paediatric patients with developmental dysplasia of hip (DDH) diagnosed at 12-18 months. Methods The adductor tenotomy, closed reduction, and dynamic long leg casting method was adopted to treat paediatric patients with DDH. The hips were divided into four groups according to the Tonnis radiographic dislocation classification. Groups were also classified according to the baseline acetabular index (AI): 30°-35°, 36°-40°, and > 40°. The outcomes of the reductions were evaluated according to McKay's hip function criteria and Severin's radiological criteria. Results A total of 246 patients (339 hips) had complete follow-up data. After 3 months of orthosis fixation, the results were satisfactory in 264 hips (77.88%). Hip function was rated as 'excellent' or 'good' in 43 of 51 (84.31%) Tonnis type 1 hips, 125 of 155 (80.65%) type 2 hips, 70 of 90 (77.78%) type 3 hips, and 34 of 43 (79.07%) type 4 hips. The higher the baseline AI, the lower the rates of 'excellent' and 'good' hip function. Favourable radiological results (Severin types I and II) were found in 266 of 339 (78.47) hips. Conclusions Dynamic long leg casting is an effective method for treating patients with DDH aged 12-18 months at diagnosis.
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Affiliation(s)
- Zhencun Cai
- Department of Paediatric Orthopaedics, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Lianyong Li
- Department of Paediatric Orthopaedics, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Lijun Zhang
- Department of Paediatric Orthopaedics, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Shijun Ji
- Department of Paediatric Orthopaedics, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Qun Zhao
- Department of Paediatric Orthopaedics, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
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