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Baljoun A, Bradley CS, Verma Y, Wedge JH, Gargan MF, Kelley SP. Intraoperative 3D Fluoroscopy During Open Reduction for DDH: An Effective Alternative to Postoperative CT/MRI. J Pediatr Orthop 2024; 44:462-467. [PMID: 38779959 DOI: 10.1097/bpo.0000000000002728] [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: 05/25/2024]
Abstract
BACKGROUND Computed tomography CT or magnetic resonance imaging (MRI) has been the most used imaging modality to assess hip reduction in developmental dysplasia of the hip (DDH) after open reduction (OR). In 2015, intraoperative 3D fluoroscopy (3D) was introduced at our center as an alternative to CT/MRI. 3D offers the advantage that if hip reduction is insufficient, it can be addressed at the time of surgery. The purpose of this study was to assess the efficacy of 3D in comparison to CT/MRI. METHODS This was a single-centre, retrospective comparative study of two consecutive cohorts: those with OR and 3D between 2015 and 2017 and those with OR and CT/MRI between 2012 and 2014. Time to imaging, re-imaging, length of stay (LOS), re-operation, and redislocation or subluxation after cast removal were evaluated. RESULTS Forty-two patients (46 hips) had 3D, and 30 patients (32 hips) had CT/MRI. Significant differences were found between groups in time to imaging, cast changes, and LOS. All 3D was intraoperative (46 hips), and only 69% (22 hips) of CT/MRI was on the day of surgery ( P <0.01). In the 3D group, 1 hip (2%) had a cast change under the same anesthetic, and 4 hips (13%) from CT/MRI had cast changes in subsequent surgery ( P =0.03). The mean LOS in days for 3D was 1.72 and 2.20 for CT/MRI ( P =0.03). There were no statistically significant differences between groups in further imaging and subluxations or re-dislocations at cast removal. Two hips (4%) in the 3D group had MRI, but with no further intervention ( P =0.51), and at cast removal, there were 3 subluxations in each group ( P =0.69) and 1 redislocation in the 3D group ( P =1.00). CONCLUSIONS Intraoperative 3D improved time to imaging, allowed for cast changes at surgery and had a shorter LOS. Moreover, there were no significant differences found in adverse outcomes between those who underwent 3D versus CT/MRI. 3D should thus be considered an effective alternative to CT/MRI for assessing hip reduction during OR for DDH. LEVEL OF EVIDENCE Diagnostic Study, level II.
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Affiliation(s)
- Amna Baljoun
- Division of Orthopaedic Surgery, The Hospital for Sick Children
- Department of Surgery, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | | | - Yashvi Verma
- Division of Orthopaedic Surgery, The Hospital for Sick Children
| | - John H Wedge
- Division of Orthopaedic Surgery, The Hospital for Sick Children
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Martin F Gargan
- Division of Orthopaedic Surgery, The Hospital for Sick Children
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Simon P Kelley
- Division of Orthopaedic Surgery, The Hospital for Sick Children
- Department of Surgery, University of Toronto, Toronto, ON, Canada
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2
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Weinstein SL. Acetabular Dysplasia After Successful Open or Closed Treatment of Developmental Hip Dysplasia Is a Biologic Failure, Not Acetabular Deficiency. J Bone Joint Surg Am 2024; 106:833-839. [PMID: 38691109 DOI: 10.2106/jbjs.23.00697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
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3
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Leonard SP, Kresch MJ. Developmental Dysplasia of the Hip Is Not Associated with Breech Presentation in Preterm Infants. Am J Perinatol 2024; 41:e465-e469. [PMID: 36096137 DOI: 10.1055/s-0042-1756139] [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: 11/01/2022]
Abstract
