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Suvorov V, Filipchuk V. Salter pelvic osteotomy for the treatment of Developmental Dysplasia of the Hip: assessment of postoperative results and risk factors. Orthop Rev (Pavia) 2022; 14:35335. [PMID: 35769652 PMCID: PMC9235433 DOI: 10.52965/001c.35335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/14/2022] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND If non-surgical treatment of Developmental Dysplasia of the Hip (DDH) fails or if DDH is late-detected, surgery is necessary. Salter pelvic osteotomy (SPO) is an effective surgical option for such cases. OBJECTIVES To study the results after SPO; to evaluate risk factors; to reveal radiological parameters that may correlate with results. METHODS Results analysis in 17 patients (22 hips). Risk factors included those that do not depend on the surgeon (patient's age, value of the acetabular index (AI) preoperatively, DDH Tonnis grade) and those that depend on the surgeon (amount of AI correction). To radiological parameters which may correlate with the amount of AI correction we referred distance "d" and the lateral rotation angle. RESULTS SPO allows performing AI correction in ranges 24.1 ± 6.5°. Excellent and good clinical results were obtained in 95.5% of patients; excellent and good radiological results in 86.4% of patients. Risk factors that do not depend on the surgeon were older patient's age and higher preoperative AI values (p <0.05). The risk factor that depends on the surgeon was the amount of AI correction (p <0.05). The distance "d" was recognized as a radiological parameter that may indicate sufficient AI correction (p <0.05). CONCLUSION In older patients with a higher preoperative AI value the results will be predictably worse. The surgeon may influence the result with a greater amount of AI correction (which may also be indicated radiologically by the distance "d" values). LEVEL OF EVIDENCE IV, therapeutic, case series.
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Affiliation(s)
- Vasyl Suvorov
- Department of Joint Diseases in Children and Adolescents, SI «The Institute of Traumatology and Orthopedics by NAMS of Ukraine»
| | - Viktor Filipchuk
- Department of Joint Diseases in Children and Adolescents, SI «The Institute of Traumatology and Orthopedics by NAMS of Ukraine»
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Yazdanshenas H, Madadi F, Sadeghi-Naini M, Madadi F, Bugarin A, Sabagh MS, Hing C, Shamie AN, Hornicek FJ, Washington III ER. Introducing a Novel Combined Acetabuloplasty and Chondroplasty Technique for the Treatment of Developmental Dysplasia of the Hip. Cureus 2022; 14:e21787. [PMID: 35251857 PMCID: PMC8890947 DOI: 10.7759/cureus.21787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2022] [Indexed: 11/05/2022] Open
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Van Geel P, Cools W, Laumen A. Evolution of head-shaft angle and neck-shaft angle in childhood. Acta Orthop Belg 2021. [DOI: 10.52628/87.3.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The current retrospective study investigates the natural evolution of head-shaft angle (HSA) and neck-shaft angle (NSA) in childhood. It is not known if a high HSA in early childhood leads to a high HSA in adulthood. This study aims to characterize the evolution of HSA and compares it with the more commonly known NSA in healthy children.
We measured radiographs of 84 different healthy hips of children between 3 and 14.5 years old who underwent at least 2 radiographs of the pelvis, corresponding to 286 measurements. We used a linear mixed model to determine the covariance between random intercept and slope while allowing each individual hip to change over time.
The covariance for HSA between random intercept and random slope was -4.262 (p < 0.001), corresponding to a high negative correlation of -0.717, for NSA -2.754 (p = 0.031) or a high negative correlation of -0.779. HSA and NSA were strongly correlated, a value of 0.736 (p < 0.001) was measured.
The high negative correlation for random intercept and random slope means that the higher the initial value (intercept), the steeper the decline (slope). Therefore HSA decreases faster in hips with high HSA at an early age. Hips with high HSA in early childhood do not necessarily lead to hips with high HSA in adulthood. Our results may aid in future clinical decision making in patients with developmental dysplasia of the hip (DDH) with high HSA in particular.
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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: 0.5] [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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Humphry S, Hall T, Hall-Craggs MA, Roposch A. Predictors of Hip Dysplasia at 4 Years in Children with Perinatal Risk Factors. JB JS Open Access 2021; 6:JBJSOA-D-20-00108. [PMID: 33748648 PMCID: PMC7963513 DOI: 10.2106/jbjs.oa.20.00108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
While perinatal risk factors are widely used to help identify those at risk for developmental dysplasia of the hip (DDH) within the first 6 to 8 weeks of life, limited data exist about their association with radiographic evidence of dysplasia in childhood. The purpose of this study was to determine which perinatal risk factors are associated with acetabular dysplasia in children who are ≥2 years of age.
