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Jesus AR, Pinto Silva C, Romão Luz I, Mendes JE, Balacó I, Alves C. Impact of Pavlik Harness treatment on motor skills acquisition: A case-control study. J Child Orthop 2024; 18:386-392. [PMID: 39100978 PMCID: PMC11295376 DOI: 10.1177/18632521241240367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 02/28/2024] [Indexed: 08/06/2024] Open
Abstract
Purpose Our purpose was to analyze the impact of Pavlik Harness treatment on children motor skills development, comparing to a control group. Methods A total of 121 children were included: 55 cases (children with Developmental Dysplasia of the Hip) and 66 healthy controls. Cases were recruited from 2017 to 2021 and followed up to 2022. Controls (healthy children without orthopedic pathology) were recruited from 2020 to 2022. The primary endpoint was the time of achievement of three gross motor milestones (sitting without support, hands-and-knees crawling, and walking independently). Results The groups had no differences regarding sex distribution, gestational age, birth weight, and rate of twin pregnancy. The prevalence of positive family history of Development Dysplasia of the Hip (20.0% vs 3.0%, p < 0.003), breech presentation (38.2% vs 1.5%, p < 0.001), and C-section delivery (60.0% vs 19.7%, p < 0.001) was significantly higher in Development Dysplasia of the Hip group. Children with Development Dysplasia of the Hip achieved the three gross milestones evaluated 1 month later than healthy controls, although this was not statistically significant (p = 0.133 for sitting, p = 0.670 for crawling, and p = 0.499 for walking). Conclusion Children with Development Dysplasia of the Hip, treated by Pavlik harness, do not have significant delays in motor skills acquisition.
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Affiliation(s)
- Ana Rita Jesus
- Department of Pediatric Orthopaedics, Pediatric Hospital, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
| | - Catarina Pinto Silva
- Department of Pediatric Orthopaedics, Pediatric Hospital, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
| | - Inês Romão Luz
- Department of Pediatric Orthopaedics, Pediatric Hospital, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
| | - José Eduardo Mendes
- Unidade de Saúde Familiar Mondego, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
| | - Inês Balacó
- Department of Pediatric Orthopaedics, Pediatric Hospital, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
| | - Cristina Alves
- Department of Pediatric Orthopaedics, Pediatric Hospital, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
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Dance S, Quan T, Parel PM, Ranson R, Tabaie SA. Predicting prolonged hospital stay following hip dysplasia surgery in the pediatric population. J Pediatr Orthop B 2024:01202412-990000000-00208. [PMID: 39037948 DOI: 10.1097/bpb.0000000000001198] [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: 07/24/2024]
Abstract
Previous studies have shown that minimizing the length of hospital stay (LOS) following surgical procedures reduces costs and can improve the patients' quality of life and satisfaction. However, this relationship has not been defined following operative treatment for developmental dysplasia of the hip (DDH). Therefore, the purpose of this study was to determine the most important nonmodifiable and modifiable factors that can predispose patients to require a prolonged LOS following hip dysplasia surgery. From 2012 to 2019, a national pediatric database was used to identify pediatric patients who underwent surgery for hip dysplasia. Demographic, clinical, and comorbidity variables were analyzed in a patient cohort who had a normal LOS versus one with an extended LOS using chi-square tests and analysis of variance. Statistically significant variables (P value <0.05) were inputted into an artificial neural network model to determine the level of importance. Out of 10,816 patients, 594 (5.5%) had a prolonged LOS following DDH surgery. The five most important variables to predict extended LOS following hip dysplasia surgery were increased operative time (importance = 0.223), decreased BMI (importance = 0.158), older age (importance = 0.101), increased preoperative international normalized ratio (importance = 0.096), and presence of cardiac comorbidities (importance = 0.077). Operative time, BMI, age, preoperative international normalized ratio, and cardiac comorbidities had the greatest effect on predicting prolonged LOS postoperatively. Evaluating factors that impact patients' LOS can help optimize costs and patient outcomes.
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Affiliation(s)
- Sarah Dance
- Department of Orthopaedic Surgery, Children's National Hospital
| | - Theodore Quan
- Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Philip M Parel
- Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Rachel Ranson
- Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Sean A Tabaie
- Department of Orthopaedic Surgery, Children's National Hospital
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Liu Y, Kan L, Huang J, Sun J, Zhang Y. Open reduction after failed closed reduction following failed Pavlik harness treatment in developmental dysplasia of the hip: One- or two-stage? Arch Orthop Trauma Surg 2024; 144:1557-1563. [PMID: 38386065 DOI: 10.1007/s00402-024-05236-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 02/17/2024] [Indexed: 02/23/2024]
Abstract
INTRODUCTION The current published evidence for the treatment of developmental dysplasia of the hip (DDH) with failed closed reduction (CR) following failed Pavlik harness (PH) treatment is still limited. This study aimed to determine whether an one-stage open reduction (OR) would lead to a similar outcome to a two-stage OR in these patients. Meanwhile, the occurrence of femoral head avascular necrosis (AVN) and further surgery (pelvic osteotomy, PO) within the follow-up period was investigated. MATERIALS AND METHODS A consecutive series of DDH patients who failed CR following failed PH treatment and received OR finally between January 2008 and December 2020 were studied. The patients were divided into two groups. One group of which received OR immediately after failed CR (one-stage OR group, Group A), and the other received a delayed OR (two-stage OR group, Group B). The McKay's criteria, acetabular index (AI) and the degree of dislocation of the hips were evaluated for the final outcomes. RESULTS At the last follow-up, 54 (84.4%) of the 64 hips in Group A and 26 (83.9%) of 31 hips in Group B were in excellent or good condition. Comparison between the two groups revealed that there were no differences in terms of McKay grading (P = 0.950), AI (P = 0.783), incidence of AVN (P = 0.745), and also incidence of PO (P = 1.000). However, a significant lower mean AI was found in Group A, when the OR was performed in Group B (31.06 ± 4.45° vs. 33.87 ± 4.12°, P = 0.004). CONCLUSION Both of the one- and two-stage OR may acheive favorable outcomes. Moreover, one-stage OR is of without the general anesthesia risk associated with two-stage OR. We therefore advocate that an OR should be performed in appropriate DDH patients during the same session once a failed CR is detected.
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Affiliation(s)
- Yong Liu
- Department of Pediatric Orthopedics, The Affiliated Provincial Pediatric Hospital of Anhui Medical University, No. 39, Wangjiang Road, Hefei, China.
| | - Lisheng Kan
- No. 91126 Military Hospital of Chinese PLA, No. 116, Youyi Road, Dalian, China.
| | - Jie Huang
- Department of Pediatric Surgery, Huainan Maternal and Child Health Hospital, Huainan, China
| | - Jun Sun
- Department of Pediatric Orthopedics, The Affiliated Provincial Pediatric Hospital of Anhui Medical University, No. 39, Wangjiang Road, Hefei, China
| | - Yapeng Zhang
- Department of Pediatric Orthopedics, The Affiliated Provincial Pediatric Hospital of Anhui Medical University, No. 39, Wangjiang Road, Hefei, China
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Dance S, Quan T, Parel PM, Farley BJ, Tabaie S. Pediatric Hip Dysplasia Surgery Outcomes by Pediatric Versus Nonpediatric Orthopedists. Cureus 2024; 16:e55951. [PMID: 38469367 PMCID: PMC10926935 DOI: 10.7759/cureus.55951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 03/13/2024] Open
Abstract
Objectives Developmental dysplasia of the hip (DDH) encompasses a spectrum of abnormalities in the immature hip. Surgical intervention is indicated if conservative management fails. Despite the increased supply of pediatric orthopedic surgeons (POSs) over the last few decades, there continues to be a maldistribution of surgeons. The purpose of this study is to determine outcomes following surgical management of hip dysplasia by POSs compared to non-pediatric orthopedic surgeons. Methods Pediatric patients who underwent surgical treatment for hip dysplasia from 2012 to 2019 were identified using a large national database. Patient demographics, comorbidities, and postoperative complications were compared by pediatric versus nonpediatric-trained orthopedic surgeons. Bivariate and multivariable regression analyses were performed. Results Of the 10,780 pediatric patients who underwent hip dysplasia surgery, 10,206 patients (94.7%) were operated on by a POS, whereas 574 (5.3%) were operated on by a non-pediatric orthopedic surgeon. POSs were more likely to operate on patients with a higher American Society of Anesthesiologists class (p<0.001) and those with a greater number of medical comorbidities, including cardiac (p=0.001), gastrointestinal (p=0.017), and neurological (p<0.001). Following analysis using multivariable regression models to control for patient baseline characteristics, there were no differences in any postoperative complications between patients treated by pediatric-trained and nonpediatric-trained orthopedic surgeons. Conclusions Compared to non-pediatric orthopedic surgeons, POSs were more likely to operate on younger patients with increased medical comorbidities. However, there were no differences in postoperative complications following surgical management for DDH in patients treated by nonpediatric and pediatric orthopedic surgeons.
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Affiliation(s)
- Sarah Dance
- Orthopaedic Surgery, Children's National Hospital, Washington, DC, USA
| | - Theodore Quan
- Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Philip M Parel
- Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Benjamin J Farley
- Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Sean Tabaie
- Orthopaedic Surgery, Children's National Hospital, Washington, DC, USA
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Ellsworth BK, Lee JY, Sankar WN. Femoral Head Remodeling After Surgical Reduction of Developmental Hip Dislocations. J Pediatr Orthop 2024; 44:e211-e217. [PMID: 38145396 DOI: 10.1097/bpo.0000000000002597] [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: 12/26/2023]
Abstract
OBJECTIVE Developmental dysplasia of the hip is prevalent and is associated with dysplasia of both the femoral head and acetabulum. There is a paucity of literature describing femoral head remodeling after surgical reduction of developmentally dislocated hips. The purpose of this study was to describe and quantify changes in femoral head sphericity after closed or open reduction for developmental dysplasia of the hip. METHODS A retrospective cohort study was performed including patients with typical developmental hip dislocations who underwent closed or open reduction from 2009 to 2022 at a single institution and had immediate postoperative and average 3-week follow-up magnetic resonance imaging (MRI) scans. A subset of patients also had 3-year follow-up MRI scans. Patients with insufficient imaging or bony procedures at the time of reduction were excluded. We developed a technique to quantify femoral head "sphericity" by comparing differences in measured radii of the femoral head on axial and coronal plane MRI slices. We then calculated the variance of the radii for each plane and averaged these to calculate a combined variance. The variance was used to represent "sphericity," with a larger variance indicating a wider distribution of radii and thus a less spherical shape. RESULTS A total of 74 patients (69 females) with 96 hips were included in this series. The median age of the child at the time of reduction was 8.7 months [interquartile range (IQR): 2.2]. Over half (58.3%) of the hips had a closed reduction, whereas the remaining were open reduced (41.7%). Immediately postoperatively, at the 3-week time point, and at the 3-year time point the median combined variance was 1.1 (IQR: 3.93), 0.51 (IQR: 1.32), and 0.31 (IQR: 0.50), respectively, indicating improved sphericity over time. CONCLUSIONS Sphericity of the femoral head in developmental hip dislocations improves in both the immediate postoperative period, as well as the first few years after reduction. Further research is needed to evaluate the mechanism of remodeling, the ideal timing of reduction, and the relationship between femoral head and acetabular remodeling. LEVEL OF EVIDENCE Level IV-case series, therapeutic study.
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Affiliation(s)
- Bridget K Ellsworth
- Department of Pediatric Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, PA
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Topak D, Aslan A, Yorgancigil H. Coxa Magna following treatment of developmental dysplasia of the hip: investigation for associated potential factors. J Pediatr Orthop B 2024; 33:21-28. [PMID: 36730017 DOI: 10.1097/bpb.0000000000001036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Coxa Magna (CM) is defined as a condition in which the horizontal (transverse) diameter of the femoral head is larger on the affected side than on the intact side. CM can occur as a manifestation of avascular necrosis (AVN) following treatment for the developmental dysplasia of the hip (DDH). Alternatively, it can also be secondary to other hip disorders, such as Perthes' disease. This study aimed to determine the prevalence and indicators of CM and AVN of the femoral head that can be detected during follow-up in patients with unilateral DDH treated with closed reduction (CR) or open reduction (OR) surgery. The files of 143 patients treated for unilateral DDH between January 1997 and December 2017 were reviewed retrospectively. A total of 104 patients, including Group 1 ( n = 49) patients who underwent CR under general anesthesia and Group 2 ( n = 55) patients who underwent OR were included in the study. CM; It was considered as the case where the femoral head was 15% or more larger than the intact side. A total of 104 patients were followed up for 77.27 ± 13.96 months, with a mean age of 15.43 ± 7.76 months. When Group 1 and Group 2 were compared, there was no statistical difference in terms of sex, side, adductor tenotomy, and AVN ( P > 0.05). CM developed in 22.4% ( n = 11) of the patients in Group 1 and in 49.1% ( n = 27) in Group 2, and the difference was statistically significant ( P = 0.008). When the effect of independent variables on the development of CM is evaluated with the multivariate logistic regression model, the risk of developing CM is 3474 times higher in those who underwent iliopsoas tenotomy compared with those who did not. The primary outcome of this study is that CM is more frequent in patients treated with OR for DDH. CM may be a nonpathological condition that occurs in connection with iliopsoas tenotomy or surgical treatment. Prospective studies with a larger number of cases, designed to minimize confounding factors, are required.
