Role of intraoperative arthrogram in decision making of closed versus medial open reduction of developmental hip dysplasia (original) (raw)
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Children
Introduction: Developmental dysplasia of the hip (DDH) is commonly managed in a tertiary centre and regularly involves surgical treatment. The aim of this study is to determine the surgical outcome of DDH patient treated with either open reduction alone or combined with bony procedures in our institution. Methods: Medical records of DDH patients treated surgically were reviewed. Patients were divided into two groups: Group A: underwent open reduction (OR) only; and Group B: underwent open reduction with additional bony procedures (ORB), such as pelvic or femoral osteotomy. Modified McKay classification was used to evaluate the clinical outcome, and Severin classification for the radiological outcome. Presence of avascular necrosis and other post-operative complications were recorded. Results: A total of 66 patients (76 hips) were reviewed with the mean age of 11.9 ± 4.8 years. Mean duration of follow up was 8.6 ± 4.7 years (ranged 2 to 23 years). From our sample, 50/66 patients (75....
Closed Reduction in Developmental Dysplasia of the Hip in Patients Older than One Year
Folia Medica, 2020
Introduction: Besides an effective screening method for developmental dysplasia of the hip, there is certain number of children in whom the condition has been overseen or they have never been screened and the parents have noticed the odd walking pattern in their toddler. Treatment of such patients is controversial. One of the recommended treatment methods because of the short-term hospitalization, but often considered unsuccessful is closed reduction of the hip followed by cast immobilization. Hypothesis: Closed hip reduction in late diagnosed developmental dysplasia of the hip gives good results. Aim: Our aim in this retrospective study was evaluation of the success of the treatment with closed reduction of hip dislocation in children older than 12 months. Patients and methods: In the study, we included 20 patients treated at our clinic from June 2004 to May 2017. Of these 20 patients, 8 had bilateral involvement, 12 had unilateral, in a total of 28 hips. In all patients we noted preoperatively the range of movement, the presence of limp, any limb inequality, and hip pain. We used clinical and radiological parameters for evaluation. Clinically, we examined the range of movement, limb inequality as well as limb function and we classified it according to the modified McKay's criteria. Same examinations were done at 1, 3, and 5 years after closed reduction. Results: At the last follow-up examination, using McKey's criteria for clinical evaluation we rated the hips in two patients (7%) as grade III, i.e. fair grade, 10 hips (36%) were grade II-rated good, and 16 hips (57%) were evaluated as grade I. In four hips, there were signs of avascular necrosis of the hip, while in one patient the avascular necrosis developed after the closed reduction. Radiographic assessment (Figs 3, 4) using Severin's scoring system showed no hips with types V and VI, type IV was observed in 7%, type III in 21%, type II in 29%, while most of the hips (12, 43%) were type I. Conclusion: We concluded that the procedure was justified. An advantage of this method is that it is inexpensive; it entails no direct operative changes of the bone structures and gives good results.
Arthrographic Evaluation of Developmental Dysplasia of the Hip
Clinical Orthopaedics and Related Research, 1996
Arthrograms of 35 hips in 33 children less than 2 years of age with typical developmental dysplasia of the hip were reviewed. After arthrograms were repeated for 11 hips 6 weeks following the initial test, results were classified into 6 types based on medial pooling ratio and morphology of the acetabular limbus. Using modified Severin's criteria for outcome evaluation, 7 of the 11 hips had been upgraded in type. All hips that were classified as Type I by arthrogram had Severin I results. The relation of arthrographic type and radiographic results was statistically significant. Immediate open reduction is recommended in hips classified as Type VI at first arthrogram or Type I11 and above at reneat arthrozram. The extent of femoral head displacement and the shape of the acetabular limbus are important both in making management decisions and in evaluating outcome of developmental
AAHKS Symposium Does Hip Arthroscopy Have a Role in the Treatment of Developmental Hip Dysplasia
Keywords: hip dysplasia developmental dysplasia arthroscopy hip morphology center edge angle acetabulum a b s t r a c t Background: Indications for hip arthroscopy in mildly dysplastic patients with a symptomatic hip remain controversial. Methods: This article provides a concise review of the available literature evaluating the role of hip arthroscopy in treating symptomatic dysplasia. Potential indications for hip arthroscopy in isolation are reviewed. Emerging evidence on the role of hip arthroscopy based on patient-specific pathomorphology is highlighted. Results: Hip arthroscopy in isolation may be helpful for select dysplastic patients with dynamic impingement or microinstability. Isolated arthroscopic treatment of intra-articular pathology resulting from static overload is unlikely to be successful in the long term and may be detrimental. Conclusion: Arthroscopic procedures for individuals with mild dysplasia in the absence of frank instability may be effective; however, great caution should be exercised when approaching dysplastic patients with symptomatic hips.