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Affiliation(s)
- Simon Humphry
- Department of Orthopaedic Surgery, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Timothy Hall
- Department of Diagnostic Imaging, University College London Hospital, London, United Kingdom
| | - Margaret A Hall-Craggs
- Department of Diagnostic Imaging, University College London Hospital, London, United Kingdom
| | - Andreas Roposch
- Department of Orthopaedic Surgery, Great Ormond Street Hospital for Children, London, United Kingdom.,Institute of Child Health, University College London, London, United Kingdom
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Tejpal T, Shanmugaraj A, Gupta A, Horner NS, Simunovic N, Kishta W, Ayeni OR. Outcomes and complications of patients undergoing Salter's innominate osteotomies for hip dysplasia: a systematic review of comparative studies. J Hip Preserv Surg 2020; 7:621-630. [PMID: 34377506 PMCID: PMC8349578 DOI: 10.1093/jhps/hnab014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/26/2021] [Accepted: 02/28/2021] [Indexed: 12/04/2022] Open
Abstract
The purpose of this systematic review is to assess outcomes and complications of patients undergoing Salter's innominate osteotomies (SIOs) for the correction of hip dysplasia along with patient and technical factors that can be optimized to improve outcomes after SIO. MEDLINE and EMBASE were searched from data inception to 9 October 2018. Data were presented descriptively. Twenty-seven studies were identified including 1818 hips (87.1%) treated with SIO (mean age of 2.1 ± 2.5 years and mean follow-up of 3.5 ± 5.0 years). Patients undergoing SIO had a post-operative center-edge angle (CEA) of 31.3° ± 5.3° and an acetabular index (AI) angle of 16.1° ± 5.2°. Patients undergoing SIO with pre-operative traction had significantly lower (P = 0.049) post-operative McKay criteria scores compared to patients without pre-operative traction. Patients undergoing SIO between the ages of 1.5-2 years had significantly better (P < 0.05) post-operative McKay criteria scores compared to patients aged 4-6 years. The complication rate was 9.4% with avascular necrosis (2.5%) being most common. This review found that SIO for developmental dysplasia of the hip produces generally good post-operative clinical outcomes. The CEA and AI can be corrected to normal range after SIO. Patients may have superior outcomes if they have SIO at a younger age, were not treated with pre-operative traction and did not have untreated contralateral hip dysplasia. Outcomes appear to be similar between one-stage bilateral SIO and a two-stage procedure in the setting of bilateral hip dysplasia; however, more multicentered studies are needed to confirm these results.
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Affiliation(s)
- Tushar Tejpal
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 1200 Main Street West, 4E15, Hamilton, ON L8N 3Z5, Canada
| | - Ajaykumar Shanmugaraj
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 1200 Main Street West, 4E15, Hamilton, ON L8N 3Z5, Canada
| | - Arnav Gupta
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON KIH 8M5, Canada
| | - Nolan S Horner
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 1200 Main Street West, 4E15, Hamilton, ON L8N 3Z5, Canada
| | - Nicole Simunovic
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 1200 Main Street West, 4E15, Hamilton, ON L8N 3Z5, Canada
| | - Waleed Kishta
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 1200 Main Street West, 4E15, Hamilton, ON L8N 3Z5, Canada
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 1200 Main Street West, 4E15, Hamilton, ON L8N 3Z5, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1200 Main Street West, 4E15, Hamilton, ON L8N 3Z5, Canada
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Castañeda P, Moscona L, Masrouha K. The effect of femoral shortening in the treatment of developmental dysplasia of the hip after walking age. J Child Orthop 2019; 13:371-376. [PMID: 31489042 PMCID: PMC6701440 DOI: 10.1302/1863-2548.13.190029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 06/20/2019] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The optimal treatment for late-presenting developmental dysplasia of the hip (DDH) is controversial. High tension forces after hip reduction increase the pressure on the femoral head, potentially causing avascular necrosis. Femoral shortening (FS) is commonly used as a means to decrease the pressure on the femoral head. We examined the effect of FS on the outcomes of patients with late-presenting DDH. METHODS A total of 645 hips of a late-presenting DDH cohort treated with open reduction and iliac osteotomies were retrospectively reviewed; 328 hips had a FS performed (FS+) and 317 (FS-) had not. The mean age was 3.9 years (sd 1.55). We classified the hips with the Tönnis and International Hip Dysplasia Institute (IHDI) methods; and the Pediatric Outcomes Data Collection Instrument (PODCI), Iowa Hip Score (IHS) and Severin classification as outcome measurements. RESULTS The FS- group had higher scores in PODCI (median 95 points; interquartile range (IQR) 78 to 91) and IHS (median 91 points; IQR 64 to 88) than the FS+ group (PODCI: median 94 points; IQR 69 to 89 points; IHS: median 89 points; IQR 62 to 87). The mean Severin scores were similar (FS- 2.65; FS+ 2.5; p = 0.93) but the FS- group had higher rates of good and excellent outcomes (FS- 56%; FS+ 41%; p < 0.00001) and lesser dislocation rates (FS- 6%; FS+ 14%; p = 0.16). CONCLUSION Although FS should be used when a hip cannot be reduced without undue tension, our results indicate that this procedure is not necessarily related to a better outcome. LEVEL OF EVIDENCE Therapeutic, Level III.
