1
|
Chen H, Wang XX, Chen Z, Ge Y. The efficacy of gradual reduction using two-stage traction for developmental dysplasia of the hip in southern China. Front Pediatr 2024; 12:1335490. [PMID: 38529051 PMCID: PMC10961385 DOI: 10.3389/fped.2024.1335490] [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: 11/09/2023] [Accepted: 02/19/2024] [Indexed: 03/27/2024] Open
Abstract
Purpose This study aimed to report the preliminary outcome of gradual reduction (GR) utilizing two-stage traction (TST) compared with traditional traction (TT) in the treatment of developmental dysplasia of the hip (DDH) and to evaluate whether the prognosis of the TST is better than that of TT. Methods The following information on children diagnosed with DDH who underwent treatment with GR using two-stage traction or traditional traction between June 2016 and August 2017 was collected: sex, age, weight, acetabular index (AI), International Hip Dysplasia Institute (IHDI) classification, femoral head ossification, traction time, reduction quality, and labrum shape in arthrography. The AI, IHDI classification, second operation rate, and incidence of femoral head avascular necrosis (AVN) were analyzed after the final comprehensive 1-year follow-up. Results In this study, 27 cases (31 hips: 18 left and 13 right) were enrolled, with 18 hips (16 cases) assigned to the TT group and 13 hips (11 cases) assigned to the TST group, with the corresponding average age at diagnosis of 5.56 ± 1.66 and 4.06 ± 1 months (p < 0.001). For both TT and TST groups, the average age at operation was 6.01 ± 1.67 and 65 ± 0.86 months (p = 0.435), the distribution of affected left and right sides was 10/8 and 8/5 hips (p = 1), and the average initial AI was 37.11 ± 3.26 and 36.77 ± 4.34 (p = 0.804), respectively. IHDI classification III/IV was observed in 15/3 and 11/2 hips, respectively (p = 1). Femoral head ossification was present in 6/18 hips in the TT group and 2/13 hips in the TT group (p = 0.412). The total traction time was 13.22 ± 2.6 days for the TT group and 49.23 ± 25.77 days for the TST group (p < 0.001). After GR, IHDI classification III/IV was observed in 9/9 and 12/1 hips, respectively (p = 0.02). AVN was present in 5/18 hips in the TT group and 0/13 hips in the TST group (p = 0.048), while the need for a second operation was approved in 5/18 hips in the TT group and 1/13 hips in the TST group (p = 0.359) at the final follow-up. Conclusions Two-stage traction can significantly decrease the ratios of IHDI classifications III and IV and the incidence of AVN compared to traditional traction; also, it significantly reduces the total traction time.
Collapse
Affiliation(s)
- Hui Chen
- Department of Pediatric Orthopedics, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
- Department of Pediatric Orthopedics, Fujian Children’s Hospital (Fujian Branch of Shanghai Children’s Medical Center), Fuzhou, China
| | - Xiang-xuan Wang
- Department of Pediatric Orthopedics, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
- Department of Pediatric Orthopedics, Fujian Children’s Hospital (Fujian Branch of Shanghai Children’s Medical Center), Fuzhou, China
| | - Zhao Chen
- Department of Pediatric Orthopedics, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
- Department of Pediatric Orthopedics, Fujian Children’s Hospital (Fujian Branch of Shanghai Children’s Medical Center), Fuzhou, China
| | - Yihua Ge
- Department of Orthopaedics, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
2
|
Gangaram-Panday SSG, de Vos-Jakobs S, Reijman M. The Effect of Traction before Closed Reduction in Patients with Developmental Dysplasia of the Hip. CHILDREN 2022; 9:children9091325. [PMID: 36138634 PMCID: PMC9497839 DOI: 10.3390/children9091325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 08/23/2022] [Accepted: 08/26/2022] [Indexed: 11/26/2022]
Abstract
Developmental dysplasia of the hip (DDH) with a dislocated hip can be treated with traction before closed reduction (CR). Currently, there is insufficient evidence supporting the use of preoperative traction treatment for a successful CR. The objective of this study was to determine the effect of preoperative traction on the success rate of primary CR in DDH patients with dislocated hips. A retrospective pair-matched study was performed in DDH patients with dislocated hips. Patients with preoperative traction treatment prior to primary CR were matched (based on age and the severity of DDH on the radiograph) to patients without preoperative traction treatment. The primary outcome was the presence or absence of maintained reduction after three weeks. A match was found for 37 hips, which resulted in the inclusion of 74 hips. No significant difference was found in the number of successful reductions after three weeks between the traction group and the control group (31 vs. 33 hips, p = 0.496). Traction treatment did not significantly improve the short-term or mid-term outcomes for closed reduction. Based on these results, we suggest that traction treatment should not be used as standard care for dislocated hips in DDH.
