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

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.

scholarly journals Dega pelvic osteotomy: indications, results and complications

2018 ◽  
Vol 12 (4) ◽  
pp. 342-348 ◽  
Author(s):  
J. Czubak ◽  
K. Kowalik ◽  
A. Kawalec ◽  
M. Kwiatkowska
Keyword(s):  
Femoral Head ◽  
Open Reduction ◽  
Age Groups ◽  
Pelvic Osteotomy ◽  
Developmental Dysplasia ◽  
Femoral Osteotomy ◽  
Complication Rates ◽  
Level Of Evidence ◽  
Significant Difference ◽  
Dysplasia Of The Hip

Purpose Developmental dysplasia of the hip (DDH) after walking age is difficult to treat. Dega pelvic osteotomy is combined with open reduction and femoral osteotomy to obtain concentric stable reduction with good coverage of the femoral head. The purpose of this study is to evaluate the use of the Dega osteotomy in the treatment of DDH in two different age groups. Methods A total of 45 patients (52 hips) with a mean age of 3.9 years (1.2 to 12.8) were treated with open reduction, Dega osteotomy and femoral osteotomy. There were 38 dislocated and 14 subluxated hips. Bilateral DDH was observed in seven female patients. Radiographic parameters included acetabular index, centre-edge angle of Wiberg and migration percentage. The final radiographic outcome was evaluated according to the Severin classification. Results The mean follow-up period was four years (3 to 9). According to the Severin criteria 78.8% were types I or II whereas 21.2% showed types III or IV. There was no statistically significant difference in final outcome between children less than three years of age and older children at the time of surgery. One hip in children with unilateral involvement had developed coxa magna, that interfered with hip concentricity. Three hips (5.8%) showed avascular necrosis of the femoral head. Conclusion Dega osteotomy is a safe and adequate procedure for the management of developmental dysplasia of the hip in walking patients with low complication rates. Restoring the acetabulum to normal or nearly normal can result in good medium-term results. Level of Evidence III

scholarly journals Role of intraoperative arthrogram in decision making of closed versus medial open reduction of developmental hip dysplasia

2019 ◽  
Vol 5 (6) ◽  
pp. 1037
Author(s):  
Amin A. Ahmed ◽  
Mohie El Din Fadel
Keyword(s):  
Soft Tissue ◽  
Closed Reduction ◽  
Open Reduction ◽  
Developmental Dysplasia ◽  
Developmental Hip Dysplasia ◽  
Hip Arthrography ◽  
Unilateral Involvement ◽  
Medial Open Reduction ◽  
Dysplasia Of The Hip

<p class="abstract"><strong>Background:</strong> Hip arthrography in developmental dysplasia of the hip (DDH) has the advantages of viewing the shape and size of the cartilaginous part of both the femoral head and acetabulum, besides the soft tissue obstacles. The aim of the work was to assess the role of arthrogram in evaluation of closed reduction of developmental dysplasia of the hip.</p><p class="abstract"><strong>Methods:</strong> This prospective study included 30 patients with 36 involved hips who presented with DDH. This study included 7 males (23.3%) and 23 females (76.7%). There were 6 patients with bilateral hip involvement (20.0%) and 24 patients with unilateral involvement (80.0%). In this study we used 3 ml Urografin 76% diluted in 7 ml saline and 3 to 5 ml of diluted Urografin was injected into the hip joint.<strong></strong></p><p class="abstract"><strong>Results:</strong> Out of the 36 hips, closed reduction was successful in 33 hips (91.7%) and failed in 3 (8.3%). After the interpretation of the arthrogram we considered the reduction of 7 (21.2%) reduced hips nonconcentric because of the soft tissue obstacles. In the 7 hips with nonconcentric reduction besides the 3 hips with failed closed reduction, we proceeded to open reduction of the hip through medial approach. At the end of follow up, all hips (100%) showed concentric reduction without re-dislocation in any case.</p><p class="abstract"><strong>Conclusions:</strong> Hip arthrogram is a very reliable method in diagnosing hip concentricity and the presence of soft tissue obstacles in management of DDH by closed reduction. Arthrogram helps the operator to decide open reduction in such cases achieving excellent results in all cases.</p>

scholarly journals Learning Curves in Orthopaedic Surgery: A Case for Super-Specialisation?

2007 ◽  
Vol 89 (2) ◽  
pp. 143-146 ◽  
Author(s):  
NPM Jain ◽  
AJL Jowett ◽  
NMP Clarke
Keyword(s):  
Learning Curve ◽  
Avascular Necrosis ◽  
Closed Reduction ◽  
Open Reduction ◽  
Orthopaedic Surgery ◽  
Outcome Measure ◽  
Developmental Dysplasia ◽  
Learning Curves ◽  
Radiological Outcome ◽  
Dysplasia Of The Hip

INTRODUCTION The objective of this study was to assess if there is a significant learning curve in the treatment of developmental dysplasia of the hip. PATIENTS AND METHODS We followed up cases of developmental dysplasia of the hip treated by a single surgeon over a 12-year period. There were 96 cases, 56 treated by open reduction and 40 treated by closed reduction. Assessment was made of the incidence and degree of avascular necrosis in the treated hips, as a radiological outcome measure. RESULTS Plotting the cumulative percentage of satisfactory outcomes demonstrated an increasingly high percentage of satisfactory results with increasing number of procedures performed, i.e. as the surgeon progressed up the ‘learning curve’. CONCLUSIONS This study demonstrates a learning curve in the treatment of developmental dysplasia of the hip. It may be possible to draw parallels to other treatments, and also support for the growing trend to specialisation.