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Affiliation(s)
- P. Castañeda
- NYU Langone Orthopedic Hospital. Department of Pediatric Orthopaedic Surgery, New York, USA
| | - L. Moscona
- NYU Langone Orthopedic Hospital. Department of Pediatric Orthopaedic Surgery, New York, USA
| | - K. Masrouha
- McMaster University Medical Center. Division of Orthopaedic Surgery, Hamilton, Ontario, Canada
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Vallim FCDM, Cruz HAD, Rodrigues RC, Abreu CSGD, Godoy EDP, Cunha MG. O uso de placas bloqueadas pediátricas no quadril paralítico: resultados preliminares de 61 casos. Rev Bras Ortop 2018. [DOI: 10.1016/j.rbo.2017.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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9
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Vallim FCDM, Cruz HAD, Rodrigues RC, Abreu CSGD, Godoy EDP, Cunha MG. The use of pediatric locked plates in the paralytic hip: preliminary results of 61 cases. Rev Bras Ortop 2018; 53:674-680. [PMID: 30377599 PMCID: PMC6204542 DOI: 10.1016/j.rboe.2017.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 09/11/2017] [Indexed: 11/03/2022] Open
Abstract
Objective To evaluate the clinical and radiologic results of proximal femoral varus derotational and shortening osteotomy (OVRF) (Port., doesn't match name) with the use of a locked plate in patients with cerebral palsy, classified by the gross motor functional classification system as class IV or V. Methods A retrospective study of 42 patients (61 hips) with cerebral palsy, gross motor functional classification system class IV or V, submitted to OVRF. The minimal follow up was 24 months. This study evaluated clinical (age at surgery, gender, Gross Motor Functional Classification System class, anatomical cerebral palsy classification, and motor pattern), pre- and post-operative radiological (neck shaft angle, acetabular index, Reimers migration index and time until bone healing) characteristics, as well as post-operative complications. Results Mean pre-operative cervicodiaphyseal angle, acetabular index, and Reimers migration index were respectively 121.6°, 22.7°, and 65.4% in uncomplicated cases, and 154.7°, 20.4°, and 81.1% in complicated ones. All parameters were statistically significant difference between pre- and postoperative values (p < 0.05). The patients with postoperative complications had a greater cervicodiaphyseal angle and Reimers migration index (p < 0.0001). There were no differences in clinical characteristics, time of immobilization, or bone healing. Fourteen patients had postoperative complications (33.3%), but only six required surgical treatment. Conclusion The locked plate is a safe resource, with low complication rates and reproducible technique for OVRF in the cerebral palsy population classified as gross motor functional classification system IV and V. Greater cervicodiaphyseal angles and Reimers migration index are associated with greater chances of postoperative complications, as well as gross motor functional classification system V classification.
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Affiliation(s)
- Frederico Coutinho de Moura Vallim
- Serviço de Ortopedia Pediátrica, Hospital Estadual da Criança, Secretaria de Estado de Saúde (SES), Rio de Janeiro, RJ, Brazil.,Instituto Nacional de Traumatologia e Ortopedia (Into), Rio de Janeiro, RJ, Brazil
| | - Henrique Abreu da Cruz
- Serviço de Ortopedia Pediátrica, Hospital Estadual da Criança, Secretaria de Estado de Saúde (SES), Rio de Janeiro, RJ, Brazil
| | - Ricardo Carneiro Rodrigues
- Serviço de Ortopedia Pediátrica, Hospital Estadual da Criança, Secretaria de Estado de Saúde (SES), Rio de Janeiro, RJ, Brazil
| | - Caroline Sandra Gomes de Abreu
- Serviço de Ortopedia Pediátrica, Hospital Estadual da Criança, Secretaria de Estado de Saúde (SES), Rio de Janeiro, RJ, Brazil
| | - Eduardo Duarte Pinto Godoy
- Serviço de Ortopedia Pediátrica, Hospital Estadual da Criança, Secretaria de Estado de Saúde (SES), Rio de Janeiro, RJ, Brazil
| | - Marcio Garcia Cunha
- Serviço de Ortopedia Pediátrica, Hospital Estadual da Criança, Secretaria de Estado de Saúde (SES), Rio de Janeiro, RJ, Brazil
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10
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Minimally invasive Dega acetabuloplasty for the treatment of neuromuscular hip dysplasia. CURRENT ORTHOPAEDIC PRACTICE 2018. [DOI: 10.1097/bco.0000000000000649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
In pediatric patients with developmental dysplasia of the hip with late presentation or failure of nonsurgical treatment, surgical management is indicated. The goal of surgery is to obtain a stable reduction to promote development of the femoral head and acetabulum while avoiding osteonecrosis of the femoral head and the need for further surgery. Treatment is related to the age of the patient and the degree of soft-tissue contracture or bony deformity present. As a general rule, in children aged <12 months, closed reduction and spica casting is preferred. Children aged 12 to 18 months may require open reduction, which can be performed safely through a medial or anterior approach. In children aged 18 months to 3 years, residual bony deformity can be corrected with a femoral or pelvic osteotomy in addition to open reduction. In children with complex deformity or in children aged >3 years, both pelvic and femoral osteotomies are commonly required to stabilize an open reduction.
