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 Dega pelvic osteotomy: indications, results and complications

2018 ◽  
Vol 12 (4) ◽  
pp. 342-348 ◽  
Author(s):  
J. Czubak ◽  
K. Kowalik ◽  
A. Kawalec ◽  
M. Kwiatkowska
Keyword(s):  
Femoral Head ◽  
Open Reduction ◽  
Age Groups ◽  
Pelvic Osteotomy ◽  
Developmental Dysplasia ◽  
Femoral Osteotomy ◽  
Complication Rates ◽  
Level Of Evidence ◽  
Significant Difference ◽  
Dysplasia Of The Hip

Purpose Developmental dysplasia of the hip (DDH) after walking age is difficult to treat. Dega pelvic osteotomy is combined with open reduction and femoral osteotomy to obtain concentric stable reduction with good coverage of the femoral head. The purpose of this study is to evaluate the use of the Dega osteotomy in the treatment of DDH in two different age groups. Methods A total of 45 patients (52 hips) with a mean age of 3.9 years (1.2 to 12.8) were treated with open reduction, Dega osteotomy and femoral osteotomy. There were 38 dislocated and 14 subluxated hips. Bilateral DDH was observed in seven female patients. Radiographic parameters included acetabular index, centre-edge angle of Wiberg and migration percentage. The final radiographic outcome was evaluated according to the Severin classification. Results The mean follow-up period was four years (3 to 9). According to the Severin criteria 78.8% were types I or II whereas 21.2% showed types III or IV. There was no statistically significant difference in final outcome between children less than three years of age and older children at the time of surgery. One hip in children with unilateral involvement had developed coxa magna, that interfered with hip concentricity. Three hips (5.8%) showed avascular necrosis of the femoral head. Conclusion Dega osteotomy is a safe and adequate procedure for the management of developmental dysplasia of the hip in walking patients with low complication rates. Restoring the acetabulum to normal or nearly normal can result in good medium-term results. Level of Evidence III

scholarly journals Comparing the Pemberton osteotomy and modified San Diego acetabuloplasty in developmental dysplasia of the hip

2019 ◽  
Vol 13 (2) ◽  
pp. 172-179 ◽  
Author(s):  
R. Badrinath ◽  
J. D. Bomar ◽  
D. R. Wenger ◽  
S. J. Mubarak ◽  
V. V. Upasani
Keyword(s):  
San Diego ◽  
Acetabular Dysplasia ◽  
Pelvic Osteotomy ◽  
Developmental Dysplasia ◽  
Level Of Evidence ◽  
Radiographic Outcomes ◽  
Medial Cortex ◽  
Retrospective Comparison ◽  
Dysplasia Of The Hip

Purpose Patients with developmental dysplasia of the hip (DDH) may require a pelvic osteotomy to treat acetabular dysplasia. The Pemberton osteotomy and modified San Diego acetabuloplasty are two options available when surgically treating DDH. The purpose of this study was to compare outcomes following the Pemberton and modified San Diego when treating patients with acetabular dysplasia in typical DDH. Methods We included 45 hips in the modified San Diego group and 38 hips in the Pemberton group. Hips with less than two years follow-up and patients with a neuromuscular diagnosis were excluded. Clinical outcomes were rated using the modified McKay criteria with radiographic outcomes graded using the Severin score. Avascular necrosis (AVN) was assessed using the Kalamchi and MacEwen criteria. Results Mean follow-up was 4.9 years (2.1 to 11.2). Both procedures produced similar decreases in the acetabular index (modified San Diego: 17.0˚ versus Pemberton: 15.2˚; p = 0.846). Most hips had good/excellent results using the modified McKay criteria (modified San Diego: 78%, Pemberton: 94%; p = 0.055). Most hips were rated as good/excellent on the Severin scale (modified San Diego: 100%, Pemberton: 97%, p = 0.485). The proportion of hips with AVN grade 2 or higher were similar between groups (modified San Diego: 0%, Pemberton: 3%; p = 0.458). Conclusion The modified San Diego acetabuloplasty is a safe and effective alternative to treat acetabular dysplasia in patients with typical DDH. By maintaining an intact medial cortex, acetabular reshaping can be customized to address each patient’s specific acetabular deficiency Level of evidence Level III retrospective comparison

scholarly journals Diagnostic and treatment preferences for developmental dysplasia of the hip: a survey of EPOS and POSNA members

