A New Radiographic Classification System for Developmental Hip Dysplasia Is Reliable and Predictive of Successful Closed Reduction and Late Pelvic Osteotomy

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Kumar A. Singh ◽  
Dhiren Ganjwala ◽  
Hitesh Shah
Keyword(s):  
Classification System ◽  
Closed Reduction ◽  
Hip Dysplasia ◽  
Pelvic Osteotomy ◽  
Developmental Hip Dysplasia ◽  
Radiographic Classification

scholarly journals Management of late-detected DDH in children under three years of age

2020 ◽  
Vol 1 (4) ◽  
pp. 55-63
Author(s):  
Terje Terjesen ◽  
Joachim Horn
Keyword(s):  
Closed Reduction ◽  
Hip Dysplasia ◽  
Skeletal Maturity ◽  
Pelvic Osteotomy ◽  
Radiological Outcome ◽  
Femoral Head Coverage ◽  
Spontaneous Improvement ◽  
Skin Traction ◽  
Dislocation Of The Hip

Aims When the present study was initiated, we changed the treatment for late-detected developmental dislocation of the hip (DDH) from several weeks of skin traction to markedly shorter traction time. The aim of this prospective study was to evaluate this change, with special emphasis on the rate of stable closed reduction according to patient age, the development of the acetabulum, and the outcome at skeletal maturity. Methods From 1996 to 2005, 49 children (52 hips) were treated for late-detected DDH. Their mean age was 13.3 months (3 to 33) at reduction. Prereduction skin traction was used for a mean of 11 days (0 to 27). Gentle closed reduction under general anaesthesia was attempted in all the hips. Concurrent pelvic osteotomy was not performed. The hips were evaluated at one, three and five years after reduction, at age eight to ten years, and at skeletal maturity. Mean age at the last follow-up was 15.7 years (13 to 21). Results Stable closed reduction was obtained in 36 hips (69%). Open reduction was more often necessary in patients ≥ 18 months of age at reduction (50%) compared with those under 18 months (24%). Residual hip dysplasia/subluxation occurred in 12 hips and was significantly associated with avascular necrosis (AVN) and with high acetabular index and low femoral head coverage the first years after reduction. Further surgery, mostly pelvic and femoral osteotomies to correct subluxation, was performed in eight hips (15%). The radiological outcome at skeletal maturity was satisfactory (Severin grades 1 or 2) in 43 hips (83%). Conclusions Gentle closed reduction can be attempted in children up to three years of age, but is likely to be less successful in children aged over 18 months. There is a marked trend to spontaneous improvement of the acetabulum after reduction, even in patients aged over 18 months and therefore simultaneous pelvic osteotomy is not always necessary.

scholarly journals Chiari pelvic osteotomy in treatment of hip dysplasia

2013 ◽  
Vol 141 (9-10) ◽  
pp. 710-714 ◽  
Author(s):  
Nemanja Slavkovic ◽  
Zoran Vukasinovic ◽  
Milan Apostolovic ◽  
Boris Vukomanovic
Keyword(s):  
Femoral Head ◽  
Distal Part ◽  
Hip Dysplasia ◽  
Young Patients ◽  
Pelvic Osteotomy ◽  
Femoral Head Coverage ◽  
Developmental Hip Dysplasia ◽  
Chiari Osteotomy ◽  
Chiari Pelvic Osteotomy

Chiari pelvic osteotomy is a surgical procedure having been performed for almost sixty years in patients with the insuffcient coverage of the femoral head. It is most frequently used in young patients with dysplastic acetabular sockets as a part of developmental hip dysplasia. Even though performance of the Chiari osteotomy is associated with positive therapeutical results, above all, its main goal is to delay inevitable degenerative changes. Original surgical technique has been modified and improved over time. Nevertheless, the basic idea has remained unchanged - increasing of the femoral head coverage by medial displacement of the distal part of the pelvis along with capsular interpositioning. Given the complexity of operation, the complication percentage is rather low. Chiari pelvic osteotomy has lost its actuality and importance during this past six decades. The role of Chiari pelvic osteotomy has been considerably taken over by other more efficient and more lasting surgical procedures. Nonetheless, Chiari pelvic osteotomy is still present in modern orthopedic practice, above all as ?salvage? osteotomy.