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Kothari A, Grammatopoulos G, Hopewell S, Theologis T. How Does Bony Surgery Affect Results of Anterior Open Reduction in Walking-age Children With Developmental Hip Dysplasia? Clin Orthop Relat Res 2016; 474:1199-208. [PMID: 26487045 PMCID: PMC4814424 DOI: 10.1007/s11999-015-4598-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Anterior open reduction is commonly used to treat hip subluxation or dislocation in developmental dysplasia of the hip (DDH) in walking-age children. Pelvic and/or femoral osteotomy may be used in addition, but it is unclear how this affects avascular necrosis (AVN) risk and radiological and clinical results. QUESTIONS/PURPOSES The purpose of this study was to review studies of walking-age patients treated either with an open reduction alone or combined with pelvic and/or femoral osteotomies and determine whether there is a difference between groups in the proportion of patients: (1) developing clinically relevant femoral head AVN (Kalamchi & MacEwen Types II to IV or equivalent); (2) achieving a satisfactory radiological result (Severin Grade I/II or equivalent); (3) achieving a satisfactory clinical result (McKay excellent or good rating or equivalent); and (4) requiring further nonsalvage surgery. METHODS MEDLINE, Embase, the Cochrane Centre Register of Controlled Trials, and ClinicalTrials.gov were searched for studies of anterior open reduction for DDH in children aged 12 months to 6 years old. We assessed AVN, clinical and radiological results, and requirement for further procedures. The effect of failed conservative management, traction, age at operation, and followup duration was also assessed. Eighteen studies met the review eligibility criteria. RESULTS Open reduction alone had a lower risk of AVN than open reduction combined with pelvic and femoral osteotomy (4% versus 24%), but there was no significant difference compared with open reduction with either pelvic (17%) or femoral osteotomy (18%). More hips treated with open reduction alone had satisfactory radiological results than open reduction combined with pelvic and femoral osteotomy (97% versus 83%) and satisfactory clinical results than all other interventions. More hips treated with open reduction alone required further surgical management (56%) compared with open reduction and pelvic osteotomy (11%) and combined pelvic and femoral osteotomies (8%). CONCLUSIONS Open reduction with concomitant pelvic osteotomy is the most appropriate option to provide durable results with the lowest risk of AVN and best radiological and clinical results. There is no evidence that addition of a femoral osteotomy provides any additional benefit to the patient, although it may be necessary to achieve reduction. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Alpesh Kothari
- grid.461589.70000000102243960Nuffield Orthopaedic Centre, Windmill Road, Oxford, OX3 7LD UK
| | - George Grammatopoulos
- grid.461589.70000000102243960Nuffield Orthopaedic Centre, Windmill Road, Oxford, OX3 7LD UK
| | - Sally Hopewell
- grid.461589.70000000102243960Nuffield Orthopaedic Centre, Windmill Road, Oxford, OX3 7LD UK
| | - Tim Theologis
- grid.461589.70000000102243960Nuffield Orthopaedic Centre, Windmill Road, Oxford, OX3 7LD UK
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Comparison of open reduction alone and open reduction plus Dega osteotomy in developmental dysplasia of the hip. J Pediatr Orthop B 2016; 25:1-6. [PMID: 26352104 DOI: 10.1097/bpb.0000000000000227] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In the treatment of developmental dysplasia of the hip, concentric reduction of the femoral head into the acetabular cavity plays a key role in the natural development of the acetabulum. However, there is still debate on the need for additional acetabular osteotomies and their timing. In this study, we compared open reduction (OR) alone with OR plus Dega osteotomy for acetabular index (AI) development. Twenty patients, 10 in each group, who underwent either OR alone or OR plus Dega osteotomy were studied retrospectively. All patients were diagnosed with developmental dysplasia of the hip and none of them received treatment previously. Preoperative, early postoperative, and follow-up radiographs were gathered, radiological grading was performed according to Tönnis, and AI angles were measured. The OR group had a mean age of 24.5 months, whereas the Dega group had a mean age of 24.8 months. The mean follow-up period of the OR group and Dega group was 57.8 and 66.6 months, respectively. In the OR group, the initial mean AI was 37.5° whereas in the Dega group it was 46°. After the follow-up, despite the acetabular development in the OR group being twice as fast, the final mean AI was 25.5, whereas it was 15.9 in the Dega group. The difference was statistically significant (P<0.05). Using Tönnis' definition, the Dega group ended up with 70% normal hips, 20% mild dysplasia, and 10% severe dysplasia, whereas the OR group had 20% normal hips, 30% mild dysplasia, and 50% severe dysplasia at the final visit. There was no correlation between the initial radiological grading of dislocation and the final result. OR plus Dega osteotomy is a good option to regain acetabular coverage over the femoral head. It provides better radiographic results after a 5-year follow-up period in patients with a mean age of 25 months. OR alone should not be performed unless the child had mildly dysplastic acetabulum according to Tönnis' definition.
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Kotlarsky P, Haber R, Bialik V, Eidelman M. Developmental dysplasia of the hip: What has changed in the last 20 years? World J Orthop 2015; 6:886-901. [PMID: 26716085 PMCID: PMC4686436 DOI: 10.5312/wjo.v6.i11.886] [Citation(s) in RCA: 181] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 08/23/2015] [Accepted: 10/13/2015] [Indexed: 02/06/2023] Open
Abstract
Developmental dysplasia of the hip (DDH) describes the spectrum of structural abnormalities that involve the growing hip. Early diagnosis and treatment is critical to provide the best possible functional outcome. Persistence of hip dysplasia into adolescence and adulthood may result in abnormal gait, decreased strength and increased rate of degenerative hip and knee joint disease. Despite efforts to recognize and treat all cases of DDH soon after birth, diagnosis is delayed in some children, and outcomes deteriorate with increasing delay of presentation. Different screening programs for DDH were implicated. The suspicion is raised based on a physical examination soon after birth. Radiography and ultrasonography are used to confirm the diagnosis. The role of other imaging modalities, such as magnetic resonance imaging, is still undetermined; however, extensive research is underway on this subject. Treatment depends on the age of the patient and the reducibility of the hip joint. At an early age and up to 6 mo, the main treatment is an abduction brace like the Pavlik harness. If this fails, closed reduction and spica casting is usually done. After the age of 18 mo, treatment usually consists of open reduction and hip reconstruction surgery. Various treatment protocols have been proposed. We summarize the current practice for detection and treatment of DDH, emphasizing updates in screening and treatment during the last two decades.
