Timing For Closed Reduction of Developmental Dysplasia of the Hip and Failure Analysis

Abstract BackgroundIt remains controversial whether the older age at closed reduction (CR) of developmental dysplasia of the hip (DDH), the higher incidence of complications.The aim of this study is to evaluate theMid-term outcome of CR for DDHamongdifference age groups, and to analyze and identify risk factors for the failure of this procedure. Methods Clinical data of DDH patients, who received CR, were retrospectively reviewed. Hips were divided into three groups according to initial age (Group I: <12 months; Group II: 12 months to ≤18 months; Group III: >18 months). The presence of avascular necrosis (AVN),residual acetabular dysplasia (RAD), re-dislocation, further surgeries (FS)and failure of CR were observed. The risk factors were identified for those outcomes abovementioned. Receiver operating characteristics (ROC) curve analysis based on age, pre-op AI and post-op AI for failure was conducted.ResultsA total of 107 patients (156 hips) undergoing CR wereevaluated with a median age at initial reduction of 13.0 months(range, 4 to 28 mo). The incidence of AVN, RADand re-dislocationwas 15.4% (24/156), 17.3% (27/156) and 14.7% (23/156). For AVN, RAD and re-dislocation, the risk factors were pre-op IHDI IV(p=0.033), age≥18 months (p=0.012), and pre-op IHDI IV and walking (p=0.004 and p=0.011), respectively. The areas under the ROC curve of failure were 0.841 (post-op AI), 0.688 (pre-op AI)and 0.650 (age).ConclusionsRAD is a complication that must be carefully considered for severepatients older than 18 months before CR. Re-dislocation is associated with pre-op IHDI IV and walking.Patients, who are older than 12.5 months or have a pre-op AI of 38.7° or a post-op AI of 26.4°, are more likely fail of CR.

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Timing for Closed Reduction of Developmental Dysplasia of the Hip and Failure Analysis

10.21203/rs.3.rs-37192/v2 ◽

2020 ◽

Author(s):

Zhiqiang Zhang ◽

Hao Li ◽

Hai Li ◽

Ziming Zhang

Keyword(s):

Risk Factors ◽

Roc Curve ◽

Closed Reduction ◽

Age Groups ◽

Developmental Dysplasia ◽

Operating Characteristics ◽

Roc Curve Analysis ◽

Term Outcome ◽

Group I ◽

Dysplasia Of The Hip

Abstract Background It remains controversial whether the older age at closed reduction (CR) of developmental dysplasia of the hip (DDH), the higher incidence of complications. The aim of this study is to evaluate the Mid-term outcome of CR for DDH among difference age groups, and to analyze and identify risk factors for the failure of this procedure. Methods Clinical data of DDH patients, who received CR, were retrospectively reviewed. Hips were divided into three groups according to initial age (Group I: <12 months; Group II: 12 months to ≤18 months; Group III: >18 months). The presence of avascular necrosis (AVN), residual acetabular dysplasia (RAD), re-dislocation, further surgeries (FS) and failure of CR were observed. The risk factors were identified for those outcomes abovementioned. Receiver operating characteristics (ROC) curve analysis based on age, pre-op AI and post-op AI for failure was conducted.Results A total of 107 patients (156 hips) undergoing CR were evaluated with a median age at initial reduction of 13.0 months (range, 4 to 28 mo). Mean follow-up time in this study was 6.7 years (range, 3-8 years). The incidence of AVN, RAD and re-dislocation was 15.4% (24/156), 17.3% (27/156) and 14.7% (23/156). For AVN, RAD and re-dislocation, the risk factors were pre-op IHDI IV (p=0.033), age≥18 months (p=0.012), and pre-op IHDI IV and walking (p=0.004 and p=0.011), respectively. The areas under the ROC curve of failure were 0.841 (post-op AI), 0.688 (pre-op AI) and 0.650 (age).Conclusions RAD is a complication that must be carefully considered for severe patients older than 18 months before CR. Re-dislocation is associated with pre-op IHDI IV and walking. Patients, who are older than 12.5 months or have a pre-op AI of 38.7° or a post-op AI of 26.4°, are more likely fail of CR.

