scholarly journals Experiences of living with developmental dysplasia of the hip in adults not eligible for surgical treatment: a qualitative study

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e052486
Author(s):  
Martin Dan Jorgensen ◽  
Sarah Bournonville Frederiksen ◽  
Dorthe Sørensen ◽  
Julie Sandell Jacobsen
Keyword(s):  
Qualitative Study ◽  
Hip Osteoarthritis ◽  
Developmental Dysplasia ◽  
Point Of View ◽  
Joint Disease ◽  
Hip Preserving Surgery ◽  
Considerable Impact ◽  
Physical Limitations ◽  
And Coping ◽  
Dysplasia Of The Hip

ObjectivesAdults with developmental dysplasia of the hip face barriers in their everyday lives due to pain and physical limitations. In Denmark, some patients may not be eligible for hip-preserving surgery due to being overweight, hip osteoarthritis, age above 45 years, negative impingement test or not wishing to undergo surgery. These patients are left with no evidence-based treatment option. The patient perspective when not being eligible for surgery has not yet been investigated. This study aimed to explore the experiences of living with developmental dysplasia of the hip in adults not eligible for hip-preserving surgery.Design and participantsIn this qualitative study, we used a phenomenological–hermeneutic approach to explore the experiences of living with developmental dysplasia of the hip. We conducted semistructured interviews with 17 purposefully selected patients (median age 37 (range 19–50) years). The patients were recruited from a population of 30 patients included in a larger feasibility study evaluating a 6-month exercise and patient education intervention. We used a ricoeur-inspired method to analyse and interpret the interview data.ResultsThree themes were identified. First, developmental dysplasia of the hip is more than just a joint disease. Second, living with pain is difficult when pain has its own life. Third, limitations imposed by hip problems challenge the perception of oneself as young, active and independent. Identity, meaningfulness, control over pain and coping with pain were areas of the patients’ lives that were influenced.ConclusionLiving with developmental dysplasia of the hip had a considerable impact on the patients of this study and their everyday life in several areas. Therefore, it may be relevant to approach patients with developmental dysplasia of the hip from a biopsychosocial point of view. However, further research is required to obtain a better understanding of the experiences of living with developmental dysplasia of the hip.

scholarly journals Day-case pelvic osteotomy for developmental dysplasia of the hip

2020 ◽  
Vol 14 (6) ◽  
pp. 508-512
Author(s):  
Dave M. Moore ◽  
Gerard A. Sheridan ◽  
Paula M. Kelly ◽  
David P. Moore
Keyword(s):  
Pelvic Osteotomy ◽  
Models Of Care ◽  
Developmental Dysplasia ◽  
Point Of View ◽  
Day Case ◽  
Level Of Evidence ◽  
Patient Resources ◽  
Bed Days ◽  
Paediatric Orthopaedic ◽  
Dysplasia Of The Hip

Purpose: In this article we report the results of a pilot study analysing the implications of performing pelvic osteotomies for developmental dysplasia of the hip (DDH) as a day case. We assess the advantages of performing paediatric pelvic osteotomies as day-case procedures from a financial perspective and from an in-patient bed resource point of view. Methods: This was a prospective cohort study analysing Salter and Pemberton pelvic osteotomies performed for DDH over a three-year period from 1st January 2017 to 30th September 2019. All patients residing within 50 km of the hospital were eligible for day-case procedures. All other cases were performed as in-patients. A detailed financial costing analysis was performed and the in-patient resources utilized were documented and compared between the two models of care. Results: In total, 84 Salter and Pemberton osteotomies were performed between 1st January 2017 to 30th September 2019. Of these cases, 35 were performed as day-case procedures. A total reduction in 70 in-patient bed days was reported. Total costs for a single in-patient requiring two nights of admission amounted to €5,752, whereas the discharge cost of a day case was reported at €2,670. The savings made by our institution amounted to €3,082 per day case. A total saving of €102,696 was made over three years. In all, seven day-case patients re-attended due to inadequate pain control. They required overnight admission and were discharged uneventfully the following day. Conclusion: Day-case pelvic osteotomies significantly reduce the number of in-patient bed days used in an elective paediatric orthopaedic setting. Significant financial savings in excess of €3,000 per case are possible. The introduction of day-case pelvic osteotomy procedures can significantly improve the cost-effectiveness of managing DDH provided there are clear protocols in place with close clinical follow-up. Level of evidence: IV

scholarly journals Medium-term outcomes of total hip arthroplasty in juvenile patients