Journal of Children's Orthopaedics, 2014
Purpose Developmental dysplasia of the hip (DDH) affects approximately 1 % of live births. Dislocated hips require reduction and stabilisation in a spica cast, and reduction efficacy is assessed radiologically. Numerous measurements are used to ascertain the adequacy of reduction but can be inconsistent in evaluating femoral head position. This study describes the morphology of the developing acetabulum in DDH and validates a novel method to assess adequate reduction of the dysplastic hip following closed or open reduction. Methods A retrospective review was performed of 66 consecutive patients undergoing reduction of hip dislocation over a 2-year period. Three independent reviewers evaluated postoperative CT scans to assess anterior-posterior (AP) displacement and modified Shenton’s line. Acetabular morphology was also assessed along with hip congruency using a described novel ‘posterior neck line’. Results Dislocated hips were successfully identified using the posterior neck line ...
Outcomes following open reduction for late-presenting developmental dysplasia of the hip
Journal of Children's Orthopaedics, 2018
Purpose Patients with late-presenting developmental dysplasia of the hip (DDH) are more likely to require an open reduction. Since many developing countries do not have mandated screening, there continues to be a relatively high incidence of late-presenting DDH. We report the clinical and radiographic outcomes of open reduction in a series of patients who presented late. Patients and methods This was a retrospective review of 712 hips in 645 patients that underwent open reduction, alone or in combination with a pelvic osteotomy. In all, 91 hips had open reduction alone and 621 had open reduction and pelvic osteotomy. Femoral shortening was performed in 221 hips. The mean age at the time of surgery was 2.1 years (1 to 6.5) and the mean follow-up time was 9.3 years (6 to 14). We used the Children's Hospital Oakland Hip Evaluation Score (CHOHES) to determine functional outcomes and the Severin classification was used to evaluate radiographic outcomes. The rate of avascular necrosis...
Long-term results of total hip arthroplasty in developmental dysplasia of hip patients
Joint Diseases and Related Surgery, 2020
Developmental dysplasia of hip (DDH) is one of the well-known orthopedic pathologies that cause coxarthrosis. [1] Pelvic bandage, traction, open or closed reduction, femoral, and pelvic osteotomies are the treatment alternatives for DDH in the pediatric age group. [2,3] For end-stage osteoarthritis, total hip arthroplasty (THA) is the standard treatment. [4,5] In the literature, several studies have reported that the anatomical hip center reconstruction yields favorable biomechanical results among those patients. [6,7] Both acetabular and femoral abnormal anatomy make this re-establishment challenging for surgeons. Among those patients, complication rates are higher than the normal arthroplasty operations due to the pathological anatomy. In DDH patient population, changing abnormal anatomy to normal and to reduce complication rates and prolong prosthesis survival, specially designed implants are needed. In this study, we aimed to report the physiological and radiological long-term results of THA combined with or without subtrochanteric osteotomy in a group of DDH patients. PATIENTS AND METHODS A total of 90 hips of 59 patients (3 males, 56 females; mean age 45.7±10.9 years; range, 24 to 67 years) who Objectives: This study aims to report the physiological and radiological long-term results of total hip arthroplasty (THA) combined with or without subtrochanteric osteotomy in a group of developmental dysplasia of hip (DDH) patients. Patients and methods: This retrospective study included 90 hips of 59 patients (3 males, 56 females; mean age 45.7±10.9 years; range, 24 to 67 years) who underwent THA between January 1979 and March 2006. Thirteen patients needed subtrochanteric shortening. The evaluation was performed through Harris hip scores, physical examination, and radiological imaging. Results: The follow-up period ranged from 5 to 32 years, and the mean follow-up period was 10.3±6.4 years. Revision was required in 17 hips out of 90. Twelve revisions were needed because of aseptic loosening of femoral or acetabular component, three were for fracture of the femoral stem, and two for protrusio acetabuli. Four patients had transient nerve palsy, and one had permanent nerve function loss. In one patient, nonunion was observed around the femoral osteotomy site. Harris hip score was remarkably improved compared to top preoperative values (48 vs. 88.2, p<0.01). Conclusion: Although revision rates tend to increase in long-term follow-up, THA is one of the best treatment options in DDH patients to relieve pain, improve daily activity levels, and minimize the damage of the knee and lumbar region.
