Idiopathic hypertonicity as a cause of stiffness after surgery for developmental dysplasia of the hip

Modified Capsulorrhaphy Technique in Open Reduction of Developmental Dysplasia of the Hip

BACKGROUND

Neglected patients with developmental dysplasia of the hip (DDH) are not uncommon. Various treatment modalities have been used. Capsulorrhaphy is one of the most critical steps during the process of open reduction of DDH. Inadequate capsulorrhaphy technique can increase the failure rate of open reduction procedures. This study presented the clinical and radiographic results of using a new capsulorrhaphy technique.

METHODS

Between November 2005 and March 2018, 540 DDH in 462 patients were retrospectively reviewed. The mean age at surgery was 31 months. All patients underwent a modified capsulorrhaphy technique developed by the main author (with or without additional pelvic or femoral procedures). Postoperative patient assessment during the follow-up period was performed both clinically and radiologically.

RESULTS

Follow-up period ranged between 36 months and 12 years. Based on the modified McKay score, good and excellent outcomes were obtained in 90.3%. Functional results were better in younger age (less than 39 mo). Both acetabular index and lateral center edge angle showed significant improvement at 3 years follow-ups. Proximal femoral growth disturbance (PFGD) was encountered in 92 hips. Classes 2 and 3 did not affect the functional results, whereas patients with PFGD classes 4 and 5 had fair to poor functional outcomes. There were 12 hips with redislocation. Revision was done using the same capsulorrhaphy technique.

CONCLUSION

Using the index technique of capsulorrhaphy in DDH surgery is safe, reliable, and yields good functional and radiologic outcomes with a relatively low complication rate.

LEVEL OF EVIDENCE

Level IV-therapeutic retrospective case series.

Relapsed hip stiffness after recovery of range of motion in a hip treated for developmental dysplasia of the hip? Think again: A case report

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How to evaluate complications following DDH treatment.

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Muscular spasm can mislead physicians following treatment of DDH.

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Hip stiffness vs muscular spasm in DDH patients.

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Examination under anesthesia could be the answer for relapsed hip stiffness.

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The value of examination under anesthesia in DDH complications.

Introduction

Several complications have been reported following treatment of developmental dysplasia of the hip (DDH). Local muscular spasm is an extremely rare complication. This case serves to enlighten orthopedists about various and unique presentations of idiopathic local muscular spasm, natural history of such condition, and appropriate treatment.

Presentation of case

A two-year-old child presented with bilateral acetabular dysplasia for orthopedic evaluation and treated with bilateral simultaneous Dega osteotomy and postoperative cast for 12 weeks. Full range of motion (ROM) of both hips was regained three months after removal of the postoperative cast. Five months later, the child presented with apparent leg length discrepancy, and severe and painless global limitation of the right hip ROM, which initially was thought to be relapsed hip stiffness. Laboratory and radiological investigations were normal apart from pelvic obliquity on radiographs. Symptoms persisted for one month. Examination under anesthesia (EUA) was then performed and revealed full ROM of the involved hip. Physical therapy was started, and hip ROM fully recovered within 3 months without further intervention.

Discussion

Stiffness, which is one of the most reported complications following surgical treatment of DDH, is usually related to lengthy periods of immobilization and/or surgical treatment. Clinically, local muscular spasm of the hip can mimic stiffness. EUA is invaluable to differentiate the common postoperative stiffness from the rare local muscular spasm.

Conclusion

Idiopathic local muscular spasm of hip might present clinically as stiffness that pose a diagnostic dilemma to the treating physician. Close observation coupled with physical therapy is sufficient.