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

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

Journal of Pediatric Orthopaedics B ◽

10.1097/bpb.0b013e32832fc8ca ◽

2010 ◽

Vol 19 (1) ◽

pp. 22-26 ◽

Cited By ~ 16

Author(s):

Stephen J. Cooke ◽

Robin Rees ◽

Dai L. Edwards ◽

Nigel T. Kiely ◽

Gwyn A. Evans

Keyword(s):

Femoral Head ◽

Closed Reduction ◽

Developmental Dysplasia ◽

Term Outcome ◽

Long Term Outcome ◽

Dysplasia Of The Hip

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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 Infantile Gratification Phenomena

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100014396 ◽

2013 ◽

Vol 40 (3) ◽

pp. 416-419 ◽

Cited By ~ 5

Author(s):

Mohammed M. Jan ◽

Mohammed H. Al Banji ◽

Baraa A. Fallatah

Keyword(s):

Attack Frequency ◽

Gradual Reduction ◽

Term Outcome ◽

Long Term Outcome ◽

Developmental Abnormalities ◽

Younger Age ◽

Long Term Follow Up ◽

Attention Deficit Hyperactivity Disorders

Background:Infantile gratification phenomena are self-stimulatory behaviors that are often misdiagnosed as epilepsy. Although the prognosis is thought to be benign, limited long-term follow-up studies exist. This was the objective of our study in addition to exploring the risks of future developmental, behavioral, or neurological abnormalities.Methods:Series of consecutive infants with gratification phenomena were identified both retrospectively and prospectively over an eight year period from a single pediatric neurology service. The diagnosis was based on descriptive history, review of videotaped events, lack of neurological or developmental abnormalities, and normal routine electroencephalogram.Results:Nineteen infants were followed for 3-11 years (mean 7.1). Their ages ranged between 4-13 months (mean 7) with 79% females. The diagnosis was not reached by the referring physician and 74% were misdiagnosed as epilepsy or movement disorder. The episodes recurred with variable frequency with gradual reduction in number and increase in length of attack-free periods with advancing age. Complete remission was noted in all patients by age 1-3 years (mean 1.9). However, 4 children (21%) developed features of attention deficit hyperactivity disorders (ADHD) on long-term follow up. In this group, the gratification phenomena appeared at a younger age with higher attack frequency.Conclusions:Gratification phenomena in infants are benign and self-limited, often spontaneously disappearing by two years of age. A correlation with future ADHD was found; however, larger prospective studies are needed to further examine this possible association.

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

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-013-1793-7 ◽

2013 ◽

Vol 133 (9) ◽

pp. 1203-1209 ◽

Cited By ~ 10

Author(s):

Atilla Çıtlak ◽

Sertaç Saruhan ◽

Celal Baki

Keyword(s):

Open Reduction ◽

Developmental Dysplasia ◽

Term Outcome ◽

Long Term Outcome ◽

Developmental Dysplasia Of Hip ◽

Medial Open Reduction

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Chronic benzodiazepine use in general practice patients with depression: An evaluation of controlled treatment and taper-off

The British Journal of Psychiatry ◽

10.1192/bjp.178.4.317 ◽

2001 ◽

Vol 178 (4) ◽

pp. 317-324 ◽

Cited By ~ 56

Author(s):

Frans G. Zitman ◽

Jaap E. Couvée

Keyword(s):

Gradual Reduction ◽

Term Outcome ◽

Long Term Outcome ◽

Therapeutic Value ◽

Controlled Treatment ◽

Benzodiazepine Use ◽

Benzodiazepine Withdrawal ◽

Ssri Treatment

BackgroundMany patients with depression take benzodiazepine drugs long term despite the absence of continuing therapeutic value.AimsTo evaluate a treatment programme involving gradual discontinuation with or without simultaneous selective serotonin reuptake inhibitor (SSRI) prescribing and to determine the long-term outcome after benzodiazepine withdrawal.MethodPatients went through three phases – change to an equivalent dose of diazepam; subsequent randomisation to either 20 mg of paroxetine or placebo; and gradual reduction of diazepam in depression-free patients – with a follow-up after 2 or 3 years.ResultsA total of 230 patients were recruited and 75% in the paroxetine group and 61% in the placebo group were successfully treated after 6 weeks (P=0.067). After 2 or 3 years 13% of patients were still benzodiazepine free: 26% of those who had successfully tapered off benzodiazepine and 6% of the total group.ConclusionsTransfer to diazepam followed by gradual withdrawal is an effective way of discontinuing chronic benzodiazepine use. The addition of SSRI treatment is of limited value.

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