Ossification of the femoral head at closed reduction for developmental dysplasia of the hip and its influence on the long-term outcome

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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Residual hip dysplasia: is there a place for hip shelf operation?

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.12.180042 ◽

2018 ◽

Vol 12 (4) ◽

pp. 358-363 ◽

Cited By ~ 3

Author(s):

T. Terjesen

Keyword(s):

Periacetabular Osteotomy ◽

Developmental Dysplasia ◽

Hip Pain ◽

Older Children ◽

Long Term Effects ◽

Term Outcome ◽

Long Term Outcome ◽

Shelf Procedure ◽

Shelf Operation

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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Long-Term Outcome of Total Hip Replacement in Patients with or without Femoral Head Contamination

Journal of Orthopaedic Surgery ◽

10.1177/230949901101900331 ◽

2011 ◽

Vol 19 (3) ◽

pp. 395-395

Author(s):

Anoop C Dhamangaonkar ◽

Arvind B Goregaonkar

Keyword(s):

Femoral Head ◽

Total Hip Replacement ◽

Hip Replacement ◽

Term Outcome ◽

Long Term Outcome ◽

Total Hip

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Treatment of coxofemoral luxation in a mature Welsh pony by femoral head ostectomy: Long-term outcome

Equine Veterinary Education ◽

10.1111/eve.12602 ◽

2016 ◽

Vol 29 (10) ◽

pp. 528-533 ◽

Cited By ~ 1

Author(s):

I. B. François ◽

A. L. Thomas ◽

O. M. Lepage

Keyword(s):

Femoral Head ◽

Term Outcome ◽

Long Term Outcome

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Contact Pressure Distribution of the Hip Joint During Closed Reduction of Developmental Dysplasia of the Hip

10.21203/rs.3.rs-35268/v1 ◽

2020 ◽

Author(s):

Zhiqiang Zhang ◽

Hai Li ◽

Dashan Sui ◽

Haiyi Qin ◽

Ziming Zhang

Keyword(s):

Finite Element ◽

Femoral Head ◽

Avascular Necrosis ◽

Contact Pressure ◽

Closed Reduction ◽

Treatment Success ◽

Developmental Dysplasia ◽

Abduction Angle ◽

Lateral Part ◽

Dysplasia Of The Hip

Abstract Background: Developmental dysplasia of the hip (DDH) is the most common deformity of the lower extremity in children, and the etiology remains unclear. The biomechanical change during closed reduction (CR) focused on cartilage contact pressure (CCP) has not been studied. Thereby, we try to provide insight into biomechanical factors potentially responsible for CR treatment success and complications by using finite element analysis (FEA) for the first time.Methods: Finite element models of one patient with DDH were established based on the data of MRI scan on which cartilage contact pressure was measured. During CR, CCP between the femoral head and acetabulum in different abduction and flexion angles were tested to estimate the efficacy and potential risk factors of avascular necrosis (AVN) following CR.Results: A 3D reconstruction by the FEA method was performed on a sixteen-month-old girl with DDH on the right side. The acetabulum of the involved side showed a long, narrow, and "plate-shaped" deformity, whereas the femoral head was smaller and irregular compared with the contralateral side. With increased abduction angle, the stress of the posterior acetabulum increased significantly, and the stress on the lateral part of the femoral head increased as well. The changes of CCP in the superior acetabulum were not apparent during CR. There were no detectable differences in terms of pressure on the femoral head.Conclusions: Severe dislocation (IHDI grade III and IV) in children showed a high mismatch between the femoral head and acetabulum. Increased abduction angle corresponded with high contact pressure, which might relate to avascular necrosis, whereas increased flexion angle was not. Enhanced pressure on the lateral part of the femoral head might increase the risk of AVN.

