1
|
Alhaddad A, Gronfula AG, Alsharif TH, Khawjah AA, Alali MY, Jawad KM. An Overview of Developmental Dysplasia of the Hip and Its Management Timing and Approaches. Cureus 2023; 15:e45503. [PMID: 37868507 PMCID: PMC10585185 DOI: 10.7759/cureus.45503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
Developmental dysplasia of the hip (DDH), if uncorrected, can result in several chronic abnormalities, including chronic hip pain, degenerative arthritis, and gait abnormalities. The outcome of DDH generally depends on the age of presentation; a worse prognosis is linked to a higher age of presentation. Although treatment continues to be a challenge, recent advancements in the field have improved our understanding of the disease, which has resulted in advancements in DDH surveillance during infancy and the reduction of complications with early intervention. The databases used for this overview include Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Library, MEDLINE, and EMBASE. These databases were used to search for ongoing trials related to the management and diagnosis of DDH.
Collapse
Affiliation(s)
- Ali Alhaddad
- Orthopedic Surgery, East Jeddah General Hospital, Jeddah, SAU
| | - Amin G Gronfula
- Orthopaedic Surgery, Royal College of Surgeons in Ireland, Dublin, IRL
| | | | - Ahmed A Khawjah
- Neurosurgery, Royal College of Surgeons in Ireland, Dublin, IRL
| | - Mohammed Y Alali
- Emergency Medicine, Royal College of Surgeons in Ireland, Dublin, IRL
| | | |
Collapse
|
2
|
Bakarman K, Alsiddiky AM, Zamzam M, Alzain KO, Alhuzaimi FS, Rafiq Z. Developmental Dysplasia of the Hip (DDH): Etiology, Diagnosis, and Management. Cureus 2023; 15:e43207. [PMID: 37692580 PMCID: PMC10488138 DOI: 10.7759/cureus.43207] [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: 08/09/2023] [Indexed: 09/12/2023] Open
Abstract
Developmental dysplasia of the hip (DDH) is a complex disorder that refers to different hip problems, ranging from neonatal instability to acetabular or femoral dysplasia, hip subluxation, and hip dislocation. It may result in structural modifications, which may lead to early coxarthrosis. Despite identifying the risk factors, the exact aetiology and pathophysiology are still unclear. Neonatal screening, along with physical examination and ultrasound, is critical for the early diagnosis of DDH to prevent the occurrence of early coxarthrosis. This review summarizes the currently practised strategies for the detection and treatment of DDH, focusing particularly on current practices for managing residual acetabular dysplasia (AD). AD may persist even after a successful hip reduction. Pelvic osteotomy is required in cases of persistent AD. It could also be undertaken simultaneously with an open hip reduction. Evaluation of the residual dysplasia (RD) of the hip and its management is still a highly active area of discussion. Recent research has opened the door to discussion on this issue and suggested treatment options for AD. But there is still room for more research to assist in managing AD.
Collapse
Affiliation(s)
| | - Abdulmonem M Alsiddiky
- Pediatric Orthopedics & Spinal Deformities, Research Chair of Spinal Deformities, King Saud University, Riyadh, SAU
| | - Mohamed Zamzam
- Pediatric Orthopedics, King Saud University, Riyadh, SAU
| | | | | | | |
Collapse
|
3
|
Yang S, Su F, Jia HR, Liu CX, Lu QD, Yang YT, Liu Y, Wang JJ, Jie Q. Cartilaginous predictors of residual acetabular dysplasia (RAD) in developmental dysplasia of the hip following closed or open reduction: A systematic review and meta-analysis. Front Pediatr 2023; 11:1124123. [PMID: 37063659 PMCID: PMC10090413 DOI: 10.3389/fped.2023.1124123] [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: 12/14/2022] [Accepted: 03/13/2023] [Indexed: 04/18/2023] Open
Abstract
Object This study was designed to analyze the cartilaginous predictors of residual acetabular dysplasia (RAD) after early treatment of developmental dysplasia of the hip and their diagnostic accuracy. Study design Databases such as PubMed, Embase, Cochrane, and Web of science were searched to screen the literature. The quality of the literature was assessed by the QUADAS-2 tool. Qualitative and quantitative synthesis of literature were performed based on extracted data. For quantitative synthesis studies, the sensitivity, specificity, diagnostic odds ratio (DOR), and summary receiver operating characteristic (SROC) curve with corresponding confidence intervals were calculated. Results For the cartilaginous acetabular index (CAI) group, the combined values of sensitivity, specificity, and DOR were 0.80 (95% CI = 0.54-0.93), 0.73 (95% CI = 0.57-0.84), and 10.62 (95% CI = 3.96-28.53), respectively. The corresponding values in the cartilaginous center-edge angle (CCE) group were 0.71 (95% CI = 0.57-0.82), 0.78 (95% CI = 0.66-0.87), and 8.64 (95% CI = 3.08-24.25), respectively. The area under the curve (AUC) of SROC was 0.82 (95% CI = 0.78-0.85) and 0.80 (95% CI = 0.76-0.83) for the CAI and CCE groups. The CAI group had higher sensitivity, DOR, and AUC than the CCE group. Conclusion Both of these two groups have good diagnostic accuracy, and CAI/L-AI has a little edge over CCE/L-CEA. However, there is still more research needed to determine whether they can be used as independent indications for secondary orthopedic surgery.Systematic review registration: [https://www.crd.york.ac.uk/PROSPERO/], identifier: [CRD42022338332].