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Affiliation(s)
- Duran Topak
- Department of Orthopaedic Surgery, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras
| | - Ahmet Aslan
- Department of Orthopedic Surgery, School of Medicine, Alanya Alaaddin Keykubat University, Antalya
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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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Zhou P, Zhang J, Dan T, Xu T, Kang X, Hang Y, Zhou Y. Closed reduction and plaster immobilization: an alternative solution for patients with developmental dysplasia of the hip who failed Pavlik harness treatment. ANZ J Surg 2023; 93:663-668. [PMID: 36732905 DOI: 10.1111/ans.18285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 12/26/2022] [Accepted: 01/08/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND The current study aims to investigate the clinical efficacy of closed reduction and cast immobilization for patients with developmental dysplasia of the hip (DDH) who failed Pavlik harness treatment. METHODS Patients with DDH who underwent cast immobilization under general anaesthesia after the failure of the Pavlik harness or Tübingen brace treatment between January 2015 and December 2020 were retrospectively recruited. General information, including Graf classification of initial diagnosis, initial treatment, age of cast immobilization, IHDI classification, AI index, avascular necrosis (AVN), and residual dysplasia, was collected. The incidence of AVN and late acetabular dysplasia (LACD) was also estimated. Moreover, factors related to AVN and LACD were investigated by multiple logistic regression analysis. RESULTS Thirty-four patients (47 hips) were finally included in the current study. Of these patients, 31 hips (66.0%) were successfully treated with closed reduction and cast immobilization. Open reduction was successfully performed in 16 hips (34.0%). Till the latest follow-up, LACD and AVN were found in 13 (27.7%) and 10 (21.3%) hips, respectively. In the open reduction group, type III and IV of the IHDI classification and type IV of the Ultrasound Graf classification were significantly higher when compared with the closed reduction group. Multiple logistic regression showed that failure of closed reduction was related to the initial types of the Ultrasound Graf and IHDI classifications. CONCLUSIONS Although the success rate of closed reduction after early harness failure in DDH is only 66%, we still advocate closed reduction as a first-line treatment for children who have failed sling treatment. Even if closed reduction fails, open reduction can still achieve acceptable results.
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Affiliation(s)
- Ping Zhou
- Department of Orthopedics, Kunming Children's Hospital, Kunming, China
| | | | - Tangzi Dan
- Graduate School, Kunming Medical University, Kunming, China
| | - Taotao Xu
- Department of Orthopedics, Kunming Children's Hospital, Kunming, China
| | - Xiaopeng Kang
- Department of Orthopedics, Kunming Children's Hospital, Kunming, China
| | - Yong Hang
- Department of Orthopedics, Kunming Children's Hospital, Kunming, China
| | - You Zhou
- Department of Orthopedics, Kunming Children's Hospital, Kunming, China
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Aarvold A, Perry DC, Mavrotas J, Theologis T, Katchburian M. The management of developmental dysplasia of the hip in children aged under three months : a consensus study from the British Society for Children's Orthopaedic Surgery. Bone Joint J 2023; 105-B:209-214. [PMID: 36722054 PMCID: PMC9869707 DOI: 10.1302/0301-620x.105b2.bjj-2022-0893.r1] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
AIMS A national screening programme has existed in the UK for the diagnosis of developmental dysplasia of the hip (DDH) since 1969. However, every aspect of screening and treatment remains controversial. Screening programmes throughout the world vary enormously, and in the UK there is significant variation in screening practice and treatment pathways. We report the results of an attempt by the British Society for Children's Orthopaedic Surgery (BSCOS) to identify a nationwide consensus for the management of DDH in order to unify treatment and suggest an approach for screening. METHODS A Delphi consensus study was performed among the membership of BSCOS. Statements were generated by a steering group regarding aspects of the management of DDH in children aged under three months, namely screening and surveillance (15 questions), the technique of ultrasound scanning (eight questions), the initiation of treatment (19 questions), care during treatment with a splint (ten questions), and on quality, governance, and research (eight questions). A two-round Delphi process was used and a consensus document was produced at the final meeting of the steering group. RESULTS A total of 60 statements were graded by 128 clinicians in the first round and 132 in the second round. Consensus was reached on 30 out of 60 statements in the first round and an additional 12 in the seond. This was summarized in a consensus statement and distilled into a flowchart to guide clinical practice. CONCLUSION We identified agreement in an area of medicine that has a long history of controversy and varied practice. None of the areas of consensus are based on high-quality evidence. This document is thus a framework to guide clinical practice and on which high-quality clinical trials can be developed.Cite this article: Bone Joint J 2023;105-B(2):209-214.
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Affiliation(s)
- Alexander Aarvold
- Southampton Children’s Hospital, Southampton, UK,University of Southampton, Southampton, UK,Correspondence should be sent to Alexander Aarvold. E-mail:
| | - Daniel C. Perry
- NDORMS, University of Oxford, Oxford, UK,Institute Population Health, University of Liverpool, Liverpool, UK,Alder Hey Children’s Hospital, Liverpool, UK
| | - Jason Mavrotas
- St Helens and Knowsley Teaching Hospitals NHS Foundation Trust, Liverpool, UK
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Yong M, Xu M, Lou Y, Lin G. Risk factors for postoperative avascular necrosis of the femoral head in children with developmental dysplasia of the hip. Front Pediatr 2023; 11:1089341. [PMID: 36950177 PMCID: PMC10025389 DOI: 10.3389/fped.2023.1089341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/30/2023] [Indexed: 03/24/2023] Open
Abstract
Aim To investigate factors associated with postoperative avascular necrosis of the femoral head (ANFH) in developmental dysplasia of the hip (DDH) patients, and if or how the associations varied among different subpopulations of age, sex and surgical method. Methods Patients with DDH were enrolled between October 31, 2016 and July 15, 2020 in this retrospective cohort study. The average follow-up time was 21.42 ± 10.02 months. The outcome was postoperative ANFH. The main study variables were the DDH classification, Tonnis grade, International Hip Dysplasia Institute (IHDI) classification, and preoperative traction. Multivariate logistic regression was employed to assess the associations between main study variables and postoperative ANFH. Subgroup analysis was carried out based on age at reduction, sex and surgical method. Odds ratio (ORs) and 95% confidence intervals (CIs) were calculated. Results A total of 427 children with DDH were included, with 92 (21.55%) in the ANFH group, and 335 (78.45%) in the non-ANFH group. DDH classification was positively correlated with the risk of postoperative ANFH (OR = 4.14, 95% CI, 1.08-15.77, P = 0.038). Children with preoperative traction had a significantly decreased risk of postoperative ANFH in contrast to those without preoperative traction (OR = 0.37, 95% CI, 0.22-0.61, P < 0.001). Children aged 1-3 years who received preoperative traction has a significantly reduced risk of postoperative ANFH than those who did not receive preoperative traction (OR = 0.28, 95% CI, 0.15-0.51, P < 0.001). For children aged >3 years, positive association was found between DDH classification and the risk of postoperative ANFH (OR = 3.75, 95% CI, 1.51-9.31, P = 0.004). Girls with a more severe DDH type had a significantly higher risk of postoperative ANFH (OR = 3.80, 95% CI, 1.80-8.02, P < 0.001). Receiving preoperative traction was associated with a significantly decreased risk of postoperative ANFH in girls (OR = 0.37, 95% CI, 0.22-0.61, P < 0.001). For children undergoing open reduction, DDH classification was positively associated with the risk of postoperative ANFH (OR = 3.01, 95% CI, 1.65-5.50, P < 0.001), and those with preoperative traction had a lower risk of postoperative ANFH compared with those without preoperative traction (OR = 0.35, 95% CI, 0.20-0.61, P < 0.001). Conclusion DDH classification and preoperative traction were associated with the risk of postoperative ANFH, and these associations varied across DDH patients with different ages, sexes and surgical methods.
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Suvorov V, Filipchuk V, Melnyk M. THE BIOMECHANICAL ANALYSIS OF PELVIC OSTEOTOMIES APPLIED FOR DDH TREATMENT IN PEDIATRIC PATIENTS. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2023; 76:1804-1812. [PMID: 37740974 DOI: 10.36740/wlek202308115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/25/2023]
Abstract
OBJECTIVE The aim: This article aimed to evaluate biomechanical changes during the most commonly used pelvic osteotomies (Salter, Dega, Pemberton) for DDH treatment in pediatric patients. PATIENTS AND METHODS Materials and methods: Virtual pelvic models of 2- and 6-years old patients were created, material properties were assigned, pelvic osteotomies were simulated and biomechanical changes were evaluated using finite element analysis (FEA). RESULTS Results: It was revealed that the patient's age impacts pelvic bones and cartilage density (in younger patients the pelvic elements are more pliable - p<0.05). Stress distribution after each of the abovementioned pelvic osteotomy was assessed in 2- and 6-year-old patients' pelvic models. The new term "restriction point" was introduced, which means a place where restriction of acetabular deformity correction occurs. CONCLUSION Conclusions: It was found that there are no purely reshaping and reorientation pelvic osteotomies as previously believed; the pelvic ring acts as a unit in carrying out the applied load. Biomechanical overload of triradiate cartilage during Salter osteotomy in 2-year-old patients and in 2- and 6-year-old patients during Pemberton osteotomy was revealed; overload of the posterior cortical layer in the greater sciatic notch in 2-years old patient during Dega osteotomy was revealed.
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Affiliation(s)
- Vasyl Suvorov
- SI «THE INSTITUTE OF TRAUMATOLOGY AND ORTHOPEDICS BY NAMS OF UKRAINE», KYIV, UKRAINE
| | - Viktor Filipchuk
- SI «THE INSTITUTE OF TRAUMATOLOGY AND ORTHOPEDICS BY NAMS OF UKRAINE», KYIV, UKRAINE
| | - Michailo Melnyk
- SI «THE INSTITUTE OF TRAUMATOLOGY AND ORTHOPEDICS BY NAMS OF UKRAINE», KYIV, UKRAINE
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Merchant RM, Tolk JJ, Ayub AA, Eastwood DM, Hashemi-Nejad A. The Importance of Monitoring and Factors That May Influence Leg Length Difference in Developmental Dysplasia of the Hip. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121945. [PMID: 36553388 PMCID: PMC9776676 DOI: 10.3390/children9121945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/01/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022]
Abstract
In unilateral Developmental Dysplasia of the Hip (DDH), avascular necrosis (AVN), femoral or pelvic osteotomy, and residual dysplasia causing subluxation of the proximal femur may influence Leg Length Discrepancy (LLD). This can lead to gait compensation, pelvic obliquity, and spinal curvature. The aim of this study is to determine the prevalence of LLD, establish which limb segment contributes to the discrepancy, describe how AVN influences LLD, and ascertain variables that may influence the need for LLD corrective procedures. METHODOLOGY This study assessed long-leg radiographs at skeletal maturity. Radiographs were assessed for the articulo-trochanteric distance (ATD) and femoral and tibial length. AVN was classified according to Kalamchi-MacEwen. RESULTS 109 patients were included. The affected/DDH leg was longer in 72/109 (66%) patients. The length difference was mainly in the subtrochanteric segment of the femur. AVN negatively influenced leg length. Older (≥three years) patients with multiple procedures were more likely to have AVN. LLD interventions were performed in 30 (27.5%) patients. AVN grade or type of DDH surgery did not influence the odds of needing a procedure to correct LLD. CONCLUSIONS Procedures to correct LLD were performed irrespective of previous DDH surgery or AVN grades. In most patients, the affected/DDH leg was longer, mainly in the subtrochanteric segment of the femur, largely influenced by femoral osteotomy in patients with multiple operative procedures for DDH. We recommend careful monitoring of LLD in DDH.
