scholarly journals EVALUATION OF AVASCULAR NECROSIS DURING MIDTERM FOLLOW UP IN DDH CASES TREATED BY SINGLE STAGE SURGERY IN THE WALKING AGE GROUP

2021 ◽  
pp. 6005-6010
Keyword(s):  
Femoral Head ◽  
Surgical Procedures ◽  
Open Reduction ◽  
Soft Tissues ◽  
Developmental Dysplasia ◽  
Single Stage ◽  
Age Group ◽  
Developmental Dysplasia Of Hip ◽  
Walking Age

Developmental dysplasia of hip (DDH) represents a spectrum of disorders in which the femoral head has an abnormal relationship to the acetabulum. Management of DDH presenting in walking stage are primarily surgical because of changes in femoral head, acetabulum and soft tissues around joint. We looked at the incidence of AVN during midterm follow up period in DDH patients in the walking age group who had undergone single stage surgery. Also it evaluates association of different variables with occurrence of AVN. The AVN of head of femur is assessed according to Kalamchi and MacEwen’s classification and AVN gradings were compared with different surgical procedures. In our study, higher incidence of AVN was seen patients who were operated at a higher age, who had higher preoperative Tonnis grading and those who required osteotomies with open reduction. But statistically significant correlation could not be established independently with any of the above mentioned variables.

scholarly journals Outcome of Closed Reduction of Developmental Dysplasia of Hip Before First Year of Age, A Retrospective Cohort Study, Saudi Arabia

2020 ◽  
Author(s):  
Fahad AlShayhan ◽  
Abdulmonem Alsiddiky ◽  
Raghad Barri
Keyword(s):  
Closed Reduction ◽  
Open Reduction ◽  
Medical Center ◽  
Developmental Dysplasia ◽  
First Year ◽  
Developmental Dysplasia Of Hip ◽  
Class 1 ◽  
One Year ◽  
Skin Traction

Abstract Background: Developmental dysplasia of hip (DDH) management is challenging hence there is no fixed rules or radiographic criteria to assess and manage DDH. There are many treating modalities including closed reduction, open reduction, skin traction, hip Spica and many others. This study is to assess the outcome of closed reduction in patients below 12 months of ages.Method: A retrospective study among patients with DDH who underwent closed reduction before the first year of age in a major referral medical center. The study included 100 patients and 168 hips. Average of follow up period was 5.97 years (±3.01). Couple of variables were measured in AP x ray of pelvis to assess the outcome of closed reduction. Results: Most of the hips were grade 1 and 2 according to the IHDI (International hip dysplasia institution) classification. Significant improvement in the acetabular index post closed reduction. In addition to the normalizing of CE angel's values. Also, majority of hips were severin's class 1 and 2 which were associated with good outcome.Conclusion: Safe closed reduction in patients with DDH below one year of age had a great outcome, less AVN, less growth complications and decrease the need of future open reduction.

scholarly journals 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

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.

scholarly journals Single-Stage Combined Surgery for Treating Neglected Bilateral Developmental Hip Dysplasia after Walking Age

Esculapio ◽  
2021 ◽  
Vol 16 (4 (oct 2020 - dec 2020)) ◽  
Author(s):  
Abdul Latif Shahid ◽  
Islam Hussain ◽  
Farhad Alam ◽  
Muhammad Nazir Awan ◽  
Hana Khurshid ◽  
...  
Keyword(s):  
Scoring System ◽  
Hip Dysplasia ◽  
Developmental Dysplasia ◽  
Single Stage ◽  
Anterolateral Approach ◽  
Combined Surgery ◽  
Developmental Hip Dysplasia ◽  
Developmental Dysplasia Of Hip ◽  
Walking Age ◽  
Grade Ii

Objectives: To determine outcome in Single Stage Surgery of Both Hips in Bilateral Developmental Dysplasia of Hip in Children after walking age. Methods: This was a retrospective review of 20 hips in 10 patients (7 females and 3 males), operated at the children's hospital and the institute of child health, Lahore between 2014 and 2016. The age of patients was between 2 and 5 years. There were 10 hips in grade IV, 6 in grade III and 4 in grade II according to Tonnis classification. Both hips were operated in single stage. Open reduction of hip joint was done by anterolateral approach in all children. Salter osteotomy was done in every child while femoral shortening was needed in 10 hips. Outcome of single stage surgery was assessed by radiological assessment of Severin's scoring system and functional assessment of MacKay's scoring system at final followup after 2 years of suegery. Results: There was no effect of age, gender, malnutrition, body mass index on outcome. According to Severin's scoring system, 14 hips (70%) were in grade I while 6 (30%) in grade II. Outcome was excellent in 6 hips (30%), good in 13 (60%) and fair in 1 (5%) by applying MacKay's scoring system. Hip spica of one child was changed after one month due to wetting with urine. There was no hip dislocation or subluxation in any case. Conclusion: Single stage surgery of both hips can be done safely in bilateral developmental dysplasia of hip by anterolateral approach in late presented children. Key Words: Developmental dysplasia of hip, Single stage surgery. How to Cite: Latif A.S, Hussain I, Alam F, Nazir M. A, Khurshid H., B. Zulqernain. Single-stage combined surgery for treating neglected bilateral developmental hip dysplasia after walking age. Esculapio.2020;16(04):70-73.