Collapse
Affiliation(s)
- Shuai Yang
- Pediatric Orthopaedic Hospital, Honghui Hospital, Xi'an Jiaotong University, Xi’an, China
- Medicle School of Yan'an University, Yan'an University, Yan’an, China
| | - Fei Su
- Pediatric Orthopaedic Hospital, Honghui Hospital, Xi'an Jiaotong University, Xi’an, China
| | - Hao-Ruo Jia
- Pediatric Orthopaedic Hospital, Honghui Hospital, Xi'an Jiaotong University, Xi’an, China
| | - Chen-Xin Liu
- Pediatric Orthopaedic Hospital, Honghui Hospital, Xi'an Jiaotong University, Xi’an, China
| | - Qing-Da Lu
- Pediatric Orthopaedic Hospital, Honghui Hospital, Xi'an Jiaotong University, Xi’an, China
| | - Ya-Ting Yang
- Pediatric Orthopaedic Hospital, Honghui Hospital, Xi'an Jiaotong University, Xi’an, China
| | - Yong Liu
- Pediatric Orthopaedic Hospital, Honghui Hospital, Xi'an Jiaotong University, Xi’an, China
- Medicle School of Yan'an University, Yan'an University, Yan’an, China
| | - Jia-Ju Wang
- Pediatric Orthopaedic Hospital, Honghui Hospital, Xi'an Jiaotong University, Xi’an, China
- Medicle School of Yan'an University, Yan'an University, Yan’an, China
| | - Qiang Jie
- Pediatric Orthopaedic Hospital, Honghui Hospital, Xi'an Jiaotong University, Xi’an, China
| |
Collapse
|
4
|
Schwanitz von Keitz P, Kleimeier D, Lutter CF, Rehberg M, Mittelmeier W, Kasch R, Osmanski-Zenk K, Fröhlich S. The effect of the design of the orthosis on the axial load transmission of two flexion abduction orthoses used in treating congenital hip dysplasia. Heliyon 2022; 8:e11942. [PMID: 36478850 PMCID: PMC9720598 DOI: 10.1016/j.heliyon.2022.e11942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 11/16/2022] [Accepted: 11/21/2022] [Indexed: 12/03/2022] Open
Abstract
Background With an incidence of 2-4% in all newborns, developmental dysplasia of the hip, DDH, represents the most frequent congenital disorder of the skeletal system in Germany. The therapy options are deduced with the help of a sonography. The conservative therapy approach includes the application of flexion abduction orthoses, which lead to a development of the child's hip through abduction and flexion angle. The overall structure of the orthoses puts a strain on the axial skeleton of the children. The following work is intended to clarify what role the design of the orthoses plays in this respect. Methods Inclusion criterion for the study was fully developed newborns without an indication of skeletal malformations with Type I hip joints according to Graf verified by ultrasound. A total of 19 newborns were recruited and included in the period 3/2013-01/2015. Two types of orthoses used in treating developmental dysplasia of the hip (Tübinger splint, Otto Bock; hip flexion abduction orthosis (Superior orthosis) according to Mittelmeier-Graf, AIDAMED e.K (Kreuz et al., 2012; Mittelmeier et al., 1998; Schmitz et al., 1999), constructions differ, were used. Force was measured with the help of three force sensors, which were even able to be integrated into these without changing the design of the orthosis. In this closed system, force transmission was measured for the duration of a fixed period of two minutes. Findings The greatest axial force development (overall force) is in the Tübinger splint with an average force of 15.1 N (min. 0.59 N, max. 53.09 N, mean 15.1, SD 2.46). 4.09 N (min. 0.96 N, max. 20.99 N, mean 4.09, SD 0.65) resulted in the Superior orthosis. Significant correlations between body weight and resulting axial traction - on average during the entire measurement period and in movement - can be taken from the statistical analysis regarding the Tübinger splint. Such a correlation cannot be depicted for the Superior orthosis. Interpretation The analysis of the load transmission of the examined flexion and abduction orthoses reveals differences between the models. The construct of the orthoses in itself appears to play a significant role. Long-term effects of orthosis therapy on a child's axial skeleton have not been studied to date. Furthermore, it seems reasonable to expand the test series to orthoses, the design of which is configured in a similar matter compared to the examined aids. Conclusion This study proves that the orthotic design has an influence on the infant's axial load.