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Affiliation(s)
| | - Jaap J. Tolk
- Erasmus MC Sophia Children’s Hospital, 3015 CN Rotterdam, The Netherlands
| | | | - Deborah M. Eastwood
- The Royal National Orthopaedic Hospital, Stanmore, Middlesex HA7 4LP, UK
- Correspondence:
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Dwan K, Kirkham J, Paton RW, Morley E, Newton AW, Perry DC. Splinting for the non-operative management of developmental dysplasia of the hip (DDH) in children under six months of age. Cochrane Database Syst Rev 2022; 10:CD012717. [PMID: 36214650 PMCID: PMC9549867 DOI: 10.1002/14651858.cd012717.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Developmental dysplasia of the hip (DDH) describes the abnormal development of a hip in childhood, ranging from complete dislocation of the hip joint to subtle immaturity of a hip that is enlocated and stable within the socket. DDH occurs in around 10 per 1000 live births, though only one per 1000 are completely dislocated. There is variation in treatment pathways for DDH, which differs between hospitals and even between clinicians within the same hospital. The variation is related to the severity of dysplasia that is believed to require treatment, and the techniques used to treat dysplasia. OBJECTIVES To determine the effectiveness of splinting and the optimal treatment strategy for the non-operative management of DDH in babies under six months of age. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, seven other electronic databases, and two trials registers up to November 2021. We also checked reference lists, contacted study authors, and handsearched relevant meetings abstracts. SELECTION CRITERIA Randomised controlled trials (RCTs), including quasi-RCTs, as well as non-RCTs and cohort studies conducted after 1980 were included. Participants were babies with all severities of DDH who were under six months of age. Interventions included dynamic splints, static splints or double nappies (diapers), compared to no splinting or delayed splinting. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, extracted data and performed risk of bias and GRADE assessments. The primary outcomes were: measurement of acetabular index at years one, two and five, as determined by radiographs (angle): the need for operative intervention to achieve reduction and to address dysplasia; and complications. We also investigated other outcomes highlighted by parents as important, including the bond between parent and child and the ability of mothers to breastfeed. MAIN RESULTS We included six RCTs or quasi-RCTs (576 babies). These were supported by 16 non-RCTs (8237 babies). Five studies had non-commercial funding, three studies stated 'no funding' and 14 studies did not state funding source. The RCTs were generally at unclear risk of bias, although we judged three RCTs to be at high risk of bias for incomplete outcome data. The non-RCTs were of moderate and critical risk of bias. We did not undertake meta-analysis due to methodological and clinical differences between studies; instead, we have summarised the results narratively. Dynamic splinting versus delayed or no splinting Four RCTs and nine non-RCTs compared immediate dynamic splinting and delayed dynamic splinting or no splinting. Of the RCTs, two considered stable hips and one considered unstable (dislocatable) hips and one jointly considered unstable and stable hips. No studies considered only dislocated hips. Two RCTs (265 babies, very low-certainty evidence) reported acetabular index at one year amongst stable or dislocatable hips. Both studies found there may be no evidence of a difference in splinting stable hips at first diagnosis compared to a strategy of active surveillance: one reported a mean difference (MD) of 0.10 (95% confidence interval (CI) -0.74 to 0.94), and the other an MD of 0.20 (95% CI -1.65 to 2.05). Two RCTs of stable hips (181 babies, very low-certainty evidence) reported there may be no evidence of a difference between groups for acetabular index at two years: one study reported an MD of -1.90 (95% CI -4.76 to 0.96), and another study reported an MD of -0.10 (95% CI -1.93 to 1.73), but did not take into account hips from the same child. No study reported data at five years. Four RCTs (434 babies, very low-certainty evidence) reported the need for surgical intervention. Three studies reported that no surgical interventions occurred. In the remaining study, two babies in the dynamic splinting group developed instability and were subsequently treated surgically. This study did not explicitly state if this treatment was to achieve concentric reduction or address residual dysplasia. Three RCTs (390 babies, very low-certainty evidence) reported no complications (avascular necrosis and femoral nerve palsy). Dynamic splinting versus static splinting One RCT and five non-RCTs compared dynamic versus static splinting. The RCT (118 hips) reported no occurrences of avascular necrosis (very low-certainty evidence) and did not report radiological outcomes or need for operative intervention. One quasi-RCT compared double nappies versus delayed or no splinting but reported no outcomes of interest. Other comparisons No RCTs compared static splinting versus delayed or no splinting or staged weaning versus immediate removal. AUTHORS' CONCLUSIONS There is a paucity of RCT evidence for splinting for the non-operative management of DDH: we included only six RCTs with 576 babies. Moreover, there was considerable heterogeneity between the studies, precluding meta-analysis. We judged the RCT evidence for all primary outcomes as being of very low certainty, meaning we are very uncertain about the true effects. Results from individual studies provide limited evidence of intervention effects on different severities of DDH. Amongst stable dysplastic hips, there was no evidence to suggest that treatment at any stage expedited the development of the acetabulum. For dislocatable hips, a delay in treatment onset to six weeks does not appear to result in any evidence of a difference in the development of the acetabulum at one year or increased risk of surgery. However, delayed splinting may reduce the number of babies requiring treatment with a harness. No RCTs compared static splinting with delayed or no splinting, staged weaning versus immediate removal or double nappies versus delayed or no splinting. There were few operative interventions or complications amongst the RCTs and the non-randomised studies. There's no apparent signal to indicate a higher frequency of either outcome in either intervention group. Given the frequency of this disease, and the fact that many countries undertake mandatory DDH screening, there is a clear need to develop an evidence-based pathway for treatment. Particular uncertainties requiring future research are the effectiveness of splinting amongst stable dysplastic hips, the optimal timing for the onset of splinting, the optimal type of splint to use and the need for 'weaning of splints'. Only once a robust pathway for treatment is established, can we properly assess the cost-effectiveness of screening interventions for DDH.
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Affiliation(s)
- Kerry Dwan
- Editorial & Methods Department, Cochrane Central Executive, London, UK
| | - Jamie Kirkham
- Centre for Biostatistics, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Robin W Paton
- East Lancashire Hospitals NHS Trust, Burnley, UK
- School of Medicine, University of Central Lancashire, Preston, Lancashire, UK
| | | | | | - Daniel C Perry
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
- Department of Orthopaedic Surgery, Alder Hey Hospital, Liverpool, UK
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Xu J, Yang Y, Yu K, Xu W, Bai G, Ye W, Shu Q, Chen W. Risk factors for re-dislocation after closed reduction in children with developmental dysplasia of the hip. Zhejiang Da Xue Xue Bao Yi Xue Ban 2022; 51:454-461. [PMID: 37202093 PMCID: PMC10264979 DOI: 10.3724/zdxbyxb-2022-0147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/12/2022] [Indexed: 05/20/2023]
Abstract
OBJECTIVE To investigate the risk factors for re-dislocation after the closed reduction in children with developmental dysplasia of the hip (DDH). METHODS The clinical data of 88 children aged ≤ 18 months with DDH (103 hips) who were treated with adductor muscle relaxation + closed reduction + plaster fixation at the Children's Hospital, Zhejiang University School of Medicine from January 2015 to December 2017, were retrospectively analyzed. According to the diagnostic criteria of hip dislocation, patients were divided into two groups: reduction group and re-dislocation group. The univariate and multivariate logistic regression analysis were applied to identify the risk factors for the re-dislocation of children. RESULTS Eighty-six patients (99 hips) successively underwent the treatment. 69 hips were fixed at the first intention, 9 hips at the second intention, and a total of 78 hips with no re-dislocation occurred till the last follow-up with a rate of 78.8%. The univariate analysis showed that preoperative acetabular index (AI), International Hip Dysplasia Institute (IHDI) grade, intraoperative hip flexion angle, and intraoperative head-socket spacing were significantly related to the occurrence of re-dislocation after closed-reduction. The multivariate logistic regression analysis showed that preoperative AI > 40.5° ( OR=5.57, P<0.01), flexion angle < 80.5° ( OR=4.93, P<0.01) and head-socket distance > 6.95 mm ( OR=8.42, P<0.01) were risk factors for the re-dislocation. The area under the receiver operator characteristic curve was 0.91 when preoperative AI > 40.5°, flexion angle < 80.5°, head-socket distance > 6.95 mm, and IHDI grade were used to predict the occurrence of re-dislocation, and the sensitivity and specificity were 0.72 and 0.87, respectively. CONCLUSIONS Preoperative AI > 40.5°, intraoperative hip flexion angle < 80.5°, and head-socket distance > 6.95 mm are risk factors for postoperative re-dislocation in children with DDH. These risk factors combining with the IHDI grade would be better to predict the occurrence of re-dislocation.
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Affiliation(s)
- Jingfang Xu
- 1. Department of Pediatric Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Regional Medical Center for Children, Hangzhou 310052, China
| | - Yi Yang
- 1. Department of Pediatric Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Regional Medical Center for Children, Hangzhou 310052, China
| | - Kai Yu
- 1. Department of Pediatric Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Regional Medical Center for Children, Hangzhou 310052, China
| | - Weize Xu
- 1. Department of Pediatric Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Regional Medical Center for Children, Hangzhou 310052, China
| | - Guannan Bai
- 2. Division of Child Health Care, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Regional Medical Center for Children, Hangzhou 310052, China
| | - Wensong Ye
- 1. Department of Pediatric Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Regional Medical Center for Children, Hangzhou 310052, China
| | - Qiang Shu
- 1. Department of Pediatric Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Regional Medical Center for Children, Hangzhou 310052, China
| | - Wenhao Chen
- 1. Department of Pediatric Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Regional Medical Center for Children, Hangzhou 310052, China
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Gather KS, Mavrev I, Gantz S, Dreher T, Hagmann S, Beckmann NA. Outcome Prognostic Factors in MRI during Spica Cast Therapy Treating Developmental Hip Dysplasia with Midterm Follow-Up. CHILDREN 2022; 9:children9071010. [PMID: 35883994 PMCID: PMC9318343 DOI: 10.3390/children9071010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/02/2022] [Accepted: 07/03/2022] [Indexed: 12/02/2022]
Abstract
Closed reduction followed by spica casting is a conservative treatment for developmental dysplasia of the hip (DDH). Magnetic resonance imaging (MRI) can verify proper closed reduction of the dysplastic hip. Our aim was to find prognostic factors in the first MRI to predict the possible outcome of the initial treatment success by means of ultrasound monitoring according to Graf and the further development of the hip dysplasia or risk of recurrence in the radiological follow-up examinations. A total of 48 patients (96 hips) with DDH on at least one side, and who were treated with closed reduction and spica cast were included in this retrospective cohort study. Treatment began at a mean age of 9.9 weeks. The children were followed for 47.4 months on average. We performed closed reduction and spica casting under general balanced anaesthesia. This was directly followed by MRI to control the position/reduction of the femoral head without anaesthesia. The following parameters were measured in the MRI: hip abduction angle, coronal, anterior and posterior bony axial acetabular angles and pelvic width. A Graf alpha angle of at least 60° was considered successful. In the radiological follow-up controls, we evaluated for residual dysplasia or recurrence. In our cohort, we only found the abduction angle to be an influencing factor for improvement of the DDH. No other prognostic factors in MRI measurements, such as gender, age at time of the first spica cast, or treatment involving overhead extension were found to be predictive of mid-term outcomes. This may, however, be due to the relatively small number of treatment failures.
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Affiliation(s)
- Katharina Susanne Gather
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany; (I.M.); (S.G.); (S.H.); (N.A.B.)
- Correspondence: ; Tel.: +49-6221-56-35491
| | - Ivan Mavrev
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany; (I.M.); (S.G.); (S.H.); (N.A.B.)
| | - Simone Gantz
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany; (I.M.); (S.G.); (S.H.); (N.A.B.)
| | - Thomas Dreher
- Pediatric Orthopedics and Traumatology, Children’s University Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland;
| | - Sébastien Hagmann
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany; (I.M.); (S.G.); (S.H.); (N.A.B.)
| | - Nicholas Andreas Beckmann
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany; (I.M.); (S.G.); (S.H.); (N.A.B.)
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Ma S, Zhou W, Li L, Wang E, Zhang L, Li Q. Retrospective Comparison of Outcomes Between Closed and Open Reduction for Developmental Dysplasia of the Hip in Children Aged 6-24 Months. Indian J Orthop 2022; 56:1640-1646. [PMID: 36052390 PMCID: PMC9385909 DOI: 10.1007/s43465-022-00690-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/13/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE We aimed to compare the outcomes between closed reduction (CR) and open reduction (OR) in children aged 6-24 months with developmental dysplasia of the hip (DDH) who could be reduced safely and stably by the closed reduction operation. METHODS We retrospectively reviewed the medical records of 77 patients who underwent CR or OR for DDH. Fifty-one patients (56 hips) underwent CR, 26 (29 hips) underwent OR. The demographic data, International Hip Dysplasia Institute classification and acetabular index (AI) before reduction and the centre-edge angle (CEA), AI, Alsberg angle (AA), Reimer's migration index (RMI), and height-to-width index (HWI) of the epiphysis were compared between two groups at the final follow-up. The percentage of coxa magna > 15% of the normal side and AA > 81° were calculated. RESULTS At the final follow-up, the mean AA in the CR and OR groups were 77.66° (60°-89°) and 81.97° (73°-91°) (p = 0.001), respectively, there were 32.14% and 58.62% of the hips with an AA > 81° (p = 0.019). The frequency of coxa magna > 15% of the normal side was higher in the OR group (60.9%) than in the CR group (6.5%) (p < 0.001). There was no difference in the improvement of AI, CEA, HWI, and RMI. CONCLUSION In children aged 6-24 months with DDH, if a stable and safe CR can be obtained but with medial joint space up to 6mm, CR should be attempted first.
