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Liu Y, Kan L, Sun J, Zhang Y. Impact of Failed Pavlik Harness Treatment on the Outcomes Following Closed or Open Reduction in Developmental Dysplasia of the Hip. Indian J Orthop 2022; 56:1634-1639. [PMID: 36052383 PMCID: PMC9385939 DOI: 10.1007/s43465-022-00680-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/02/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE To investigate the impact of failed Pavlik harness (PH) treatment on the outcomes following closed reduction (CR) or open reduction (OR) in developmental dysplasia of the hip (DDH). METHODS Ninety-three DDH patients treated with CR or OR were enrolled. One group of which received previous PH treatment (F group) and the other (L group) not. The clinical outcomes were evaluated according to McKay's criteria. Radiographs were evaluated for acetabular index (AI) and the degree of dislocation of the hips. RESULTS A higher rate of CR was found in F group (P = 0.034). Before CR/OR, the mean AI in F group was significantly lower than that in L group (P = 0.000), while at the last follow-up, the AIs in both groups were all improved. In F group, there were 7 (16.67%), 18 (42.86%) and 17 (40.48%) hips were classified as Graf type II, III and IV pathologic changes, respectively, when PH treatment started, while the corresponding data were 17 (40.48%), 17 (40.48%) and 8 (19.05%) after PH treatment (P = 0.024). At the last follow-up, no significant difference was found concerning the complications between the two groups (P > 0.05). CONCLUSIONS PH treatment, even if failed, may have the ability of accelerating the development of the acetabulum and increasing the rate of successful CR. Thus we advocate a trial of PH treatment for all DDH patients less than 6 months of age. Meanwhile, a close monitoring by dynamic ultrasonography is required due to the risk of AVN.
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Affiliation(s)
- Yong Liu
- grid.186775.a0000 0000 9490 772XDepartment of Pediatric Orthopedic, The Affiliated Provincial Pediatric Hospital of Anhui Medical University, No 39, Wangjiang Road, Hefei City, China
| | - Lisheng Kan
- No 91126 Military Hospital of Chinese PLA, No 116, Youyi Road, Lvshunkou District, Dalian City, China
| | - Jun Sun
- grid.186775.a0000 0000 9490 772XDepartment of Pediatric Orthopedic, The Affiliated Provincial Pediatric Hospital of Anhui Medical University, No 39, Wangjiang Road, Hefei City, China
| | - Yapeng Zhang
- grid.186775.a0000 0000 9490 772XDepartment of Pediatric Orthopedic, The Affiliated Provincial Pediatric Hospital of Anhui Medical University, No 39, Wangjiang Road, Hefei City, China
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Yazdanshenas H, Madadi F, Sadeghi-Naini M, Madadi F, Bugarin A, Sabagh MS, Hing C, Shamie AN, Hornicek FJ, Washington III ER. Introducing a Novel Combined Acetabuloplasty and Chondroplasty Technique for the Treatment of Developmental Dysplasia of the Hip. Cureus 2022; 14:e21787. [PMID: 35251857 PMCID: PMC8890947 DOI: 10.7759/cureus.21787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2022] [Indexed: 11/05/2022] Open
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Badrinath R, Orner C, Bomar JD, Upasani VV. Narrative Review of Complications Following DDH Treatment. Indian J Orthop 2021; 55:1490-1502. [PMID: 34987725 PMCID: PMC8688677 DOI: 10.1007/s43465-021-00550-y] [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] [Received: 08/07/2021] [Accepted: 10/10/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND The purpose of this narrative review was to survey the literature for common complications following treatment of DDH in children less than 4 years old. METHODS The Pubmed database was queried. Search result titles were reviewed to identify papers that were pertinent to the topic. Abstracts for these papers were obtained and read, and a subset of these were selected for review of the complete manuscript. RESULTS 92 manuscripts were reviewed. Residual dysplasia, redislocation, and osteonecrosis are the primary complications of treatment in this age group. In the long term, hips without complications related to DDH treatment tend to do well, although a significant percentage of them will inevitably require joint replacement surgery. CONCLUSION Although there is excellent potential for a good outcome when DDH is diagnosed and treated under age 4 years, osteonecrosis continues to be a concern with all treatment methods. A subset of patients from this young cohort will continue to have residual dysplasia or recurrent dislocation requiring return to the operating room.
