The path to minimizing instability in developmental dysplasia of the hip: is Capsulorrhaphy a necessity or a futile habit?

Abstract Background To evaluate and quantify the intraoperative effect of capsulorrhaphy on the deep seating of femoral head within the acetabulum as measured by medial joint space, a surrogate measure of acetabular-head contact. Methods In order to determine the exact effect of capsulorrhaphy, we prospectively scrutinized a consecutive sample of 18 patients with unilateral dysplastic hips aging > 18 months and followed them for a period of at least 12 months. The procedure of open reduction is described in detail. Two pediatric orthopedists carried out the operations from August 2014 to January 2019 at a tertiary pediatric hospital. Intraoperatively, AP radiographs of the pelvis were obtained before and after capsulorrhaphy. The distance between the inferomedial edge of the proximal femoral metaphysis and the lateral edge of the obturator foramen was recorded. To determine if there were differences in medial joint space due to capsulorrhaphy, a generalized linear model was run on the study sample. All patients were followed for at least 12 months to determine the rate of re-dislocation. Results Mean age (±standard deviation) of the participants was 37.5 (±24.7) months. All cases underwent Salter osteotomy, 5 cases needed femoral shortening (27.8%) and none needed derotational osteotomy. Capsulorrhaphy lead to a statistically significant decrease in the mean medial joint space from 1.59 cm before (95% CI: 1.12–2.05) to 0.76 cm after (95% CI: 0.50–1.02) the capsulorrhaphy (P < 0.001). When we took the effect of age into account the corresponding figures were 1.47 (95% CI: 1.22–1.75) and 0.67 (95% CI: 0.39–0.94), respectively (P < 0.001). After follow up periods of 1 to 5.5 years, none of the patients experienced instability or re-dislocation. Conclusions Capsulorrhaphy, independently, of age was associated with a 1-cm decrease in the mean medial hip joint space and a more deeply seated femoral head. Furthermore, this study presents a successful experience with capsulorrhaphy to prevent hip instability.

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A Newly Modified Salter Osteotomy Technique for Treatment of Developmental Dysplasia of Hip That Is Associated with Decrease in Pressure on Femoral Head and Triradiate Cartilage

BioMed Research International ◽

10.1155/2019/6021271 ◽

2019 ◽

Vol 2019 ◽

pp. 1-9

Author(s):

Seyed Mokhtar Esmaeilnejad-Ganji ◽

Seyed Mohammad Reza Esmaeilnejad-Ganji ◽

Mohammad Zamani ◽

Hesam Alitaleshi

Keyword(s):

Femoral Head ◽

Developmental Dysplasia ◽

Developmental Dysplasia Of Hip ◽

Center Edge ◽

Salter Osteotomy ◽

Innominate Osteotomy ◽

Femoral Shortening ◽

Osteotomy Technique ◽

The Mean

Background and Purpose. The Salter innominate osteotomy has been an effective method to treat the developmental dysplasia of hip (DDH) over the past decades; however, several postoperative complications and deficiencies were reported. In this study, we evaluated outcome of a newly modified Salter osteotomy in patients presenting with DDH. Methods. We reviewed retrospectively 76 patients (90 hips) with DDH aged ≥ 18 months, who underwent open reduction and a modified osteotomy by a single surgeon. The distal osteotomy segment of pelvis was shifted anterolaterally in the amount of osteotomy cross-section, but not downwards. The mean age at surgery was 2 years and 11 months (1.5 to 16 years). Femoral shortening was conducted when necessary. The duration of operation varied between 60 and 90 minutes. The mean follow-up was 4 years and one month (range 15 months to 7 years and 9 months). All patients were followed up both clinically (based on the modified MacKay criteria) and radiologically (based on the modified Severin criteria). Results. Clinically, 94.5% of hips had excellent and good results at final follow-up, and only 5.5% had a fair condition. Radiographically, at the final follow-up 77.8% of hips were grade IA (excellent), 12.2% were grade IB, 6.7% were grade II, and 3.3% were grade III (fair). The preoperative mean acetabular index was 47.85° (41° to 59), which decreased to 17.16° (13° to 22°) immediately after the surgery (p<0.0001) and progressed to 11.24° (7° to 19°) at the final follow-up (p<0.0001). The mean initial postoperative center-edge angle was 30.3° (25° to 42°) significantly improved to 39.1 (31° to 56°) at the final follow-up (p<0.0001). Avascular necrosis of femoral head occurred in 4.4% of hips (4 patients). Conclusion. The results show that our modified Salter osteotomy is safe and associated with significant benefit for the management of patients suffering from DDH.