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Affiliation(s)
- Shuyu Ma
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang, 110004 China
| | - Weizheng Zhou
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang, 110004 China
| | - Lianyong Li
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang, 110004 China
| | - Enbo Wang
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang, 110004 China
| | - Lijun Zhang
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang, 110004 China
| | - Qiwei Li
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang, 110004 China
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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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Duan J, Yuan H, Hu X, Lou Y, Zheng P. Femoral osteotomy is not recommended for children aged 2-3 years with Tönnis grade III developmental dysplasia of the hip. J Pediatr Orthop B 2022; 31:242-246. [PMID: 33720074 DOI: 10.1097/bpb.0000000000000860] [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: 11/27/2022]
Abstract
The objective of this study was to compare outcomes following open reduction with and without femoral shortening when treating patients aged 2-3 years with Tönnis grade III developmental dysplasia of the hip (DDH). In this prospective study, 78 patients (6 boys and 72 girls; mean age: 27.8 months; age range: 24-35 months) with Tönnis grade III DDH at our hospital from January 2014 to August 2017 were included. There were 34 hips in the without femoral shortening group and 44 hips in the femoral shortening group. Clinical outcomes were rated using the modified McKay criteria, and the hips were graded using the Severin score. Avascular necrosis (AVN) and redislocation were assessed. Mean follow-up was 26.5 months (range 17-32 months). In the without femoral shortening group (n = 34), there were five patients with AVN (14.7%), and 30 scored excellent and 4 scored good results per the modified McKay criteria. Further, 28 excellent and six good results were obtained using the Severin scale; no patient had redislocation. In the femoral shortening group(n = 44), there were seven patients with AVN (15.9%), and 38 scored excellent and six scored good results per the modified McKay criteria. Further, 31 excellent and 13 good results were obtained using the Severin scale; no patient had redislocation. Additionally, there were no statistically significant differences based on Modified McKay criteria, Severin score and AVN rate. Femoral shortening is not required for children aged 2-3 years with Tönnis grade III DDH.
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Affiliation(s)
- Jiahua Duan
- Department of Orthopaedic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
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Johnson MA, Gohel S, Nguyen JC, Sankar WN. MRI Predictors of Residual Dysplasia in Developmental Dysplasia of the Hip Following Open and Closed Reduction. J Pediatr Orthop 2022; 42:179-185. [PMID: 35125414 DOI: 10.1097/bpo.0000000000002062] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Following open or closed reduction for children with developmental dysplasia of the hip, there remains a significant risk of residual acetabular dysplasia which can compromise the long-term health of the hip joint. The purpose of this study was to use postoperative in-spica magnetic resonance imaging (MRI) data to determine factors predictive of residual acetabular dysplasia at short-term follow-up. METHODS We retrospectively reviewed 63 hips in 48 patients which underwent closed or open reduction and spica casting for developmental dysplasia of the hip. MRI performed in-spica at ∼3-week follow-up were used to assess 11 validated metrics and 2 subjective factors. Acetabular index (AI) was measured on anteroposterior pelvic radiographs at 2-year postoperative follow-up. Binary logistic regression was then used to identify variables predictive of residual dysplasia, defined as an AI greater than the 90th percentile for age based on historic normative data. RESULTS Average age at surgical reduction was 9.3±3.2 months. 58.7% (37/63) of reductions were open. A total of 43 (68.3%) hips demonstrated residual acetabular dysplasia at 2 years postoperatively based on normative values. In those with persistent dysplasia, patients were on average older at the time of reduction (10.0 mo±3.2 vs. 8.0 mo±2.8, P=0.010) and more likely female (88.4% vs. 60.0%, P=0.010). Patients with residual dysplasia were more likely to have mild subluxation on postoperative MRI (40.0% vs. 10.5%, P=0.022). Hips with a cartilaginous acetabular index (CAI) of >23 degrees were 7.6 times more likely to develop residual dysplasia. Type of reduction (ie, closed vs. open) did not appear to influence the rate of residual dysplasia (P=0.682). CONCLUSION In this series, the rate of residual dysplasia after surgical reduction was higher than most previous reports, with no appreciable difference between closed and open reductions. Older age, female sex, and a higher CAI were associated with a greater risk of persistent radiographic dysplasia. In particular, hips with a CAI >23 degrees were 7.6 times more likely to be dysplastic at 2-year follow-up. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Mitchell A Johnson
- Departments of Orthopaedics
- The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Jie C Nguyen
- Radiology, The Children's Hospital of Philadelphia
| | - Wudbhav N Sankar
- Departments of Orthopaedics
- The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Huang P, Wang D, Mo Y, Zheng Y, Ning B. Teardrop and sourcil line (TSL): a novel radiographic sign that predicts residual acetabular dysplasia (RAD) in DDH after closed reduction. Transl Pediatr 2022; 11:458-465. [PMID: 35558977 PMCID: PMC9085947 DOI: 10.21037/tp-21-401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 02/17/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Residual acetabular dysplasia (RAD) is a major problem of developmental dysplasia of the hip (DDH) after closed reduction (CR). Several parameters have been investigated as ways of predicting RAD; however, prediction of RAD remains controversial. The purpose of this study was to evaluate the radiographic sign of teardrop and sourcil line (TSL) in pediatric patients with DDH to enable prediction of RAD after CR. METHODS One hundred and twenty-five hips with DDH treated with CR and followed up for at least 2 years were included in this study. The mean age at CR was 18.3 months (range, 9 to 32 months) and the average follow-up time was 50.2 months (range, 24 to 89 months). The acetabular index (AI) was measured at different time points. The cases were divided into two groups according to whether TSL became continuous or not. The relationships among TSL, AI and RAD were analyzed. RESULTS The RAD incidence was 73.6% (92/125) at the last follow-up. AI at CR and TSL were the prognostic factors for RAD (P=0.017 and 0.001, respectively). Thirty-four hips showed a continuous TSL. There was a lower RAD rate in the TSL continuous group (P<0.001). There was no statistical difference in the AI at CR between the TSL continuous and discontinuous groups; however, the level of AI after CR was lower in the TSL continuous group. The TSL of 74% (20/27) hips became continuous after acetabular osteotomy surgery. CONCLUSIONS The TSL continuous group had a lower AI and incidence of RAD than the discontinuous group. The TSL can be a predictive factor of RAD in DDH after CR and restore the continuous of TSL maybe a potential parameter that can help surgeons to make a judgment intra-operation.
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Affiliation(s)
- Peng Huang
- Department of Orthopaedics Surgery, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
| | - Dahui Wang
- Department of Orthopaedics Surgery, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
| | - Yueqiang Mo
- Department of Orthopaedics Surgery, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
| | - Yiming Zheng
- Department of Orthopaedics Surgery, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
| | - Bo Ning
- Department of Orthopaedics Surgery, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
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Zhou W, Guo H, Duan R, Shi Q. Visualized simulative surgery in preoperative planning for proximal femoral varus osteotomy of DDH. BMC Musculoskelet Disord 2022; 23:295. [PMID: 35346154 PMCID: PMC8962210 DOI: 10.1186/s12891-022-05219-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 03/07/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose To assess the preoperative planning of visualized simulative surgery (VSS) and clinical outcomes based on computer-aided design (CAD) and 3D reconstruction for proximal femoral varus osteotomy of DDH. Methods A total of 31 consecutive patients (23 females and 8 males) with DDH who underwent proximal femoral varus osteotomy were retrospectively reviewed between June 2014 and July 2018. Patients were divided into conventional group (n = 15) and VSS group (n = 16) according to different surgical methods. In VSS group, 16 consecutive patients who underwent proximal femoral varus osteotomy were evaluated preoperatively with the aid of VSS. The VSS steps included morphological evaluation of DDH, simulated reconstruction of proximal femoral varus osteotomy, and the implantation of locking compression pediatric hip plate (LCP-PHP). Meanwhile, the osteotomy degrees, surgery time, and radiation exposure were compared between the two groups. Results The average follow-up time was 33.5 months (range, 24 to 46 months). The varus angle for proximal femoral varus osteotomy was 24.2 ± 1.1° in VSS group and 25.1 ± 1.0° in conventional group (P = 0.4974). The surgery time was 31.0 ± 4.5 mins in VSS group and 48.2 ± 7.3 mins in conventional group, while radiography was 5.0 ± 1.5 times in VSS group and 8.3 ± 2.4 times in conventional group. There was a statistical significance in surgery time and radiography (P < 0.0001) when compared with the conventional group. Conclusion The VSS can greatly decrease surgery time and radiation exposure for proximal femoral varus osteotomy, which could also be a tool to train young doctors to improve surgical skills and academic communication. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05219-7.
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Willemsen K, Möring MM, Harlianto NI, Tryfonidou MA, van der Wal BCH, Weinans H, Meij BP, Sakkers RJB. Comparing Hip Dysplasia in Dogs and Humans: A Review. Front Vet Sci 2022; 8:791434. [PMID: 34977223 PMCID: PMC8714762 DOI: 10.3389/fvets.2021.791434] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/17/2021] [Indexed: 11/13/2022] Open
Abstract
Hip dysplasia (HD) is common in both humans and dogs. This interconnection is because humans and dogs descended from a common ancestor and therefore have a similar anatomy at micro- and macroscopic levels. Furthermore, dogs are the animals of choice for testing new treatments for human hip dysplasia and orthopedic surgery in general. However, little literature exists comparing HD between the two species. Therefore, the aim of this review is to describe the anatomy, etiology, pathogenesis, diagnostics, and treatment of HD in humans and dogs. HD as an orthopedic condition has many common characteristics in terms of etiology and pathogenesis and most of the differences can be explained by the evolutionary differences between dogs and humans. Likewise, the treatment of HD shows many commonalities between humans and dogs. Conservative treatment and surgical interventions such as femoral osteotomy, pelvic osteotomy and total hip arthroplasty are very similar between humans and dogs. Therefore, future integration of knowledge and experiences for HD between dogs and humans could be beneficial for both species.
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Affiliation(s)
- Koen Willemsen
- 3D Lab, Division of Surgical Specialties, University Medical Center Utrecht, Utrecht, Netherlands.,Department of Orthopedics, University Medical Center Utrecht, Utrecht, Netherlands
| | - Michelle M Möring
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, Netherlands
| | - Netanja I Harlianto
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, Netherlands
| | - Marianna A Tryfonidou
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | - Bart C H van der Wal
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, Netherlands
| | - Harrie Weinans
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, Netherlands.,Department of Biomechanical Engineering, Delft University of Technology, Delft, Netherlands
| | - Björn P Meij
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | - Ralph J B Sakkers
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, Netherlands
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Badawy MY, Afifi A, Shaker ES, Elbarbary H, Hegazy M, Mohamed MT, Arafa A. Is capsulorrhaphy a necessary step during open reduction of developmental dysplasia of the hip? A randomized controlled trial. INTERNATIONAL ORTHOPAEDICS 2021; 46:589-596. [PMID: 34817631 DOI: 10.1007/s00264-021-05267-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 11/09/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate the necessity of performing capsulorrhaphy during open reduction of DDH. METHODS A single-centre, prospective, randomized controlled trial was conducted between 2015 and 2020. The study included 82 hips in 67 patients with developmental dysplasia of the hip (DDH) who were treated with open reduction via the anterior approach. Patients were randomized into two equal groups (41 hips in each group); group A (capsulorrhaphy was done) and group B (capsulorrhaphy was not done). Dega osteotomy was performed in all cases, while femoral derotation shortening osteotomy was performed only in four hips in group A and four hips in group B. The mean age at the time of surgery was 33 ± 22.3 months. The follow-up period was 24 months for all patients. At the final follow-up, maintenance of reduction was chosen as the primary outcome and was assessed radiologically by the Severin's grading system. Secondary outcome measures were functional evaluation (by using the modified McKay's criteria), Shenton line assessment, acetabular index measurement, and complications. RESULTS According to the Severin's grading system, concentric reduction was achieved in 36 hips in group A and 37 hips in group B, subluxation occurred in three hips in each group, and redislocation was encountered in two hips in group A and one hip in group B. There was no statistically significant difference between both groups (p-value = 0.239). According to the modified McKay's criteria, the results were satisfactory (excellent and good) in 34 hips (82.9%) in group A and 36 hips (87.8%) in group B. The difference was statistically insignificant (p-value = 0.352). The rate of complications was higher in group A (17.1%) than group B (12.2%) (p-value = 0.532). CONCLUSION The stability of the hip joint after open reduction depends mainly on adequate removal of soft tissue obstacles that impede reduction and proper correction of the bony configuration of the hip using pelvic and/or femoral osteotomy. So, the authors believe that capsulorrhaphy is not necessary in the surgical management of DDH, provided that adequate soft tissue and bony gestures are combined.
