Ligamentum Teres Transfer During Medial Open Reduction in Patients with Developmental Dysplasia of the Hip (original) (raw)
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The Bone & Joint Journal, 2018
Aims Open reduction is required following failed conservative treatment of developmental dysplasia of the hip (DDH). The Ludloff medial approach is commonly used, but poor results have been reported, with rates of the development of avascular necrosis (AVN) varying between 8% and 54%. This retrospective cohort study evaluates the long-term radiographic and clinical outcome of dislocated hips treated using this approach. Patients and Methods Children with a dislocated hip, younger than one year of age at the time of surgery, who were treated using a medial approach were eligible for the study. Radiographs were evaluated for the degree of dislocation and the presence of an ossific nucleus preoperatively, and for the degree of AVN and residual dysplasia at one and five years and at a mean of 12.7 years (4.6 to 20.8) postoperatively. Radiographic outcome was assessed using the Severin classification, after five years of age. Further surgical procedures were recorded. Functional outcome ...
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.
Revision of Failed Open Reduction of Developmental Dysplasia of the Hip
Clinics in Orthopedic Surgery
Background: The most common causes of re-dislocation after open reduction are inadequate exposure and failure to release the obstructing soft tissues inside and around the hip. Methods: This clinical study included 33 consecutive children (34 hips) who underwent a revision surgery after failed open reduction of developmental dysplasia of the hip (DDH). Results: According to the McKay clinical criteria, the results were good in 28 cases (82.4%), fair in 4 cases (11.8%), and poor in 2 cases with re-dislocation (5.9%). Radiological results according to the modified Severin criteria were as follows: 28 hips (82.4%) were identified as category 2 (good), 4 hips (11.8%) category 4 (fair), and 2 hips (5.9%) category 5 (poor). Conclusions: Revision surgery for DDH is demanding and the long-term consequences are usually serious, but stable, concentric reduction should be obtained either at the first or second open reduction by addressing the causes of failure. Failed acetabulum remodeling and technical errors with inadequate soft-tissue release were the most common causes of failure in the primary operation. Based on the results, the outcome of revision surgery after failed open reduction for DDH was good.
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...
Closed Compared with Open Reduction in Developmentally Dislocated Hips
JBJS Reviews, 2019
» The treatment of developmental dislocation of the hip after walking age continues to be controversial. » Success can be considered in terms of the rates of osteonecrosis or proximal growth disturbance, the rate of recurrent dislocation, and residual dysplasia. » Case series are small and have many confounders. » The rate of residual dysplasia is lowest after an open reduction and pelvic osteotomy.
One-stage bilateral open reduction through a medial approach in developmental dysplasia of the hip
The outcome of one-stage bilateral open reduction through a medial approach for the treatment of developmental dysplasia of the hip in children under 18 months was studied in 23 children, 18 girls and five boys. Their mean age at operation was 10.1 months (6 to 17) and the mean follow-up was 5.4 years (3 to 8). Acceptable clinical and radiological results were achieved in 44 (95.7%) and 43 (93.5%) of 46 hips, respectively. Excellent results were significantly evident in patients younger than 12 months, those who did not require acetabuloplasty, those whose ossific nucleus had appeared, and in those who did not develop avascular necrosis. One-stage bilateral medial open reduction avoids the need for separate procedures on the hips and has the advantages of accelerated management and shorter immobilisation and rehabilitation than staged operations.
Acta orthopaedica Belgica, 2013
The principles of treatment of developmental dislocation of the hip (DDH) in an older child are different from those in a newborn. In the older child retraction of the muscles around the hip, associated with a marked acetabular dysplasia and elongation of the joint capsule explain the difficulty and instability of reduction and the frequency of complications. The aim of this study is to evaluate the effect of age on the results of a one-stage open reduction in developmental dislocation of the hip. We present the results of 21 children (27 hips) with a mean age of 6 years and 10 months at time of operation, consisting of one- stage open reduction, femoral shortening and Salter or triple pelvic osteotomy. Two groups were formed : one older and one younger than 8 years of age. We evaluated the patients according to the Severin and Mc Kay classifications. After an average follow-up of 49 months (24-84 months) 74% of patients showed a very good or good result according to Severin's r...
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....
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 ...