Midterm Results Of Total Hip Arthroplasty (THA) In Developmental Dysplasia Of The Hip (DDH)
Objectives Total hip arthroplasty (THA) in developmental dysplasia of the hip (DDH) is a challenging procedure. We analysed 51 patients with this condition. The focus of this article is to provide our experience; the results and complications of THA in DDH. Patients and Methods In a retrospective approach, 51 patients with 59 hip arthrosis secondary to developmental dysplasia of the hip were included. Eight patients with 8 hips were lost to follow-up. Forty three patients with 51 hip arthrosis secondary to developmental dysplasia of hip were available for clinical and radiological evaluation at a mean follow-up time of 57 months (20 to 81 months). Results According to Crowe, 27 hip were Type 1, 12 hips were Type 2, 5 hips were Type 3, and 7 hips were Type 4. Mean Harris hip score was improved from 31 to 93,23. Complications were 2 acetabular cup migration and 1 femoral stem migration in the early period as well as dislocation in 5 hips during the early postoperative period. During i...
Management of developmental dysplasia of the hip in less than 24 months old children
Indian Journal of Orthopaedics, 2013
Background: There is no consensus on the treatment of developmental dysplasia of the hip in children less than 24 months of age. The aim of this study was to present the results of open reduction and concomitant primary soft-tissue intervention in patients with developmental dysplasia of the hip in children less than 24 months of age. Materials and Methods: Sixty hips of 50 patients (4 male, 46 female) with mean age of 14.62 ± 5.88 (range 5-24 months) months with a mean followup of 40.00 ± 6.22 (range 24-58 months) months were included. Twenty five right and 35 left hips (10 bilaterally involved) were operated. Open reduction was performed using the medial approach in patients aged < 20 months (with Tönnis type II-III and IV hip dysplasias) and for those aged 20-24 months with Tönnis type II and III hip dysplasias (n = 47). However for 13 patients aged 20-24 months with Tönnis type IV hip dysplasias, anterior bikini incision was used. Results: Mean acetabular index was 41.03 ± 3.78° (range 34°-50°) in the preoperative period and 22.98 ± 3.01° (range 15°-32°) at the final visits. Mean center-edge angle at the final visits was 22.85 ± 3.35° (18°-32°). Based on Severin radiological classification, 29 (48.3%) were type I (very good), 25 (41.7%) were type II (good) and 6 (10%) were type III (fair) hips. According to the McKay clinical classification, postoperatively the hips were evaluated as excellent (n = 42; 70%), good (n = 14; 23.3%) and fair (n = 4; 6.7%). Reduction of all hip dislocations was achieved. Additional pelvic osteotomies were performed in 14 (23.3%) hips for continued acetabular dysplasia and recurrent subluxation. (Salter [n = 12]/Pemberton [n = 2] osteotomy was performed). Avascular necrosis (AVN) developed in 7 (11.7%) hips. Conclusion: In DDH only soft-tissue procedures are not enough, because of the high rate of the secondary surgery and AVN for all cases aged less than 24 months. Bone procedures may be necessary in the walking age group with high acetabular index.