scholarly journals Effect of abduction on avascular necrosis of the femoral epiphysis in patients with late-detected developmental dysplasia of the hip treated by closed reduction: a MRI study of 59 hips

2019 ◽  
Vol 13 (5) ◽  
pp. 438-444 ◽  
Author(s):  
Y. H. Liu ◽  
H. W. Xu ◽  
Y. Q. Li ◽  
K. Hong ◽  
J. C. Li ◽  
...  
Keyword(s):  
Avascular Necrosis ◽  
Hip Joint ◽  
Closed Reduction ◽  
Developmental Dysplasia ◽  
Abduction Angle ◽  
Normal Side ◽  
Hip Abduction ◽  
The Mean ◽  
Dysplasia Of The Hip

Purpose The purpose of this study was to explore whether increasing the hip abduction angle would increase the incidence of avascular necrosis (AVN) in patients with late- detected developmental dysplasia of the hip (DDH) treated by closed reduction (CR) and spica cast immobilization. Methods A total of 55 patients (59 hips) with late-detected DDH underwent MRI after CR. Hip abduction angle and hip joint distance were measured on postoperative MRI transverse sections. The acetabular index and centre-edge angle were measured on plain radiographs at the last follow-up. The presence of AVN according to Kalamchi and McEwen’s classification was assessed. We retrospectively analyzed the associations among abduction angles, hip joint distances, radiographic parameters, AVN and final outcomes, exploring the relationship between hip joint abduction angle and AVN rate. Results The mean age at the time of CR was 14.4 months SD 5.5 (6 to 28), and the mean follow-up was 26.2 months SD 8.1 (12.4 to 41.7). The mean hip abduction angle was 70.2° SD 7.2° (53° to 85°) on the dislocated side and 63.7° SD 8.8° (40° to 82°) on the normal side; the mean hip joint distance was 5.1 mm SD 1.9 (1.3 to 9.1) on the dislocated side and 2.2 mm SD 0.6 on the normal side (1.3 to 3.3). Eight of 59 hips (13.6%) developed AVN. Neither the amount of abduction nor hip joint distance increased the AVN rate (p = 0.97 and p = 0.65, respectively) or the dislocation rate (p = 0.38 and p = 0.14, respectively). Conclusion Abduction angle up to 70.2° following CR did not increase the AVN rate in children aged six to 28 months with late-detected DDH treated by CR. Level of evidence III.

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

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.

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

2020 ◽  
Vol 102-B (5) ◽  
pp. 618-626 ◽  
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.

Does Pre-Operative Hip Location or Post-Operative Hip Abduction Angle Better Predict Perfusion Abnormalities on MRI after Closed Reduction for Developmental Dysplasia of the Hip?

PEDIATRICS ◽  
2016 ◽  
Vol 137 (Supplement 3) ◽  
pp. 550A-550A
Author(s):  
Michael J Rivlin ◽  
J. Herman Kan ◽  
Siddharth P Jadhav ◽  
Erika Schallert ◽  
Scott Rosenfeld ◽  
...  
Keyword(s):  
Closed Reduction ◽  
Developmental Dysplasia ◽  
Abduction Angle ◽  
Hip Abduction ◽  
Dysplasia Of The Hip

scholarly journals Retrospective Comparison of Outcomes between Closed and Open Reduction for Developmental Dysplasia of the Hip in Children Aged 6–24 Months

2021 ◽  
Author(s):  
Shuyu Ma ◽  
Weizheng Zhou ◽  
Lianyong Li ◽  
Enbo Wang ◽  
Lijun Zhang ◽  
...  
Keyword(s):  
Open Reduction ◽  
Demographic Data ◽  
Joint Space ◽  
Developmental Dysplasia ◽  
Normal Side ◽  
Retrospective Comparison ◽  
Or Groups ◽  
The Mean ◽  
Dysplasia Of The Hip

Abstract Background: This study aimed to compare the early outcomes between closed reduction (CR) and open reduction (OR) in children aged 6–24 months with developmental dysplasia of the hip (DDH) who could be reduced safely and stably by the closed method.Methods: We retrospectively reviewed the medical records of 77 patients who underwent CR or OR treatment for DDH from August 2012 to October 2017. Fifty-one patients (56 hips) underwent CR, while 26 (29 hips) underwent OR. The demographic data, International Hip Dysplasia Institute classification, and acetabular index (AI) before reduction were analysed. The centre-edge angle (CEA), AI, Alsberg angle (AA), Reimer’s migration index (RMI), and height-to-width index (HWI) of the epiphysis were compared between the CR and OR groups at the final follow-up. The percentages of avascular necrosis (AVN), residual acetabular dysplasia (RAD), HWI < 0.357, RMI > 33%, AA > 81˚, and coxa magna > 15% of the normal side were calculated.Results: At the final follow up, the mean AA in the CR and OR groups were 77.66˚ (60˚–89˚) and 81.97˚ (73˚–91˚) (p=0.001), respectively, and there were 32.14% and 58.62% of the hips with an AA > 81˚ (p=0.019). The frequency of coxa magna > 15% of the normal side was higher in the OR group (60.9%) than in the CR group (6.5%) (p<0.001). There was no difference in the improvement of AI, CEA, HWI, and RMI at the final follow-up. The percentages of RAD, HWI < 0.357, RMI > 33%, and AVN were not statistically different.Conclusion: In children aged 6–24 months with DDH, if a stable and safe CR can be obtained but with a widening joint space, an OR may not benefit acetabular remodelling more than a CR procedure, and thus, CR should be attempted.

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.

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.

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

Folia Medica ◽  
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.&nbsp; 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.&nbsp; 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&rsquo;s criteria. Same examinations were done at 1, 3, and 5 years after closed reduction. Results: At the last follow-up examination, using McKey&rsquo;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 &ndash; 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&rsquo;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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