Collapse
|
3
|
Elerson EE, Martin BD, Muchow RD, Pierce WA, Jo CH, Hinds SA, Birch JG. Outpatient Bryant's Overhead Traction Does Not Affect the Rate of Open Reduction or Avascular Necrosis in Developmental Dislocation of the Hip. J Pediatr Orthop 2022; 42:e266-e270. [PMID: 34967806 DOI: 10.1097/bpo.0000000000002038] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The efficacy of preliminary traction to increase the likelihood of closed reduction and/or decrease the incidence of avascular necrosis in the management of developmental dysplasia of the hip (DDH) is controversial. We sought to document compliance with and effectiveness of Bryant's outpatient traction in patients with idiopathic DDH. METHODS Patients presenting between 6 and 24 months of age with idiopathic irreducible DDH were prospectively enrolled in the study. Prereduction outpatient traction was prescribed at participating surgeons' preference and parents' expressed willingness to comply with a traction protocol of at least 14 hours/day for 4 weeks. Traction hours were documented using a validated monitor; parents also reported average daily usage. Rate of successful closed reduction and evidence of capital epiphyseal growth disturbance 1 year' and 2 years' postreduction were documented. RESULTS Ninety-six patients with 115 affected hips were enrolled. Reliable recorded traction hours were obtained in 31 patients with 36 affected hips. Defining compliance as 14 hours/day average use, 14 of 31 patients (45.2%) were compliant, 2 (6.5%) admitted noncompliance, while 15 (48.2%) claimed to be compliant, but were not. Overall, 68/115 hips (59.0%) were closed reduced. Age at treatment was the only demographic characteristic associated with an increased incidence of closed reduction (11.7 vs. 14.6 mo, P<0.01). Successful closed reduction was achieved in 10/16 hips (62.5%) of compliant patients, 12/20 (60.0%) of noncompliant patients, and 43/72 (59.7%) of no-traction patients. Irregular ossific nucleus development was noted 1-year postindex reduction in 5/16 (31.3%) of complaint-patient hips and 25/92 (27.2%) of noncomplaint and no-traction hips. Distorted proximal femoral epiphysis was noted at 2 years postreduction in 2/15 hips (13.3%) of compliant patients and 15/52 hips (28.8%) in noncompliant and no-traction patients. None of these differences was statistically significant. CONCLUSIONS Parent-reported use of outpatient traction is unreliable. Four weeks of outpatient overhead Bryant's traction did not affect the rate of closed reduction or avascular necrosis in late-presenting DDH in this cohort. LEVEL OF EVIDENCE Level II-prospective cohort.