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Affiliation(s)
- Raghav Badrinath
- Orthopedics and Scoliosis, Rady Children’s Hospital San Diego, 3020 Children’s Way, MC 5062, San Diego, CA 92123 USA
| | - Caitlin Orner
- Orthopedics and Scoliosis, Rady Children’s Hospital San Diego, 3020 Children’s Way, MC 5062, San Diego, CA 92123 USA
| | - James D. Bomar
- Orthopedics and Scoliosis, Rady Children’s Hospital San Diego, 3020 Children’s Way, MC 5062, San Diego, CA 92123 USA
| | - Vidyadhar V. Upasani
- Orthopedics and Scoliosis, Rady Children’s Hospital San Diego, 3020 Children’s Way, MC 5062, San Diego, CA 92123 USA
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Tejpal T, Shanmugaraj A, Gupta A, Horner NS, Simunovic N, Kishta W, Ayeni OR. Outcomes and complications of patients undergoing Salter's innominate osteotomies for hip dysplasia: a systematic review of comparative studies. J Hip Preserv Surg 2020; 7:621-630. [PMID: 34377506 PMCID: PMC8349578 DOI: 10.1093/jhps/hnab014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/26/2021] [Accepted: 02/28/2021] [Indexed: 12/04/2022] Open
Abstract
The purpose of this systematic review is to assess outcomes and complications of patients undergoing Salter's innominate osteotomies (SIOs) for the correction of hip dysplasia along with patient and technical factors that can be optimized to improve outcomes after SIO. MEDLINE and EMBASE were searched from data inception to 9 October 2018. Data were presented descriptively. Twenty-seven studies were identified including 1818 hips (87.1%) treated with SIO (mean age of 2.1 ± 2.5 years and mean follow-up of 3.5 ± 5.0 years). Patients undergoing SIO had a post-operative center-edge angle (CEA) of 31.3° ± 5.3° and an acetabular index (AI) angle of 16.1° ± 5.2°. Patients undergoing SIO with pre-operative traction had significantly lower (P = 0.049) post-operative McKay criteria scores compared to patients without pre-operative traction. Patients undergoing SIO between the ages of 1.5-2 years had significantly better (P < 0.05) post-operative McKay criteria scores compared to patients aged 4-6 years. The complication rate was 9.4% with avascular necrosis (2.5%) being most common. This review found that SIO for developmental dysplasia of the hip produces generally good post-operative clinical outcomes. The CEA and AI can be corrected to normal range after SIO. Patients may have superior outcomes if they have SIO at a younger age, were not treated with pre-operative traction and did not have untreated contralateral hip dysplasia. Outcomes appear to be similar between one-stage bilateral SIO and a two-stage procedure in the setting of bilateral hip dysplasia; however, more multicentered studies are needed to confirm these results.