scholarly journals The Ilizarov technology for closed reduction of hip dislocation in children with developmental hip dysplasia

2021 ◽  
Vol 27 (3) ◽  
pp. 345-350
Author(s):  
M.P. Teplenky ◽  
◽  
E.V. Oleinikov ◽  
V.S. Bunov ◽  
◽  
...  
Keyword(s):  
Closed Reduction ◽  
Functional Outcomes ◽  
Hip Dysplasia ◽  
Hip Dislocation ◽  
Treatment Method ◽  
Long Term Results ◽  
Aseptic Necrosis ◽  
Developmental Hip Dysplasia

Introduction The possibility of gradual closed reduction of hip dislocation in children over 1.5 years old is considered doubtful. Purpose Analysis of long-term results of applying the Ilizarov technique of gradual closed reduction in combination with the reconstruction of the hip joint components. Methods The outcomes of treatment of 62 children (81 joints) with congenital hip dislocation in the follow-up period from 5 to 16 years were studied. The treatment method included closed reduction of the dislocation using the technology proposed by G.A. Ilizarov and subsequent reconstruction of the joint components. The patients are divided into two groups based on their age. The first group included 33 patients (43 joints) under the age of 5 years. The second group consisted of 29 patients (38 joints) aged 5–8 years. Results Closed reduction failed in five cases. The recurrence of dislocation after closed reduction was 5.3 %. The rate of aseptic necrosis after closed reduction was 9.7 %. Good functional outcomes were reported in 87.7 %. They were significantly better in the younger group. The proportion of good anatomical results did not depend on age and was 77 % in general. Poor results were obtained in 8.8 %. Conclusion The anatomical and functional outcomes and the number of complications by using the technique described were comparable to other methods of gradual closed reduction of hip dislocation. But the technique we have described expands the age restrictions for its use.

Dega transiliac pelvic osteotomy for developmental hip dysplasia

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Lukasz Wozniak ◽  
Maciej Idzior ◽  
Marek Jozwiak
Keyword(s):  
Hip Dysplasia ◽  
Pelvic Osteotomy ◽  
Developmental Hip Dysplasia

scholarly journals Management of late-detected DDH in children under three years of age

2020 ◽  
Vol 1 (4) ◽  
pp. 55-63 ◽  
Author(s):  
Terje Terjesen ◽  
Joachim Horn
Keyword(s):  
Closed Reduction ◽  
Hip Dysplasia ◽  
Skeletal Maturity ◽  
Pelvic Osteotomy ◽  
Radiological Outcome ◽  
Femoral Head Coverage ◽  
Spontaneous Improvement ◽  
Skin Traction ◽  
Dislocation Of The Hip

Aims When the present study was initiated, we changed the treatment for late-detected developmental dislocation of the hip (DDH) from several weeks of skin traction to markedly shorter traction time. The aim of this prospective study was to evaluate this change, with special emphasis on the rate of stable closed reduction according to patient age, the development of the acetabulum, and the outcome at skeletal maturity. Methods From 1996 to 2005, 49 children (52 hips) were treated for late-detected DDH. Their mean age was 13.3 months (3 to 33) at reduction. Prereduction skin traction was used for a mean of 11 days (0 to 27). Gentle closed reduction under general anaesthesia was attempted in all the hips. Concurrent pelvic osteotomy was not performed. The hips were evaluated at one, three and five years after reduction, at age eight to ten years, and at skeletal maturity. Mean age at the last follow-up was 15.7 years (13 to 21). Results Stable closed reduction was obtained in 36 hips (69%). Open reduction was more often necessary in patients ≥ 18 months of age at reduction (50%) compared with those under 18 months (24%). Residual hip dysplasia/subluxation occurred in 12 hips and was significantly associated with avascular necrosis (AVN) and with high acetabular index and low femoral head coverage the first years after reduction. Further surgery, mostly pelvic and femoral osteotomies to correct subluxation, was performed in eight hips (15%). The radiological outcome at skeletal maturity was satisfactory (Severin grades 1 or 2) in 43 hips (83%). Conclusions Gentle closed reduction can be attempted in children up to three years of age, but is likely to be less successful in children aged over 18 months. There is a marked trend to spontaneous improvement of the acetabulum after reduction, even in patients aged over 18 months and therefore simultaneous pelvic osteotomy is not always necessary.

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