Effect of acetabular morphological parameters applied in proximal femoral varus osteotomy on the treatment of developmental dysplasia of the hip in children

Visualized simulative surgery in preoperative planning for proximal femoral varus osteotomy of DDH

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.

Case report: Morphological changes evident after manual therapy in two cases of late-diagnosed developmental dysplasia of the hip

BACKGROUND

Late diagnosed Developmental Dysplasia of the Hip (DDH) is the detection of DDH after 3 months of age and is associated with significantly poorer outcomes than when diagnosed and managed early. Late diagnosed DDH has lower rates of success with bracing, higher rates of surgery and higher rates of complications, including avascular necrosis of the femoral head and early osteoarthritis of the hip. We describe two cases of late-diagnosed DDH which demonstrated changes in femoroacetabular joint morphology on radiographic interpretation after a 6-month trial period of manual therapy.

CASE PRESENTATION

Two cases (13 and 30 months of age) with late-diagnosed DDH presented to a private chiropractic clinic for conservative, non-bracing management. One case had unilateral DDH and the other bilateral DDH. A trial of manual therapy was utilized over a 6-month period. Both cases demonstrated changes to femoroacetabular morphology as well as improvements in gross motor activity and lower extremity muscle tone.

CONCLUSION

Manual therapy, as an adjunct or alternative to static bracing, may be of benefit in individuals with late-diagnosed DDH not responding to bracing, and prior to more invasive interventions. Additional cases of manual therapy-based management of this condition are required to inform the design of future trials to investigate this hypothesis.