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Timing for Closed Reduction Procedure for Developmental Dysplasia of the Hip and its Failure Analysis

10.21203/rs.3.rs-37192/v3 ◽

2020 ◽

Author(s):

Zhiqiang Zhang ◽

Hao Li ◽

Hai Li ◽

Ziming Zhang

Keyword(s):

Risk Factors ◽

Closed Reduction ◽

Age Groups ◽

Significant Risk ◽

Developmental Dysplasia ◽

Operating Characteristics ◽

Logistic Regression Models ◽

Midterm Outcome ◽

Group I ◽

Dysplasia Of The Hip

Abstract Background It remains controversial whether the older age to perform closed reduction (CR) procedure for developmental dysplasia of the hip (DDH), the higher incidence of complications. The aim of this study is to evaluate the midterm outcome of CR for DDH among difference age groups, and to analyze and identify risk factors for the failure of this procedure. Methods Clinical data of 107 DDH patients, who received CR, were retrospectively reviewed. Data were divided into three groups according to initial treatment age (Group I: younger than 12 months; Group II: 12 months to less or equal to18 months; Group III: older than 18 months). The presence of avascular necrosis (AVN), residual acetabular dysplasia (RAD), re-dislocation, and further surgeries (FS) were observed. The risk factors were identified for those outcomes aforementioned using univariable logistic regression models. For identified risk factor age, pre-op acetabular index (AI) and post-op AI, their prediction of CR failure were evaluated by receiver operating characteristics curve (ROC).Results A total of 107 patients (156 hips) undergoing CR procedure were evaluated with a median age at initial reduction of 13.0±5.4 months (range, 4 to 28 mo). Mean follow-up time in this study was 6.7±0.8 years (range, 3-8 years). The incidence of AVN, RAD and re-dislocation was 15.4% (24/156), 17.3% (27/156) and 14.7% (23/156) respectively. For AVN, RAD and re-dislocation, the significant risk factors are pre-op IHDI IV (p=0.033), age≥18 months (p=0.012), and pre-op IHDI IV (p=0.004) and walking (p=0.011), respectively. The areas under the ROC curve of each type of failures were 0.841 (post-op AI), 0.688 (pre-op AI) and 0.650 (age).Conclusions Severe DDH patients older than 18 months with CR procedure may result in a high risk of RAD complication. Re-dislocation is significantly associated with pre-op IHDI IV and walking. Patients, who are older than 12.5 months or have a pre-op AI of 38.7° or a post-op AI of 26.4°, are also more likely to fail of CR procedure.

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Timing for closed reduction procedure for developmental dysplasia of the hip and its failure analysis

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03635-1 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Zhiqiang Zhang ◽

Hao Li ◽

Hai Li ◽

Ziming Zhang

Keyword(s):

Risk Factors ◽

Closed Reduction ◽

Age Groups ◽

Significant Risk ◽

Developmental Dysplasia ◽

Operating Characteristics ◽

Logistic Regression Models ◽

Midterm Outcome ◽

Group I ◽

Dysplasia Of The Hip

Abstract Background It remains controversial whether the older age to perform closed reduction (CR) procedure for developmental dysplasia of the hip (DDH), the higher incidence of complications. The aim of this study is to evaluate the midterm outcome of CR for DDH among different age groups, and to analyze and identify risk factors for the failure of this procedure. Methods Clinical data of 107 DDH patients, who received CR, were retrospectively reviewed. Data were divided into three groups according to initial treatment age (Group I: younger than 12 months; Group II: 12 months to less or equal to18 months; Group III: older than 18 months). The presence of avascular necrosis (AVN), residual acetabular dysplasia (RAD), re-dislocation, and further surgeries (FS) were observed. The risk factors were identified for those outcomes aforementioned using univariable logistic regression models. For identified risk factor age, pre-op acetabular index (AI) and post-op AI, their prediction of CR failure were evaluated by receiver operating characteristics curve (ROC). Results A total of 107 patients (156 hips) undergoing CR procedure were evaluated with a median age at initial reduction of 13.0 ± 5.4 months (range, 4 to 28 mo). Mean follow-up time in this study was 6.7 ± 0.8 years (range, 3–8 years). The incidence of AVN, RAD and re-dislocation was 15.4% (24/156), 17.3% (27/156) and 14.7% (23/156) respectively. For AVN, RAD and re-dislocation, the significant risk factors are pre-op IHDI IV (p = 0.033), age ≥ 18 months (p = 0.012), and pre-op IHDI IV (p = 0.004) and walking (p = 0.011), respectively. The areas under the ROC curve of each type of failures were 0.841 (post-op AI), 0.688 (pre-op AI) and 0.650 (age). Conclusions Severe DDH patients older than 18 months with CR procedure may result in a high risk of RAD complication. Re-dislocation is significantly associated with pre-op IHDI IV and walking. Patients, who are older than 12.5 months or have a pre-op AI of 38.7° or a post-op AI of 26.4°, are also more likely to fail of CR procedure.