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The effect of femoral shortening in the treatment of developmental dysplasia of the hip after walking age

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.13.190029 ◽

2019 ◽

Vol 13 (4) ◽

pp. 371-376

Author(s):

P. Castañeda ◽

L. Moscona ◽

K. Masrouha

Keyword(s):

Femoral Head ◽

Developmental Dysplasia ◽

Level Of Evidence ◽

High Tension ◽

Femoral Shortening ◽

Data Collection Instrument ◽

Hip Reduction ◽

Walking Age ◽

The Mean ◽

Dysplasia Of The Hip

Purpose The optimal treatment for late-presenting developmental dysplasia of the hip (DDH) is controversial. High tension forces after hip reduction increase the pressure on the femoral head, potentially causing avascular necrosis. Femoral shortening (FS) is commonly used as a means to decrease the pressure on the femoral head. We examined the effect of FS on the outcomes of patients with late-presenting DDH. Methods A total of 645 hips of a late-presenting DDH cohort treated with open reduction and iliac osteotomies were retrospectively reviewed; 328 hips had a FS performed (FS+) and 317 (FS-) had not. The mean age was 3.9 years (sd 1.55). We classified the hips with the Tönnis and International Hip Dysplasia Institute (IHDI) methods; and the Pediatric Outcomes Data Collection Instrument (PODCI), Iowa Hip Score (IHS) and Severin classification as outcome measurements. Results The FS- group had higher scores in PODCI (median 95 points; interquartile range (IQR) 78 to 91) and IHS (median 91 points; IQR 64 to 88) than the FS+ group (PODCI: median 94 points; IQR 69 to 89 points; IHS: median 89 points; IQR 62 to 87). The mean Severin scores were similar (FS- 2.65; FS+ 2.5; p = 0.93) but the FS– group had higher rates of good and excellent outcomes (FS- 56%; FS+ 41%; p < 0.00001) and lesser dislocation rates (FS- 6%; FS+ 14%; p = 0.16). Conclusion Although FS should be used when a hip cannot be reduced without undue tension, our results indicate that this procedure is not necessarily related to a better outcome. Level of evidence: Therapeutic, Level III.

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Radiological Measurement of Femoral Head Position in Legg-Calvé-Perthes Disease

Acta Radiologica ◽

10.1177/02841851960373p285 ◽

1996 ◽

Vol 37 (3P2) ◽

pp. 863-869 ◽

Cited By ~ 1

Author(s):

C. Kaniklides ◽

P. Dimopoulos

Keyword(s):

Femoral Head ◽

Normal Values ◽

Lateral Displacement ◽

Weight Bearing ◽

Joint Space ◽

Perthes Disease ◽

Radiological Measurement ◽

Migration Percentage ◽

The Mean ◽

Methods Of Treatment

Purpose: Since the establishment of the principle of weight-bearing methods of treatment in Legg-Calvé-Perthes disease (LCPD), lateral displacement of the femoral head has become an important prognostic factor. Material and Methods: In order to establish reliable boundary lines between orthotopic and subluxated hip, the migration percentage (MP) and the medial joint space (MJS) were determined retrospectively: a) on 166 normal hip radiographs; b) on bilateral arthrograms and radiographs from 37 patients with unilateral LCPD. Results and Conclusion: The mean upper normal values for MP and MJS on normal radiographs were 20.8 and 11.5 respectively. On arthrograms, the corresponding values were 31 and 5.7. The MP is easy to determine on both radiographs and arthrograms, and is recommended for detecting and measuring subluxation in cases with LCPD. MJS is of no advantage for detecting containment in LCPD but may be used in other diseases such as coxitis simplex.

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Mid-Term Outcomes of Cemented Stem and Subtrochanteric Shortening Derotational Osteotomy in Total Hip Arthroplasty for Crowe IV Developmental Dysplasia

10.21203/rs.3.rs-745383/v1 ◽

2021 ◽

Author(s):

Zhe-Yu Huang ◽

Jing Ling ◽

Zhi-Min Zeng ◽

Zheng-Lin Di ◽

Jun-Hui Zhang ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Cement Leakage ◽