OBJECTIVES The aim of the study is to (1) determine the incidence of developmental dysplasia of the hip (DDH) in preterm infants born prior to 35 completed weeks' gestation in a breech presentation, and (2) evaluate if the association between breech presentation and DDH in full-term infants holds for premature infants. STUDY DESIGN This study design comprises retrospective review of infants born between January 1, 2008, and December 31, 2017, at <35 weeks' gestation and admitted to the NICU. Infants had hip ultrasounds at 4 to 6 weeks' corrected age if they were born in a breech presentation with a stable hip examination. We excluded infants born in a presentation other than breech or vertex, had no documentation of presentation at birth, or if they died within the first year. RESULTS We included 1,533 infants. Preterm infants <35 weeks' gestation born in the breech versus vertex position had an incidence of DDH of 0.47% (2/428) and 0.36% (4/1,105), respectively. There was no significant difference in the incidence of DDH between infants born in the breech versus vertex position (Chi-square and Fisher's exact tests). The sensitivity, specificity, and positive and negative predictive values of breech presentation in detecting DDH were 33, 72, 0.47, and 99.6%, respectively. CONCLUSION There is no association between breech presentation and DDH in preterm infants <35 weeks' gestation. Obtaining hip ultrasounds on preterm infants <35 weeks' gestation born in the breech presentation with a normal hip examination is not recommended. KEY POINTS · Breech position is a risk factor for DDH in term newborns.. · Preterm infants are often in the breech position until 37 weeks' gestation.. · This study shows that breech presentation is not a risk factor for DDH in preterm infants..
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Affiliation(s)
- Samantha P Leonard
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Penn State Health Children's Hospital, Hershey, Pennsylvania
| | - Mitchell J Kresch
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Penn State Health Children's Hospital, Hershey, Pennsylvania
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4
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Sawamura K, Kitoh H, Matsushita M, Mishima K, Kamiya Y, Imagama S. Quality of life in adult patients with developmental dysplasia of the hip who were treated for hip dislocation during childhood. J Pediatr Orthop B 2024:01202412-990000000-00190. [PMID: 38451811 DOI: 10.1097/bpb.0000000000001173] [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: 03/09/2024]
Abstract
Developmental dysplasia of the hip (DDH) can lead to premature loss of hip function if not properly treated; however, few studies have focused on the long-term outcomes of DDH. We conducted a survey of health-related quality of life in adult patients with DDH who were treated for hip dislocation during childhood. We sent a questionnaire to 287 adult patients with DDH who were treated for hip dislocation during childhood in our institutions. We examined patient demographics, disease-specific medical history, and health-related quality of life using the short form-36. Physical component summary (PCS), mental component summary (MCS) and role/social component summary (RCS) were compared between the patients and Japanese standard values. Sixty-eight patients were evaluated after exclusion. The overall mean PCS, MCS and RCS scores of the patients were comparable to the standard values. The PCS was maintained until the age of 50, but it was significantly decreased in 10 patients over 50 years old. In addition, PCS was significantly lower in patients who underwent open reduction than in those who were conservatively reduced. The MCS and RCS of the patients did not differ from the standard values in each age and treatment group. Additionally, the PCS, MCS and RCS did not differ according to bilaterality, age at diagnosis, or requirement for additional surgeries. Physical quality of life was maintained until the age of 50 but rapidly declined thereafter in patients with DDH, especially in those who required open reduction during childhood.