Collapse
Affiliation(s)
| | | | | | | | - Chan-Hee Jo
- Texas Scottish Rite Hospital for Children, Dallas, TX
| | - Sean A Hinds
- Texas Scottish Rite Hospital for Children, Dallas, TX
| | - John G Birch
- Texas Scottish Rite Hospital for Children, Dallas, TX
| |
Collapse
|
4
|
Mazaleyrat M, Lacroix R, Lakhal W, Morel B, Bonnard C, Odent T. Petit-Morel method for hip development dysplasia in toddlers: A retrospective observational study in 34 patients. Orthop Traumatol Surg Res 2022; 108:103127. [PMID: 34700059 DOI: 10.1016/j.otsr.2021.103127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 02/06/2021] [Accepted: 02/11/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND The Petit-Morel method allows the treatment of developmental hip dysplasia in toddlers by combining gradual traction to achieve reduction followed by immobilisation during which pelvic osteotomy is performed. The objective of this study was to assess the radiographic and clinical outcomes in a retrospective cohort of patients. HYPOTHESIS The Petit-Morel method is associated with low rates of avascular necrosis and residual acetabular dysplasia at skeletal maturity, as well as with satisfactory medium-term clinical outcomes. MATERIAL AND METHODS We conducted a single-centre retrospective study of 34 patients (35 hips) treated between 1997 and 2014. The radiological assessment criteria included an evaluation for avascular necrosis classified according to Kalamchi and MacEwan, the vertical centre edge (VCE) angle, femoral head sphericity according to Mose, and acetabular dysplasia at skeletal maturity according to Severin. Hip function was assessed by determining the Postel-Merle d'Aubigné (PMA) score. RESULTS Mean age at treatment was 19±4 months (range, 14-29). Mean follow-up was 11 years (range, 5-20). There were two failures including one case of recurrent dislocation requiring surgical reduction. Group II avascular necrosis occurred in 1 (3%) patient. Tönnis Grade IV dysplasia was significantly associated with resolving irregularity of the ossification centre, seen in 19 (54%) cases (p=0.002). In the 18 patients followed-up to skeletal maturity, with a mean follow-up of 15 years (range, 12-20 years), 17 hips were Severin Class I. The mean VCE angle was 29° (range, 15°-38°), and the head was spherical for 34 (98%) hips. The PMA score at last follow-up was excellent (17-18). The mean VCE angle was greater in all 5 patients who experienced pain during long walks (35° [range, 32°-37°]) than in the asymptomatic patients (28° [range, 15°-38°]) (p=0.009). DISCUSSION The Petit-Morel method is a reliable treatment that provides good clinical and radiological outcomes. Overcorrection of the VCE angle was noted in the patients who experienced walking-related pain in adulthood. LEVEL OF EVIDENCE IV, retrospective observational cohort study.
Collapse
Affiliation(s)
- Matthieu Mazaleyrat
- Service de chirurgie orthopédique pédiatrique, Hôpital Gatien de Clocheville, CHU de Tours - Université François Rabelais de Tours, PRES Centre-Val de Loire Université, Tours, France
| | - Richard Lacroix
- Service de chirurgie orthopédique pédiatrique, Hôpital Gatien de Clocheville, CHU de Tours - Université François Rabelais de Tours, PRES Centre-Val de Loire Université, Tours, France
| | - Walid Lakhal
- Nouvelle Clinique Bordeaux Tondu (NCBT), 46, avenue Jean Alfonséa, 33270 Floirac, France
| | - Baptiste Morel
- Service de radiologie pédiatrique, Hôpital Gatien de Clocheville, CHU de Tours - Université François Rabelais de Tours, PRES Centre-Val de Loire Université, Tours, France
| | - Christian Bonnard
- Service de chirurgie orthopédique pédiatrique, Hôpital Gatien de Clocheville, CHU de Tours - Université François Rabelais de Tours, PRES Centre-Val de Loire Université, Tours, France
| | - Thierry Odent
- Service de chirurgie orthopédique pédiatrique, Hôpital Gatien de Clocheville, CHU de Tours - Université François Rabelais de Tours, PRES Centre-Val de Loire Université, Tours, France.