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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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MRI risk factors for development of avascular necrosis after closed reduction of developmental dysplasia of the hip: Predictive value of contrast-enhanced MRI

PLoS ONE ◽

10.1371/journal.pone.0248701 ◽

2021 ◽

Vol 16 (3) ◽

pp. e0248701

Author(s):

Jung-Eun Cheon ◽

Ji Young Kim ◽

Young Hun Choi ◽

Woo Sun Kim ◽

Tae-Joon Cho ◽

...

Keyword(s):

Risk Factors ◽

Femoral Head ◽

Contrast Enhancement ◽

Closed Reduction ◽

Interobserver Agreement ◽

Developmental Dysplasia ◽

Enhancement Pattern ◽

Contrast Enhanced ◽

Dysplasia Of The Hip ◽

Hip Mri

Purpose The purpose of this study was to identify imaging risk factors on contrast-enhanced hip MRI after closed reduction of developmental dysplasia of the hip (DDH) that could predict future development of avascular necrosis (AVN) of the femoral head. Materials and methods Fifty-eight infants (F: M = 53: 5, aged 3–18 months) who underwent immediate postoperative contrast-enhanced hip MRI after closed reduction of DDH were included in this study. Quality of reduction (concentric vs eccentric reduction with or without obstacles), abduction angle of the hip, presence of ossific nucleus, and pattern of contrast enhancement of the femoral head were retrospectively evaluated on MRI. Interobserver agreement of contrast enhancement pattern on MRI were evaluated by two radiologists. Development of AVN was determined through radiographic findings at 1 year after reduction. Results AVN of the femoral head developed in 13 (22%) of 58 patients. Excessive abduction of the hip joint (OR 4.65, [95% CI 1.20, 18.06] and global decreased enhancement of the femoral head (OR 71.66, [95% CI 10.54, 487.31]) exhibited statistically significant differences between the AVN and non-AVN groups (P < 0.05). Eccentric reduction (P = 0.320) did not show statistically significant difference between two groups and invisible ossific nucleus (P = 0.05) showed borderline significance. Multi-variable logistic regression indicated that global decreased enhancement of the femoral head was a significant risk factor of AVN (OR 27.92, 95% CI [4.17, 350.18]) (P = 0.0031). Interobserver agreement of contrast enhancement pattern analysis and diagnosis of AVN were good (0.66, 95% CI [0.52, 0.80]). Conclusion Contrast-enhanced hip MRI provides accurate anatomical assessment of the hip after closed reduction of DDH. Global decreased enhancement of the femoral head could be used as a good predictor for future development of AVN after closed reduction of DDH.

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Risk factors for avascular necrosis after closed reduction for developmental dysplasia of the hip

Journal of Children s Orthopaedics ◽

10.1007/s11832-016-0743-7 ◽

2016 ◽

Vol 10 (3) ◽

pp. 185-192 ◽

Cited By ~ 16

Author(s):

Mathew D. Schur ◽

Christopher Lee ◽

Alexandre Arkader ◽

Anthony Catalano ◽

Paul D. Choi

Keyword(s):

Risk Factors ◽

Avascular Necrosis ◽

Closed Reduction ◽

Developmental Dysplasia ◽

Dysplasia Of The Hip

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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/v2 ◽

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 ◽

Factors Associated ◽

Related Risk ◽

Younger Age ◽

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 to investigate risk factors associated with CR failure and avascular necrosis (AVN) occurrence in follow-ups. Mehtods: The study retrospectively included 110 patients and 138 hips with DDH diagnosis that underwent closed reduction between February 2012 and November 2015 in our single tertiary medical institution. 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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Efficacy of closed reduction for developmental dysplasia of the hip: midterm outcomes and risk factors associated with treatment failure and avascular necrosis

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-02098-3 ◽

2020 ◽

Vol 15 (1) ◽

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 ◽

Factors Associated ◽

Related Risk ◽

Younger Age ◽

Dysplasia Of The Hip

Abstract Background The purpose of this study was to evaluate the efficacy of closed reduction (CR) in the treatment of developmental dysplasia of the hip (DDH) and to investigate risk factors associated with CR failure and avascular necrosis (AVN) occurrence in follow-ups. Methods The study retrospectively included 110 patients and 138 hips with DDH diagnosis that underwent closed reduction between February 2012 and November 2015 in our single tertiary medical institution. 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 the present study was 31.16% (43/138). Risk factors for the CR failure were older age at the time of CR (≥ 18.35 month), large medical interval before CR (≥ 35.35 mm), and severer dislocation of the affected hip (IDHI grades III and IV). The incidence of AVN was 8.33% (6/72) in patients with successful CR at the last follow-up. No significant risk factors had been established in the 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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