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Affiliation(s)
- Kenta Sawamura
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya
| | - Hiroshi Kitoh
- Department of Orthopaedic Surgery, Aichi Children's Health and Medical Center, Obu
- Department of Comprehensive Pediatric Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masaki Matsushita
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya
| | - Kenichi Mishima
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya
| | - Yasunari Kamiya
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya
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Walter SG, Ossendorff R, Bornemann R, Zarghooni K, Peterlein CD, Placzek R. Mid-term Follow-Up after Closed Reduction in Developmental Dysplastic Hips. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2024; 162:52-56. [PMID: 35839820 DOI: 10.1055/a-1865-0091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Closed reduction and subsequent spica casting is the gold standard for treatment of unstable or dislocated developmental dysplastic hips (DDHs). There are few data on mid-term results after treatment of DDH, especially on closed reduction. METHODS Thirty-one consecutive patients with unstable or dislocated hips (n = 36) that were treated by fluoroscopic, contrast agent-supported closed reduction and spica casting were included and evaluated clinically and radiologically 2 and 5 years after treatment. RESULTS After 2 and 5 years, there were no significant differences between healthy and successfully treated hips that were detectable with respect to acetabular coverage (AC) angle, center-edge angle, and clinical stability of the hip. There was a significant difference at the 2-year follow-up between healthy hips and hips that needed to undergo secondary open reduction surgery (n = 4) with respect to the AC angle (p < 0.001). CONCLUSION Closed reduction in DDHs results in acceptable clinical and radiological results in the mid-term follow-up. It remains unclear why some patients with subsequent sonographically matured hips show secondary deterioration and recurrence of dysplasia.
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Affiliation(s)
- Sebastian G Walter
- Department of Orthopedic Surgery and Traumatology, University Hospital Cologne, Köln, Germany
| | - Robert Ossendorff
- Department of Orthopedic Surgery and Traumatology, University Hospital Bonn, Bonn, Germany
| | - Rahel Bornemann
- Department of Orthopedic Surgery and Traumatology, University Hospital Bonn, Bonn, Germany
| | - Kourosh Zarghooni
- Department of Orthopedic Surgery and Traumatology, University Hospital Cologne, Köln, Germany
| | | | - Richard Placzek
- Department of Orthopedic Surgery and Traumatology, University Hospital Bonn, Bonn, Germany
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Mojica ES, Pardo García JM, Huebschmann NA, Castañeda P. The tension of the iliopsoas tendon more than doubles during extension of the dysplastic hip in open reduction. J Pediatr Orthop B 2023; 32:324-328. [PMID: 35834787 DOI: 10.1097/bpb.0000000000000999] [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: 11/26/2022]
Abstract
The role of the iliopsoas as an obstructing and re-dislocating factor in developmentally dislocated hips is unclear. The purpose of this article is to determine the change in the iliopsoas' tension during flexion and extension when performing an open reduction. We evaluated 34 hips undergoing an anterior open reduction for a developmental dislocation. At the time of surgery, we identified the iliopsoas, and before sectioning it as part of the open reduction, we measured the tension while cycling the reduced hip through flexion and extension. We performed statistical analysis using Pearson and Spearman correlation tests. We created an initial tension artificially at 20 N with the hip held in 90º of flexion, which then doubled to a mean of 42 N when placed in extension. We found a significant increase in tension when the hip went below 20º of flexion. We also found the correlation between the angle of the hip and the force of tension to be statistically significant ( P = 0.003). This study provides quantitative support that the tension of the iliopsoas tendon increases significantly in extension when performing an open reduction of a developmentally dislocated hip.