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Affiliation(s)
- Tushar Tejpal
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 1200 Main Street West, 4E15, Hamilton, ON L8N 3Z5, Canada
| | - Ajaykumar Shanmugaraj
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 1200 Main Street West, 4E15, Hamilton, ON L8N 3Z5, Canada
| | - Arnav Gupta
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON KIH 8M5, Canada
| | - Nolan S Horner
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 1200 Main Street West, 4E15, Hamilton, ON L8N 3Z5, Canada
| | - Nicole Simunovic
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 1200 Main Street West, 4E15, Hamilton, ON L8N 3Z5, Canada
| | - Waleed Kishta
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 1200 Main Street West, 4E15, Hamilton, ON L8N 3Z5, Canada
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 1200 Main Street West, 4E15, Hamilton, ON L8N 3Z5, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1200 Main Street West, 4E15, Hamilton, ON L8N 3Z5, Canada
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Treatment of developmental dysplasia of the hip (DDH) between the age of 18 and 24 months. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 30:637-641. [PMID: 31865456 DOI: 10.1007/s00590-019-02601-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 12/13/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Treatment of developmental dysplasia of the hip between the age of 6 and 18 months starts with closed reduction (CR). If CR is not attainable, open reduction is performed. Open reduction and pelvic osteotomy (ORPO) is usually done directly after the age of two. The aim of this study is to evaluate CR compared to ORPO with respect to early radiographic outcome in patients aged 18 to 24 months at reduction. METHODS A single-surgeon cohort was reviewed. Inclusion criteria were age between 18 and 24 months, no prior treatment and minimal follow-up of 2 years. Hips that were not displaced or had a nonidiopathic cause were excluded. Residual dysplasia was defined as a center edge angle (CEA) of less than 15° or CEA less than 20° with an acetabular index (AI) of more than 30°. Multiple regression was used, the outcome was follow-up CEA, and the explanatory variables were age, sex, type of surgery, international hip dysplasia grade and preoperative AI. Values of preoperative AI in the CR group and follow-up CEA were plotted. RESULTS Eighty-two hips in fifty patients were included. Residual dysplasia was identified in 16 hips (20%), 12 (27%) after CR, and 4 (11%) after ORPO (p = 0.10). Recurrence and avascular necrosis rates were not statistically different. Preoperative AI and type of surgery independently affected CEA. CR patients with a preoperative AI of more the 40° had a 50% (10/20) risk of residual dysplasia. CONCLUSION CR is an important option to consider in selected patients between the age of 18 and 24 months and the selection should not be based on intraoperative assessment only, but also on preoperative measurement of AI. LEVEL OF EVIDENCE Level III.
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Badrinath R, Bomar JD, Wenger DR, Mubarak SJ, Upasani VV. Comparing the Pemberton osteotomy and modified San Diego acetabuloplasty in developmental dysplasia of the hip. J Child Orthop 2019; 13:172-179. [PMID: 30996742 PMCID: PMC6442505 DOI: 10.1302/1863-2548.13.190004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 02/22/2019] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Patients with developmental dysplasia of the hip (DDH) may require a pelvic osteotomy to treat acetabular dysplasia. The Pemberton osteotomy and modified San Diego acetabuloplasty are two options available when surgically treating DDH. The purpose of this study was to compare outcomes following the Pemberton and modified San Diego when treating patients with acetabular dysplasia in typical DDH. METHODS We included 45 hips in the modified San Diego group and 38 hips in the Pemberton group. Hips with less than two years follow-up and patients with a neuromuscular diagnosis were excluded. Clinical outcomes were rated using the modified McKay criteria with radiographic outcomes graded using the Severin score. Avascular necrosis (AVN) was assessed using the Kalamchi and MacEwen criteria. RESULTS Mean follow-up was 4.9 years (2.1 to 11.2). Both procedures produced similar decreases in the acetabular index (modified San Diego: 17.0˚ versus Pemberton: 15.2˚; p = 0.846). Most hips had good/excellent results using the modified McKay criteria (modified San Diego: 78%, Pemberton: 94%; p = 0.055). Most hips were rated as good/excellent on the Severin scale (modified San Diego: 100%, Pemberton: 97%, p = 0.485). The proportion of hips with AVN grade 2 or higher were similar between groups (modified San Diego: 0%, Pemberton: 3%; p = 0.458). CONCLUSION The modified San Diego acetabuloplasty is a safe and effective alternative to treat acetabular dysplasia in patients with typical DDH. By maintaining an intact medial cortex, acetabular reshaping can be customized to address each patient's specific acetabular deficiency. LEVEL OF EVIDENCE Level III retrospective comparison.
