Surgical outcomes of open hip reduction with synovectomy for developmental dysplasia of the hip patient with Juvenile idiopathic arthritis: A case report

The term ‘developmental dysplasia of the hip’ (DDH) includes a wide spectrum of hip alterations: neonatal instability; acetabular dysplasia; hip subluxation; and true dislocation of the hip. DDH alters hip biomechanics, overloading the articular cartilage and leading to early osteoarthritis. DDH is the main cause of total hip replacement in young people (about 21% to 29%). Development of the acetabular cavity is determined by the presence of a concentrically reduced femoral head. Hip subluxation or dislocation in a child will cause an inadequate development of the acetabulum during the remaining growth. Clinical screening (instability manoeuvres) should be done universally as a part of the physical examination of the newborn. After two or three months of life, limited hip abduction is the most important clinical sign. Selective ultrasound screening should be performed in any child with abnormal physical examination or in those with high-risk factors (breech presentation and positive family history). Universal ultrasound screening has not demonstrated its utility in diminishing the incidence of late dysplasia. Almost 90% of patients with mild hip instability at birth are resolved spontaneously within the first eight weeks and 96% of pathologic changes observed in echography are resolved spontaneously within the first six weeks of life. However, an Ortolani-positive hip requires immediate treatment. When the hip is dislocated or subluxated, a concentric and stable reduction without forceful abduction needs to be obtained by closed or open means. Pavlik harness is usually the first line of treatment under the age of six months. Hip arthrogram is useful for guiding the decision of performing a closed or open reduction when needed. Acetabular dysplasia improves in the majority due to the stimulus provoked by hip reduction. The best parameter to predict persistent acetabular dysplasia at maturity is the evolution of the acetabular index. Pelvic or femoral osteotomies should be performed when residual acetabular dysplasia is present or in older children when a spontaneous correction after hip reduction is not expected. Avascular necrosis is the most serious complication and is related to: an excessive abduction of the hip; a force closed reduction when obstacles for reduction are present; a maintained dislocated hip within the harness or spica cast; and a surgical open reduction.Cite this article: EFORT Open Rev 2019;4:548-556. DOI: 10.1302/2058-5241.4.180019

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The young arthritic hip

10.1093/med/9780199550647.003.007007 ◽

2011 ◽

Author(s):

Ahmad K. Malik ◽

Aresh Hashemi-Nejad

Keyword(s):

Rheumatoid Arthritis ◽

Juvenile Idiopathic Arthritis ◽

Femoral Head ◽

Femoroacetabular Impingement ◽

Acetabular Fracture ◽

Developmental Dysplasia ◽

Neck Fracture ◽

Slipped Upper Femoral Epiphysis ◽

Dysplasia Of The Hip ◽

Head Neck

♦ Impingement:• Primary femoroacetabular impingement:▪ Cam type▪ Pincer type▪ Combined cam and pincer• Secondary femoroacetabular impingement:▪ Slipped upper femoral epiphysis (cam type)▪ Protusio (pincer type)▪ Retroverted acetabulum (pincer type)▪ Malunited femoral head/neck fracture (cam type)▪ Acetabular fracture (pincer type)▪ Perthes disease (cam type)♦ Instability:• Developmental dysplasia of the hip (treated/residual and untreated)• Dislocation• Subluxation• Dysplasia♦ Inflammatory:• Juvenile idiopathic arthritis• Rheumatoid arthritis.

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274 The Accuracy of Clinical Coding of Developmental Dysplasia of The Hip (DDH) Operations

British Journal of Surgery ◽

10.1093/bjs/znab134.395 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

M Sharrock ◽

C Whelton ◽

R Paton

Keyword(s):

Surgical Outcomes ◽

Closed Reduction ◽

Open Reduction ◽

Developmental Dysplasia ◽

Femoral Osteotomy ◽

Clinical Coding ◽

Cost Implications ◽

Dysplasia Of The Hip

Abstract Aim: To assess the accuracy of clinical coding of developmental dysplasia of the hip (DDH) operations Method 106 children underwent surgery for DDH at our turst from 1997 to 2018. Our coding department was sent a list of patients and operation dates and asked to tabulate data on what each operation had been coded as. We compared what each operation was coded as with the procedure actually performed (as per operation notes, clinic letters and intra-operative fluoroscopy images). Results Of the 106 patients included in our study, 128 operations were performed. 36 out of 128 (28%) of operations were coded incorrectly. The commonest error was that closed reduction was missed from coding (n = 13). Seven patients did not have their femoral osteotomy coded. Seven patients had a closed reduction incorrectly labelled as an open reduction. Four patients had pelvic osteotomies that were not coded. Two patients had open reductions that were not coded. Conclusions We have shown that an unacceptably high number of DDH operations are being coded for incorrectly. This has clear cost implications for the trust. This study questions the use of retrospective coding data in audit and research and suggests inaccuracy when considering the surgical outcomes of developmental dysplasia of the hip.