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Affiliation(s)
| | - Ahmed Afifi
- Department of Orthopaedic Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Ezzat Samir Shaker
- Department of Orthopaedic Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hassan Elbarbary
- Department of Orthopaedic Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Hegazy
- Department of Orthopaedic Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Amr Arafa
- Department of Orthopaedic Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
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Arneill M, Cosgrove A, Robinson E. Should closed reduction of the dislocated hip be attempted after failed Pavlik harness treatment in developmental dysplasia of the hip? Bone Jt Open 2021; 2:584-588. [PMID: 34351213 PMCID: PMC8384449 DOI: 10.1302/2633-1462.28.bjo-2021-0088.r1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aims To determine the likelihood of achieving a successful closed reduction (CR) of a dislocated hip in developmental dysplasia of the hip (DDH) after failed Pavlik harness treatment We report the rate of avascular necrosis (AVN) and the need for further surgical procedures. Methods Data was obtained from the Northern Ireland DDH database. All children who underwent an attempted closed reduction between 2011 and 2016 were identified. Children with a dislocated hip that failed Pavlik harness treatment were included in the study. Successful closed reduction was defined as a hip that reduced in theatre and remained reduced. Most recent imaging was assessed for the presence of AVN using the Kalamchi and MacEwen classification. Results There were 644 dislocated hips in 543 patients initially treated in Pavlik harness. In all, 67 hips failed Pavlik harness treatment and proceeded to arthrogram (CR) under general anaesthetic at an average age of 180 days. The number of hips that were deemed reduced in theatre was 46 of the 67 (69%). A total of 11 hips re-dislocated and underwent open reduction, giving a true successful CR rate of 52%. For the total cohort of 67 hips that went to theatre for arthrogram and attempted CR, five (7%) developed clinically significant AVN at an average follow-up of four years and one month, while none of the 35 hips whose reduction was truly successful developed clinically significant AVN. Conclusion The likelihood of a successful closed reduction of a dislocated hip in the Northern Ireland population, which has failed Pavlik harness treatment, is 52% with a clinically significant AVN rate of 7%. As such, we continue to advocate closed reduction under general anaesthetic for the hip that has failed Pavlik harness. Cite this article: Bone Jt Open 2021;2(8):594–598.
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The effectiveness of preliminary traction in the treatment of congenital dislocation of the hip. J Orthop Traumatol 2021; 22:26. [PMID: 34180020 PMCID: PMC8236418 DOI: 10.1186/s10195-021-00586-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 06/03/2021] [Indexed: 11/10/2022] Open
Abstract
Background Historical papers on the treatment of congenital dislocation of the hip suggest the use of preliminary traction to facilitate closed reduction or to decrease the risk of avascular necrosis (AVN) of the femoral head. In the 1980s, some authors questioned the role of preliminary traction and suspended its use, yielding satisfactory results. Since then, several studies called into question this method, and some authors have continued to recommend preliminary traction while other authors have discouraged its use. Materials and methods We reanalysed the full set of radiographs of 71 hips (52 patients) surgically treated by a medial approach after 4 weeks of preoperative longitudinal traction. The mean age at operation was 16 months. Before and after traction, the height of the dislocation was graded according to the Gage and Winter method. The hips were divided into two groups: group 1, in which the traction was effective, and group 2, in which the traction was not effective. These two groups were statistically analysed regarding the severity of the dislocation, the age of the patient at surgery and the incidence of AVN. Results Preliminary traction was effective in 48 hips (68%, group 1), while it was not effective in the remaining 23 (32%, group 2). The effectiveness of preliminary traction was statistically related to the height of the dislocation and to the age of the patient at surgery, with traction being less effective in more severe dislocations and in older children. The incidence of AVN was statistically lower in group 1 than in group 2. Conclusions In our study population, despite not having a control group, preliminary traction—when effective—seemed to reduce the incidence of AVN in patients surgically treated for congenital dislocation of the hip. The effectiveness of the traction was influenced by the severity of the dislocation and the age of the patient; it worked better for less severe dislocations and in younger children. To reduce hospital costs, traction should be applied at home. Level of evidence 3.
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Developmental hip dysplasia and hip ultrasound frequency in a large American payer database. Clin Imaging 2021; 76:213-216. [PMID: 33965847 DOI: 10.1016/j.clinimag.2021.04.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 03/30/2021] [Accepted: 04/19/2021] [Indexed: 11/21/2022]
Abstract
Developmental dysplasia of the hip (DDH) is an important contributor to musculoskeletal morbidity, but effective strategies to screen for DDH remain controversial. The current utilization of hip ultrasound (US) screening for DDH in the United States is not defined. This study utilized Optum's de-identified Clinformatics® Data Mart, a large commercial and Medicare Advantage claims database. The frequency of DDH and hip US utilization was estimated using billing data on an average of 2.9 million relevant beneficiaries included annually from 2007 through 2017. A total of 6806 DDH cases were identified with an average annual prevalence of 1.7 per 1000 infants, which was stable during the study period. Girls were more likely to be screened and diagnosed with DDH, comprising 72% of DDH cases with an OR of 2.55 (95% CI 2.42-2.69), p < 0.001. Hip US screening was employed in 0.9% of the infant population on average but increased substantially from 2007 (0.4%) to 2017 (2.2%). Most common billing diagnoses included hip deformity (27.4%), breech delivery (20.4%), and physical exam abnormality (17.7%). The average imaging costs per patient for all screened children was $108.94. Insurance claims reflect the current American practice of selective hip US with relative adherence to American Academy of Pediatrics guidelines based on reported diagnoses. While hip US utilization increased during the study period, prevalence of DDH diagnoses did not increase. Our results suggest that expansion of hip US screening may not effectively increase DDH detection although further investigation is needed to ascertain optimal screening strategies to improve patient outcomes.
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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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Zhang G, Li M, Qu X, Cao Y, Liu X, Luo C, Zhang Y. Efficacy of closed reduction for developmental dysplasia of the hip: midterm outcomes and risk factors associated with treatment failure and avascular necrosis. J Orthop Surg Res 2020; 15:579. [PMID: 33267908 PMCID: PMC7709328 DOI: 10.1186/s13018-020-02098-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 11/19/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the efficacy of closed reduction (CR) in the treatment of developmental dysplasia of the hip (DDH) and to investigate risk factors associated with CR failure and avascular necrosis (AVN) occurrence in follow-ups. METHODS The study retrospectively included 110 patients and 138 hips with DDH diagnosis that underwent closed reduction between February 2012 and November 2015 in our single tertiary medical institution. The failure rate of CR and the underlying risk factors were evaluated. Meanwhile, the incidence of AVN and the related risk factors among the successful CR cases were assessed. RESULTS The overall failure rate of DDH treated by CR in the present study was 31.16% (43/138). Risk factors for the CR failure were older age at the time of CR (≥ 18.35 month), large medical interval before CR (≥ 35.35 mm), and severer dislocation of the affected hip (IDHI grades III and IV). The incidence of AVN was 8.33% (6/72) in patients with successful CR at the last follow-up. No significant risk factors had been established in the present study that associated with the AVN occurrence. CONCLUSIONS For the treatment of DDH with CR, patients with younger age might achieve better outcomes; early diagnosis and early treatment might be the key point in the DDH treatment.
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Affiliation(s)
- Ge Zhang
- Department of Orthopaedics; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders (Chongqing); China International Science and Technology Cooperation base of Child development and Critical Disorders; Children's Hospital of Chongqing Medical University, 136 Zhongshan Er Road, Yuzhong District, Chongqing, 400014, People's Republic of China
| | - Ming Li
- Department of Orthopaedics; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders (Chongqing); China International Science and Technology Cooperation base of Child development and Critical Disorders; Children's Hospital of Chongqing Medical University, 136 Zhongshan Er Road, Yuzhong District, Chongqing, 400014, People's Republic of China
| | - Xiangyang Qu
- Department of Orthopaedics; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders (Chongqing); China International Science and Technology Cooperation base of Child development and Critical Disorders; 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; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders (Chongqing); China International Science and Technology Cooperation base of Child development and Critical Disorders; 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; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders (Chongqing); China International Science and Technology Cooperation base of Child development and Critical Disorders; Children's Hospital of Chongqing Medical University, 136 Zhongshan Er Road, Yuzhong District, Chongqing, 400014, People's Republic of China
| | - Cong Luo
- Department of Orthopaedics; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders (Chongqing); China International Science and Technology Cooperation base of Child development and Critical Disorders; Children's Hospital of Chongqing Medical University, 136 Zhongshan Er Road, Yuzhong District, Chongqing, 400014, People's Republic of China
| | - Yuan Zhang
- Department of Orthopaedics; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders (Chongqing); China International Science and Technology Cooperation base of Child development and Critical Disorders; Children's Hospital of Chongqing Medical University, 136 Zhongshan Er Road, Yuzhong District, Chongqing, 400014, People's Republic of China.
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Alanazi H, Almalik F, Alanazi N, Alhussainan T. Relapsed hip stiffness after recovery of range of motion in a hip treated for developmental dysplasia of the hip? Think again: A case report. Int J Surg Case Rep 2020; 77:843-847. [PMID: 33395909 PMCID: PMC8253858 DOI: 10.1016/j.ijscr.2020.11.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 11/25/2020] [Indexed: 11/16/2022] Open
Abstract
How to evaluate complications following DDH treatment. Muscular spasm can mislead physicians following treatment of DDH. Hip stiffness vs muscular spasm in DDH patients. Examination under anesthesia could be the answer for relapsed hip stiffness. 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.
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Affiliation(s)
- Hasan Alanazi
- Department of Orthopedic Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
| | - Faisal Almalik
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Naif Alanazi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Thamer Alhussainan
- Department of Orthopedic Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Buddhdev PK, Vanhegan IS, Khan T, Hashemi-Nejad A. Early to medium-term outcomes of uncemented ceramic-bearing total hip arthroplasty in teenagers for paediatric hip conditions. Bone Joint J 2020; 102-B:1491-1496. [PMID: 33135445 DOI: 10.1302/0301-620x.102b11.bjj-2020-0668.r1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Despite advances in the treatment of paediatric hip disease, adolescent and young adult patients can develop early onset end-stage osteoarthritis. The aims of this study were to address the indications and medium-term outcomes for total hip arthroplasty (THA) with ceramic bearings for teenage patients. METHODS Surgery was performed by a single surgeon working in the paediatric orthopaedic unit of a tertiary referral hospital. Databases were interrogated from 2003 to 2017 for all teenage patients undergoing THA with a minimum 2.3 year follow-up. Data capture included patient demographics, the underlying hip pathology, number of previous surgeries, and THA prostheses used. Institutional ethical approval was granted to contact patients for prospective clinical outcomes and obtain up-to-date radiographs. In total, 60 primary hips were implanted in 51 patients (35 female, 16 male) with nine bilateral cases. The mean age was 16.7 years (12 to 19) and mean follow-up was 9.3 years (2.3 to 16.8). RESULTS The most common indication for teenage hip arthroplasty was avascular necrosis secondary to slipped upper femoral epiphysis (31%; n = 16). Overall, 64% of patients (n = 33) had undergone multiple previous operations. The survival at follow-up was 97%; two patients required revision for aseptic loosening (one femoral stem, one acetabular component). Both patients had fused hips noted at the time of arthroplasty. A further two patients had radiolucent lines but were asymptomatic. At latest follow-up the mean Oxford Hip Score was 44 (31 to 48) and a Visual Analogue Scale measurement of 1.5, indicating satisfactory function. CONCLUSION Operating on this cohort can be complicated by multiple previous surgeries and distorted anatomy, which in some cases require custom-made prostheses. We have demonstrated a good outcome with low revision rate in this complex group of patients. Cite this article: Bone Joint J 2020;102-B(11):1491-1496.