2018 ◽  
Vol 12 (3) ◽  
pp. 236-244 ◽  
Author(s):  
C. Alves ◽  
W. H. Truong ◽  
M. V. Thompson ◽  
J. R. Suryavanshi ◽  
C. L. Penny ◽  
...  
Keyword(s):  
Developmental Dysplasia ◽  
Diagnosis And Treatment ◽  
Treatment Preferences ◽  
Level Of Evidence ◽  
Hip Abduction ◽  
Frequent Response ◽  
Radiology Technicians ◽  
Paediatric Orthopaedic ◽  
Orthopaedic Society ◽  
Dysplasia Of The Hip

Purpose The aim of this study was to elucidate developmental dysplasia of the hip (DDH) diagnosis and treatment preferences among members of the Pediatric Orthopaedic Society of North America (POSNA) and European Paediatric Orthopaedic Society (EPOS). Methods A 54-question survey on DDH diagnosis and treatment preferences was distributed to POSNA and EPOS members. Descriptive statistics were performed. Results A total of 459 responses were analyzed. Ultrasound was the preferred modality for diagnosing DDH in infants less than six months old; few surgeons preferred radiographs. In all, 57% of POSNA members had radiology technicians perform ultrasounds, only 7% of EPOS members did. The percent coverage defining a dislocated hip varied greatly, the most frequent response being < 20% for POSNA and < 40% for EPOS members. Pavlik harnesses were the most popular harness/brace, used by 90% of POSNA and 71% of EPOS members. POSNA members were more likely than EPOS members to use a rigid abduction brace following initial harness/brace failure. For residual acetabular dysplasia, POSNA members were twice as likely as EPOS members to institute hip abduction bracing. Most surgeons would not perform closed reduction at less than three months of age or open reduction at less than six months of age. Most EPOS ­members used traction prior to reduction; few POSNA members did. Few POSNA and EPOS members believed that reduction should be delayed until the ossific nucleus was visible. Conclusion There is great variation in the preferred methods for diagnosing and treating DDH. This survey is the largest transcontinental survey to compile diagnostic and treatment preferences for DDH. With wide variations in practice, there is room for quality improvement. Level of Evidence II

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

2021 ◽  
pp. 1-1
Author(s):  
Dave M. Moore ◽  
Gerard A. Sheridan ◽  
Paula M. Kelly ◽  
David P. Moore ◽  
Kevin F. McCarthy
Keyword(s):  
Pelvic Osteotomy ◽  
Developmental Dysplasia ◽  
Day Case ◽  
Dysplasia Of The Hip

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

Complete Transiliac Pelvic Osteotomy for Patients with Developmental Dysplasia of the Hip without Internal Fixation

2009 ◽  
Vol 19 (1) ◽  
pp. 13-17 ◽  
Author(s):  
Haldun Orhun ◽  
Volkan Gurkan ◽  
Ilhan Bayhan ◽  
Muhsin Dursun ◽  
Cuma Kilickap ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Pelvic Osteotomy ◽  
Developmental Dysplasia ◽  
Dysplasia Of The Hip

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 The lateral edge and sourcil acetabular indices for surgical decision-making in developmental dysplasia of the hip