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Affiliation(s)
- Edward S Mojica
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
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Cummings JL, Oladeji AK, Rosenfeld S, Johnson M, Goldstein R, Georgopoulos G, Stephenson L, White NW, Hosseinzadeh P. Outcomes of Open Reduction in Children With Developmental Hip Dislocation: A Multicenter Experience Over a Decade. J Pediatr Orthop 2023; 43:e405-e410. [PMID: 37037660 DOI: 10.1097/bpo.0000000000002413] [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: 04/12/2023]
Abstract
BACKGROUND Open reduction of the hip is commonly performed in children with severe developmental dysplasia of the hip, or in cases that are refractory to nonoperative forms of treatment. The open reduction has been associated with numerous complications including avascular necrosis (AVN) of the femoral head, the need for reoperation, and residual radiographic dysplasia. This study seeks to determine the effects of preoperative severity of dysplasia, associated procedures (femoral and acetabular osteotomies), age on AVN, and the need for reoperation. METHODS Children with developmental dysplasia of the hip and a minimum of 2 years of follow-up who underwent open reduction were identified. The following data points were recorded: sex, laterality of hip involvement, simultaneous procedures, surgical approach used, age, acetabular index, and International Hip Dysplasia Institute grade. We analyzed the effects of preoperative International Hip Dysplasia Institute, age, surgical approach (anterior/medial), bilateral reduction, and simultaneous femoral shortening or pelvic osteotomy on the outcomes of AVN and reoperation. RESULTS One hundred eighty-five hips in 149 patients were included in this study with an average follow-up of 4 years (range: 2 to 5 y). The average age at index surgery was 23 months (range: 1 to 121 mo). Overall, 60 hips (32.4%) required secondary surgical procedures at an average age of 58.5 months. High-grade AVN was noted in 24 hips (13.0%) and was found to be associated with the severity of the hip dislocation ( P = 0.02). A higher rate of reoperation was found in children over 18 months at the time of open reduction who did not receive an acetabular osteotomy ( P = 0.012). CONCLUSION Approximately 1/3 of patients require another operative intervention within the first 4 years after open reduction of the hip. We found the severity of hip dislocation to be associated with a higher risk of AVN development. These findings support performing an acetabular osteotomy in children over 18 months of age at the time of open reduction to decrease the likelihood of requiring future reoperation during the first 4 years after the index procedure. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Jason L Cummings
- Department of Orthopaedic Surgery, Washington University in St. Louis, Saint Louis, MO
| | - Afolayan K Oladeji
- Department of Orthopaedic Surgery, Washington University in St. Louis, Saint Louis, MO
| | | | | | | | | | | | - Nathan W White
- Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, TX
| | - Pooya Hosseinzadeh
- Department of Orthopaedic Surgery, Washington University in St. Louis, Saint Louis, MO
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8
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Wen Z, Wu YY, Kuang GY, Wen J, Lu M. Effects of different pelvic osteotomies on acetabular morphology in developmental dysplasia of hip in children. World J Orthop 2023; 14:186-196. [PMID: 37155509 PMCID: PMC10122774 DOI: 10.5312/wjo.v14.i4.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/19/2023] [Accepted: 03/30/2023] [Indexed: 04/18/2023] Open
Abstract
Developmental dysplasia of hip seriously affects the health of children, and pelvic osteotomy is an important part of surgical treatment. Improving the shape of the acetabulum, preventing or delaying the progression of osteoarthritis is the ultimate goal of pelvic osteotomies. Re-directional osteotomies, reshaping osteotomies and salvage osteotomies are the three most common types of pelvic osteotomy. The influence of different pelvic osteotomy on acetabular morphology is different, and the acetabular morphology after osteotomy is closely related to the prognosis of the patients. But there lacks comparison of acetabular morphology between different pelvic osteotomies, on the basis of retrospective analysis and measurable imaging indicators, this study predicted the acetabular shape after developmental dysplasia of the hip pelvic osteotomy in order to help clinicians make reasonable and correct decisions and improve the planning and performance of pelvic osteotomy.
