Age as a predictor of additional surgeries following initial closed reduction for children with developmental dysplasia of the hip: the 10-year experience of a national paediatric orthopaedic unit

2021 ◽  
pp. 112070002110620
Author(s):  
Robert J Hurley ◽  
Martin S Davey ◽  
Matthew G Davey ◽  
Patrick Groarke ◽  
Jim Kennedy ◽  
...  
Keyword(s):  
Closed Reduction ◽  
Surgical Intervention ◽  
Neuromuscular Disorders ◽  
Multivariable Analysis ◽  
Significant Proportion ◽  
Female Gender ◽  
Developmental Dysplasia ◽  
Operative Intervention ◽  
Paediatric Orthopaedic ◽  
Dysplasia Of The Hip

Background and purpose: Dislocated and unstable hip joints which do not stabilize in an orthosis in the neonatal period require operative intervention to achieve a stable concentric joint. The aim of this study is to assess the requirement for further operative intervention in patients who have undergone successful closed reduction to treat developmental dysplasia of the hip (DDH). Methods: We identified all patients who had undergone closed reduction of an unstable hip joint at our institution within 10 years, with further identification of patients who underwent a second procedure. We used logistic regression to evaluate correlation between age at closed reduction and the probability of secondary procedures. Results: A total of 694 patients (84.5% females) who underwent a closed reduction in the study period were identified. 235 were excluded (patients with underlying genetic conditions, neuromuscular disorders, syndromic disorders). 250 patients had closed reductions only. 209 patients (45.5%) had at least 1 secondary procedure after their initial closed reduction. In multivariable analysis, female gender (OR 0.310; 95% CI, 0.108–0.885; p = 0.029) and patients aged ⩽12 months at the time of first surgery (OR 0.055; 95% CI, 0.007–0.423; p = 0.005) independently predicted being less likely to require a second surgery for their DDH. Discussion: In conclusion, we found that a significant proportion of children (45.5%) who underwent closed reduction of a dislocated hip required additional surgical intervention in early childhood. Our data show that those children who undergo later closed reduction of a dislocated hip in DDH after 12 months of age, and male infants, have a significantly higher incidence of additional surgical intervention.

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

Outcomes of closed reduction in patients with developmental dysplasia of the hip incorporating open psoas and adductor release and using short leg cast

2021 ◽  
Vol 15 (5) ◽  
pp. 1529-1532
Author(s):  
M. S. Abdulqader ◽  
L. J. Khorsheed ◽  
Hwaizi .
Keyword(s):  
Soft Tissue ◽  
Closed Reduction ◽  
Case Series ◽  
Developmental Dysplasia ◽  
Soft Tissue Release ◽  
Plaster Of Paris ◽  
Dysplasia Of The Hip ◽  
Mid Term Results ◽  
Tönnis Grade

Background and objectives: Closed reduction and short leg spica casting are the preferred treatment options for children with developmental dysplasia of the hip. This study aimed to show the efficacy behind a standardized closed reduction for managing patients with developmental dysplasia of the hip with concomitant soft tissue releases when indicated and using a short leg plaster of Paris cast to maintain reduction and reporting mid-term results. Methods: A case series of 95 hips in 84 children aged 6-18 months who had closed reduction, with five years follow up or until next operation, involved in this study. The protocol defines acceptable concentric reduction criteria and the indications for an associated soft tissue release. All the patients were immobilized in a short leg cast for three months. Multiple follow-up radiographs were taken to assess Tönnis grade, Severin grade, acetabular index, and osteonecrosis signs. Results: A total of 48 hips were Tönnis grade 3/4 hips. At one year, 15 reductions couldn’t be maintained, and these patients needed open reduction. Of these 15 failed reductions, 7 patients were Severin 1; others were Severin 2. Of the 80 successful closed reductions, 70 hips were Severin 1. Surgical management for residual dysplasia was offered for 8 hips. Osteonecrosis was seen in 23 hips but was transient in 20. Bilateral hip dislocations and most Tönnis 4 hips were more likely to fail. Two children had severe osteonecrosis. Conclusions: Closed reduction, with subsequent adductor and psoas releases, when indicated and using a short leg plaster of Paris cast for three months, brings about good mid-term results in children with developmental dysplasia of the hip aged 6-18 months. Keywords: Developmental dysplasia of the hip, closed hip reduction, open psoas release, short leg cast.

scholarly journals Closed Reduction for Developmental Dysplasia of the Hip

2019 ◽  
Vol 39 (3) ◽  
pp. 111-118 ◽  
Author(s):  
Wudbhav N. Sankar ◽  
Alex L. Gornitzky ◽  
Nicholas M.P. Clarke ◽  
José A. Herrera-Soto ◽  
Simon P. Kelley ◽  
...  
Keyword(s):  
Closed Reduction ◽  
Developmental Dysplasia ◽  
Dysplasia Of The Hip

The ‘clicky hip’