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Affiliation(s)
- Pranai K Buddhdev
- Catterall Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, UK
| | - Ivor S Vanhegan
- Catterall Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, UK
| | - Tahir Khan
- Catterall Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, UK
| | - Aresh Hashemi-Nejad
- Catterall Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, UK
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Yuan Z, Li Y, Hong K, Wu J, Canavese F, Xu H. Poor delineation of labrum and acetabular surface on arthrogram is a predictor of early failure of closed reduction in children aged six to 24 months with developmental dysplasia of the hip. J Child Orthop 2020; 14:372-378. [PMID: 33204344 PMCID: PMC7666794 DOI: 10.1302/1863-2548.14.200132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE The objective of this study was to explore the predictors for failed reduction in children with developmental dysplasia of the hip (DDH) managed by arthrogram, closed reduction (CR) and spica cast immobilization. METHODS We retrospectively reviewed the clinical data of patients with DDH treated by CR and cast immobilization (2015-2020), including age, sex, affected side, presence/absence of an ossific nucleus, International Hip Dysplasia Institute classification, the delineation of labrum and acetabular surface on arthrogram, inverted labrum, acetabular index (AI), hip abduction angle and medial dye pool (MDP) distance. Predictors that potentially predicted failure of CR were evaluated by logistic regression analysis, simple t-test, Fisher's Exact Test and chi-square test. RESULTS In total, 16 out of 187 hips failed to achieve initial CR (8.6%). Gender, age, preoperative AI and poor delineation of arthrogram were candidate predictors for failed CR in children aged six to 24 months with DDH; on the other hand, logistic regression analysis confirmed age and poor delineation of arthrogram significantly predicted failure of CR. Receive operating characteristic curve (ROC) showed MDP less than 6 mm and age higher than 14.5 months significantly increased the failure rate of CR in children aged six to 24 months with DDH. CONCLUSION Age and poor delineation of labrum and acetabular surface during arthrogram predicted failure of CR in children with DDH. In particular, age > 14.5 months and MDP distance ≥ 6 mm significantly increased the risk of CR failure. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Zhe Yuan
- GuangZhou Women and Children’s Medical Center, GuangZhou Medical University, GuangZhou, China
| | - Yiqiang Li
- GuangZhou Women and Children’s Medical Center, GuangZhou Medical University, GuangZhou, China
| | - Kai Hong
- GuangZhou Women and Children’s Medical Center, GuangZhou Medical University, GuangZhou, China
| | - Jianping Wu
- GuangZhou Women and Children’s Medical Center, GuangZhou Medical University, GuangZhou, China
| | - Federico Canavese
- GuangZhou Women and Children’s Medical Center, GuangZhou Medical University, GuangZhou, China,University Hospital Estaing, Department of Pediatric Surgery, Clermont Ferrand, France,Correspondence should be sent to Federico Canavese, Department of Pediatric Orthopaedics, GuangZhou Women and Children’s Medical Center, 9th JinSui Road, GuangZhou, 510623, China. E-mail:
| | - Hongwen Xu
- GuangZhou Women and Children’s Medical Center, GuangZhou Medical University, GuangZhou, China,HongWen Xu, Department of Pediatric Orthopaedics, GuangZhou Women and Children’s Medical Center, 9th JinSui Road, GuangZhou, 510623, China. E-mail:
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Should I Plan to Open? Predicting the Need for Open Reduction in the Treatment of Developmental Dysplasia of the Hip. J Pediatr Orthop 2020; 40:e329-e334. [PMID: 31385896 DOI: 10.1097/bpo.0000000000001429] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Closed reduction is generally attempted on children under 18 months of age who present as older infants or who fail nonoperative management for developmental dysplasia of the hip (DDH). However, many of these patients will not achieve concentric reduction by closed means and will ultimately require open reduction (OR). Limited evidence exists to predict which patients can be adequately closed reduced versus those who will need open treatment. METHODS Prospectively collected data from 4 select centers of an international multicenter study group sharing a common treatment approach were reviewed for all DDH infants under 18 months old that required operative management. Patients were categorized into 2 groups: those whose hips were successfully closed reduced or those who ultimately required OR. Factors were compared between the closed reduction and OR groups for 2 separate cohorts-those presenting early in life with ultrasound (US) data, and those presenting later with radiographic data. RESULTS A total of 154 patients (166 hips) were included in the analysis. Overall, 87.3% were female. In the early-presenting cohort, purposeful entry multivariate regression revealed that patients with Graf IV hips on US had 3.8 times higher odds of requiring an OR. For the later cohort, hips that were clinically irreducible (ie, negative Ortolani sign) had 3.3 times higher odds of requiring OR. Patients with International Hip Dysplasia Institute (IHDI) grade IV hips had 2.5 times higher odds of needing an OR versus those with grade III hips and 15.4 times higher odds than those with grade II hips. Children with an IHDI grade IV hip and a negative Ortolani sign had 4.4 times higher odds of needing OR. CONCLUSION Children younger than 18 months with dislocated hips who require OR are more likely to have a high-grade radiographic dislocation (IHDI grade IV), negative preoperative Ortolani sign, and a Graf IV classification on initial US. This information may help surgeons budget the use of operating room time and better counsel parents about intraoperative expectations. LEVEL OF EVIDENCE Level III-Prognostic.
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Effect of age on radiographic outcomes of patients aged 6-24 months with developmental dysplasia of the hip treated by closed reduction. J Pediatr Orthop B 2020; 29:431-437. [PMID: 31464797 DOI: 10.1097/bpb.0000000000000672] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
This study aimed to investigate the effect of age on the rates of redislocation, avascular necrosis (AVN) of the femoral head, and final radiographic outcomes in patients with developmental dysplasia of the hip (DDH) treated with closed reduction. A total of 308 hips (276 patients) with DDH treated with closed reduction were included and divided into three groups according to age (<12, 12-18, 18-24 months). Tönnis grade, rate of redislocation and AVN, Severin radiographic grade, and risk of surgery were evaluated on radiographs. Tönnis grade significantly increased with age (P < 0.001). Redislocation occurred in 17 (5.5%) and AVN occurred in 36 (11.7%) hips. The rate of redislocation and AVN was similar among the three age groups in all Tönnis grades. However, redislocation rate significantly increased with Tönnis grade (P = 0.027). Overall, 246 hips (79.9%) had satisfactory final outcomes, and 62 hips (20.1%) had unsatisfactory outcome; no difference was observed among three age groups. A total of 103 hips (33.4%) were found to be at risk for secondary surgery. The surgical risk (25%) in patients younger than 12 months was lower than that of older patients (12-18 months: 34.4%; 18-24 months: 37.9%). Logistic regression analysis also confirmed that age was not a risk factor for redislocation, AVN, or poor radiographic outcome. In conclusion, age has no significant impact on redislocation and AVN in patients aged 6-24 months with DDH treated by closed reduction. Although older patients have a higher risk developing residual acetabular dysplasia, secondary pelvic surgery provides favorable outcomes in most patients.
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Walter SG, Endler CHJ, Remig AC, Luetkens JA, Bornemann R, Placzek R. Risk factors for failed closed reduction in dislocated developmental dysplastic hips. INTERNATIONAL ORTHOPAEDICS 2020; 44:2343-2348. [PMID: 32488566 PMCID: PMC8275556 DOI: 10.1007/s00264-020-04655-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 05/26/2020] [Indexed: 11/26/2022]
Abstract
AIM OF THE STUDY The present study aimed to identify risk factors for unsuccessful CR. INTRODUCTION Closed reduction (CR) represents the gold standard for treatment of developmental dysplasia of the hip (DDH), but to a minor percentage, it fails to reduce dysplastic hips successfully. METHODS Seventy-three dysplastic hips underwent closed reduction and post-interventional MRI of the pelvis. MRIs were evaluated for successful reduction of the hip, volumes of femoral heads, and acetabular diameter. Initial treatment results were correlated to AC angles at two years of follow-up. Contralateral, healthy hips served as control. RESULTS Out of 73 instable, dysplastic hips, there were nine cases of CR failure. These cases showed significantly increased femoral head volumes (p = 0.002) and a significantly (p = 0.02) larger ratio of femoral head volume to acetabular opening area. There was no significant difference (p = 0.15) in acetabular diameter between both groups. At two years of follow-up, AC angles were significantly (p = 0.003) larger and pathologic in cases of CR failure. CONCLUSION Exclusive enlargement of the femoral head is a risk factor for unsuccessful reduction and its ratio to the acetabular opening surface is predictive for CR success in DDH.
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Affiliation(s)
- Sebastian Gottfried Walter
- Department of Orthopaedic Surgery, University Hospital Bonn, Bonn, Germany.
- Department of Cardiothoracic Surgery, University Hospital Cologne, Kerpener Str. 63, 50937, Cologne, Germany.
| | | | | | | | - Rahel Bornemann
- Department of Orthopaedic Surgery, University Hospital Bonn, Bonn, Germany
| | - Richard Placzek
- Department of Orthopaedic Surgery, University Hospital Bonn, Bonn, Germany
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Lussier EC, Lei WT, Sun YT, Chen HW, Chang TY, Chang CH. Newborn Hip Screenings at 4 to 8 Weeks Are Optimal in Predicting Referral and Treatment Outcomes: A Retrospective Review. ACTA ACUST UNITED AC 2020. [DOI: 10.4236/ojped.2020.102034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Dibello D, Odoni L, Pederiva F, Di Carlo V. MRI in Postreduction Evaluation of Developmental Dysplasia of the Hip: Our Experience. J Pediatr Orthop 2019; 39:449-452. [PMID: 31503229 DOI: 10.1097/bpo.0000000000001037] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Developmental dysplasia of the hip (DDH) is one of the most common congenital defects in the newborn. When its severe form is not corrected, it is associated with long-term morbidity. Closed reduction with casting is the standard primary treatment and reduction is confirmed by magnetic resonance imaging (MRI). We reported our experience on the reliability of MRI in postreduction assessment of DDH. METHODS All children who underwent closed reduction for Graf type IV DDH at our institution between September 2010 and June 2016 were retrospectively reviewed. Since 2010 we assessed postreduction position of the femoral head by performing a MRI. RESULTS Twenty-five (5 male, 20 female) patients presented with 29 (15 left sided, 6 right sided, 4 bilateral) Graf type IV DDH and underwent closed reduction at a mean age of 3.4 months. In all patients MRI studies performed within 24 hours were diagnostic, showing a concentric reduction of the femoral head within the acetabulum in 24/25 patients. In the patient with persistent hip instability, a subsequent open reduction was performed. In all the cases, there was no need of any contention or sedation during MRI. CONCLUSIONS On the basis of our experience, MRI is an excellent, safe and, reliable modality to confirm maintenance of adequate femoral head position and to evaluate soft tissue interposition. We agree that MRI is the gold standard to early depict dislocation after closed reduction of DDH.
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Affiliation(s)
| | | | - Federica Pederiva
- Pediatric Surgery, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", Trieste, Italy
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Castañeda PG, Moses MJ. Closed Compared with Open Reduction in Developmentally Dislocated Hips: A Critical Analysis Review. JBJS Rev 2019; 7:e3. [PMID: 31663917 DOI: 10.2106/jbjs.rvw.18.00179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» The treatment of developmental dislocation of the hip after walking age continues to be controversial.» Success can be considered in terms of the rates of osteonecrosis or proximal growth disturbance, the rate of recurrent dislocation, and residual dysplasia.» Case series are small and have many confounders.» The rate of residual dysplasia is lowest after an open reduction and pelvic osteotomy.