| |
Collapse
|
5
|
Schaeffer EK, Ponton E, Sankar WN, Kim HK, Kelley SP, Cundy PJ, Price CT, Clarke NM, Wedge JH, Mulpuri K. Interobserver and Intraobserver Reliability in the Salter Classification of Avascular Necrosis of the Femoral Head in Developmental Dysplasia of the Hip. J Pediatr Orthop 2022; 42:e59-e64. [PMID: 34889834 PMCID: PMC8663514 DOI: 10.1097/bpo.0000000000001979] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Avascular necrosis (AVN) of the femoral head is a concerning complication that can result from treatments for developmental dysplasia of the hip (DDH). AVN can lead to degenerative osteoarthritis, persistent acetabular dysplasia, reduced function, and continuing hip pain. The incidence of AVN reported in the DDH literature is widely varied (0% to 73%). This variability may arise from lack of consensus on what constitutes true AVN in this patient population, and lack of clear criteria provided in studies reporting incidence rates. METHODS A multicentre, prospective database of infants diagnosed with DDH between 2010 and 2014 from 0 to 18 months of age was analyzed for patients treated by closed reduction (CR). Twelve pediatric orthopaedic surgeons completed 2 rounds of AVN assessments. Deidentified anteroposterior radiographs at most recent follow-up were provided to surgeons along with patient age at radiographic assessment, length of follow-up, ands affected hip. Ten of 12 surgeons completed a third round of assessments where they were provided with 1 to 2 additional radiographs within the follow-up period. Radiographic criteria for total AVN described by Salter and colleagues were used. Surgeons rated the presence of AVN as "yes" or "no" and kappa values were calculated within and between rounds. RESULTS A total of 69 hips in 60 patients were assessed for AVN a median of 22 months (range: 12 to 36) post-CR. Interobserver kappa values for rounds 1, 2, and 3 were 0.52 (range: 0.11 to 0.90), 0.61 (range: 0.21 to 0.90), and 0.53 (range: 0.10 to 0.79), respectively. Intraobserver agreement for AVN diagnosis was an average of 0.72 (range: 0.31 to 0.96). CONCLUSIONS Despite using the most commonly referenced diagnostic criteria, radiographic diagnosis of AVN following CR in DDH patients demonstrated only moderate agreement across surgeons. The addition of sequential radiographs did not improve cross-observer reliability, and while substantial agreement was seen within observers, the range of intraobserver kappa values was large. LEVEL OF EVIDENCE Level I-diagnostic study.
Collapse
Affiliation(s)
- Emily K. Schaeffer
- Department of Orthopaedics, University of British Columbia
- Department of Orthopaedic Surgery, BC Children’s Hospital
| | - Ethan Ponton
- Department of Orthopaedics, University of British Columbia
- Office of Pediatric Surgical Evaluation and Innovation, BC Children’s Hospital, University of British Columbia, Vancouver, BC
| | - Wudbhav N. Sankar
- Division of Orthopaedics, The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Harry K.W. Kim
- Center for Excellence in Hip Disorders, Texas Scottish Rite Hospital for Children, Dallas, TX
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Peter J. Cundy
- Centre for Orthopaedic and Trauma Research, The University of Adelaide
- Department of Orthopaedic Surgery, Women’s and Children’s Hospital, Adelaide, SA, Australia
| | | | - Nicholas M.P. Clarke
- Department of Pediatric Orthopaedic Surgery, Southampton Children’s Hospital
- University of Southampton, Southampton, UK
| | | | - Kishore Mulpuri
- Department of Orthopaedics, University of British Columbia
- Department of Orthopaedic Surgery, BC Children’s Hospital
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
The effectiveness of preliminary traction in the treatment of congenital dislocation of the hip. J Orthop Traumatol 2021; 22:26. [PMID: 34180020 PMCID: PMC8236418 DOI: 10.1186/s10195-021-00586-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 06/03/2021] [Indexed: 11/10/2022] Open
Abstract
Background Historical papers on the treatment of congenital dislocation of the hip suggest the use of preliminary traction to facilitate closed reduction or to decrease the risk of avascular necrosis (AVN) of the femoral head. In the 1980s, some authors questioned the role of preliminary traction and suspended its use, yielding satisfactory results. Since then, several studies called into question this method, and some authors have continued to recommend preliminary traction while other authors have discouraged its use. Materials and methods We reanalysed the full set of radiographs of 71 hips (52 patients) surgically treated by a medial approach after 4 weeks of preoperative longitudinal traction. The mean age at operation was 16 months. Before and after traction, the height of the dislocation was graded according to the Gage and Winter method. The hips were divided into two groups: group 1, in which the traction was effective, and group 2, in which the traction was not effective. These two groups were statistically analysed regarding the severity of the dislocation, the age of the patient at surgery and the incidence of AVN. Results Preliminary traction was effective in 48 hips (68%, group 1), while it was not effective in the remaining 23 (32%, group 2). The effectiveness of preliminary traction was statistically related to the height of the dislocation and to the age of the patient at surgery, with traction being less effective in more severe dislocations and in older children. The incidence of AVN was statistically lower in group 1 than in group 2. Conclusions In our study population, despite not having a control group, preliminary traction—when effective—seemed to reduce the incidence of AVN in patients surgically treated for congenital dislocation of the hip. The effectiveness of the traction was influenced by the severity of the dislocation and the age of the patient; it worked better for less severe dislocations and in younger children. To reduce hospital costs, traction should be applied at home. Level of evidence 3.