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Timing For Closed Reduction of Developmental Dysplasia of the Hip and Failure Analysis

10.21203/rs.3.rs-37192/v1 ◽

2020 ◽

Author(s):

Zhiqiang Zhang ◽

Hao Li ◽

Hai Li ◽

Ziming Zhang

Keyword(s):

Risk Factors ◽

Roc Curve ◽

Closed Reduction ◽

Age Groups ◽

Developmental Dysplasia ◽

Operating Characteristics ◽

Roc Curve Analysis ◽

Term Outcome ◽

Group I ◽

Dysplasia Of The Hip

Abstract BackgroundIt remains controversial whether the older age at closed reduction (CR) of developmental dysplasia of the hip (DDH), the higher incidence of complications.The aim of this study is to evaluate theMid-term outcome of CR for DDHamongdifference age groups, and to analyze and identify risk factors for the failure of this procedure. Methods Clinical data of DDH patients, who received CR, were retrospectively reviewed. Hips were divided into three groups according to initial age (Group I: <12 months; Group II: 12 months to ≤18 months; Group III: >18 months). The presence of avascular necrosis (AVN),residual acetabular dysplasia (RAD), re-dislocation, further surgeries (FS)and failure of CR were observed. The risk factors were identified for those outcomes abovementioned. Receiver operating characteristics (ROC) curve analysis based on age, pre-op AI and post-op AI for failure was conducted.ResultsA total of 107 patients (156 hips) undergoing CR wereevaluated with a median age at initial reduction of 13.0 months(range, 4 to 28 mo). The incidence of AVN, RADand re-dislocationwas 15.4% (24/156), 17.3% (27/156) and 14.7% (23/156). For AVN, RAD and re-dislocation, the risk factors were pre-op IHDI IV(p=0.033), age≥18 months (p=0.012), and pre-op IHDI IV and walking (p=0.004 and p=0.011), respectively. The areas under the ROC curve of failure were 0.841 (post-op AI), 0.688 (pre-op AI)and 0.650 (age).ConclusionsRAD is a complication that must be carefully considered for severepatients older than 18 months before CR. Re-dislocation is associated with pre-op IHDI IV and walking.Patients, who are older than 12.5 months or have a pre-op AI of 38.7° or a post-op AI of 26.4°, are more likely fail of CR.

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Does the vascular development of the femoral head correlate with the incidence of avascular necrosis of the proximal femoral epiphysis in children with developmental dysplasia of the hip treated by closed reduction?

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.15.210059 ◽

2021 ◽

pp. 1-7

Author(s):

JianPing Wu ◽

Zhe Yuan ◽

JingChun Li ◽

MingWei Zhu ◽

Federico Canavese ◽

...

Keyword(s):

Femoral Head ◽

Avascular Necrosis ◽

Closed Reduction ◽

Vascular Development ◽

Contralateral Side ◽

Developmental Dysplasia ◽

Level Of Evidence ◽

Class B ◽

Class C ◽

Dysplasia Of The Hip

Purpose The purpose of this study was to identify the correlation between the vascular development of the femoral head and avascular necrosis (AVN) in patients with developmental dysplasia of the hip (DDH) treated by closed reduction (CR). Methods We retrospectively reviewed 78 patients with DDH treated by CR (83 hips). The vascular maturity, number of vessels and perfusion changes of the femoral head were assessed on perfusion MRI (pMRI) before and after CR. Results The number of vessels (mean 4.2 sd 1.4) of the femoral head and the ratio (36.1%) of mature vessels (type III) on the dislocated side were significantly less than those at contralateral side (mean 6.0 sd 1.2; 82.2%) (p < 0.001). Of the included 83 hips, 39 hips (61.5%) showed decreased perfusion of the femoral head, including partial decreased (Class B, 47.0%) and global decreased (Class C, 14.5%), at the dislocated side, which was significantly more than those at contralateral side (0.0%) (p < 0.001). In total, 32 out of 83 hips (38.5%) developed AVN. The rate of AVN with Class A (18.8%) which perfusion of the femoral head was normal (unchanged or enhanced) was significantly less than those with Class C (66.7%) (p = 0.006). Conclusion The vascular development and perfusion changes of the femoral head on the dislocated side are significantly worse than those at contralateral side. Immature vascularity of the femoral head before CR and poor perfusion of the femoral head after CR may be risk factors for AVN in patients with DDH. Level of evidence III

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