Collapse
Affiliation(s)
| | - Dana Kleimeier
- Institut für Bioinformatik, Universitätsmedizin Greifswald, Germany
| | | | - Mirko Rehberg
- Universität zu Köln, Medizinische Fakultät und Uniklinik Köln, Klinik und Poliklinik für Kinder und Jugendmedizin, Köln, Germany
| | | | - Richard Kasch
- Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, Germany
| | | | - Susanne Fröhlich
- Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, Germany
| |
Collapse
|
5
|
Automated diagnosis of hip dysplasia from 3D ultrasound using artificial intelligence: A two-center multi-year study. INFORMATICS IN MEDICINE UNLOCKED 2022. [DOI: 10.1016/j.imu.2022.101082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
6
|
Jia H, Wang L, Chang Y, Song Y, Liu Y, Zhang F, Feng J, Yang X, Sheng M. Assessment of irreducible aspects in developmental hip dysplasia by magnetic resonance imaging. BMC Pediatr 2020; 20:550. [PMID: 33278888 PMCID: PMC7718709 DOI: 10.1186/s12887-020-02420-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 11/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The developmental dysplasia of the hip (DDH) can cause a wide range of pathological changes, and often requires surgical treatment. Preoperative evaluation is very important for DDH. We aimed to assess the diagnostic capability of magnetic resonance imaging (MRI) for irreducible aspects preventing hip reduction in DDH. METHODS A total of 39 pediatric patients who received DDH evaluation in pediatric orthopedics from January 2015 to December 2019 were included. The samples included 4 cases of bilateral DDH and 35 cases of unilateral DDH, a total of 43 hip joint samples. All patients underwent surgical treatment, pathological examination and MRI of hip joint. RESULTS With pathological results or intraoperative findings as the gold standard, the sensitivity and specificity of MRI were 90.3% and 83.3% for the affected labrum, 92% and 83.3% for thickening of the round ligament, 90.0% and 91.3% for atrophy of the iliopsoas muscle, and 100% and 100% for fibrofatty pulvinar tissue and joint effusion, respectively. CONCLUTIONS The MRI showed an extraordinary capability of detecting these irreducible factors and helped surgeon choose the appropriate treatment strategies.
Collapse
Affiliation(s)
- Huihui Jia
- Department of Radiology, Children's Hospital of Soochow University, Suzhou, 215000, PR China
| | - Liang Wang
- Department of Orthopaedics, The Affiliated Suzhou Science & Technology Town Hospital of Nanjing Medical University, Suzhou, 215000, PR China
| | - Yan Chang
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, 215163, PR China
| | - Yongrui Song
- Department of Radiology, Children's Hospital of Soochow University, Suzhou, 215000, PR China
| | - Yuqi Liu
- Department of Radiology, Children's Hospital of Soochow University, Suzhou, 215000, PR China
| | - Fuyong Zhang
- Department of Orthopaedics, Children's Hospital of Soochow University, Suzhou, 215000, PR China
| | - Jie Feng
- Department of Radiology, Children's Hospital of Soochow University, Suzhou, 215000, PR China
| | - Xiaodong Yang
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, 215163, PR China
| | - Mao Sheng
- Department of Radiology, Children's Hospital of Soochow University, Suzhou, 215000, PR China.