Developmental Dysplasia ◽

Harris Hip Score ◽

Total Hip ◽

Derotational Osteotomy ◽

Femoral Shortening ◽

Cemented Stem ◽

The Mean

Abstract Background Performing total hip arthroplasty (THA) in patients with Crowe IV developmental dysplasia of the hip (DDH) is technically challenging. Subtrochanteric shortening osteotomy is typically required for placing the acetabular component within the anatomic hip center. However, the outcomes of subtrochanteric osteotomy using cemented components are not widely reported. This study aimed to evaluate the outcomes of cemented stem THA with subtrochanteric femoral shortening and transverse derotational osteotomy in patients with Crowe IV DDH.Methods We retrospectively evaluated data of patients with Crowe IV DDH who underwent cemented stem THA with subtrochanteric femoral shortening and transverse derotational osteotomy between 2010 and 2018. Patients who underwent surgery at the hip joint were excluded. Data regarding pre- and postoperative clinical and radiological parameters were collected and reviewed.Results Among 14 patients included (14 hips), the mean age was 60.4 (range, 47–73) years. The mean Harris hip score improved from 40.7 to 87.7. The mean limb length discrepancy reduced from 52 mm to 12.7 mm. No neurologic deficits were noted. The mean osteotomy union time was 10.6 months. Delayed union and postoperative dislocation were observed in one and two patients, respectively. Cement leakage into the osteotomy gap was observed in one patient. No revisions were required. No signs of loosening or migration were observed. Conclusions Cemented stem THA combined with subtrochanteric femoral shortening and transverse derotational osteotomy is safe and effective for the treatment of patients with Crowe IV DDH. The cemented femoral component showed promising mid-term follow up results. However, cement leakage affects bone healing. Osteotomy and cementing should be performed meticulously.Trial Registration: Retrospectively registered

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Double-tapered conical taper in primary and revision surgery: rationale and short-term follow-up

Hip International ◽

10.1177/1120700018812990 ◽

2018 ◽

Vol 28 (2_suppl) ◽

pp. 73-77

Author(s):

Loris Perticarini ◽

Mario Mosconi ◽

Marta Medetti ◽

Laura Caliogna ◽

Francesco M Benazzo

Keyword(s):

Revision Surgery ◽

Developmental Dysplasia ◽

Modular System ◽

Harris Hip Score ◽

Metastatic Tumour ◽

Leg Length ◽

Short Term ◽

Femoral Shortening ◽

The Mean

Background: The new double-conical tapered stem is a novel cementless modular system, which is indicated for both primary and revision surgeries. It has been designed with different angles at the proximal (5°) and distal sections (1° 36’) in order to obtain optimal fixation by proximal and distal fit and fill of the femoral canal. Aim: The aim of this prospective study was to evaluate the short-term clinical and radiographic outcomes of primary and revision hip surgery with the new double-conical stem. Methods: 61 stems were implanted (December 2013 to September 2016) in 42 cases of primary and in 19 cases of revision surgery. The mean age of patients was 64.7 (17–94; standard deviation [SD] 21.9) years. Results: The mean body mass index of the patients was 24.6 (17–34.6). In 3 cases of developmental dysplasia of the hip we performed femoral shortening osteotomy. The mean follow-up was 26 (8–40) months. 3 patients died due to causes unrelated to surgery. Postoperative complications included 3 hip dislocations, 2 infections and 1 case of stem explant for metastatic tumour. For all other cases, at the last follow-up radiographs showed no loosening, no radiolucent lines nor subsidence. The mean Harris Hip Score significantly improved from 45 (range 35–58) preoperatively to 87 (range 75–94). Leg length discrepancy was found in 10% of cases but never >1 cm. Conclusions: Radiographic analysis showed the bone-stem contact full at 2 levels of taper. The double-tapered prosthetic stem can therefore be usefully employed both in primary and in revision surgeries.

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Evolution of concentricity after closed reduction in developmental dysplasia of the hip

The Bone & Joint Journal ◽

10.1302/0301-620x.102b5.bjj-2019-1496.r1 ◽

2020 ◽

Vol 102-B (5) ◽

pp. 618-626 ◽

Cited By ~ 3

Author(s):

Weizheng Zhou ◽

Wudbhav N. Sankar ◽

Fangfang Zhang ◽

Lianyong Li ◽

Lijun Zhang ◽

...

Keyword(s):

