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Cummings JL, Oladeji AK, Rosenfeld S, Johnson M, Goldstein R, Georgopoulos G, Stephenson L, White NW, Hosseinzadeh P. Severity of hip dysplasia as the major factor affecting outcome of closed reduction in children with hip dysplasia. J Pediatr Orthop B 2024; 33:322-327. [PMID: 37669157 DOI: 10.1097/bpb.0000000000001122] [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: 09/07/2023]
Abstract
The objective of this study was to analyze a multicenter cohort of children with developmental dysplasia of the hip (DDH) who underwent treatment with closed reduction. We sought to report the effects that severity of hip dysplasia and age have on the development of femoral head avascular necrosis (AVN) and the need for additional procedures. All patients with DDH and minimum 2 years of follow-up who underwent closed reduction were identified. The following variables were recorded: sex, laterality of hip involvement, age, acetabular index (AI), and International Hip Dysplasia Institute (IHDI) grade. The effects of patient age and pre-procedure IHDI grade on the rate of AVN and need for additional procedures after the closed reduction were analyzed using an alpha of 0.05. Seventy-eight total hips were included in the final analysis. The average patient age was 12 months. AVN of the femoral head was reported in 24 hips (30.8%) and 32 hips (41.0%) required additional surgery. Higher pre-op IHDI grade was associated with higher risk of developing Bucholz-Ogden grades II-IV AVN of the femoral head ( P = 0.025) and requiring additional surgery ( P = 0.033) regardless of patient age. There were no statistically significant differences for the effect of age on the measured outcomes ( P > 0.05). These findings suggest that severity of dislocation (IHDI grade) is a significant risk factor for the development of AVN and need for additional procedure.
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Affiliation(s)
- Jason L Cummings
- Department of Orthopedic Surgery, Washington University in St. Louis, Saint Louis, Missouri
| | - Afolayan K Oladeji
- Department of Orthopedic Surgery, Washington University in St. Louis, Saint Louis, Missouri
| | | | - Megan Johnson
- Vanderbilt Children's Hospital, Nashville, Tennessee
| | | | | | | | - Nathan W White
- Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Pooya Hosseinzadeh
- Department of Orthopedic Surgery, Washington University in St. Louis, Saint Louis, Missouri
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Tang Z, Li R, Lu C, Ma N, Xie R, Kang X, Chen X, Yang H, Hang Y, Li J, Zhou Y. Risk factors for avascular necrosis of the femoral head after developmental hip dislocation reduction surgery and construction of Nomogram prediction model. BMC Musculoskelet Disord 2024; 25:464. [PMID: 38877449 PMCID: PMC11179329 DOI: 10.1186/s12891-024-07575-y] [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: 01/10/2024] [Accepted: 06/07/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND To analyze the risk factors for the development of avascular necrosis (AVN) of the femoral head after reduction surgery in children with developmental hip dysplasia (DDH), and to establish a prediction nomogram. METHODS The clinical data of 134 children with DDH (169 hips) treated with closure reduction or open reduction from December 2016 to December 2019 were retrospectively analyzed. Independent risk factors for AVN after DDH reduction being combined with cast external immobilization were determined by univariate analysis and multivariate logistic regression and used to generate nomograms predicting the occurrence of AVN. RESULTS A total of 169 hip joints in 134 children met the inclusion criteria, with a mean age at surgery of 10.7 ± 4.56 months (range: 4-22 months) and a mean follow-up duration of 38.32 ± 27.00 months (range: 12-94 months). AVN developed in 42 hip joints (24.9%); univariate analysis showed that the International Hip Dysplasia Institute (IHDI) grade, preoperative development of the femoral head ossification nucleus, cartilage acetabular index, femoral head to acetabular Y-shaped cartilage distance, residual acetabular dysplasia, acetabular abduction angle exceeding 60°, and the final follow-up acetabular index (AI) were associated with the development of AVN (P < 0.05). Multivariate logistic regression analysis showed that the preoperative IHDI grade, development of the femoral head ossification nucleus, acetabular abduction angle exceeding 60°, and the final follow-up AI were independent risk factors for AVN development (P < 0.05). Internal validation of the Nomogram prediction model showed a consistency index of 0.833. CONCLUSION Preoperative IHDI grade, preoperative development of the femoral head ossification nucleus, final AI, and acetabular abduction angle exceeding 60° are risk factors for AVN development. This study successfully constructed a Nomogram prediction model for AVN after casting surgery for DDH that can predict the occurrence of AVN after casting surgery for DDH.