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Affiliation(s)
- R. Badrinath
- University of California, San Diego Medical Center, San Diego, California, USA
- Rady Children’s Hospital, San Diego, California, USA
| | - J. D. Bomar
- Rady Children’s Hospital, San Diego, California, USA
| | - D. R. Wenger
- University of California, San Diego Medical Center, San Diego, California, USA
- Rady Children’s Hospital, San Diego, California, USA
| | - S. J. Mubarak
- University of California, San Diego Medical Center, San Diego, California, USA
- Rady Children’s Hospital, San Diego, California, USA
| | - V. V. Upasani
- University of California, San Diego Medical Center, San Diego, California, USA
- Rady Children’s Hospital, San Diego, California, USA
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Wicart P, Seringe R, Glorion C, Brassac A, Rampal V. Closed reduction in late-detected developmental dysplasia of the hip: indications, results and complications. J Child Orthop 2018; 12:317-322. [PMID: 30154921 PMCID: PMC6090199 DOI: 10.1302/1863-2548.12.180088] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The aim of the study was a review of the literature in order to evaluate the results and complications of closed reduction in late-detected developmental dysplasia of the hip (DDH). METHODS This study consisted of an analysis of the literature relative to late-detected DDH treatment options considering hip congruency, rates of re-dislocation and of avascular necrosis. RESULTS Gradual closed reduction (Petit-Morel method) appears to be an effective method concerning joint congruency restitution. Dislocation relapse and avascular necrosis are more efficiently prevented with closed versus open reduction. The tendency for spontaneous correction of acetabular dysplasia decreases if closed reduction is performed after 18 months of age. Patient age at the beginning of traction should be considered for the prognosis, with a lower rate of satisfactory results showing after the age of 3 years. CONCLUSION In our opinion, the Petit-Morel method is a suitable treatment option for children aged between six months and three years with idiopathic DDH.
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Affiliation(s)
- P. Wicart
- Department of Paediatric Orthopaedic Surgery, Paris Descartes University, Necker/Sick Kid University Hospital, APHP, Paris, France, Correspondenceshould be sent to P. Wicart, Department of Paediatric Orthopaedic Surgery, Paris Descartes University, Necker/Sick Kid University Hospital, APHP, 149 rue de Sèvres, 75015 Paris, France. E-mail:
| | - R. Seringe
- Department of Orthopaedic Surgery, Paris Descartes University, Cochin University Hospital, APHP, Paris, France
| | - C. Glorion
- Department of Paediatric Orthopaedic Surgery, Paris Descartes University, Necker/Sick Kid University Hospital, APHP, Paris, France
| | - A. Brassac
- Department of Paediatric Orthopaedic Surgery, Paris Descartes University, Necker/Sick Kid University Hospital, APHP, Paris, France
| | - V. Rampal
- Department of Pediatric Orthopaedic Surgery, Lenval University Hospital, Nice, France
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Wang YJ, Yang F, Wu QJ, Pan SN, Li LY. Association between open or closed reduction and avascular necrosis in developmental dysplasia of the hip: A PRISMA-compliant meta-analysis of observational studies. Medicine (Baltimore) 2016; 95:e4276. [PMID: 27442664 PMCID: PMC5265781 DOI: 10.1097/md.0000000000004276] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The risk of avascular necrosis of the femoral head (AVN) after treatment of developmental dysplasia of the hip is associated with the method of reduction. Some authors have suggested that open reduction is a risk factor for AVN; however, this is controversial. To our knowledge, a quantitative comparison of the incidence of AVN between closed and open reduction has not been conducted. METHODS Published studies were identified by searching PubMed, EMBASE, and the Cochrane Library up to May, 2015, focusing on the incidence of AVN after closed or open reduction for developmental dysplasia of the hip in children aged <3 years. Patients were age-matched who were treated by either closed or open reduction, but without pelvic or femoral osteotomy. Two authors independently assessed eligibility and abstracted data. Discrepancies were discussed and resolved by consensus. We pooled the odds ratios (ORs) and 95% confidence intervals (95%CIs) from individual studies using a random-effects model and evaluated heterogeneity and publication bias. RESULTS Nine retrospective studies were included in this analysis. The pooled OR for comparing open reduction with closed reduction for all grades of AVN was 2.26 (95%CI = 1.21-4.22), with moderate heterogeneity (I = 44.7%, P = 0.107). The pooled OR for grades II to IV AVN was 2.46 (95%CI = 0.93-6.51), with high heterogeneity (I = 69.6%, P = 0.003). A significant association was also found for the further surgery between open and closed reduction, with a pooled OR of 0.30 (95%CI = 0.15-0.60) and moderate heterogeneity (I = 46.4%, P = 0.133). No evidence of publication bias or significant heterogeneity between subgroups was detected by meta-regression analyses. CONCLUSION Findings from this meta-analysis suggest that open reduction is a risk factor for the development of AVN compared with closed treatment. Future studies are warranted to investigate how open reduction combined with pelvis and/or femoral osteotomy affects the incidence of AVN.