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Kaneko H, Kitoh H, Mishima K, Matsushita M, Kadono I, Ishiguro N, Hattori T. Factors associated with an unfavourable outcome after Salter innominate osteotomy in patients with unilateral developmental dysplasia of the hip: does occult dysplasia of the contralateral hip affect the outcome? Bone Joint J 2014; 96-B:1419-23. [PMID: 25274931 DOI: 10.1302/0301-620x.96b10.34263] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Salter innominate osteotomy is an effective reconstructive procedure for the treatment of developmental dysplasia of the hip (DDH), but some children have a poor outcome at skeletal maturity. In order to investigate factors associated with an unfavourable outcome, we assessed the development of the contralateral hip. We retrospectively reviewed 46 patients who underwent a unilateral Salter osteotomy at between five and seven years of age, with a mean follow-up of 10.3 years (7 to 20). The patients were divided into three groups according to the centre-edge angle (CEA) of the contralateral hip at skeletal maturity: normal (> 25°, 22 patients), borderline (20° to 25°, 17 patients) and dysplastic (< 20°, 7 patients). The CEA of the affected hip was measured pre-operatively, at eight to nine years of age, at 11 to 12 years of age and at skeletal maturity. The CEA of the affected hip was significantly smaller in the borderline and dysplastic groups at 11 and 12 years of age (p = 0.012) and at skeletal maturity (p = 0.017) than in the normal group. Severin group III was seen in two (11.8%) and four hips (57.1%) of the borderline and dysplastic groups, respectively (p < 0.001). Limited individual development of the acetabulum was associated with an unfavourable outcome following Salter osteotomy.
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Affiliation(s)
- H Kaneko
- Department of Rehabilitation, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi 466-8550, Japan
| | - H Kitoh
- Department of Rehabilitation, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi 466-8550, Japan
| | - K Mishima
- Department of Rehabilitation, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi 466-8550, Japan
| | - M Matsushita
- Department of Rehabilitation, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi 466-8550, Japan
| | - I Kadono
- Department of Rehabilitation, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi 466-8550, Japan
| | - N Ishiguro
- Department of Rehabilitation, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi 466-8550, Japan
| | - T Hattori
- Aichi Children's Health and Medical Center, Department of Orthopaedic Surgery, 1-2 Osakada, Morioka-Cho, Obu, Aichi 474-8710, Japan
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Akgül T, Göksan SB, Eren I. Idiopathic hypertonicity as a cause of stiffness after surgery for developmental dysplasia of the hip. Int J Surg Case Rep 2014; 5:155-8. [PMID: 24568944 DOI: 10.1016/j.ijscr.2014.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 12/28/2013] [Accepted: 01/19/2014] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION There are various complications reported with surgical treatment of DDH. Most studied complication is avascular necrosis of the femoral head and hip stiffness. The purpose of this report was to describe a case with severe stiffness of the hip due to hypertonicity in periarticular muscles after it was treated for developmental dysplasia of the hip (DDH). PRESENTATION OF CASE Three-year-old patient referred to our institution with bilateral DDH. Two hips were operated separately in one year with anterior open reduction, femoral shortening osteotomy. Third month after last surgery, limited right hip range of motion and limb length discrepency identified. Clinical examination revealed that patient had limited range of motion (ROM) in the right hip and compensated this with pelvis obliquity. Gluteus medius, sartorius and iliofemoral band release performed after examination under general anesthesia. Symptoms were persisted at 3rd week control and examination of the patient in general anesthesia revealed full ROM without increased tension. For the identified hypertonicity, ultrasound guided 100IU botulinum toxin A injection performed to abductor group and iliopsoas muscles. Fifth month later, no flexor or abductor tension observed, and there was no pelvic obliquity. DISCUSSION Stiffness as a complication is rare and is usually resolved without treatment or simple physical therapy. Usually it is related with immobilization or surgery associated joint contracture, and spontaneous recovery reported. Presented case is diagnosed as hip stiffness due to underlying local hypertonicity. That is resolved with anesthesia and it was treated after using botulinum toxin A injection. CONCLUSION Hypertonicity with hip stiffness after surgical treatment of DDH differ from spontaneous recovering hip range of motion limitation and treatment can only be achieved by reduction of the muscle hypertonicity by neuromuscular junction blockage.
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Affiliation(s)
- Turgut Akgül
- İstanbul University, İstanbul Medicine Faculty, Orthopaedics and Traumatology Department, Millet caddesi. Çapa, Fatih, İstanbul, Turkey.
| | - Süleyman Bora Göksan
- İstanbul University, İstanbul Medicine Faculty, Orthopaedics and Traumatology Department, Millet caddesi. Çapa, Fatih, İstanbul, Turkey.
| | - Ilker Eren
- İstanbul University, İstanbul Medicine Faculty, Orthopaedics and Traumatology Department, Millet caddesi. Çapa, Fatih, İstanbul, Turkey.