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Affiliation(s)
- Zidan Tang
- Graduate School, Kunming Medical University, Kunming, 650500, China
| | - Rong Li
- Department of Obstetric Ultrasound, The First Affiliated Hospital of Kunming Medical University, Kunming, 650032, China
| | - Chan Lu
- Graduate School, Kunming Medical University, Kunming, 650500, China
| | - Na Ma
- Graduate School, Kunming Medical University, Kunming, 650500, China
| | - Rui Xie
- Graduate School, Kunming Medical University, Kunming, 650500, China
| | - Xiaopeng Kang
- Department of Orthopedics, Kunming Children's Hospital, No. 288, Qianxing Road, Xishan District, Kunming, Yunnan, 650100, China
| | - Xinhao Chen
- Graduate School, Kunming Medical University, Kunming, 650500, China
| | - Han Yang
- Graduate School, Kunming Medical University, Kunming, 650500, China
| | - Yong Hang
- Department of Orthopedics, Kunming Children's Hospital, No. 288, Qianxing Road, Xishan District, Kunming, Yunnan, 650100, China
| | - Jun Li
- Department of Orthopedics, Kunming Children's Hospital, No. 288, Qianxing Road, Xishan District, Kunming, Yunnan, 650100, China
| | - You Zhou
- Department of Orthopedics, Kunming Children's Hospital, No. 288, Qianxing Road, Xishan District, Kunming, Yunnan, 650100, China.
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Dragonas CG, Kottaridou E, Vampertzis T, Abbakr L, Taha N, Manoukian D. Length of treatment and ultrasound timing in infants with developmental dysplasia of the hip. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1079-1086. [PMID: 37934277 DOI: 10.1007/s00590-023-03771-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 10/23/2023] [Indexed: 11/08/2023]
Abstract
PURPOSE Developmental dysplasia of the hip (DDH) joint is a complex condition that may lead to severe problems. Ultrasound scan (USS) in the first four-to-six weeks of life is considered the gold-standard for diagnosis while the Pavlik harness (PH) is a widely utilized method as first-line treatment. The purpose of this study is to compare clinical outcomes of infants with DDH in relation to the timing and frequency of USS following application of the PH. METHODS Retrospective data were collected over a 5-year period from February 2017 to February 2022. We included patients who underwent the first USS post-diagnosis and PH application in two, three, four and six weeks. Two-hundred-twenty-five patients were included and divided in four groups according to timing of the first follow-up: week-2, n = 13; week-3, n = 66; week-4, n = 95; and week-6, n = 51. For every patient Graf classification, treatment length and number of follow-ups were documented. RESULTS Week-3 and week-4 groups displayed a statistically significant shorter treatment length compared to week-6 group (p value < 0.001), while also demonstrating a lower number of sonographic follow-ups per patient compared to both week-6 (p value < 0.001) and week-2 (p value = 0.002 vs week-3; p value < 0.001 vs week 4). Week-4 group presented the highest treatment completion (56%) on first visit post-diagnosis. Conservative treatment with PH failed in 1.8% (4/225) and displayed no significant difference among all subgroups. CONCLUSIONS Differences in timing of first USS post-DDH diagnosis and initiation of treatment can lead to discrete outcomes with implications to the clinical outcome and cost effectiveness.
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Affiliation(s)
| | | | - Themistoklis Vampertzis
- The Royal London Hospital, Barts Health Trust, London, UK
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Lina Abbakr
- Princess Alexandra Hospital NHS Trust, Hamstel Road, Harlow, Essex, CM20 1QX, UK
| | - Narmeen Taha
- Princess Alexandra Hospital NHS Trust, Hamstel Road, Harlow, Essex, CM20 1QX, UK
| | - Dimitrios Manoukian
- Princess Alexandra Hospital NHS Trust, Hamstel Road, Harlow, Essex, CM20 1QX, UK
- The Royal London Hospital, Barts Health Trust, London, UK
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Sacks H, Pargas-Colina C, Masrouha K, Castañeda P. Outcomes of treatment for developmental dislocation of the hip when the Pavlik method has failed. J Pediatr Orthop B 2023:01202412-990000000-00171. [PMID: 38189781 DOI: 10.1097/bpb.0000000000001142] [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: 01/09/2024]
Abstract
OBJECTIVES Despite the success rate of the Pavlik method in the treatment of developmental dislocation of the hip, there is a subset of hips that do not reduce with harness use. The purpose of this study was to determine the outcomes after closed reduction (CR), open reduction (OR) and combined open reduction and pelvic osteotomy (OR+PO) in patients with infantile hip dislocations who initially failed the Pavlik method. METHODS This was a retrospective cohort study of patients with infantile hip dislocations who failed the Pavlik method and subsequently underwent a secondary procedure for persistent hip dislocation. The primary outcome measure was the Severin classification of the involved hip 3 years after the secondary procedure. Other outcomes assessed included rates of redislocation, residual acetabular dysplasia and proximal femoral growth disturbance. RESULTS Twenty-three patients were included; seven subsequently underwent CR, three underwent isolated OR and 13 proceeded directly to OR+PO. The overall successful outcome rate at final follow-up (as determined by radiographic Severin class I or II) was 11/23 (48%). However, patients undergoing OR+PO had significantly higher rates of successful outcomes (77%) compared with CR (15%) and OR (0%), P < 0.05. The rate of residual acetabular dysplasia and proximal femoral growth disturbance was significantly lower in patients treated with OR+PO compared with CR and isolated OR, P < 0.05. CONCLUSION Patients with dislocated hips who failed Pavlik harness treatment had better radiographic outcomes 3 years after OR+PO in comparison to patients undergoing CR or isolated OR.