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Affiliation(s)
- Zhi Wen
- Graduate School, Hunan University of Chinese Medicine, Changsha 410007, Hunan Province, China
- Department of Joint Orthopedics, The First Hospital of Hunan University of Chinese Medicine, Changsha 410007, Hunan Province, China
| | - Yu-Yuan Wu
- Department of Pediatric Orthopedics, Traditional Chinese Medicine Hospital in Huaihua, Huaihua 418000, Hunan Province, China
| | - Gao-Yan Kuang
- Department of Joint Orthopedics, The First Hospital of Hunan University of Chinese Medicine, Changsha 410007, Hunan Province, China
| | - Jie Wen
- Department of Pediatric Orthopedics, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
| | - Min Lu
- Department of Joint Orthopedics, The First Hospital of Hunan University of Chinese Medicine, Changsha 410007, Hunan Province, China
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9
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Young E, Regan C, Milbrandt TA, Grigoriou E, Shaughnessy WJ, Stans AA, Larson AN. Predictors of Total Hip Arthroplasty Following Pediatric Surgical Treatment of Developmental Hip Dysplasia at 20-Year Follow-Up. J Clin Med 2022; 11:7198. [PMID: 36498771 PMCID: PMC9735613 DOI: 10.3390/jcm11237198] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/21/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022] Open
Abstract
Long-term outcomes of surgical treatment for pediatric developmental dysplasia of the hip (DDH) are not well defined. The purpose of this study was to report long-term radiographic and clinical outcomes, survivorship free of total hip arthroplasty (THA), and predictors of subsequent THA following childhood treatment of DDH. This study was a single-institution retrospective review of hips treated for DDH with closed or open reduction at a minimum 10-year follow-up. 107 patients (119 hips) were included with a mean patient age of 3.3 years at childhood treatment. At mean 30.5 years follow-up, 24 hips had undergone THA (20%). Mean patient age at time of THA was 33.5 years. None of the hips treated with closed reduction alone required THA, whereas 8 hips treated with open reduction (25%) underwent THA. Hips with patient age > 4 years at the time of treatment had lower survivorship at 35 years follow-up (50% vs. 85%; p < 0.001). Additionally, femoral osteotomy (OR 2.0, p < 0.001), and previous treatment elsewhere (27% vs. 16%; p < 0.01) were associated with subsequent THA. Early referral and appropriate intervention may prove important, as age and prior treatment were predictive of subsequent THA.
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Affiliation(s)
| | | | | | | | | | | | - A. Noelle Larson
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
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10
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Baghdadi S, Sankar WN. Residual Acetabular Dysplasia in the Reduced Hip. Indian J Orthop 2021; 55:1480-1489. [PMID: 35003538 PMCID: PMC8688620 DOI: 10.1007/s43465-021-00515-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/04/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Residual acetabular dysplasia occurs in up to a third of patients treated successfully for developmental dysplasia of the hip (DDH) and has been found to be a significant risk factor for early hip osteoarthritis (OA). DISCUSSION Age at the time of initial reduction and the initial severity of DDH have been linked to residual acetabular dysplasia. An anteroposterior pelvic radiograph is the main diagnostic modality, but MRI also provides valuable information, particularly in equivocal cases. The literature supports intervening when significant residual acetabular dysplasia persists at 4-5 years of age, and common surgical indications include acetabular index (AI) > 25°-30°, lateral center-edge angle (LCEA) < 8°-10°, and a broken Shenton's line on radiographs; and a cartilaginous acetabular angle (CAI) > 18°, cartilaginous center-edge angle (CCE) < 13°, and/or the presence of high-signal intensity areas on MRI. Surgical options include redirectional pelvic osteotomies and reshaping acetabuloplasties, which provide comparable radiographic and clinical results. CONCLUSION RAD is common after treatment of DDH and requires regular follow-up for diagnosis and appropriate management to decrease the long-term risk of OA. Long-term outcomes of patients treated with pelvic osteotomies are generally favorable, and the risk of OA can be decreased, although the risk of total hip replacement in the long-term remains.