2018 ◽  
Vol 100-B (9) ◽  
pp. 1249-1252 ◽  
Author(s):  
S. Humphry ◽  
D. Thompson ◽  
N. Price ◽  
P. R. Williams
Keyword(s):  
Service Provision ◽  
Closed Reduction ◽  
Developmental Dysplasia ◽  
Ultrasound Screening ◽  
Ultrasound Scan ◽  
Type Iv ◽  
Referral Practices ◽  
Adductor Tenotomy ◽  
The Mean ◽  
Dysplasia Of The Hip

Aims The significance of the ‘clicky hip’ in neonatal and infant examination remains controversial with recent conflicting papers reigniting the debate. We aimed to quantify rates of developmental dysplasia of the hip (DDH) in babies referred with ‘clicky hips’ to our dedicated DDH clinic. Patients and Methods A three-year prospective cohort study was undertaken between 2014 and 2016 assessing the diagnosis and treatment outcomes of all children referred specifically with ‘clicky hips’ as the primary reason for referral to our dedicated DDH clinic. Depending on their age, they were all imaged with either ultrasound scan or radiographs. Results There were 69 ‘clicky hip’ referrals over the three-year period. This represented 26.9% of the total 257 referrals received in that time. The mean age at presentation was 13.6 weeks (1 to 84). A total of 19 children (28%) referred as ‘clicky hips’ were noted to have hip abnormalities on ultrasound scan, including 15 with Graf Type II hips (7 bilateral), one Graf Type III hip, and three Graf Type IV hips. Of these, ten children were treated with a Pavlik harness, with two requiring subsequent closed reduction in theatre; one child was treated primarily with a closed reduction and adductor tenotomy. In total, 11 (15.9%) of the 69 ‘clicky hip’ referrals required intervention with either harness or surgery. Conclusion Our study provides further evidence that the ‘clicky hip’ referral can represent an underlying diagnosis of DDH and should, in our opinion, always lead to further clinical and radiological assessment. In the absence of universal ultrasound screening, we would encourage individual units to carefully assess their own outcomes and protocols for ‘clicky hip’ referrals and tailor ongoing service provision to local populations and local referral practices. Cite this article: Bone Joint J 2018;100-B:1249–52.

The Continuing Development of Vibration Arthrometry as a Screening Method in Developmental Dysplasia of the Hip

1994 ◽  
Vol 4 (1) ◽  
pp. 41-49
Author(s):  
W. G. Kernohan ◽  
B. Trainor ◽  
P. Haugh ◽  
A. Johnston ◽  
I. Turner ◽  
...  
Keyword(s):  
Screening Method ◽  
Clinical Signs ◽  
Developmental Dysplasia ◽  
Non Invasive ◽  
Experienced Nurse ◽  
Diagnostic Modalities ◽  
Paediatric Orthopaedic ◽  
Further Development ◽  
Dysplasia Of The Hip ◽  
Vibration Arthrometry

As part of the continuing development of a non-invasive, objective screening method to achieve efficient early detection of developmental dysplasia of the hip (DDH), we determined the diagnostic sensitivity of an experienced nurse examiner and vibration arthrometry in the range of pathological anatomy of the disease. A cohort of 25 children were studied prior to commencement of their treatment. The hips were classified into four categories by an experienced paediatric orthopaedic surgeon with all diagnostic modalities available (“normal”, “stable but dysplastic”, “unstable and reducible” or “irreducible”). Of the 28 hips identified as abnormal, two hips were classified as stabledysplastic, 11 were unstable/reducible and 15 were irreducible hips. The experienced nurse examiner identified eight out of 11 unstable-reducible hips and reported clinical signs of abnormality in another 18 cases. Vibration arthrometry identified nine out of 11 unstable-reducible dislocations and detected abnormal signals from three irreducible hips. Vibration arthrometry may be of value in detecting abnormality in unstable-reducible and clicking hips. The low detection rate in the irreducible and dysplastic hips by vibration arthrometry was due to the absence of detectable vibration from mechanical events as the hips were manoeuvred. Examination by an experienced clinical examiner continues to be necessary if all degrees of mechanical abnormality in DDH are to be detected. Further development is required to achieve an objective non-invasive system of detecting all stages in the pathology of DDH.

scholarly journals Biomechanical evaluation of femoral anteversion in developmental dysplasia of the hip and potential implications for closed reduction

2020 ◽  
Vol 72 ◽  
pp. 179-185
Author(s):  
Victor Huayamave ◽  
Blake Lozinski ◽  
Christopher Rose ◽  
Hessein Ali ◽  
Alain Kassab ◽  
...  
Keyword(s):  
Closed Reduction ◽  
Femoral Anteversion ◽  
Developmental Dysplasia ◽  
Biomechanical Evaluation ◽  
Dysplasia Of The Hip

Soft-tissue interposition after closed reduction in developmental dysplasia of the hip

1999 ◽  
Vol 81-B (3) ◽  
pp. 385-391 ◽  
Author(s):  
T. Hattori ◽  
Y. Ono ◽  
T. Kitakoji ◽  
S. Takashi ◽  
H. Iwata
Keyword(s):  
Soft Tissue ◽  
Closed Reduction ◽  
Developmental Dysplasia ◽  
Dysplasia Of The Hip
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