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Affiliation(s)
- Pablo G Castañeda
- Department of Orthopaedic Surgery, NYU Langone Health and Hassenfeld Children's Hospital, New York University School of Medicine, New York, NY
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Liu YH, Xu HW, Li YQ, Hong K, Li JC, Pereira B, Xun FX, Canavese F. Effect of abduction on avascular necrosis of the femoral epiphysis in patients with late-detected developmental dysplasia of the hip treated by closed reduction: a MRI study of 59 hips. J Child Orthop 2019; 13:438-444. [PMID: 31695810 PMCID: PMC6808074 DOI: 10.1302/1863-2548.13.190045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The purpose of this study was to explore whether increasing the hip abduction angle would increase the incidence of avascular necrosis (AVN) in patients with late- detected developmental dysplasia of the hip (DDH) treated by closed reduction (CR) and spica cast immobilization. METHODS A total of 55 patients (59 hips) with late-detected DDH underwent MRI after CR. Hip abduction angle and hip joint distance were measured on postoperative MRI transverse sections. The acetabular index and centre-edge angle were measured on plain radiographs at the last follow-up. The presence of AVN according to Kalamchi and McEwen's classification was assessed. We retrospectively analyzed the associations among abduction angles, hip joint distances, radiographic parameters, AVN and final outcomes, exploring the relationship between hip joint abduction angle and AVN rate. RESULTS The mean age at the time of CR was 14.4 months SD 5.5 (6 to 28), and the mean follow-up was 26.2 months SD 8.1 (12.4 to 41.7). The mean hip abduction angle was 70.2° SD 7.2° (53° to 85°) on the dislocated side and 63.7° SD 8.8° (40° to 82°) on the normal side; the mean hip joint distance was 5.1 mm SD 1.9 (1.3 to 9.1) on the dislocated side and 2.2 mm SD 0.6 on the normal side (1.3 to 3.3). Eight of 59 hips (13.6%) developed AVN. Neither the amount of abduction nor hip joint distance increased the AVN rate (p = 0.97 and p = 0.65, respectively) or the dislocation rate (p = 0.38 and p = 0.14, respectively). CONCLUSION Abduction angle up to 70.2° following CR did not increase the AVN rate in children aged six to 28 months with late-detected DDH treated by CR. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Y. H. Liu
- Department of Pediatric Orthopedics, GuangZhou Women and Children’s Medical Center, Guangzhou, China
| | - H. W. Xu
- Department of Pediatric Orthopedics, GuangZhou Women and Children’s Medical Center, Guangzhou, China
| | - Y. Q. Li
- Department of Pediatric Orthopedics, GuangZhou Women and Children’s Medical Center, Guangzhou, China
| | - K. Hong
- Department of Pediatric Orthopedics, GuangZhou Women and Children’s Medical Center, Guangzhou, China
| | - J. C. Li
- Department of Pediatric Orthopedics, GuangZhou Women and Children’s Medical Center, Guangzhou, China
| | - B. Pereira
- Department of Pediatric Orthopedic Surgery, University Hospital Estaing, Clermont Ferrand, France
| | - F. X. Xun
- Department of Pediatric Orthopedics, GuangZhou Women and Children’s Medical Center, Guangzhou, China
| | - F. Canavese
- Department of Pediatric Orthopedics, GuangZhou Women and Children’s Medical Center, Guangzhou, China,Department of Pediatric Orthopedic Surgery, University Hospital Estaing, Clermont Ferrand, France,Correspondence should be sent to F. Canavese, Department of Pediatric Orthopedics, GuangZhou Women and Children’s Medical Center, 9th Jingshui Rd. Guangzhou, 510623, China. E-mail:
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Traction does not decrease failure of reduction and femoral head avascular necrosis in patients aged 6-24 months with developmental dysplasia of the hip treated by closed reduction: a review of 385 patients and meta-analysis. J Pediatr Orthop B 2019; 28:436-441. [PMID: 30585878 DOI: 10.1097/bpb.0000000000000586] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study aimed to investigate the effects of preliminary traction on the rate of failure of reduction and the incidence of femoral head avascular necrosis (AVN) in patients with late-detected developmental dysplasia of the hip treated by closed reduction. A total of 385 patients (440 hips) treated by closed reduction satisfied the inclusion criteria. Patients were divided in two groups according to treatment modality: a traction group (276 patients) and a no-traction group (109 patients). Tönnis grade, rate of failure reduction, AVN rate, acetabular index, center-edge angle of Wiberg, and Severin's radiographic grade were assessed on plain radiographs, and the results were compared between the two groups of patients. In addition, a meta-analysis was performed based on the existing comparative studies to further evaluate the effect of traction on the incidence of AVN. Tönnis grade in the traction group was significantly higher than in the no-traction group (P = 0.021). The overall rate of failure reduction was 8.2%; no significant difference was found between the traction (9.2%) and no-traction groups (5.6%) (P = 0.203). The rates of failure reduction were similar in all Tönnis grades, regardless of treatment modality (P > 0.05). The rate of AVN in the traction group (14%) was similar to that of the no-traction group (14.5%; P = 0.881). Moreover, the rates of AVN were similar in all Tönnis grades, regardless of treatment modality (P > 0.05). The meta-analysis did not identify any significant difference in the AVN rate whether preliminary traction was used or not (odds ratio = 0.76, P = 0.32). At the last follow-up visit, the two groups of patients had comparable acetabular indices, center-edge angles, and Severin's radiographic grades (P > 0.05). In conclusion, preliminary traction does not decrease the failure of reduction and the incidence of AVN in developmental dysplasia of the hip treated by closed reduction between 6 and 24 months of age.
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AAOS Appropriate Use Criteria: The Management of Developmental Dysplasia of the Hip in Infants up to Six Months of Age: Intended for Use by Orthopaedic Specialists. J Am Acad Orthop Surg 2019; 27:e369-e372. [PMID: 30418271 DOI: 10.5435/jaaos-d-18-00499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Li Y, Guo Y, Shen X, Liu H, Mei H, Xu H, Canavese F. Radiographic outcome of children older than twenty-four months with developmental dysplasia of the hip treated by closed reduction and spica cast immobilization in human position: a review of fifty-one hips. INTERNATIONAL ORTHOPAEDICS 2019; 43:1405-1411. [PMID: 30980114 DOI: 10.1007/s00264-019-04315-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 02/15/2019] [Indexed: 01/20/2023]
Abstract
PURPOSE This study aimed to investigate the radiographic outcomes, rate of redislocation, and avascular necrosis of proximal femoral epiphysis (AVN) in patients aged 24 to 36 months with developmental dysplasia of the hip (DDH) treated by closed reduction (CR) and spica cast immobilization in human position. MATERIAL AND METHODS We reviewed the medical records of 39 patients (51 hips) aged 24 to 36 months with DDH treated by CR and spica cast immobilization in human position. The Tönnis grade, rate of redislocation and AVN, acetabular index (AI), centre-edge angle (CEA), and Severin radiographic grade were evaluated on plain radiographs. RESULTS Among the included 39 patients (51 hips), 15 hips (29.4%) were Tönnis grade II, 24 hips (47.1%) were grade III, and 12 hips (23.5%) were grade IV. In 47 hips (92.2%), the ossific nucleus was present at the time of CR. Stable reduction was achieved by CR in 39/51 hips (76.5%) and redislocation occurred in 12/51 hips (23.5%). Among the 12 hips that redislocated, 11 underwent open reduction and one repeated CR. Two out of 40 hips (5%) treated by CR developed AVN. Overall, 54.6% of the hips had satisfactory outcomes (39.2% Severin type I and 17.6% type II), while 45.4% had unsatisfactory outcomes (39.2% Severin type III and 3.9% type IV). Of the 40 hips treated by CR, 57.5% and 42.5% of cases had satisfactory outcomes and residual acetabular dysplasia, respectively. Six out of 11 hips (54.6%) treated by open reduction and pelvic osteotomy had satisfactory outcomes. CONCLUSIONS Our study showed that stable CR could be achieved in 76.5% of patients aged 24 to 36 months with DDH at the time of index procedure. Satisfactory outcomes can be expected in 56.4% of the cases (5.0% AVN rate), although late acetabular dysplasia may develop in 43.6% of the hips.
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Affiliation(s)
- YiQiang Li
- GuangZhou Women and Children's Medical Center, GuangZhou Medical University, GuangZhou, China
| | | | - XianTao Shen
- Wuhan Women and Children Medical Care Center, Wuhan, China
| | - Hang Liu
- Children's Hospital of Chongqing Medical University, Chongqing, China
| | - HaiBo Mei
- Hunan Children's Hospital, ChangSha, China
| | - HongWen Xu
- GuangZhou Women and Children's Medical Center, GuangZhou Medical University, GuangZhou, China
| | - Federico Canavese
- GuangZhou Women and Children's Medical Center, GuangZhou Medical University, GuangZhou, China.
- Department of Pediatric Orthopaedics, GuangZhou Women and Children's Medical Center, 9th JinSui Road, GuangZhou, 510623, China.
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Comparison of 3 Pediatric Pelvic Osteotomies for Acetabular Dysplasia Using Patient-specific 3D-printed Models. J Pediatr Orthop 2019; 39:e159-e164. [PMID: 30300278 DOI: 10.1097/bpo.0000000000001271] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Children with developmental dysplasia of the hip may require a pelvic osteotomy to treat acetabular dysplasia. Three osteotomies are commonly performed in these patients (Pemberton, Dega, and San Diego), though comparative studies of each are limited. The purpose of this study was to compare changes in acetabular morphology (acetabular version, volume, and octant coverage angles) created by these 3 osteotomies using matched patient-specific 3D-printed pelvic models. METHODS Fourteen patients with developmental dysplasia of the hip and preoperative computed tomography (CT) imaging were retrospectively included. For each patient CT, bone and cartilage tissues were independently segmented, and 3 identical pelvises were 3D-printed using a dual material printer. Bone was printed with rigid material and cartilage with flexible material to simulate the flexibility of the triradiate cartilage and pubic symphysis. Pemberton, Dega, and San Diego acetabular osteotomies were performed on the triplicate set of 3D prints. Acetabular version, volume, and octant coverage angles (posterior, superior-posterior, superior, superior-anterior, and anterior) were determined before and after each mock surgery by morphologic assessment using preoperative and postoperative CT images. RESULTS San Diego osteotomy yielded a small increase (+3.34±1.71 degrees) in version, compared with decreases with Pemberton (-5.47±1.54 degrees) and Dega (-8.57±1.21 degrees, P<0.05). Acetabular volume decreased similarly for Pemberton (-13.36%±2.88%), Dega (-19.21%±2.73%), and San Diego (-19.29%±2.44%; P=0.215) osteotomies. San Diego osteotomy tended to have a larger postoperative increase in the posterior regions, and the Dega and Pemberton osteotomies tended to have larger postoperative increases in the anterior coverage regions. CONCLUSIONS Quantifiable differences were identified in acetabular octant coverage angles and version between the 3 pelvic osteotomies. San Diego osteotomy increased acetabular coverage posteriorly resulting in acetabular anteversion, whereas Pemberton and Dega had greater superior-anterior coverage resulting in relative acetabular retroversion. This study is the first known to utilize 3D-printed models for comparison of surgical approaches in pediatric pelvic osteotomies.
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Abstract
BACKGROUND Closed reduction (CR) is a common treatment for infantile developmental dysplasia of the hip. The purpose of this observational, prospective, multicenter study was to determine the early outcomes following CR. METHODS Prospectively collected data from an international multicenter study group was analyzed for patients treated from 2010 to 2014. Baseline demographics, clinical exam, radiographic/ultrasonographic data, and history of previous orthotic treatment were assessed. At minimum 1-year follow-up, failure was defined as an IHDI grade 3 or 4 hip and/or need for open reduction. The incidence of avascular necrosis (AVN), residual dysplasia, and need for further surgery was assessed. RESULTS A total of 78 patients undergoing CR for 87 hips were evaluated with a median age at initial reduction of 8 months (range, 1 to 20 mo). Of these, 8 hips (9%) were unable to be closed reduced initially. At most recent follow-up (median 22 mo; range, 12 to 36 mo), 72/79 initially successful CRs (91%) remained stable. The likelihood of failure was unaffected by initial clinical reducibility of the hip (P=0.434), age at initial CR (P=0.897), or previous treatment in brace (P=0.222). Excluding those hips that failed initial CR, 18/72 hips (25%) developed AVN, and the risk of osteonecrosis was unaffected by prereduction reducibility of the hip (P=0.586), age at CR (P=0.745), presence of an ossific nucleus (P=0.496), or previous treatment in brace (P=0.662). Mean acetabular index on most recent radiographs was 25 degrees (±6 degrees), and was also unaffected by any of the above variables. During the follow-up period, 8/72 successfully closed reduced hips (11%) underwent acetabular and/or femoral osteotomy for residual dysplasia. CONCLUSIONS Following an initially successful CR, 9% of hips failed reduction and 25% developed radiographic AVN at early-term follow-up. History of femoral head reducibility, previous orthotic bracing, and age at CR did not correlate with success or chances of developing AVN. Further follow-up of this prospective, multicenter cohort will be necessary to establish definitive success and complication rates following CR for infantile developmental dysplasia of the hip. LEVEL OF EVIDENCE Level II-prospective observational cohort.