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Affiliation(s)
| | | | | | - Shi-Nong Pan
- Department of Radiology
- Correspondence: Shi-Nong Pan, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, 110004 Shenyang, Liaoning, China (e-mail: ); Lian-Yong Li, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, 110004 Shenyang, Liaoning, China (e-mail: )
| | - Lian-Yong Li
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang, China
- Correspondence: Shi-Nong Pan, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, 110004 Shenyang, Liaoning, China (e-mail: ); Lian-Yong Li, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, 110004 Shenyang, Liaoning, China (e-mail: )
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Is Age or Surgical Approach Associated With Osteonecrosis in Patients With Developmental Dysplasia of the Hip? A Meta-analysis. Clin Orthop Relat Res 2016; 474:1166-77. [PMID: 26472583 PMCID: PMC4814411 DOI: 10.1007/s11999-015-4590-5] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Osteonecrosis of the femoral head is a major complication that negatively impacts the clinical and radiographic long-term outcome after treatment of developmental hip dysplasia (DDH). There are conflicting results in the literature whether age at the time of closed or open reduction and a specific surgical approach are associated with osteonecrosis. Better understanding of the impact of age at reduction and surgical approach is important to reduce the risk of osteonecrosis in patients with DDH. QUESTIONS/PURPOSES We aimed to evaluate the association between occurrence of osteonecrosis and (1) age at closed reduction; (2) age at open reduction; and (3) medial versus anterior operative approaches. METHODS A systematic review identified studies reporting osteonecrosis occurrence after treatment of DDH and at least 2 years of followup. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Methodologic quality was assessed using the methodologic index for nonrandomized studies. Generalized logistic models were used to estimate pooled odds ratios (ORs) in the meta-analysis. Sixty-six studies were included in the systematic review and 24 in the meta-analysis. Data on 481 hips treated by closed reduction and 584 hips treated by open reduction were available to evaluate the association between osteonecrosis and age. The association between osteonecrosis and operative approach was assessed using data on 364 hips treated by medial open reduction and 220 hips treated by anterior open reduction. RESULTS Age at reduction (> 12 months versus ≤ 12 months) was not associated with osteonecrosis after closed reduction (OR, 1.1; 95% confidence interval [CI], 0.4-3.2; p = 0.9) or open reduction (OR, 1.1; 95% CI, 0.7-1.9; p = 0.66). The overall, adjusted incidence of osteonecrosis (≥ Grade II) was 8.0% (95% CI, 2.8%-20.6%) among patients treated with closed reduction at or before 12 months of age and 8.4% (95% CI, 3.0%-21.5%) among those treated after 12 months. Similarly, the odds of osteonecrosis after open reduction did not differ between patients treated after the age of 12 months compared with those treated at or before 12 months (OR, 1.1; 95% CI, 0.7-1.9; p = 0.7). The incidence of osteonecrosis (≥ Grade II) was 18.3% (95% CI, 11.7%-27.4%) among patients who had index open reduction at or before 12 months of age and 20.0% (95% CI, 13.1%-29.4%) among those who had index open reduction after 12 months of age. Among hips treated with open reductions, there was no difference in osteonecrosis after medial versus anterior approaches (18.7% medial versus 19.6% anterior; OR, 1.1; 95% CI, 0.5-2.2; p = 0.9). Conclusions We did not find an association between closed or open reduction performed at or before 12 months of age and an increased risk of osteonecrosis of the femoral head. Delayed treatment past 1 year of age as a strategy to reduce the development of osteonecrosis was not supported by this meta-analysis. Open reduction through a medial or anterior approach may be recommended based on surgeon's preference, because we found no association between development of osteonecrosis and the type of surgical approach. However, many of the studies in the current literature are nonrandomized Level III or IV observational studies of inconsistent quality. Higher quality evidence is needed to better understand the effects of age at reduction and operative approach on the development of osteonecrosis after DDH treatment. LEVEL OF EVIDENCE Level III, therapeutic study.