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Ramani N, Patil MS, Mahna M. Outcome of surgical management of developmental dysplasia of hip in children between 18 and 24 months. Indian J Orthop 2014; 48:458-62. [PMID: 25298551 PMCID: PMC4175858 DOI: 10.4103/0019-5413.139841] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Developmental dysplasia of hip (DDH) is a common condition presenting to a pediatric orthopedic surgeon. There is a consensus on the surgical treatment of children with ages ranged from 18 to 24 months where majority agree on open reduction and hip spica. Open reduction was done with an additional pelvic procedure wherever required to get better results and prevent residual acetabular dysplasia (RAD) and early osteoarthritis. MATERIALS AND METHODS 35 children with unilateral DDH were operated between 2002 and 2007 at our institute. Open reduction was performed in all using the standard anterior approach and peroperative test for hip stability was done. Nine children got an additional pelvic procedure in the form of Dega acetabuloplasty. All were followed up for a minimal period of 2 years (range 2-7 years). RESULTS No hip got redislocated. At the end of 18 months, there were seven cases of RAD with acetabular index (AI) of 35° and above. These were all from the group where open reduction alone was done. CONCLUSION We feel that a preoperative AI of >40° and a per-operative safe-zone <20° increases the need for supplementary pelvic osteotomy in age group of 18 to 24 months because in such cases, the remodeling capacity of the acetabulum is unable to overcome the dysplasia and to form a relatively normal acetabulum.
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Affiliation(s)
- Narasimhan Ramani
- Department of Paediatric Orthopaedics, Indraprastha Apollo Hospital, New Delhi, India,Address for correspondence: Dr. Narasimhan Ramani, D-73, Ground Floor, Saket, New Delhi - 110 017, India. E-mail:
| | - Mithun S Patil
- Department of Paediatric Orthopaedics, Indraprastha Apollo Hospital, New Delhi, India
| | - Madhur Mahna
- Department of Paediatric Orthopaedics, Indraprastha Apollo Hospital, New Delhi, India
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Retrospective radiographic evaluation of treatment results of developmental dysplasia of the hip in walking-age children. J Pediatr Orthop B 2013; 22:427-31. [PMID: 23636226 DOI: 10.1097/bpb.0b013e328361c877] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
UNLABELLED We evaluated treatment results of 22 children (32 hips) with idiopathic hip dislocation after walking age in two Dutch academic hospitals. The Tönnis classification was used preoperatively. Outcome was measured using the Severin and Kalamchi classification. The mean age at treatment was 24 months and the mean follow-up was 6.8 years. In 24 hips (73%), a perfect outcome was found (Kalamchi score≤1 and Severin score of 1). A fair or a poor outcome according to Severin (≥3) was found in five hips (15%). Treatment of a hip dislocation beyond 18 months of age usually results in adequate hip development with limited avascular necrosis. LEVEL OF EVIDENCE Level III.
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Osteonecrosis complicating developmental dysplasia of the hip compromises subsequent acetabular remodeling. Clin Orthop Relat Res 2013; 471:2318-26. [PMID: 23354465 PMCID: PMC3676631 DOI: 10.1007/s11999-013-2804-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Accepted: 01/15/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Osteonecrosis of the femoral head secondary to treatment of developmental dysplasia of the hip (DDH) affects acetabular remodeling but the magnitude of this effect is unclear. QUESTIONS/PURPOSES Using four measures of acetabular development, we (1) determined whether acetabular remodeling differed in hips with and without osteonecrosis; and (2) determined the impact of severity of osteonecrosis contributing to acetabular remodeling. METHODS We retrospectively reviewed 95 patients (118 hips) treated for DDH by closed or open reduction with or without femoral osteotomy between 1992 and 2006. We evaluated serial radiographs from the time when a stable reduction had been achieved. In 902 radiographs taken over 19 years, we measured the acetabular index and three other indices of hip development. Patients were followed for a mean of 8 years (range, 1-19 years). At last followup, 86 of the 118 hips (73%) had osteonecrosis according to the criteria by Bucholz and Ogden. RESULTS The acetabular index improved with time in all hips but the magnitude of improvement was larger in hips without osteonecrosis. The adjusted mean acetabular index at 14 years was 17° for hips with osteonecrosis (95% CI, 15°-18°) and 10° for hips without osteonecrosis (95% CI, 7°-13°). The lateral centering ratio improved after reduction to a normal value less than 0.85 in both groups but the rate of change with 0.06 versus 0.05 was higher in hips with osteonecrosis. The superior centering ratio was worse at all times in hips with osteonecrosis with a mean difference of 0.04. If only radiographic changes of Grades II and greater were considered osteonecrosis, the mean adjusted acetabular index at 14 years was 17.7° (15.6°-19.7°) for hips with osteonecrosis and 12.4° (10.3°-14.4°) for hips without osteonecrosis. CONCLUSIONS Although radiographic indices improved consistently with time in hips without osteonecrosis, hips with osteonecrosis had abnormal indices of acetabular remodeling throughout followup. Osteonecrosis of the femoral head inhibited acetabular remodeling. LEVEL OF EVIDENCE Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
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20
