Closed reduction in late-detected developmental dysplasia of the hip: indications, results and complications

PurposeThe aim of the study was a review of the literature in order to evaluate the results and complications of closed reduction in late-detected developmental dysplasia of the hip (DDH).MethodsThis study consisted of an analysis of the literature relative to late-detected DDH treatment options considering hip congruency, rates of re-dislocation and of avascular necrosis.ResultsGradual closed reduction (Petit-Morel method) appears to be an effective method concerning joint congruency restitution. Dislocation relapse and avascular necrosis are more efficiently prevented with closed versus open reduction. The tendency for spontaneous correction of acetabular dysplasia decreases if closed reduction is performed after 18 months of age. Patient age at the beginning of traction should be considered for the prognosis, with a lower rate of satisfactory results showing after the age of 3 years.ConclusionIn our opinion, the Petit-Morel method is a suitable treatment option for children aged between six months and three years with idiopathic DDH.

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Faculty Opinions recommendation of Avascular necrosis following closed reduction for treatment of developmental dysplasia of the hip: a systematic review.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.729524230.793540307 ◽

2017 ◽

Author(s):

Edilson Forlin

Keyword(s):

Systematic Review ◽

Avascular Necrosis ◽

Closed Reduction ◽

Developmental Dysplasia ◽

Dysplasia Of The Hip

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Developmental dysplasia of the hip: update of management

EFORT Open Reviews ◽

10.1302/2058-5241.4.180019 ◽

2019 ◽

Vol 4 (9) ◽

pp. 548-556 ◽

Cited By ~ 7

Author(s):

Alfonso Vaquero-Picado ◽

Gaspar González-Morán ◽

Enrique Gil Garay ◽

Luis Moraleda

Keyword(s):

Physical Examination ◽

Open Reduction ◽

Acetabular Dysplasia ◽

Wide Spectrum ◽

Positive Family History ◽

Developmental Dysplasia ◽

Ultrasound Screening ◽

Spontaneous Correction ◽

Hip Reduction ◽

Dysplasia Of The Hip

The term ‘developmental dysplasia of the hip’ (DDH) includes a wide spectrum of hip alterations: neonatal instability; acetabular dysplasia; hip subluxation; and true dislocation of the hip. DDH alters hip biomechanics, overloading the articular cartilage and leading to early osteoarthritis. DDH is the main cause of total hip replacement in young people (about 21% to 29%). Development of the acetabular cavity is determined by the presence of a concentrically reduced femoral head. Hip subluxation or dislocation in a child will cause an inadequate development of the acetabulum during the remaining growth. Clinical screening (instability manoeuvres) should be done universally as a part of the physical examination of the newborn. After two or three months of life, limited hip abduction is the most important clinical sign. Selective ultrasound screening should be performed in any child with abnormal physical examination or in those with high-risk factors (breech presentation and positive family history). Universal ultrasound screening has not demonstrated its utility in diminishing the incidence of late dysplasia. Almost 90% of patients with mild hip instability at birth are resolved spontaneously within the first eight weeks and 96% of pathologic changes observed in echography are resolved spontaneously within the first six weeks of life. However, an Ortolani-positive hip requires immediate treatment. When the hip is dislocated or subluxated, a concentric and stable reduction without forceful abduction needs to be obtained by closed or open means. Pavlik harness is usually the first line of treatment under the age of six months. Hip arthrogram is useful for guiding the decision of performing a closed or open reduction when needed. Acetabular dysplasia improves in the majority due to the stimulus provoked by hip reduction. The best parameter to predict persistent acetabular dysplasia at maturity is the evolution of the acetabular index. Pelvic or femoral osteotomies should be performed when residual acetabular dysplasia is present or in older children when a spontaneous correction after hip reduction is not expected. Avascular necrosis is the most serious complication and is related to: an excessive abduction of the hip; a force closed reduction when obstacles for reduction are present; a maintained dislocated hip within the harness or spica cast; and a surgical open reduction.Cite this article: EFORT Open Rev 2019;4:548-556. DOI: 10.1302/2058-5241.4.180019

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Contact Pressure Distribution of the Hip Joint During Closed Reduction of Developmental Dysplasia of the Hip