| |
Collapse
|
7
|
Barbosa RDO, Albernaz EP. Profile of Patients Diagnosed with Developmental Dysplasia of the Hip. Rev Bras Ortop 2019; 54:497-502. [PMID: 31736518 PMCID: PMC6855922 DOI: 10.1016/j.rbo.2018.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 02/21/2018] [Indexed: 11/26/2022] Open
Abstract
Objective
To describe the profile of patients with developmental dysplasia of the hip (DDH) diagnosed by physical and ultrasound examination, with the implementation of a protocol for the treatment and follow-up of DDH.
Methods
A cross-sectional study with DDH patients born between January 2014 and December 2016, in the city of Pelotas, Southern Brazil. Ethnicity, gender, birth weight, fetal presentation, affected side of the hip, gestational age, maternal age and family history were considered. The data on the medical records were compared with the characteristics of the general population described on the Brazilian National Information System on Live Births (Sistema de Informação sobre Nascidos Vivos [SINASC]).
Results
A total of 33 DDH patients were identified, mostly female, with a four-fold higher probability of having the condition (
p
< 0.001); the left was the most affected side. No statistically significant association was found regarding the following factors: birth weight, gestational age, ethnicity, and maternal age. The newborns in breech presentation had a 15-fold higher probability of presenting DDH (
p
< 0.001). A total of 21 newborns required immediate treatment of the hips, since the ultrasound showed a Graf classification of IIb or higher, or the radiography showed dislocation in DDH patients older than 6 months of age.
Conclusion
Screening for DDH is essential in all newborns; physical examinations revealing alterations must be complemented with ultrasound imaging to avoid the delayed diagnosis of the condition.
Collapse
|
8
|
Abstract
The term ‘developmental dysplasia of the hip’ (DDH) includes a wide spectrum of hip alterations: neonatal instability; acetabular dysplasia; hip subluxation; and true dislocation of the hip. DDH alters hip biomechanics, overloading the articular cartilage and leading to early osteoarthritis. DDH is the main cause of total hip replacement in young people (about 21% to 29%). Development of the acetabular cavity is determined by the presence of a concentrically reduced femoral head. Hip subluxation or dislocation in a child will cause an inadequate development of the acetabulum during the remaining growth. Clinical screening (instability manoeuvres) should be done universally as a part of the physical examination of the newborn. After two or three months of life, limited hip abduction is the most important clinical sign. Selective ultrasound screening should be performed in any child with abnormal physical examination or in those with high-risk factors (breech presentation and positive family history). Universal ultrasound screening has not demonstrated its utility in diminishing the incidence of late dysplasia. Almost 90% of patients with mild hip instability at birth are resolved spontaneously within the first eight weeks and 96% of pathologic changes observed in echography are resolved spontaneously within the first six weeks of life. However, an Ortolani-positive hip requires immediate treatment. When the hip is dislocated or subluxated, a concentric and stable reduction without forceful abduction needs to be obtained by closed or open means. Pavlik harness is usually the first line of treatment under the age of six months. Hip arthrogram is useful for guiding the decision of performing a closed or open reduction when needed. Acetabular dysplasia improves in the majority due to the stimulus provoked by hip reduction. The best parameter to predict persistent acetabular dysplasia at maturity is the evolution of the acetabular index. Pelvic or femoral osteotomies should be performed when residual acetabular dysplasia is present or in older children when a spontaneous correction after hip reduction is not expected. Avascular necrosis is the most serious complication and is related to: an excessive abduction of the hip; a force closed reduction when obstacles for reduction are present; a maintained dislocated hip within the harness or spica cast; and a surgical open reduction.
Cite this article: EFORT Open Rev 2019;4:548-556. DOI: 10.1302/2058-5241.4.180019
Collapse
Affiliation(s)
| | | | - Enrique Gil Garay
- Department of Orthopedic Surgery, Hospital Universitario La Paz, Madrid, Spain
| | - Luis Moraleda
- Department of Orthopedic Surgery, Hospital Universitario La Paz, Madrid, Spain
| |
Collapse
|