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Reliability of Bucholz and Ogden classification for osteonecrosis secondary to developmental dysplasia of the hip. Clin Orthop Relat Res 2012; 470:3499-505. [PMID: 22903283 PMCID: PMC3492596 DOI: 10.1007/s11999-012-2534-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Accepted: 08/01/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND Osteonecrosis is perhaps the most important serious complication after treatment of developmental dysplasia of the hip (DDH). The classification by Bucholz and Ogden has been used most frequently for grading osteonecrosis in this context, but its reliability is not established and unreliability could affect the validity of studies reporting the outcome of treatment. QUESTIONS/PURPOSE We established the interrater and intrarater reliabilities of this classification and analyzed the frequency and nature of disagreements. METHODS Three pediatric hip surgeons, a musculoskeletal pediatric radiologist, and three orthopaedic trainees graded 39 radiographs (hips) according to the Bucholz and Ogden classification, blinded to any clinical data. Ratings were repeated after 2 weeks. Interrater reliability and intrarater reliability were determined using the simple kappa statistic. Grading was compared among raters, the nature and frequency of disagreements established, and subgroup analyses performed. RESULTS Interrater reliability was 0.34 (95% CI = 0.28, 0.40) for all raters, and 0.31 (0.20 to 0.43) for the three surgeons. The best interrater reliability was observed between the radiologist and a surgeon with a kappa of 0.51 (0.30, 0.72). Intrarater reliability estimates ranged from 0.44 to 0.69. Raters disagreed regarding the grade of osteonecrosis in 26 of 39 hips (67%), with seven of 26 disagreements (27%) involving confusion between Grades I and II. CONCLUSIONS The interrater reliability was lower than expected, considering the raters' experience. Distinguishing between Grades I and II was the most frequently observed problem. We believe that the low reliability was a result of an ambiguous classification scheme rather than the variability among the raters. Outcome studies of DDH based on this classification should be interpreted with caution. We recommend the development of a new classification with better prognostic ability. LEVEL OF EVIDENCE Level III, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Bittersohl B, Hosalkar HS, Wenger DR. Surgical treatment of hip dysplasia in children and adolescents. Orthop Clin North Am 2012; 43:301-15. [PMID: 22819159 DOI: 10.1016/j.ocl.2012.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Residual hip dysplasia (a relatively common condition in young children and adolescents) left undetected or partially treated, almost certainly leads to further progression of deformity, eventually ending in a nonfunctional, painful hip joint. Therefore, every effort should be made to identify and treat hip dysplasia early.The use of 3D imaging, including CT and MRI assessment, has enhanced the diagnosis and treatment of patients with dysplasia because they facilitate proper identification of important pathomorphologic anatomy and cartilage degeneration. Future studies should take these novel imaging modalities into consideration with the attempt to (re-) evaluate optimal selection criteria for surgery, risk factors for clinical failure and optimal deformity correction. Treatment of residual hip dysplasia requires corrective surgery. The goal of surgical treatment is to normalize joint loading by increasing the contact area and improving the level arm of the hip to forestall the development of OA. Proper selection and performance of a correction osteotomy and adjunctive procedures are prerequisites for a good clinical outcome and high survivorship of the reconstructed hip. Augmentation procedures, such as the Chiari osteotomy or the shelf procedure described by Staheli, remain as a salvage option in cases when irreversible cartilage damage is present or when reorientation is not feasible.
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Affiliation(s)
- Bernd Bittersohl
- Department of Orthopedic Surgery, Rady Children's Hospital San Diego, San Diego, CA 92123, USA
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22
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Roposch A, Liu LQ, Offiah AC, Wedge JH. Functional outcomes in children with osteonecrosis secondary to treatment of developmental dysplasia of the hip. J Bone Joint Surg Am 2011; 93:e145. [PMID: 22258780 DOI: 10.2106/jbjs.j.01623] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Osteonecrosis of the femoral head is a major potential complication following the treatment of developmental dysplasia of the hip. It remains unclear if the radiographic changes associated with osteonecrosis are clinically relevant. METHODS In the present cross-sectional study, we determined the relationship between morphological changes on radiographs (classified with use of the Bucholz-Ogden system) and health-related quality of life (assessed with the Health Utilities Index Mark 3 [HUI3]; maximum score, 1), physical function (assessed with the Activities Scale for Kids [ASK]; maximum score, 100), and hip function (assessed with the Children's Hospital Oakland Hip Evaluation Scale [CHOHES]; maximum score, 100). The study group included seventy-two children (mean age, 14 ± 2.5 years) with a diagnosis of osteonecrosis of the hip secondary to the treatment of developmental dysplasia of the hip. Patient assessments were standardized (intraclass correlation coefficient, ≥0.93). Radiographs were graded by three experts according to consensus. Analyses were adjusted for the number of previous surgical procedures on the hip and for the severity of residual hip dysplasia. RESULTS The median ASK score was 97 (interquartile range, 93 to 100), the median CHOHES score was 86 (interquartile range, 77 to 96), and the median HUI3 score was 1 (interquartile range, 0.9 to 1). The ASK summary scores were nearly equal (median, >90) across all radiographic grades. Adjusted mean scores showed a downward shift with worse radiographic grades. The ASK scores (p = 0.004) and CHOHES scores (p = 0.006) differed across radiographic grades, with Bucholz-Ogden grade-I and II hips demonstrating significantly better scores than grade-III and IV hips. DISCUSSION Osteonecrosis secondary to the treatment of developmental dysplasia of the hip is a relatively benign condition in children and teenagers. While it was associated with limited hip function, it was not associated with physical disability. However, we speculate that this function will decline with increasing age. With regard to clinical outcome, Bucholz-Ogden grade-I hips are similar to grade-II hips and grade-III hips are similar to grade-IV hips.
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Affiliation(s)
- Andreas Roposch
- Department of Orthopaedic Surgery, Great Ormond Street Hospital for Children and UCL Institute of Child Health, London, United Kingdom.