Collapse
|
8
|
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: 3] [Impact Index Per Article: 0.6] [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.
Collapse
|
9
|
Liu YH, Xu HW, Li YQ, Hong K, Li JC, Pereira B, Xun FX, Canavese F. Effect of abduction on avascular necrosis of the femoral epiphysis in patients with late-detected developmental dysplasia of the hip treated by closed reduction: a MRI study of 59 hips. J Child Orthop 2019; 13:438-444. [PMID: 31695810 PMCID: PMC6808074 DOI: 10.1302/1863-2548.13.190045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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 purpose of this study was to explore whether increasing the hip abduction angle would increase the incidence of avascular necrosis (AVN) in patients with late- detected developmental dysplasia of the hip (DDH) treated by closed reduction (CR) and spica cast immobilization. METHODS A total of 55 patients (59 hips) with late-detected DDH underwent MRI after CR. Hip abduction angle and hip joint distance were measured on postoperative MRI transverse sections. The acetabular index and centre-edge angle were measured on plain radiographs at the last follow-up. The presence of AVN according to Kalamchi and McEwen's classification was assessed. We retrospectively analyzed the associations among abduction angles, hip joint distances, radiographic parameters, AVN and final outcomes, exploring the relationship between hip joint abduction angle and AVN rate. RESULTS The mean age at the time of CR was 14.4 months SD 5.5 (6 to 28), and the mean follow-up was 26.2 months SD 8.1 (12.4 to 41.7). The mean hip abduction angle was 70.2° SD 7.2° (53° to 85°) on the dislocated side and 63.7° SD 8.8° (40° to 82°) on the normal side; the mean hip joint distance was 5.1 mm SD 1.9 (1.3 to 9.1) on the dislocated side and 2.2 mm SD 0.6 on the normal side (1.3 to 3.3). Eight of 59 hips (13.6%) developed AVN. Neither the amount of abduction nor hip joint distance increased the AVN rate (p = 0.97 and p = 0.65, respectively) or the dislocation rate (p = 0.38 and p = 0.14, respectively). CONCLUSION Abduction angle up to 70.2° following CR did not increase the AVN rate in children aged six to 28 months with late-detected DDH treated by CR. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Y. H. Liu
- Department of Pediatric Orthopedics, GuangZhou Women and Children’s Medical Center, Guangzhou, China
| | - H. W. Xu
- Department of Pediatric Orthopedics, GuangZhou Women and Children’s Medical Center, Guangzhou, China
| | - Y. Q. Li
- Department of Pediatric Orthopedics, GuangZhou Women and Children’s Medical Center, Guangzhou, China
| | - K. Hong
- Department of Pediatric Orthopedics, GuangZhou Women and Children’s Medical Center, Guangzhou, China
| | - J. C. Li
- Department of Pediatric Orthopedics, GuangZhou Women and Children’s Medical Center, Guangzhou, China
| | - B. Pereira
- Department of Pediatric Orthopedic Surgery, University Hospital Estaing, Clermont Ferrand, France
| | - F. X. Xun
- Department of Pediatric Orthopedics, GuangZhou Women and Children’s Medical Center, Guangzhou, China
| | - F. Canavese
- Department of Pediatric Orthopedics, GuangZhou Women and Children’s Medical Center, Guangzhou, China,Department of Pediatric Orthopedic Surgery, University Hospital Estaing, Clermont Ferrand, France,Correspondence should be sent to F. Canavese, Department of Pediatric Orthopedics, GuangZhou Women and Children’s Medical Center, 9th Jingshui Rd. Guangzhou, 510623, China. E-mail:
| |
Collapse
|