Closed Reduction ◽

Joint Space ◽

Developmental Dysplasia ◽

Consecutive Series ◽

The Mean ◽

One Year ◽

Safety And Stability ◽

Dysplasia Of The Hip ◽

Over Time

Aims The goal of closed reduction (CR) in the treatment of developmental dysplasia of the hip (DDH) is to achieve and maintain concentricity of the femoral head in the acetabulum. However, concentric reduction is not immediately attainable in all hips and it remains controversial to what degree a non-concentric reduction is acceptable. This prospective study is aimed at investigating the dynamic evolution of the hip joint space after CR in DDH using MRI. Methods A consecutive series of patients with DDH who underwent CR since March 2014 were studied. Once the safety and stability were deemed adequate intraoperatively, reduction was accepted regardless of concentricity. Concentricity was defined when the superior joint space (SJS) and medial joint space (MJS) were both less than 2 mm, based on MRI. A total of 30 children, six boys and 24 girls, involving 35 hips, were recruited for the study. The mean age at CR was 13.7 months (3.5 to 27.6) and the mean follow-up was 49.5 months (approximately four years) (37 to 60). The joint space was evaluated along with the interval between the inverted and everted limbus. Results Only three hips (8.6%) were fully concentric immediately after CR. During follow-up, 24 hips (68.6%) and 27 hips (77.1%) became concentric at six months and one year, respectively. Immediate SJS after CR decreased from 3.51 mm to 0.79 mm at six months follow-up (p = 0.001). SJS in the inverted group decreased from 3.75 mm to 0.97 mm at six months follow-up. SJS or MJS in the everted group were less than those in the inverted group at each time of follow-up (p = 0.008, p = 0.002). Conclusion A stable, safe but non-concentric reduction achieved before the age of two years appears to improve over time with nearly 80% of hips becoming fully concentric by one year. Cite this article: Bone Joint J 2020;102-B(5):618–626.

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Simultaneous versus two stage surgical treatment of developmental dislocation of the hip with excessive femoral anteversion in children under the age of three years

Journal of Ideas in Health ◽

10.47108/jidhealth.vol1.iss2.9 ◽

2018 ◽

Vol 1 (2) ◽

pp. 34-41 ◽

Cited By ~ 2

Author(s):

Ahmed Kanaan Mansoor ◽

Baqer Kraidi ◽

Luay M. Al-Naser

Keyword(s):

Femoral Head ◽

Open Reduction ◽

Functional Disability ◽

Delayed Diagnosis ◽

Femoral Anteversion ◽

Developmental Dysplasia ◽

Two Stage ◽

Salter Osteotomy ◽

Derotation Osteotomy ◽

The One

Background: Delayed diagnosis and improper treated cases of developmental dysplasia of the hip (DDH) in the presence of excessive anteversion of femoral head may lead to undesirable consequences, including more extensive interventions with severe complications and functional disability. This study aimed to compare the clinical, radiological, and complication outcomes of simultaneously versus two-stage surgical procedures (open reduction and proximal femoral derotation osteotomy) in the treatment of DDH with excessive femoral anteversion among a sample of Iraqi children aged less than three years old. Methods: A total of 26 DDH cases were treated in two groups (GI, GII) at Al-Wasity Teaching Hospital (Baghdad, Iraq) from January 2014 to March 2015. GI (15 hips) in 13 patients subjected to simultaneous open reduction (with/without salter osteotomy) and proximal femoral derotation osteotomy. GII (18 hips) in 13 patients operated in two stages procedure; open reduction (with/without salter osteotomy) followed by proximal femoral derotation osteotomy six weeks later. Results: At the time of operation, the average age was 21.79±3.51months (range: 18-30). The mean follow-up period was 10.36 ±1.45 months (range, 8 -12). Statistically, the postoperative clinical, radiological, and complication findings were not significantly different between the two groups. However, in post-operative clinical assessment (McKay's criteria), the satisfying results (excellent and good) were 93% in GI and 88% in GII, respectively. Moreover, in radiological assessment (Severins classification), the satisfying results (excellent and good) were 94% in GI and 83% in GII, respectively. Two cases of re-dislocation and avascular necrosis (AVN) were reported in GII. Conclusion: When the clinical and radiological findings of one and two-stage open reduction and proximal femoral derotation osteotomy procedures are similar, the one-stage is more likely to overcome the two-stage in terms of minimizing the cost, length of stay and the risk of AVN of the femoral head.

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Therapeutic Outcomes of Salter Osteotomy Vs Varus Derotational having Femoral Shortening in Patients with Developmental Dysplasia of the Hip

AMBIENT SCIENCE ◽

10.21276/ambi.2019.06h.2.oa03 ◽

2019 ◽

Vol 06 & 06h (2) ◽

Author(s):

Seyed Shahnam Moosavi ◽

◽

Hamid Reza Arti ◽

Seyed Abdolhosein Mehdinasab ◽

Mohammad Fakoor ◽

...