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Affiliation(s)
- Soroush Baghdadi
- Division of Orthopaedics, Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - Wudbhav N. Sankar
- Division of Orthopaedics, Children’s Hospital of Philadelphia, Philadelphia, PA USA
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11
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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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12
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Lucchesi G, Sacco R, Zhou W, Li Y, Li L, Canavese F. DDH in the Walking Age: Review of Patients with Long-Term Follow-Up. Indian J Orthop 2021; 55:1503-1514. [PMID: 35003539 PMCID: PMC8688669 DOI: 10.1007/s43465-021-00531-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 09/17/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The best treatment option in children with late detected DDH is still a subject of much controversy and only few studies have investigated the long-term outcome of treatment in such patients. We performed a systematic review to assess long-term outcome of late detected DDH hips treated after walking age. METHODS Studies met inclusion criteria if they: (1) reported at least 30 hips treated; (2) included children aged between 9 months and 12 years; (3) treatment indication was late detected DDH after walking age; (4) presented a minimum follow-up of 10 years; (5) reported a clinical or radiological outcome. The Kaplan-Meier method was used to evaluate long-term survival according to clinical and radiological outcomes. The rate of total hip replacement (THR) was retrieved. RESULTS From a total of 6561 articles, 13 articles with grade IV level of evidence were included in our review. A total of 988 hips in 800 patients with a mean follow-up of 27.9 years (range 10-67) were included. The mean age at surgery was 3.3 years (range, 9 months-12 years). The rate of THR increased according to the length of final follow-up. In particular, all studies reported no case of THR at 23.5 years of follow-up, a rate of 10.2% of THR between 30 and 40 years of follow-up and a rate of 35.6% of THR in patients with follow-up more than 40 years. CONCLUSIONS In patients with late detected DDH, most THR became necessary more than 30 years after the index procedure and their number increased further after 40 years and more of follow-up. Late detected DDH diagnosed after walking age is a life-long disease.
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Affiliation(s)
- Giovanni Lucchesi
- Orthopaedic Clinic, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Riccardo Sacco
- Department of Orthopedic and Traumatology, Orthopedic and Trauma Center, Turin, Italy
| | - Weizheng Zhou
- Department of Pediatric Orthopaedics, Shengjing Hospital of China Medical University, Shenyang, China
| | - YiQiang Li
- GuangZhou Women and Children’s Medical Center, GuangZhou Medical University, 9th JinSui Road, GuangZhou, 510623 China
| | - Lianyong Li
- Department of Pediatric Orthopaedics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Federico Canavese
- Department of Pediatric Orthopedic Surgery, Lille University Centre, Jeanne de Flandre Hospital, 59000 Lille, France
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Pinto D, Aroojis A, Shah H, Patwardhan S, Venkatadass K, Sahu C, Schaeffer E, Mulpuri K. Demographic and Practice Variability Amongst Indian Centres in a Multicentre Prospective Observational Study on Developmental Dysplasia of the Hip. Indian J Orthop 2021; 55:1559-1567. [PMID: 35003542 PMCID: PMC8688623 DOI: 10.1007/s43465-021-00516-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/04/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Since 2017, five Indian centres have enrolled into the International Hip Dysplasia Registry for prospective collection of data on Developmental Dysplasia of Hip (DDH). AIMS To assess how baseline patient characteristics and initial treatment modalities differ across these five centres. METHODS Registry data collected over 3 years were analyzed. Children with DDH that had radiograph-based diagnoses were included. RESULTS Collectively, there were 234 hips (181 patients), of which 218 had undergone surgery. Overall, median age at presentation was 25.3 months (IQR 16.8-46.0); female/male ratio was 2.6:1 (range 1.46-4.75:1); with 42%, 29%, and 29% unilateral left, bilateral and unilateral right hip dislocations respectively. Most were IHDI grade III and IV dislocations (94%). Closed reduction was performed at all but one centre, at median 15.3 months (IQR 9.6-21.1). Open reduction (OR) as a stand-alone procedure was performed at all centres, at median 20.8 months (IQR 15.4-24.9). Combination of OR with a single osteotomy, femoral (FO) or acetabular (AO), was performed at all centres at median 29.7 months (IQR 22.1-43.5). However, for the same age group, three centres exclusively performed FO, whereas the other two exclusively performed AO. The combination of OR with both FO and AO was used at all centres, at median 53.4 months (IQR 42.1-70.8). CONCLUSIONS The preliminary findings of this multi-centre study indicate similar patient demographics and diagnoses, but important differences in treatment regimens across the five Indian centres. Comparison of treatment regimens, using the 'centre' as a predictive variable, should allow us to identify protocols that give superior outcomes.