10.21203/rs.3.rs-35268/v1 ◽

2020 ◽

Author(s):

Zhiqiang Zhang ◽

Hai Li ◽

Dashan Sui ◽

Haiyi Qin ◽

Ziming Zhang

Keyword(s):

Finite Element ◽

Femoral Head ◽

Avascular Necrosis ◽

Contact Pressure ◽

Closed Reduction ◽

Treatment Success ◽

Developmental Dysplasia ◽

Abduction Angle ◽

Lateral Part ◽

Dysplasia Of The Hip

Abstract Background: Developmental dysplasia of the hip (DDH) is the most common deformity of the lower extremity in children, and the etiology remains unclear. The biomechanical change during closed reduction (CR) focused on cartilage contact pressure (CCP) has not been studied. Thereby, we try to provide insight into biomechanical factors potentially responsible for CR treatment success and complications by using finite element analysis (FEA) for the first time.Methods: Finite element models of one patient with DDH were established based on the data of MRI scan on which cartilage contact pressure was measured. During CR, CCP between the femoral head and acetabulum in different abduction and flexion angles were tested to estimate the efficacy and potential risk factors of avascular necrosis (AVN) following CR.Results: A 3D reconstruction by the FEA method was performed on a sixteen-month-old girl with DDH on the right side. The acetabulum of the involved side showed a long, narrow, and "plate-shaped" deformity, whereas the femoral head was smaller and irregular compared with the contralateral side. With increased abduction angle, the stress of the posterior acetabulum increased significantly, and the stress on the lateral part of the femoral head increased as well. The changes of CCP in the superior acetabulum were not apparent during CR. There were no detectable differences in terms of pressure on the femoral head.Conclusions: Severe dislocation (IHDI grade III and IV) in children showed a high mismatch between the femoral head and acetabulum. Increased abduction angle corresponded with high contact pressure, which might relate to avascular necrosis, whereas increased flexion angle was not. Enhanced pressure on the lateral part of the femoral head might increase the risk of AVN.

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Closed Reduction in Developmental Dysplasia of the Hip in Patients Older than One Year

Folia Medica ◽

10.3897/folmed.62.e48212 ◽

2020 ◽

Vol 62 (2) ◽

pp. 276-281

Author(s):

Zoran Bozinovski ◽

Milena Bogojevska Doksevska ◽

Keti P. Tokmakova

Keyword(s):

Avascular Necrosis ◽

Closed Reduction ◽

Screening Method ◽

Hip Dislocation ◽

Developmental Dysplasia ◽

Type I ◽

Range Of Movement ◽

Cast Immobilization ◽

Recommended Treatment ◽

Dysplasia Of The Hip

Introduction: Besides an effective screening method for developmental dysplasia of the hip, there is certain number of children in whom the condition has been overseen or they have never been screened and the parents have noticed the odd walking pattern in their toddler. Treatment of such patients is controversial. One of the recommended treatment methods because of the short-term hospitalization, but often considered unsuccessful is closed reduction of the hip followed by cast immobilization. Hypothesis: Closed hip reduction in late diagnosed developmental dysplasia of the hip gives good results.  Aim: Our aim in this retrospective study was evaluation of the success of the treatment with closed reduction of hip dislocation in children older than 12 months.  Patients and methods: In the study, we included 20 patients treated at our clinic from June 2004 to May 2017. Of these 20 patients, 8 had bilateral involvement, 12 had unilateral, in a total of 28 hips. In all patients we noted preoperatively the range of movement, the presence of limp, any limb inequality, and hip pain. We used clinical and radiological parameters for evaluation. Clinically, we examined the range of movement, limb inequality as well as limb function and we classified it according to the modified McKay’s criteria. Same examinations were done at 1, 3, and 5 years after closed reduction. Results: At the last follow-up examination, using McKey’s criteria for clinical evaluation we rated the hips in two patients (7%) as grade III, i.e. fair grade, 10 hips (36%) were grade II – rated good, and 16 hips (57%) were evaluated as grade I. In four hips, there were signs of avascular necrosis of the hip, while in one patient the avascular necrosis developed after the closed reduction. Radiographic assessment (Figs 3, 4) using Severin’s scoring system showed no hips with types V and VI, type IV was observed in 7%, type III in 21%, type II in 29%, while most of the hips (12, 43%) were type I. Conclusion: We concluded that the procedure was justified. An advantage of this method is that it is inexpensive; it entails no direct operative changes of the bone structures and gives good results.