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An Unusual Complication Seen in a Six-Year-Old Girl Treated with Open Reduction and Pemberton Osteotomy for Neglected Developmental Dysplasia of the Hip: A Femoral Neck Fracture Sustained during Passive Motion under General Anesthesia. Case Rep Orthop 2014; 2014:804098. [PMID: 24971184 PMCID: PMC4058270 DOI: 10.1155/2014/804098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 05/13/2014] [Accepted: 05/17/2014] [Indexed: 11/18/2022] Open
Abstract
Despite the screening programs for newborn children with hip ultrasonography, neglected developmental dysplasia of the hip (DDH) is still continuing to be a problem in the east and southeast parts of our country. The main complications are redislocation, avascular necrosis, and joint stiffness. We present an unusual complication, femoral neck fracture during passive motion under general anesthesia, of a six-year-old girl with neglected DDH treated by open reduction and Pemberton osteotomy without femoral shortening. The fracture was treated by open reduction and internal fixation combined with proximal femoral shortening. After 5 years the patient had excellent clinical results, no avascular necrosis was seen, and the radiologic appearance was type IA according to modified Severin classification. In conclusion older children with neglected DDH are more likely to have joint stiffness after open reduction. If there is even a little doubt about joint stiffness after open reduction, one should not refrain from femoral shortening. Also passive motion under general anesthesia should be applied very carefully with fluoroscopic control.
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Al-Moussa S, Moroz P, Beaulé PE. Effect of pelvic osteotomy in the skeletally immature on acetabular coverage. HSS J 2012; 8:235-9. [PMID: 24082866 PMCID: PMC3470677 DOI: 10.1007/s11420-012-9286-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Accepted: 06/06/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although pelvic osteotomy in children has been effective in re-establishing containment of the hip joint, its impact on hip joint development with respect to acetabular coverage is ill defined. PURPOSE The purpose of this study is to determine the prevalence of acetabular overcoverage in patients who had pelvic osteotomy during childhood and its impact on patient function. PATIENTS AND METHODS Between 1980 and 2008, all patients who had a pelvic osteotomy done at our institution for non-neuropathic hip dysplasia (DDH) or secondary to Legg-Calvé-Perthes disease (LCP) prior to skeletal maturity were reviewed. A clinical assessment and the WOMAC, UCLA Activity Score, Marx activity score, and SF-36 quality-of-life questionnaires were completed. A standardized AP pelvic X-ray was performed to determine the acetabular coverage, signs of retroversion, and degenerative changes. RESULTS Twenty-eight patients (32 hips) were identified, of which 14 (9 DDH, 5 LCP) agreed to participate. Impingement sign was positive in eight patients (six DDH, two LCP). Crossover and ischial spine signs were each present in ten hips. Tonnis grades were: 0 in 1 hip, 1 in 10 hips, 2 in 2 hips, and 3 in 1 hip. The mean Tonnis angle was 11.6 ± 8.6°. The mean CE angle was 24.0 ± 15.9° with six hips having a CE angle <20° and one hip with a CE angle >40°. There was no correlation between crossover sign or ischial sign and Tonnis grade (p = 0.739), hip pain (p = 0.520), or impingement sign (p = 1.00). CONCLUSIONS Acetabular overcoverage is common in patients who underwent pelvic osteotomy during childhood. No correlation was identified between retroversion and hip pain in our patient cohort.
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Affiliation(s)
| | | | - Paul E. Beaulé
- University of Ottawa, Ottawa, ON Canada
- University of Ottawa, The Ottawa Hospital, 501 Smyth Rd., CCW 1646, Ottawa, ON Canada K1H 8L6
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