Long-term outcome of medial open reduction in developmental dysplasia of hip

Purpose After modern acetabular osteotomies were introduced, hip shelf operations have become much less commonly used. The aims of this study were to assess the short-term and long-term outcome of a modified Spitzy shelf procedure and to compare the results with those of periacetabular osteotomy (PAO). Methods In all, 44 patients (55 hips) with developmental dysplasia of the hip and residual dysplasia had a modified Spitzy shelf operation. Mean age at surgery was 13.2 years (8 to 22). Indication for surgery was a centre-edge angle < 20° with or without hip pain. Outcome was evaluated using duration of painless period and survival analysis with conversion to total hip arthroplasty (THA) as endpoints. Results Preoperative hip pain was present in 46% of the hips and was more common in patients ≥ 12 years at surgery (p < 0.001). One year postoperatively, 93% of the hips were painless. Analysis of pain in hips with more than ten years follow-up showed a mean postoperative painless period of 20.0 years (0 to 49). In all, 44 hips (80%) had undergone THA at a mean patient age of 50.5 years (37 to 63). Mean survival of the shelf procedure (time from operation to THA) was 39.3 years (21 to 55). Conclusions The Spitzy operation had good short and long-term effects on hip pain and a 30-year survival (no THA) of 72% of the hips. These results compare favourably with those of PAO and indicate that there is still a place for the shelf procedure in older children and young adults.

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Fractures and Fracture Dislocations of the Midfoot: Occurrence, Causes and Long-term Results

Foot & Ankle International ◽

10.1177/107110070102200506 ◽

2001 ◽

Vol 22 (5) ◽

pp. 392-398 ◽

Cited By ~ 177

Author(s):

Martinus Richter ◽

Burkhard Wippermann ◽

Christian Krettek ◽

Hanns Eberhard Schratt ◽

Tobias Hufner ◽

...

Keyword(s):

Open Reduction ◽

Traffic Accidents ◽

Fracture Dislocation ◽

Long Term Results ◽

Treatment Optimization ◽

Term Outcome ◽

Long Term Outcome ◽

Fracture Dislocations

Etiology and outcome of 155 patients with midfoot fractures between 1972 and 1997 were analyzed to create a basis for treatment optimization. Cause of injuries were traffic accidents (72.2%), falls (11.6%), blunt injuries (7.7%) and others (5.8%). Isolated midfoot fractures (I) were found in 55 (35.5%) cases, Lisfranc fracture dislocations (L) in 49 (31.2%), Chopart-Lisfranc fracture dislocations (CL) in 26 (16.8%) and Chopart fracture dislocations (C) in 25 (16%). One hundred and forty eight (95%) of the midfoot fractures were treated operatively; 30 with closed reduction, 115 with open reduction, 3 patients had a primary amputation. Seven (5%) patients were treated non-operatively. Ninety seven (63%) patients had follow-up at an average of 9 (1.3–25, median 8.5) years. The average scores of the entire follow-up group were as follows: AOFAS – sum of all four sections (AOFAS-ET): 296, AOFAS-Midfoot (AOFAS-M): 71, Hannover Scoring System (HSS): 65, and Hannover Questionnaire (Q): 63. Regarding age, gender, cause, time from injury to treatment and method of treatment no score differences were noted (t-test: p > 0.05). L, C or I showed similar scores and CL significantly lower scores (AOFAS-ET, AOFAS-M, HSS, Q). The highest scores in all groups were achieved in those fractures treated with early open reduction and operative fixation. Midfoot fractures, particularly fracture dislocation injuries, effect the function of the entire foot in the long-term outcome. But even in these complex injuries, an early anatomic (open) reduction and stable (internal) fixation can minimize the percentage of long-term impairment.

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The Long-Term Outcome of Open Reduction and Internal Fixation of Stable Displaced Isolated Partial Articular Fractures of the Radial Head

Journal of Trauma and Acute Care Surgery ◽

10.1097/ta.0b013e31818234d6 ◽

2009 ◽

Vol 67 (1) ◽

pp. 143-146 ◽

Cited By ~ 41

Author(s):

Anneluuk L. C. Lindenhovius ◽

Quinten Felsch ◽

David Ring ◽

Peter Kloen

Keyword(s):

Internal Fixation ◽

Radial Head ◽

Open Reduction ◽

Term Outcome ◽

Long Term Outcome ◽

Articular Fractures

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Long-Term Outcome after Open Reduction through an Anteromedial Approach for Congenital Dislocation of the Hip*

The Journal of Bone and Joint Surgery (American) ◽

10.2106/00004623-199706000-00002 ◽

1997 ◽

Vol 79 (6) ◽

pp. 810-17 ◽

Cited By ~ 107

Author(s):

JOSÉ A. MORCUENDE ◽

MARK D. MEYER ◽

LORI A. DOLAN ◽

STUART L. WEINSTEIN

Keyword(s):