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Efficacy of closed reduction for developmental dysplasia of the hip: midterm outcomes and risk factors associated with treatment failure and avascular necrosis

10.21203/rs.3.rs-38289/v1 ◽

2020 ◽

Author(s):

Ge Zhang ◽

Ming Li ◽

Xiangyang Qu ◽

Yujiang Cao ◽

Xing Liu ◽

...

Keyword(s):

Risk Factors ◽

Avascular Necrosis ◽

Failure Rate ◽

Closed Reduction ◽

Significant Risk ◽

Developmental Dysplasia ◽

Secondary Outcome ◽

Factors Associated ◽

Related Risk ◽

Dysplasia Of The Hip

Abstract Background: The purpose of this study was to evaluate the efficacy after closed reduction (CR) in the treatment of developmental dysplasia of the hip (DDH) and investigate risk factors associated with CR failure and avascular necrosis (AVN) occurrence in the follow-ups.Primary and secondary outcome measures: The study retrospectively included 110 patients and 138 hips with DDH diagnosis between February 2012 and November 2015 in our single tertiary medical institution and underwent closed reduction. The failure rate of CR and the underlying risk factors were evaluated. meanwhile, the incidence of AVN and the related risk factors among the successful CR cases were assessed.Results: The overall failure rate of DDH treated by CR in present study was 31.16% (43/138). Risk factors for the CR failure was older age at the time of CR (≥18.35 month), large medical interval before CR (≥35.35 millimeters), and severer dislocation of the affected hip (IDHI grade III and IV). The incidence of AVN was 8.33% (6/72) in the patients with successful CR at last follow-up. No significant risk factors had been established in present study that associated with the AVN occurrence.Conclusions: For the treatment of DDH with CR, patients with younger age might achieve better outcomes, early diagnosis and early treatment might be the key point in the DDH treatment.

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Does the vascular development of the femoral head correlate with the incidence of avascular necrosis of the proximal femoral epiphysis in children with developmental dysplasia of the hip treated by closed reduction?

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.15.210059 ◽

2021 ◽

pp. 1-7

Author(s):

JianPing Wu ◽

Zhe Yuan ◽

JingChun Li ◽

MingWei Zhu ◽

Federico Canavese ◽

...

Keyword(s):

Femoral Head ◽

Avascular Necrosis ◽

Closed Reduction ◽

Vascular Development ◽

Contralateral Side ◽

Developmental Dysplasia ◽

Level Of Evidence ◽

Class B ◽

Class C ◽

Dysplasia Of The Hip

Purpose The purpose of this study was to identify the correlation between the vascular development of the femoral head and avascular necrosis (AVN) in patients with developmental dysplasia of the hip (DDH) treated by closed reduction (CR). Methods We retrospectively reviewed 78 patients with DDH treated by CR (83 hips). The vascular maturity, number of vessels and perfusion changes of the femoral head were assessed on perfusion MRI (pMRI) before and after CR. Results The number of vessels (mean 4.2 sd 1.4) of the femoral head and the ratio (36.1%) of mature vessels (type III) on the dislocated side were significantly less than those at contralateral side (mean 6.0 sd 1.2; 82.2%) (p < 0.001). Of the included 83 hips, 39 hips (61.5%) showed decreased perfusion of the femoral head, including partial decreased (Class B, 47.0%) and global decreased (Class C, 14.5%), at the dislocated side, which was significantly more than those at contralateral side (0.0%) (p < 0.001). In total, 32 out of 83 hips (38.5%) developed AVN. The rate of AVN with Class A (18.8%) which perfusion of the femoral head was normal (unchanged or enhanced) was significantly less than those with Class C (66.7%) (p = 0.006). Conclusion The vascular development and perfusion changes of the femoral head on the dislocated side are significantly worse than those at contralateral side. Immature vascularity of the femoral head before CR and poor perfusion of the femoral head after CR may be risk factors for AVN in patients with DDH. Level of evidence III

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