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Kumar A, Chau WW, Hung ALH, Wong JKT, Ng BKW, Cheng JCY. Gonadal shield: is it the Albatross hanging around the neck of developmental dysplasia of the hip research? J Child Orthop 2018; 12:606-613. [PMID: 30607208 PMCID: PMC6293337 DOI: 10.1302/1863-2548.12.180133] [Citation(s) in RCA: 8] [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] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Prospective randomized controlled trials and long-term studies are essential future directions for building -evidence-based practices in developmental dysplasia of the hip (DDH), however, sufficient attrition in data (> 20%) can introduce bias deteriorating research quality. Pelvic radiography is synonymous with DDH assessment and so are -Gonadal Shield (GS) recommendations with pelvic radiography. -Nonetheless, losses to diagnostic information and inadequate protection have been increasingly implicated to GS usage, with significantly worse implications in female patients. Understandably for DDH, a disease with 80% female prevalence, the impact of GS usage on quality of radiographs and readability of radiological data may be drastic. This study aims to objectively define the implications of GS recommendations in DDH patients. METHODS Pelvis radiographs of all DDH patients under the hip surveillance programme at a tertiary care hospital with a written protocol for GS usage were evaluated. Images were reviewed for gender, GS presence, adequate gonadal protection and obstruction of essential anatomical landmarks for pelvic indices. RESULTS In all, 131 pelvis radiographs with DDH diagnoses (age: 1.25 to 6 years; 107 female, 24 male pelvises) were reviewed. Only 42.67% (56) of pelvis radiographs used GS despite the presence of a clear protocol. Useful anatomical landmarks were obstructed in 58.9% of radiographs with GS present. Lost diagnostic information was more common in female patients than male patients (68.1% versus 11.1%, p < 0.01). GS was ineffective at gonadal protection in 73.2% (41) of the pelvises with worse protection in female patients (78.7% vs 44.4%; p = 0.03). CONCLUSIONS Ironically, essential anatomy was obstructed in all the adequately protected female pelvises. Routine GS usage results in substantial attrition of radiographic data in DDH patients. LEVEL OF EVIDENCE III.
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Affiliation(s)
- A. Kumar
- Department of Orthopaedics & Traumatology, Chinese University of Hong Kong, Shatin, Hong Kong
| | - W. W. Chau
- Department of Orthopaedics & Traumatology, Chinese University of Hong Kong, Shatin, Hong Kong
| | - A. L.-H. Hung
- Department of Orthopaedics & Traumatology, Chinese University of Hong Kong, Shatin, Hong Kong
| | - J. K.-T. Wong
- Department of Imaging and Interventional Radiology, Chinese University of Hong Kong, Shatin, Hong Kong
| | - B. K. W. Ng
- Department of Orthopaedics & Traumatology, Chinese University of Hong Kong, Shatin, Hong Kong
| | - J. C. Y. Cheng
- Department of Orthopaedics & Traumatology, Chinese University of Hong Kong, Shatin, Hong Kong, Correspondence should be sent to J. C. Y. Cheng, FRCS,Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T. Hong Kong. E-mail:
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Voos MC, Maria Clara Drummond SDM, Hasue RH. Hip Mobilization at Preterm Age May Accelerate Developmental Dysplasia Recovery. Case Rep Med 2018; 2018:8625721. [PMID: 30510581 PMCID: PMC6231373 DOI: 10.1155/2018/8625721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 09/13/2018] [Accepted: 10/11/2018] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Few studies have described mobilization approaches in developmental dysplasia of the hip (DDH). The present study describes the hip mobilization of a preterm infant (born at 33 6/7 weeks of gestational age) diagnosed with DDH. DESIGN AND METHODS During the 43-day hospital stay, the infant was seen twice a week (ten sessions, 20 minutes each). All sessions included hip approximation maneuvers, with the hip positioned in abduction, lateral rotation and flexion, and lower limbs passive mobilization, which were taught to the mother. Early intervention with auditory, tactile, visual, and vestibular stimulations was also performed. The infant was assessed with hip ultrasound before and after treatment. RESULTS At 34 2/7 weeks of gestational age, she was classified as Graf IIa (left: alpha: 55°, beta: 68°; right: alpha: 59°, beta: 64°). At 40 5/7 weeks, she was classified as Graf I for left (alpha: 67°; beta: 42°) and right (alpha: 66°; beta: 42°) hips. PRACTICAL IMPLICATIONS The intervention seemed to accelerate the acquisition of stability of dysplasic hips in a preterm infant. The outcome supports further investigation of hip approximation maneuvers as part of early stimulation in preterm infants with DDH during hospital stay.
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Affiliation(s)
- Mariana Callil Voos
- Department of Physical Therapy, Communication Sciences and Disorders and Occupational Therapy, Faculty of Medicine, University of São Paulo, Brazil
| | - Soares de Moura Maria Clara Drummond
- Department of Physical Therapy, Communication Sciences and Disorders and Occupational Therapy, Faculty of Medicine, University of São Paulo, Brazil
| | - Renata Hydee Hasue
- Department of Physical Therapy, Communication Sciences and Disorders and Occupational Therapy, Faculty of Medicine, University of São Paulo, Brazil
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Abstract
BACKGROUND It has been suggested that the femoral head can "dock" deeper into the acetabulum after initial closed reduction (CR) for developmental dysplasia of the hip (DDH). The purpose of this study was to quantify the interval change in femoral head position between immediate postoperative magnetic resonance imaging (MRI) and follow-up imaging at ~3 weeks. METHODS A retrospective review of 29 patients (30 hips) who underwent CR and spica casting for DDH was conducted. Immediate postoperative and average 3-week follow-up MRI scans in spica were performed on all patients. On both scans, 2 blinded reviewers measured the following indices: the distance between the femoral head and the acetabulum on midcoronal and midaxial images, the displacement of the center of femoral head from Hilgenreiner's line in the coronal and axial plane, and the left-right displacement of the center of femoral head from Perkins line. Measurements were averaged between the 2 reviewers and the interval change in femoral head position between the immediate postoperative and follow-up scans were compared. RESULTS There were 26 female individuals and 3 male individuals in our series with a mean age of 7.6 months (range, 4 to 13 mo). Follow-up MRI scans were performed at an average of 23.8 days (range, 13 to 46 d). On the basis of the averaged measurements from both readers, the distance between the femoral head and the acetabulum decreased significantly on coronal measurement and on all 3 axial measurements between initial and follow-up MRI. In addition, the position of the femoral head became significantly more medial, more anterior, and more cranial relative to the acetabulum. The interrater correlation coefficient between both readers across all measurements was 0.731. CONCLUSIONS These findings provide evidence that femoral head position within the acetabulum improves even over a short time period following initial CR for DDH, suggesting that the "docking" phenomenon may in fact occur. LEVEL OF EVIDENCE Level IV-therapeutic study.
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Li Y, Zhou Q, Liu Y, Chen W, Li J, Canavese F, Xu H. Closed reduction and dynamic cast immobilization in patients with developmental dysplasia of the hip between 6 and 24 months of age. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 29:51-57. [PMID: 30076476 DOI: 10.1007/s00590-018-2289-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 08/01/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND Closed reduction and spica cast is still the preferred treatment option for children presenting with developmental dysplasia of the hip (DDH) after the age of 6 months. This study aims to investigate the outcomes of patients with DDH treated by closed reduction and dynamic cast immobilization. METHODS In total, 159 patients (mean age 15.6 ± 4.2 months; 172 hips) were treated with a dynamic cast immobilization for 3 months, followed by an abduction brace until a stable concentric reduction was achieved. Radiological examination was performed at each follow-up visit to assess reduction, redislocation rate and presence of avascular necrosis (AVN) of the femoral epiphysis. Final radiographic results were evaluated with the Severin classification. RESULTS The redislocation rate was 4.1% (7/172); the overall AVN rate was 14.5% (grade II: 16 hips; grade III: 5 hips; grade IV: 3 hips). At last follow-up visit, the mean age of patients was 61.6 ± 21.3 months (range 30.8-141), and the mean acetabular index was 22.6° ± 5.6°; 67.3% of the hips had Severin type I radiographic criteria, 8.5% had type II, 23.6% had type III, and 0.6% had type IV. CONCLUSIONS Dynamic cast is an alternative to spica cast immobilization in DDH patients undergoing closed reduction. It has similar redislocation and AVN rates compared to standard spica cast immobilization, as reported by previous studies.
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Affiliation(s)
- YiQiang Li
- Department of Pediatric Orthopaedics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9th Jinsui Road, Guangzhou, 510623, China
| | - QingHe Zhou
- Department of Pediatric Orthopaedics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9th Jinsui Road, Guangzhou, 510623, China
| | - Yuanzhong Liu
- Department of Pediatric Orthopaedics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9th Jinsui Road, Guangzhou, 510623, China
| | - WeiDong Chen
- Department of Pediatric Orthopaedics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9th Jinsui Road, Guangzhou, 510623, China
| | - JingChun Li
- Department of Pediatric Orthopaedics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9th Jinsui Road, Guangzhou, 510623, China
| | - Federico Canavese
- Department of Pediatric Orthopaedics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9th Jinsui Road, Guangzhou, 510623, China. .,Pediatric Surgery Department, University Hospital Estaing Clermont Ferrand, 63003, Clermont Ferrand, France.
| | - HongWen Xu
- Department of Pediatric Orthopaedics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9th Jinsui Road, Guangzhou, 510623, China
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Abstract
BACKGROUND Although many studies have separately investigated the treatment of developmental dysplasia of the hip and spastic hip disease, little data exist regarding the treatment of infants with dislocated hips and underlying spasticity. The purpose of this study was to review our results after the surgical treatment of these infants. METHODS We retrospectively reviewed all children below 3 years of age who underwent hip reconstruction for dislocated hips in the setting of cerebral palsy or other spastic/high-tone neuromuscular disease. Medical records were reviewed for clinical data including treatment course, complications, and need for further surgery. Preoperative and postoperative radiographs were used to determine International Hip Dysplasia Institute (IHDI) grade of dislocation, acetabular index, migration percentage, and presence of avascular necrosis according to the Salter criteria. RESULTS Eleven patients with 15 hips met our inclusion criteria with a mean age of 20±8 (range, 6 to 34) months. Preoperatively, 12 of 15 hips (80%) were IHDI grade 4 and 3 of 15 (20%) were IHDI grade 3. Mean acetabular index was 29±8 (range, 19 to 46) degrees. Patients underwent open reduction (15 hips), adductor tenotomy (14 hips), femoral osteotomy (10 hips), and pelvic osteotomy (12 hips). At a mean follow-up of 40±16 (range, 13 to 71) months, 13 of 15 hips were IHDI grade 1 (86.7%), 1 was IHDI grade 2 (6.7%), and 1 hip was IHDI grade 3 (6.7%). The mean postoperative migration index was 7%±24% (range, -30% to 46%); the mean acetabular index was 22±8 (range, 9 to 38) degrees. No patients developed radiographically significant osteonecrosis. Complications included 2 femur fractures (13.3%) and 1 symptomatic implant that required early removal. One patient underwent further reconstructive hip surgery. CONCLUSIONS In this series of infants with hip dislocations and underlying spasticity, open reduction±pelvic osteotomy and/or femoral osteotomy has a nearly 90% success rate in achieving and maintaining adequate hip reduction at intermediate-term follow-up. In the unique population of infants with dislocated hips and underlying spasticity, comprehensive hip reconstruction is largely successful with an acceptable rate of complications. LEVEL OF EVIDENCE Level IV-retrospective.
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Abstract
BACKGROUND Current dogma contends that prolonged treatment of a dislocated hip in Pavlik harness beyond 3 weeks will cause "Pavlik harness disease." To our knowledge, however, no previous studies have documented objective morphologic changes to the acetabulum from continued treatment of a persistently dislocated hip. METHODS We retrospectively reviewed a consecutive series of infants with developmental dysplasia of the hip, below 6 months old, who failed Pavlik treatment from a single, tertiary-care pediatric hospital and a multicenter, international study group. Inclusion criteria were dislocated hips confirmed by ultrasound (both initially and at Pavlik termination) and a minimum of 2 ultrasounds during harness treatment at least 3 weeks apart. As a global measure of acetabular morphology, α angle (AA) was compared between initial and final ultrasound. The final means of obtaining successful hip reduction was recorded from the medical records. RESULTS Forty-nine hips in 38 patients were identified. Median age at Pavlik initiation was 4 weeks (range, 0 to 18 wk); median time in harness was 6 weeks (range, 3 to 14 wk). Surprisingly, a mean of 4 degrees improvement in AA (95% CI, 2-6 degrees; P=0.001) was observed between first and final ultrasound. We found no difference in AA change between those in harness 3 to 5 weeks and those with prolonged wear >5 weeks (P=0.817). There was no significant association between change in AA and time in harness (P=0.545), age at Pavlik initiation (P=0.199), clinical reducibility of the hip (P=0.202), or initial percent femoral head coverage (P=0.956). Following harness failure, 22/49 hips (45%) were successfully treated with rigid abduction bracing, 16 (33%) by closed reduction/spica casting, and 10 (20%) by open reduction; 1 hip (2%) spontaneously reduced and required no further treatment. CONCLUSIONS On the basis of the lengths of harness treatment in our series, most hips did not exhibit negative changes in the acetabular AA in response to prolonged treatment of a dislocated hip in harness. Furthermore, 80% of hips failing Pavlik treatment were successfully reduced through closed means, indicating that subsequent treatment was not compromised. LEVEL OF EVIDENCE Level IV-retrospective case series.
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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: 22] [Impact Index Per Article: 3.7] [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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