A COMPREHENSIVE PELVIC AND FEMORAL OSTEOTOMY REVISION TO TREAT A FAILED PELVIC AND FEMORAL OSTEOTOMY: A CASE REPORT

2021 ◽  
pp. 2150022
Author(s):  
Panos K. Megremis ◽  
Orestis P. Megremis
Keyword(s):  
Surgical Procedure ◽  
Open Reduction ◽  
Pelvic Osteotomy ◽  
Femoral Osteotomy ◽  
Salter Osteotomy ◽  
Shortening Osteotomy ◽  
Innominate Osteotomy ◽  
Walking Age ◽  
One Year

Hip’s open reduction combined with Salter innominate osteotomy and femoral osteotomy is the treatment of choice when treating Developmental Dislocation of the Hip (DDH) at walking age. We report a case of a five-year-old girl who underwent a failed surgical procedure of hip’s open reduction, Salter innominate osteotomy, and the femoral osteotomy. One year later, one-stage surgical procedure of hip’s open reduction, Dega pelvic osteotomy, and femoral de-rotation varus shortening osteotomy was performed. During the five-year follow-up, the clinical outcome was evaluated as excellent. The Dega pelvic osteotomy is an effective pelvic osteotomy for DDH, in a case of a failed Salter osteotomy.

scholarly journals Capsular arthroplasty for neglected developmental dysplasia of hip

2018 ◽  
Vol 26 (2) ◽  
pp. 230949901877788 ◽  
Author(s):  
Saeed Ahmad ◽  
Irfan Qadir ◽  
Atiq uz Zaman ◽  
Chiragh Muhammad Khan ◽  
Shahzad Javed ◽  
...  
Keyword(s):  
Hip Dislocation ◽  
Developmental Dysplasia ◽  
Harris Hip Score ◽  
Functional Evaluation ◽  
Short Term ◽  
Scoring Method ◽  
Developmental Dysplasia Of Hip ◽  
Femoral Shortening ◽  
Shelf Procedure

Introduction: Treatment of developmental dysplasia of hip (DDH) diagnosed after 10 years of age is extremely difficult because of the soft tissue and bone deformities. In this study, we evaluated short-term results of a single-stage procedure performed with surgical hip dislocation, femoral shortening and capsular arthroplasty. Patients and Methods: A retrospective review of charts of five patients with DDH, older than 10 years, who underwent capsular arthroplasty at Ghurki Trust Teaching Hospital between 2013 and 2015 was performed. Post-operative functional evaluation was performed using modified McKay’s scoring system and radiographic assessment using Severin’s scoring method at a minimum of 2-year follow-up. Results: We present results of five patients (six hips) with a mean age of 18.16 years. All patients had limping gait and International Hip dysplasia Institute classification (IHDI) class 4 hip dislocation. Harris hip score showed a significant improvement (53.13 vs 84.16; p = 0.0001). Femoral shortening of 2–2.5 cm was done. Additional shelf procedure was required in one patient. This patient persistently has post-operative hip subluxation. All patients had good to excellent outcomes according to McKay classification. Post-operative Severin classification was 1A in all patients. No case of avascular necrosis of the femoral head was noted during the follow-up. Conclusion: Capsular arthroplasty with subtrochanteric shortening is a useful procedure for neglected cases of DDH in patients older than 10 years.

scholarly journals Correlation between ultrasonic and radiographic imaging of developmental dysplasia of the hip

2019 ◽  
Vol 13 (2) ◽  
pp. 155-160 ◽  
Author(s):  
A. J. Spaans ◽  
F. J. A. Beek ◽  
C. S. P. M. Uiterwaal ◽  
J. E. H. Pruijs ◽  
R. J. Sakkers
Keyword(s):  
Femoral Head ◽  
Developmental Dysplasia ◽  
Acetabular Index ◽  
Ultrasound Images ◽  
Radiographic Imaging ◽  
Femoral Head Coverage ◽  
Level Of Evidence ◽  
Developmental Hip Dysplasia ◽  
Α Angle