Surgical Outcomes of Developmental Dysplasia of the Hip With or Without Prior Failed Closed Reduction

2015 ◽  
Vol 35 (7) ◽  
pp. 703-707 ◽  
Author(s):  
Hao-Che Tang ◽  
Wei-Chun Lee ◽  
Hsuan-Kai Kao ◽  
Wen-E Yang ◽  
Chia-Hsieh Chang
Keyword(s):  
Surgical Outcomes ◽  
Closed Reduction ◽  
Developmental Dysplasia ◽  
Dysplasia Of The Hip

scholarly journals Prediction of the requirement of open reduction for developmental dysplasia of the hip

2017 ◽  
Vol 46 (1) ◽  
pp. 54-61 ◽  
Author(s):  
Nabil Alassaf
Keyword(s):  
Open Reduction ◽  
Area Under The Curve ◽  
Internal Validity ◽  
Developmental Dysplasia ◽  
Estimation Model ◽  
Cross Sectional ◽  
Noninvasive Treatment ◽  
Dysplasia Of The Hip ◽  
Logistic Regression Equation ◽  
Objective Tool

Objective Closed reduction (CR) is a noninvasive treatment for developmental dysplasia of the hip (DDH), and this treatment is confirmed intraoperatively. This study aimed to develop a preoperative estimation model of the probability of requiring open reduction (OR) for DDH. Methods The study design was cross-sectional by screening all patients younger than 2 years who had attempted CR between October 2012 and July 2016 by a single surgeon. Potential diagnostic determinants were sex, age, side, bilaterality, International Hip Dysplasia Institute (IHDI) grade, and acetabular index (AI). An intraoperative arthrogram was the reference standard. A logistic regression equation was built from a reduced model. Bootstrapping was performed for internal validity. Results A total of 164 hips in 104 patients who met the inclusion criteria were analysed. The prevalence of CR was 72.2%. Independent factors for OR were older age, higher IHDI grade, and lower AI. The probability of OR = 1/[1 + exp − (−2.753 + 0.112 × age (months) + 1.965 × IHDI grade III (0 or 1) + 3.515 × IHDI grade IV (0 or 1) − 0.058 × AI (degrees)]. The area under the curve was 0.79. Conclusion This equation is an objective tool that can be used to estimate the requirement for OR.

scholarly journals The potential role of the Alsberg angle as a predictor of lateral growth disturbance of the capital femoral epiphysis in children with developmental dysplasia of the hip treated by closed reduction

2020 ◽  
Vol 14 (2) ◽  
pp. 106-111 ◽  
Author(s):  
Ronghua Gui ◽  
Federico Canavese ◽  
Shuang Liu ◽  
Lianyong Li ◽  
Lijun Zhang ◽  
...  
Keyword(s):  
Closed Reduction ◽  
Normal Values ◽  
Developmental Dysplasia ◽  
Lateral Growth ◽  
Growth Disturbance ◽  
Level Of Evidence ◽  
Normal Children ◽  
One Year ◽  
Dysplasia Of The Hip

Purpose Early diagnosis and prevention of lateral growth disturbance of the capital femoral epiphysis is challenging after treatment for developmental dysplasia of the hip (DDH). The aim of the study was to evaluate the radiographic changes of the Alsberg angle (AA) in normal children and those with DDH, and to assess the role of AA as a potential predictor of lateral growth disturbance of the capital femoral epiphysis. Methods AA was measured on the anterior-posterior pelvic radiographs of 1000 normal children ranging in age from one to ten years and in 66 children (92 hips) with DDH treated by closed reduction (CR). A comparative analysis was performed. Results In the normal children, mean AA decreased linearly with age, from 76° at age one year to 65° at age ten years, irrespective of gender and laterality. In children with DDH, the average AA was 81.5°(sd 3.9°; 74° to 87°) prior to CR; it was 75.9° (sd 4.5°; 68° to 83°) in normal children of the same age (p < 0.001). Among the 42 children (64 hips) with successfully and uneventfully treated DDH, AA reached normal values between the ages of five and six years. In contrast, children with lateral growth disturbance of the proximal femur physis (24 children, 28 hips) showed significantly higher AA values in comparison with the age-matched controls. Conclusion In DDH patients with successful CR, AA could be expected to match normal values in children between the ages of five and six years. On the other hand, AA can be used as an early predictor for lateral growth disturbance of the capital femoral epiphysis. Level of Evidence Level III

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