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Affiliation(s)
- Deepika Pinto
- grid.414135.60000 0001 0430 6611Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Mumbai, India
| | - Alaric Aroojis
- grid.414135.60000 0001 0430 6611Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Acharya Donde Marg, Parel, Mumbai, Maharashtra 400012 India
| | - Hitesh Shah
- grid.465547.10000 0004 1765 924XDepartment of Orthopaedics, Kasturba Medical College, Manipal, India
| | - Sandeep Patwardhan
- grid.489159.80000 0004 1767 0852Department of Orthopaedics, Sancheti Institute, Pune, India
| | - K. Venkatadass
- grid.415287.d0000 0004 1799 7521Department of Orthopaedics, Ganga Medical Centre, Coimbatore, India
| | - Chittaranjan Sahu
- Department of Orthopaedics, Balaji Institute of Surgery, Research and Rehabilitation, Tirupati, India
| | - Emily Schaeffer
- grid.414137.40000 0001 0684 7788Department of Orthopaedic Surgery, BC Children’s Hospital, Vancouver, BC Canada
| | - Kishore Mulpuri
- grid.414137.40000 0001 0684 7788Department of Orthopaedic Surgery, BC Children’s Hospital, Vancouver, BC Canada
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14
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Lee WC, Chen TY, Hung LW, Wang TM, Chang CH, Lu TW. Increased Loading Rates During Gait Correlate With Morphology of Unaffected Hip in Juveniles With Treated Developmental Hip Dysplasia. Front Bioeng Biotechnol 2021; 9:704266. [PMID: 34368099 PMCID: PMC8335483 DOI: 10.3389/fbioe.2021.704266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 06/29/2021] [Indexed: 11/13/2022] Open
Abstract
Long-term follow-up studies on children with surgically treated developmental dysplasia of the hip (DDH) have shown that not only the affected side progresses to premature osteoarthritis, but the unaffected side may also suffer from insidious hip dysplasia or osteonecrosis. The current gait analysis study identified the loading and unloading rates of the ground reaction forces (GRF) and lower limb joint axial forces during gait, and their correlations with the hip morphology in twenty juvenile patients with surgically treated unilateral DDH during toddlerhood. In a gait laboratory, each subject walked at preferred speed on a 10-m walkway while the kinematics and the GRF were measured. Loading and unloading rates of the vertical GRF and the joint axial forces were obtained as the maximum instantaneous slope of these force curves. Radiographic measurements of the hips were taken, and the correlations between the morphological parameters and the loading and unloading rates were obtained. The patients showed greater-than-normal peak loading rates of the joint axial forces, and the loading rates on both the affected and unaffected sides were strongly correlated to the acetabular index on the unaffected side, which was also significantly correlated with the peak unloading rates on the affected side. These results suggest that apart from regular follow-up of the affected hip, routine assessment of the morphological changes and/or increased loading rates on the unaffected hip is also important for early identification of any signs of insidious hip dysplasia and risk of premature degeneration of the cartilage.