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To study the cost-effectiveness of clinical screening with ultrasonography (USG) of hip for diagnosing developmental dysplasia of the hip (DDH) in new borns

VIMS Health Science Journal ◽

10.46858/vimshsj.8205 ◽

2021 ◽

Vol 8 (2) ◽

pp. 71-74

Author(s):

Dr. Pandurang M. Daule ◽

Dr. Ganesh G. Zarekar ◽

Dr. Sunil Natha Mhaske ◽

Dr. Shreya N. Bhate

Keyword(s):

Cost Effectiveness ◽

Large Population ◽

Breech Presentation ◽

Population Based ◽

Developmental Dysplasia ◽

Type Iiib ◽

Hip Replacements ◽

Hip Reduction ◽

The Cost ◽

Dysplasia Of The Hip

Aim: To study the cost-effectiveness of clinical screen with ultrasonography (USG) of hip for diagnosing developmental dysplasia of the hip (DDH) in new borns. Methods: Retrospective study (2018-20). Term new borns had (i) target scan at 6 weeks—family history of DDH or breech presentation—and (ii) early scan—abnormal clinical screen. Results: In all, 58 babies had USG scan. Five early scans (Graf’s classification; three Type IIA, one Type IIC and one Type IIIB] and 15 target scans (Type IIA) were reported abnormal. All Type IIA DDH had subsequent 12 weeks' scans normal. Babies with Type IIIB and IIC had hip reduction surgery at 6 and 16 months of age, respectively. At cost 200 INR/scan, total 147?200 INR was incurred against two possible hip replacements prevented. Conclusion: Universal clinical screen with USG of hip can aid in early diagnosis of DDH in newborns. Large population-based studies from developing countries need to look in its cost-effectiveness.

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Establishing reference values for the pubofemoral distance in normal infant medial hips by ultrasound

Acta Radiologica ◽

10.1177/0284185120933240 ◽

2020 ◽

pp. 028418512093324

Author(s):

Yongguang Ban ◽

Qinhua Luan ◽

Miao Shi ◽

Bo Sun ◽

Tianyou Li ◽

...

Keyword(s):

Age Groups ◽

Developmental Dysplasia ◽

Pubic Bone ◽

Normal Infant ◽

Male And Female ◽

Type Ia ◽

Hip Reduction ◽

And Gender ◽

Dysplasia Of The Hip

Background Measuring the pubofemoral distance (PFD) is important for evaluating the effectiveness of hip reduction in the treatment of developmental dysplasia of the hip (DDH). However, reference PFD values have not been established in normal infants. Purpose To investigate variations in PFD values measured in normal infant medial hips stratified by age, laterality, and gender. Material and Methods A total of 240 infants diagnosed with Graf type Ia and/or Graf type Ib hips by ultrasonography were stratified into eight age groups: 0–1 month; 1–2 months; 2–3 months; 3–4 months; 4–5 months; 5–6 months; 6–7 months; and 7–12 months. The bilateral medial hips were scanned with transinguinal ultrasound. The PFD was defined as the distance between the lateral edge of the superior ramus of pubic bone and the medial edge of the femoral head. Inter-observer reproducibility was assessed. Results Among the 240 infants, there were 371 Graf type Ia hips and 109 Graf type Ib hips. Mean ± SD bilateral PFD values of eight groups were measured separately. There were no significant differences in mean PFD values for left or right hips (t = 0.946, P = 0.345) or mean bilateral PFD values in male and female infants (t = 1.445, P = 0.149). Mean PFD values increased linearly with age (left: r = 0.680, P < 0.0001; right: r = 0.682, P < 0.0001). Inter-observer reproducibility was excellent. Conclusion This study established reference PFD values from the medial hip in infants aged 0–12 months. PFD values increased with age, but were not significantly influenced by laterality or gender. These data provide detailed information that can support follow-up of infants treated for DDH.

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