Open Reduction ◽

Congenital Dislocation ◽

Term Outcome ◽

Long Term Outcome ◽

Dislocation Of The Hip

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Long-term outcome after anterolateral open reduction and Salter osteotomy for late presenting developmental dysplasia of the hip

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.12.180076 ◽

2018 ◽

Vol 12 (4) ◽

pp. 364-368 ◽

Cited By ~ 2

Author(s):

S. R. Y. W. Thomas

Keyword(s):

Femoral Head ◽

Open Reduction ◽

Skeletal Maturity ◽

Hip Dislocation ◽

Term Outcome ◽

Long Term Outcome ◽

Femoral Head Osteonecrosis ◽

Salter Osteotomy ◽

Innominate Osteotomy

IntroductionOnly a handful of studies report outcomes after open reduction for developmental hip dislocation beyond skeletal maturity. For successfully reduced hips it is the outcome into late adulthood on which the results of this intervention should be judged. These studies indicate clearly the importance of preservation of the acetabular growth centres during surgery. The acetabulum must also be addressed when insufficient growth remains reliably to remodel residual dysplasia even after stable, concentric reduction.SummaryComparing the longest-term outcome studies for open reduction to less invasive, but mainly historical, techniques of gradual traction reduction it is unsettling to note that the latter protocols are associated with the best results. Whereas open reduction and innominate osteotomy are practised as originally described by Salter, gradual traction reduction has largely been abandoned.ConclusionsThere are probably aspects of the more time-consuming methods of gradual reduction that do not violate the hip joint capsule that expose the femoral head to a lower risk of femoral head osteonecrosis leading to better long-term outcomes.

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Long-term Outcome of Gradual Reduction Using Overhead Traction for Developmental Dysplasia of the Hip Over 6 Months of Age

Journal of Pediatric Orthopaedics ◽

10.1097/bpo.0b013e31829b2d8b ◽

2013 ◽

Vol 33 (6) ◽

pp. 628-634 ◽

Cited By ~ 19

Author(s):

Hiroshi Kaneko ◽

Hiroshi Kitoh ◽

Kenichi Mishima ◽

Masaki Matsushita ◽

Naoki Ishiguro

Keyword(s):

Developmental Dysplasia ◽

Gradual Reduction ◽

Term Outcome ◽

Long Term Outcome ◽

Dysplasia Of The Hip

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Mid- and long-term outcome of Salter’s, Pemberton’s and Dega’s osteotomy for treatment of developmental dysplasia of the hip: a systematic review and meta-analysis

Hip International ◽

10.1177/1120700020942866 ◽

2020 ◽

pp. 112070002094286

Author(s):

Sophie R Merckaert ◽

Pierre-Yves Zambelli ◽

Shannon N Edd ◽

Starnoni Daniele ◽

Jolles Brigitte

Keyword(s):

Systematic Review ◽

Initial Treatment ◽

Meta Analysis ◽

Developmental Dysplasia ◽

Unfavourable Outcome ◽

Term Outcome ◽

Long Term Outcome ◽

Dysplasia Of The Hip

Introduction: Early diagnosis and early treatment have become the gold standard for management of developmental dysplasia of the hip. Surgery is required in case of failed initial treatment. Innominate pelvic osteotomy of Salter (SIO), Pemberton’s pericapsular osteotomy (PPO) and Dega’s acetabuloplasty (DA) are among the most used procedures. We performed a systematic review and meta-analysis of the past 57 years in order to assess the mid- and long-term outcome of these techniques. Methods: Studies met inclusion criteria if they: (1) reported at least 5 cases treated by 1 of the abovementioned surgical techniques; (2) included children aged between 1 and 8 years; (3) surgical indication was late detected DDH or a failed initial treatment; (4) presented a minimal follow-up of 24 months; (5) reported the radiological score of Severin and/or the clinical score of McKay. Clinical and radiological outcomes were dichotomised into favourable and unfavourable outcome and weighted summary rates were determined using meta-analysis models. Results: From a total of 7391 articles, 48 level of evidence grade IV articles were included in our review. A total of 2143 cases with a mean follow up of 112.4 months were included. Pooled Severin score indicated a statistically better outcome for PPO and DA compared to SIO ( p = 0.0003 and p = 0.002, respectively). By dichotomising the results in favourable and unfavourable outcome, PPO showed the best results ( p = 0.0002 vs. SIO, p = 0.01 vs. DA). Pooled McKay score showed a statistically better outcome for PPO and DA compared to SIO ( p < 0.0001 and p = 0.03, respectively) as well as better outcomes for PPO compared to DA ( p = 0.01). By dichotomising the results in favourable and unfavourable, PPO showed the best results. Conclusions: Even if our review demonstrates slightly better radiological and clinical results with the PPO, the currently available and limited data do not allow for clear recommendation towards one of these techniques.

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