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Affiliation(s)
- Wei-Chun Lee
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan.,Department of Pediatric Orthopedics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tsan-Yang Chen
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Li-Wei Hung
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan.,Department of Orthopedics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Ting-Ming Wang
- Department of Orthopedic Surgery, School of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chia-Hsieh Chang
- Department of Pediatric Orthopedics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tung-Wu Lu
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan.,Department of Orthopedic Surgery, School of Medicine, National Taiwan University, Taipei, Taiwan
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15
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Hussain RN, Rad D, Watkins WJ, Carpenter C. The incidence of avascular necrosis following a cohort of treated developmental dysplasia of the hip in a single tertiary centre. J Child Orthop 2021; 15:232-240. [PMID: 34211599 PMCID: PMC8223083 DOI: 10.1302/1863-2548.15.200246] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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 Avascular necrosis (AVN) may occur following treatment for developmental dysplasia of the hip (DDH). The primary aim of this study was to identify the incidence of AVN in a cohort of patients treated for DDH. Secondary aims were to classify AVN using available classification systems, analyze the correlation between the systems and investigate their relationship with the age at diagnosis of DDH. METHODS An 11-year retrospective study was carried out at a single tertiary centre, using data from the clinical portal (patient records database) and IMPAX (system used to store plain radiographic images). Clinical details (patient demographics and outcomes) and plain radiographic images were used to identify cases of DDH and categorize cases of AVN using available classification systems: Tonnis and Kuhlmann, Kalamchi and McEwen, Bucholz and Ogden and Salter. Severin was used to assess final clinical outcome. RESULTS In total, 405 (522 hips) cases of DDH were identified, of which 213 resolved without treatment, 93 were treated conservatively and 99 surgically. Only treated cases were included in the analysis (n = 192). AVN (45/99; 45.5%) was found to occur only postoperatively. A positive correlation was present between age at presentation and severity of AVN as classified according to Salter's criteria (chi-squared p value < 0.01). CONCLUSION AVN incidence was 23.4% (45/192) and only occurred in surgically treated patients. Older age at diagnosis was associated with a higher incidence of AVN, as defined according to Salter's criteria. The classification systems appeared to show no correlation amongst each other (p-value < 0.01). LEVEL OF EVIDENCE III - Retrospective cohort study.
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Affiliation(s)
- Rahim Nawaz Hussain
- University Hospital of Wales, Cardiff, UK,Correspondence should be sent to: Dr. Rahim Nawaz Hussain, Worcestershire Royal Hospital, Charles Hastings Way, Worcester, WR5 1DD, United Kingdom. E-mail:
| | - Darius Rad
- Children’s Hospital for Wales, University Hospital of Wales, Cardiff, UK
| | | | - Clare Carpenter
- Children’s Hospital for Wales, University Hospital of Wales, Cardiff, UK
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16
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Andras LM, Abousamra O. What's New in Pediatric Orthopaedics. J Bone Joint Surg Am 2021; 103:287-294. [PMID: 33369978 DOI: 10.2106/jbjs.20.01953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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17
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Canavese F, Castañeda P, Hui J, Li L, Li Y, Roposch A. Developmental dysplasia of the hip: Promoting global exchanges to enable understanding the disease and improve patient care. Orthop Traumatol Surg Res 2020; 106:1243-1244. [PMID: 33069603 DOI: 10.1016/j.otsr.2020.09.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 09/15/2020] [Indexed: 02/03/2023]
Affiliation(s)
- Federico Canavese
- Lille University Center, Jeanne de Flandres Hospital, Department of Pediatric Orthopedics, Avenue Eugène-Avinée, 59037 Lille cedex, France; Nord-de-France Lille University, Faculty of Medicine, 59000 Lille, France.
| | - Pablo Castañeda
- Elly and Steven Hammerman, NYU School of Medicine, Pediatric Orthopaedic Surgery, NYU Langone Health/Hassenfeld Children's Hospital, 301 East 17th Street, New York, NY, 10003 USA; NYU Langone Health/Hassenfeld Children's Hospital, 301 East 17th Street, New York, NY, 10003 USA
| | - James Hui
- Department of Orthopaedic Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Department of Orthopaedic Surgery, National University Health System, Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228 Singapore
| | - LianYong Li
- Pediatric Orthopaedic Professor of China Medical University, Chief of Department of Pediatric Orthopaedics, Shengjing Hospital of China Medical University, No.36 Sanhao Street, Heping District, Shenyang City, Liaoning Province, 110004 PR China
| | - YiQiang Li
- Department of Pediatric Orthopaedic, GuangZhou Women and Children's Medical Center, 9th JinSui Road, GuangZhou, 510623 PR China
| | - Andreas Roposch
- University College London, Great Ormond Street Institute of Child Health 30 Guildford St, London WC1N 3EH UK
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