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Affiliation(s)
- Hayley Sacks
- NYU Langone Health Department of Orthopaedic Surgery, New York, USA
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Poacher AT, Hathaway I, Crook DL, Froud JLJ, Scourfield L, James C, Horner M, Carpenter EC. The impact of the introduction of selective screening in the UK on the epidemiology, presentation, and treatment outcomes of developmental dysplasia of the hip. Bone Jt Open 2023; 4:635-642. [PMID: 37607720 PMCID: PMC10444535 DOI: 10.1302/2633-1462.48.bjo-2022-0158.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2023] Open
Abstract
Aims Developmental dysplasia of the hip (DDH) can be managed effectively with non-surgical interventions when diagnosed early. However, the likelihood of surgical intervention increases with a late presentation. Therefore, an effective screening programme is essential to prevent late diagnosis and reduce surgical morbidity in the population. Methods We conducted a systematic review and meta-analysis of the epidemiological literature from the last 25 years in the UK. Articles were selected from databases searches using MEDLINE, EMBASE, OVID, and Cochrane; 13 papers met the inclusion criteria. Results The incidence of DDH within the UK over the last 25 years is 7.3/1,000 live births with females making up 86% of the DDH population (odds ratio 6.14 (95% confidence interval 3.3 to 11.5); p < 0.001). The incidence of DDH significantly increased following the change in the Newborn and Infant Physical Examination (NIPE) guidance from 6.5/1,000 to 9.4/1,000 live births (p < 0.001). The rate of late presentation also increased following the changes to the NIPE guidance, rising from 0.7/1,000 to 1.2/1,000 live births (p < 0.001). However, despite this increase in late-presenting cases, there was no change in the rates of surgical intervention (0.8/1,000 live births; p = 0.940). Conclusion The literature demonstrates that the implementation of a selective screening programme increased the incidence of DDH diagnosis in the UK while subsequently increasing the rates of late presentation and failing in its goal of reducing the rates of surgical intervention for DDH.
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Affiliation(s)
| | | | | | | | | | - Catherine James
- Trauma Department, University Hospital of Wales, Cardiff, UK
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Garcia S, Demetri L, Starcevich A, Gatto A, Swarup I. Developmental Dysplasia of the Hip: Controversies in Management. Curr Rev Musculoskelet Med 2022; 15:272-282. [PMID: 35489017 DOI: 10.1007/s12178-022-09761-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/01/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Many aspects of developmental hip dysplasia (DDH) care and evaluation are still active areas of debate. Recent studies have provided more insight into these topics such as strategies for reducing osteonecrosis, assessing hip reduction after closed and open reduction, and the management of residual acetabular dysplasia. RECENT FINDINGS The presence of the ossific nucleus at the time of reduction does not alter the risk of osteonecrosis. The risk of osteonecrosis may be higher when hips are immobilized in excessive abduction. Limited sequence MRI may be the best choice for assessing hip reduction after closed and open reduction; however, new technologies are emerging such as 3D fluoroscopy and perfusion MRI. The treatment of residual acetabular dysplasia with bracing has been shown to be effective and the decision to perform a pelvic osteotomy is based on patient-specific factors. The spectrum of DDH treatment has evolved over the past several decades. Recent studies have provided insights into strategies for osteonecrosis prevention, hip evaluation during after reduction, and the management of residual acetabular dysplasia. However, there is ample room for additional and more rigorous studies guiding advanced imaging for assessing hip reduction such as 3D fluoroscopy and perfusion MRI, as well as the management of residual acetabular dysplasia.
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Affiliation(s)
- Steven Garcia
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Leah Demetri
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Ana Starcevich
- University of California, Davis School of Medicine, Sacramento, CA, USA
| | - Andrew Gatto
- Touro University California College of Osteopathic Medicine, Vallejo, CA, USA
| | - Ishaan Swarup
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA.
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