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Noordin S, Umer M, Hafeez K, Nawaz H. Developmental dysplasia of the hip. Orthop Rev (Pavia) 2011; 2:e19. [PMID: 21808709 PMCID: PMC3143976 DOI: 10.4081/or.2010.e19] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Revised: 08/31/2010] [Accepted: 09/01/2010] [Indexed: 01/02/2023] Open
Abstract
Developmental dysplasia of the hip (DDH) is a spectrum of anatomical abnormalities of the hip joint in which the femoral head has an abnormal relationship with the acetabulum. Most studies report an incidence of 1 to 34 cases per 1,000 live births and differences could be due to different diagnostic methods and timing of evaluation. Risk factors include first born status, female sex, positive family history, breech presentation and oligohydramnios. Clinical presentations of DDH depend on the age of the child. Newborns present with hip instability, infants have limited hip abduction on examination, and older children and adolescents present with limping, joint pain, and/or osteoarthritis. Repeated, careful examination of all infants from birth and throughout the first year of life until the child begins walking is important to prevent late cases. Provocative testing includes the Barlow and Ortolani maneuvers. Other signs, such as shorting of the femur with hips and knees flexed (Galeazzi sign), asymmetry of the thigh or gluteal folds, and discrepancy of leg lengths are potential clues. Treatment depends on age at presentation and outcomes are much better when the child is treated early, particularly during the first six months of life.
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Affiliation(s)
- Shahryar Noordin
- Section of Orthopedics, Dept. of Surgery, Aga Khan University, Karachi, Pakistan
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Roposch A, Odeh O, Doria AS, Wedge JH. The presence of an ossific nucleus does not protect against osteonecrosis after treatment of developmental dysplasia of the hip. Clin Orthop Relat Res 2011; 469:2838-45. [PMID: 21312075 PMCID: PMC3171532 DOI: 10.1007/s11999-011-1801-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Accepted: 01/25/2011] [Indexed: 01/31/2023]
Abstract
BACKGROUND Osteonecrosis (ON) is a major complication after treatment of developmental dysplasia of the hip (DDH). Several studies have explored the absence of the femoral head ossific nucleus at the time of hip reduction as a risk factor for the development of ON, but findings have been inconsistent. QUESTIONS/PURPOSES We therefore determined the incidence of ON in children who underwent reduction of a dislocated hip in the presence or absence of the ossific nucleus. PATIENTS AND METHODS We retrospectively reviewed the radiographs of 105 hips in 89 patients treated for DDH at the age of 18 months or younger. Radiographs were graded for the presence of the ossific nucleus at the time of hip reduction and for the presence of ON, as graded by the Bucholz and Ogden classification, for patients at a mean age of 10 years. We used log-binomial regression to estimate if the presence of the ossific nucleus was associated with a lower incidence of ON. RESULTS We identified ON in 37 of the 105 hips (35%). The incidence of ON at 10 years was 40% in the absence of the ossific nucleus and 32% in the presence of the ossific nucleus (adjusted relative risk, 0.86; 95% confidence interval, 0.36-1.81). When only radiographic changes of Grade II and greater were considered ON, the risk was still not increased (relative risk, 1.26; 95% confidence interval, 0.62-2.56). CONCLUSION Patients with an ossific nucleus at the time of hip reduction showed a slight tendency toward better outcomes. The ossific nucleus did not protect for ON. LEVEL OF EVIDENCE Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Andreas Roposch
- Department of Orthopaedic Surgery, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH UK ,Institute of Child Health, University College London, London, UK
| | - Odeh Odeh
- Institute of Child Health, University College London, London, UK
| | - Andrea S. Doria
- Department of Diagnostic Imaging, Hospital for Sick Children, and University of Toronto, Toronto, Canada
| | - John H. Wedge
- Division of Orthopaedic Surgery, Hospital for Sick Children, and University of Toronto, Toronto, Canada
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Sewell MD, Eastwood DM. Screening and treatment in developmental dysplasia of the hip-where do we go from here? INTERNATIONAL ORTHOPAEDICS 2011; 35:1359-67. [PMID: 21553044 DOI: 10.1007/s00264-011-1257-z] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Revised: 03/24/2011] [Accepted: 03/25/2011] [Indexed: 12/30/2022]
Abstract
PURPOSE Developmental dysplasia of the hip (DDH) is a leading cause of disability in childhood and early adult life. Clinical and sonographic screening programmes have been used to facilitate early detection but the effectiveness of both screening strategies is unproven. This article discusses the role for screening in DDH and provides an evidence-based review for early management of cases detected by such screening programmes. METHODS We performed a literature review using the key words 'hip dysplasia,' 'screening,' 'ultrasound,' and 'treatment.' RESULTS The screening method of choice and its effectiveness in DDH still needs to be established although it seems essential that screening tests are performed by trained and competent examiners. There is no level 1 evidence to advise on the role of abduction splinting in DDH although clinicians feel strongly that hip instability does improve with such a treatment regime. The definition of what constitutes a pathological dysplasia and when this requires treatment is also poorly understood. CONCLUSION Further research needs to establish whether early splintage of clinically stable but sonographically dysplastic hips affects future risk of late-presenting dysplasia/dislocation and osteoarthritis. There is a need for high quality studies in the future if these questions are to be answered.
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Affiliation(s)
- Mathew D Sewell
- The Catterall Unit, The Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK.
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Noonan KJ, Zaltz I, Wenger D. What's New in Pediatric Orthopaedics. J Bone Joint Surg Am 2011; 93:597-606. [PMID: 21411710 DOI: 10.2106/jbjs.j.01693] [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]
Affiliation(s)
- Kenneth J Noonan
- University of Wisconsin School of Medicine and Public Health, Health Sciences Learning Center, Madison, 53705, USA.
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