2020 ◽  
Vol 14 (6) ◽  
pp. 513-520
Author(s):  
Alpesh Kothari ◽  
Saqib Noor ◽  
Connor L. Maddock ◽  
Jan H. H. Vanderstappen ◽  
Catharine S. Bradley ◽  
...  
Keyword(s):  
Decision Making ◽  
Acetabular Dysplasia ◽  
Developmental Dysplasia ◽  
Poor Agreement ◽  
Level Of Evidence ◽  
Surgical Decision ◽  
Lateral Edge ◽  
Surgical Decision Making ◽  
Dysplasia Of The Hip ◽  
Level Of Agreement

Purpose The acetabular index (AI) is a radiographic measure that guides surgical decision-making in developmental dysplasia of the hip (DDH). Two AI measurement methods are described; to the lateral edge of the acetabulum (AI-L) and to the lateral edge of the sourcil (AI-S). The purpose of this study was to determine the level of agreement between AI-L and AI-S on the diagnosis and degree of acetabular dysplasia in DDH. Methods A total of 35 patients treated for DDH with Pavlik harness were identified. The AI-L and AI-S were measured on radiographs (70 hips) at two and five years of age. AI-L and AI-S were then transformed relative to published normative data (tAI-L and tAI-S). Bland-Altman plots, linear regression and heat mapping were used to evaluate the agreement between tAI-L and tAI-S. Results There was poor agreement between tAI-S and tAI-L on the Bland-Altman plots with wide limits of agreement and no proportional bias. The two AI measurements were in agreement as to the presence and severity of dysplasia in only 63% of hips at two years of age and 81% at five years of age, leaving the remaining hips classified as various combinations of normal, mildly and severely dysplastic. Conclusion AI-L and AI-S have poor agreement on the presence or degree of acetabular dysplasia in DDH and cannot be used interchangeably. Clinicians are cautioned to prudently evaluate both measures of AI in surgical decision-making. Level of evidence I

scholarly journals Should paediatricians initiate orthopaedic hip dysplasia referrals for infants with isolated asymmetric skin folds?

2019 ◽  
Vol 13 (6) ◽  
pp. 593-599 ◽  
Author(s):  
C. R. Louer ◽  
J. D. Bomar ◽  
M. E. Pring ◽  
S. J. Mubarak ◽  
V. V. Upasani ◽  
...  
Keyword(s):  
Alpha Angle ◽  
Developmental Dysplasia ◽  
Clinical Environment ◽  
Single Institution ◽  
Level Of Evidence ◽  
Radiographic Findings ◽  
Mild Dysplasia ◽  
Paediatric Practice ◽  
Patient Referrals ◽  
Dysplasia Of The Hip

Purpose Asymmetric skin folds (ASFs) have been linked to developmental dysplasia of the hip (DDH) in select studies, leading to their inclusion in paediatric practice guidelines regarding orthopaedic referral for hip evaluation. The purpose of this study was to investigate the utility of isolated ASFs as a screening tool for DDH in a series of patient referrals evaluated at a single institution. Methods We performed a retrospective review of consecutive patients between 0 and 12 months of age referred to orthopaedic clinics for isolated ASFs. We recorded radiographic findings (acetabular inclination or alpha angle), diagnosis rendered and treatment administered. Results A total of 66 patients were included (mean age 6.4 months; 2.47 to 10.76). All patients received pelvic radiographs or ultrasound. In all, 36 patients (55%) were considered normal by their treating physician and 25 (38%) were considered dysplastic and underwent brace treatment. One hip with an isolated ASF was found to have a dislocated hip on radiograph prior to their initial orthopaedic visit. None of the patients in this study have required surgery to date. Conclusion Using ASFs as a reason for referral led to increased diagnosis of mild dysplasia resulting in orthotic treatment. Thus, in our particular clinical environment, isolated ASFs can be an indicator of mild dysplasia and warrant further workup or referral. Because treatment philosophies regarding recognition and treatment of mild dysplasia vary amongst centres, the value of screening with ASFs likewise depends on the treating orthopaedic surgeon’s threshold for treatment of mild dysplasia. Level of evidence Level IV- Retrospective

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