Keyword(s):

Developmental Dysplasia ◽

Salter Osteotomy ◽

Therapeutic Outcomes ◽

Femoral Shortening ◽

Dysplasia Of The Hip

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Outcomes following open reduction for late-presenting developmental dysplasia of the hip

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.12.180078 ◽

2018 ◽

Vol 12 (4) ◽

pp. 323-330 ◽

Cited By ~ 5

Author(s):

P. Castañeda ◽

K. Z. Masrouha ◽

C. Vidal Ruiz ◽

L. Moscona-Mishy

Keyword(s):

Open Reduction ◽

Pelvic Osteotomy ◽

Developmental Dysplasia ◽

High Rate ◽

Type I ◽

Radiographic Outcomes ◽

Femoral Shortening ◽

The Mean ◽

Dysplasia Of The Hip

Purpose Patients with late-presenting developmental dysplasia of the hip (DDH) are more likely to require an open reduction. Since many developing countries do not have mandated screening, there continues to be a relatively high incidence of late-presenting DDH. We report the clinical and radiographic outcomes of open reduction in a series of patients who presented late. Patients and methods This was a retrospective review of 712 hips in 645 patients that underwent open reduction, alone or in combination with a pelvic osteotomy. In all, 91 hips had open reduction alone and 621 had open reduction and pelvic osteotomy. Femoral shortening was performed in 221 hips. The mean age at the time of surgery was 2.1 years (1 to 6.5) and the mean follow-up time was 9.3 years (6 to 14). We used the Children’s Hospital Oakland Hip Evaluation Score (CHOHES) to determine functional outcomes and the Severin classification was used to evaluate radiographic outcomes. The rate of avascular necrosis (AVN) and the need for a reoperation were also recorded and analyzed. Results In all 80% (570 hips) had good radiographic outcomes (Severin type I or II) and 87% had a CHOHES score of > 90 at final follow up. There was a 14% rate of AVN and only a 2% rate of redislocation. Better radiographic outcomes and lower reoperation rates were seen with patients who underwent both an open reduction and pelvic osteotomy. A trend was observed towards worse outcomes in older patients. Conclusions There was a high rate of good clinical and radiographic outcomes at a minimum six-year follow-up in patients with late-presenting DDH who underwent open reduction. Those who underwent open reduction in combination with a pelvic osteotomy had a higher rate of good radiographic outcomes and a lower rate of complications, particularly reoperation.

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Magnetic resonance imaging follow-up can screen for soft tissue changes and evaluate the short-term prognosis of patients with developmental dysplasia of the hip after closed reduction

BMC Pediatrics ◽

10.1186/s12887-021-02587-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Xianghong Meng ◽

Jianping Yang ◽

Zhi Wang

Keyword(s):

Magnetic Resonance Imaging ◽

Risk Factors ◽

Femoral Head ◽

Ligamentum Teres ◽

Developmental Dysplasia ◽

Resonance Imaging ◽

Acetabular Head Index ◽

Before And After ◽

Dysplasia Of The Hip

Abstract Background Magnetic resonance imaging (MRI) can show the architecture of the hip joint clearly and has been increasingly used in developmental dysplasia of the hip (DDH) confirmation and follow-up. In this study, MRI was used to observe changes in the hip joints before and after closed reduction (CR) and to explore risk factors of residual acetabular dysplasia (RAD). Methods This is a prospective analysis of unilateral DDH patients with CR and spica cast in our hospital from October 2012 to July 2018. MRI and pelvic plain radiography were performed before and after CR. The labro-chondral complex (LCC) of the hip was divided into four types on MRI images. The variation in the thickening rate of the ligamentum teres, transverse ligaments, and pulvinar during MRI follow-up was analyzed, and the difference in cartilaginous acetabular head index was evaluated. The “complete relocation” rate of the femoral head was analyzed when the cast was changed for the last time, and the necrotic rate of the femoral head was evaluated after 18 months or more after CR. Lastly, the risk factors of RAD were analyzed. Results A total of 63 patients with DDH and CR were included. The LCC was everted before CR and inverted after CR, and the ligamentum teres, transverse ligaments, and pulvinar were hypertrophic before and after CR, and then gradually returned to normal shape. The cartilaginous acetabular head index gradually increased to normal values. Complete relocation was observed in 58.7% of femoral heads, while 8.6% had necrosis. The abnormalities in LCC was related to RAD (OR: 4.35, P = 0.03), and the rate of type 3 LCC in the RAD group was higher. However, the IHDI classification (P = 0.09); the “complete relocation” of femoral heads (P = 0.61); and hypertrophy of the ligamentum teres (P = 1.00), transverse ligaments (P = 1.00), and pulvinar (P = 1.00) were not related to RAD. Conclusions In this study, MRI can observe the variations of the abnormal soft tissue structures of the diseased hips after CR and spica casting, and can evaluate which hips will have RAD after CR. Therefore, we can utilize MRI in DDH patients appropriately.

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