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Francesco Luceri ◽  
Ilaria Morelli ◽  
Carlo Maria Sinicato ◽  
Alberto Della Grazia ◽  
Fabio Verdoni ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Slipped Capital Femoral Epiphysis ◽  
Hip Osteoarthritis ◽  
Developmental Dysplasia ◽  
Harris Hip Score ◽  
Total Hip ◽  
Stage Juvenile ◽  
End Stage ◽  
Dysplasia Of The Hip

Abstract Background Juvenile hip osteoarthritis is often the end result of congenital conditions or acquired hip ailments occurred during the paediatric age. This study evaluated the middle term results of total hip arthroplasty for end-stage juvenile hip osteoarthritis. Materials and methods This is a retrospective analysis of prospectively collected data on a cohort of 10 consecutive patients (12 hips), aged between 14 and 20 at operation, who underwent cementless total hip arthroplasty for end-stage juvenile secondary hip osteoarthritis in two orthopaedic tertiary referral centres between 2009 and 2018. Results Juvenile hip osteoarthritis occurred as a consequence of developmental dysplasia of the hip, Legg-Calvé-Perthes disease, femoral head necrosis or slipped capital femoral epiphysis. All patients showed a significant improvement in Harris Hip Score (p < 0.01) at 3.3 years average follow-up (range 0.7–10.1 years). Conclusion The management of juvenile hip osteoarthritis following developmental dysplasia of the hip, Legg-Calvé-Perthes disease, femoral head necrosis or slipped capital femoral epiphysis is still challenging. Careful preoperative planning is essential to achieve good outcomes and improve the Harris Hip Score in these young patients. Total hip arthroplasty is a suitable option for end-stage secondary juvenile hip osteoarthritis, when proximal femoral osteotomies and conservative treatments fail to improve patients’ symptoms and quality of life. Level of evidence IV

scholarly journals Quantifying Dynamic Assessment of Developmental Dysplasia of the Hip

10.29007/zh41 ◽  
2018 ◽  
Author(s):  
Olivia Paserin ◽  
Niamul Quader ◽  
Kishore Mulpuri ◽  
Anthony Cooper ◽  
Emily Schaeffer ◽  
...  
Keyword(s):  
Femoral Head ◽  
Lateral Displacement ◽  
Dynamic Assessment ◽  
Early Adulthood ◽  
Developmental Dysplasia ◽  
Joint Disease ◽  
Qualitative Assessment ◽  
Congenital Deformities ◽  
Phase Symmetry ◽  
Dysplasia Of The Hip

Although physical and ultrasound (US)-based screening for congenital deformities of the hip (developmental dysplasia of the hip, or DDH) is routinely performed in most countries, one of the most commonly performed maneuvers done under ultrasound observation - dynamic assessment - has been shown to be relatively unreliable and is associated with significant misdiagnosis rates, on the order of 29%.Our overall research objective is to develop a quantitative method of assessing hip instability, which we hope will standardize diagnosis across different raters and health-centers, and may perhaps improve reliability of diagnosis. To quantify dynamic assessment, we propose to use the variability in femoral head coverage (FHC) measurements within multiple US scans collected during a dynamic assessment. In every US scan, we use our recently-developed automatic FHC measuring tool which leverages phase symmetry features to approximate vertical cortex of ilium and a random forest classifier to identify approximate location of the femoral head. Having estimated FHC in each scan, we estimate the change in FHC across all the US scans during a dynamic assessment and compare this change with variability of FHC found in previous studies.Our findings - in a dynamic assessment on an infant done by an orthopaedic surgeon, the femoral centre moved by up to 19% of its diameter during distraction, from 55% FHC to 74% FHC. This change in FHC is slightly greater than its variability in static US scans reported in previous studies, suggesting that the distraction force likely produced a real lateral displacement. Our clinician’s qualitative assessment concluded the hip to be normal as this degree of distraction was not indicative of instability. This suggests that our technique likely has sufficient resolution and repeatability to quantify differences in laxity between stable and unstable hips, although this presumption will have to be confirmed in a subsequent study with additional subjects. The long-term significance of this approach to evaluating dynamic assessments may lie in increasing early diagnostic sensitivity in order to prevent dysplasia remaining undetected prior to manifesting itself in early adulthood joint disease.

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