Purpose The correlation between the degree of developmental hip dysplasia (DDH) measured on ultrasound images compared with that measured on radiographs is not clear. Most studies have compared ultrasonography (US) and radiographic images made at different times of follow-up. In this study the correlation between US images and radiographs of the hip made on the same day was evaluated. Methods US images and radiographs of both hips of 74 infants, who were treated for stable DDH, were reviewed in a retrospective study. Only infants who had an US examination and a radiograph on the same day were included. Results The correlation between α-angle of Graf and femoral head coverage on US was strong (p ≤ 0.0001). Weak correlations were found between the acetabular index of Tönnis on radiographs and α-angle of Graf on US (p = 0.049) and between acetabular index of Tönnis on radiographs and femoral head coverage of Morin on US (p = 0.100). Conclusion This study reports on the correlation between US and radiographic imaging outcomes, both made on the same day in patients for treatment and follow-up of DDH. Level of Evidence IV

scholarly journals Presentation and Management of Neglected Developmental Dysplasia of Hip (DDH): 8-years’experience with single stage triple procedure

2018 ◽  
Vol 34 (3) ◽  
Author(s):  
Faridullah Khan Zimri ◽  
Syed Shujaat Ali Shah ◽  
Muhammad Saaiq ◽  
Faisal Qayyum ◽  
Muhammad Ayaz
Keyword(s):  
Developmental Dysplasia ◽  
Single Stage ◽  
Developmental Dysplasia Of Hip ◽  
Triple Procedure

scholarly journals Evaluation of CE angle of Wiberg for the functional outcome in various hip pathologies: an observational study

2018 ◽  
Vol 5 (1) ◽  
pp. 182
Author(s):  
Juzer Bagwala ◽  
Susheel Soni
Keyword(s):  
Femoral Head ◽  
Observational Study ◽  
Functional Outcome ◽  
Avascular Necrosis ◽  
Femoroacetabular Impingement ◽  
Operative Management ◽  
Developmental Dysplasia ◽  
Developmental Dysplasia Of Hip ◽  
Necrosis Of Femoral Head ◽  
Non Operative Management

<p class="abstract"><strong>Background:</strong> The objective of the study was to evaluate CE Angle of Wiberg for the functional outcome in various hip pathologies.</p><p class="abstract"><strong>Methods:</strong> This is a non-randomised prospective, observational study carried out for the period of 15 months. In this study 35 hips of 28 patients with hip pathologies with age more than 5 years of both genders, hip pathologies like CAM and/or Pincer type of femoroacetabular impingement, Acetabular retroversion, Perthes like deformity, osteoarthritis hip, avascular necrosis of femoral head, developmental dysplasia of hip were studed.<strong></strong></p><p class="abstract"><strong>Results:</strong> In this prospective study out of 28 patients 9 (32.14%) were FAI, 8 (28.57%) were OA hip, 8 (28.57%) were avascular necrosis of femoral head and 3 case (10.71%) is of Perthes' disease. In FAI cases 4(44.44%) patients were of Pincer type, 5 (55.55%) were of combined type with no any case of isolated CAM form. All were unilateral involvement with average CE angle of 32.67<sup>0</sup>±11.67<sup>0</sup>. In Pincer type mean CE angle was 36.25<sup>0 </sup>±7.5<sup>0 </sup>while in Combined form the mean CE angle was 29.8<sup>0</sup>±14.4<sup>0</sup>. Out of 4 patients of Pincer FAI, 3 patients of Pincer type had CE angle between 25<sup>0</sup>-40<sup>0 </sup>which comes under normal range of CE angle, so all were planned for non operative management.</p><strong>Conclusions:</strong> We have found that all the hip pathologies reported to us had spectrum of variations in CE angle depending on the severity of disease. Variation was maximum seen in osteoarthritis and femoroacetabular impingement, in the cases of FAI maximum was of Pincer type.

scholarly journals Neglected Locked Patellar Dislocation in an Adult Female: Report of a Rare Case

2021 ◽  
Vol 11 (5) ◽  
Author(s):  
Sumedh D Chaudhary ◽  
Pratik R Gandhi ◽  
Maruti R Koichade ◽  
Suchit P Chavan ◽  
Shreyas H Ghuguskar
Keyword(s):  
Open Reduction ◽  
Patellar Dislocation ◽  
Soft Tissues ◽  
Vertical Axis ◽  
Successful Outcome ◽  
Trochlear Groove ◽  
Osteochondral Fracture ◽  
Chondral Injury ◽  
Wound Healing Problems

Introduction: Dislocation of patella is a very common injury which usually reduces spontaneously or can be reduced easily using gentle manipulation. Irreducible patellar dislocations are rare and usually result due to either rotation of patella along the horizontal or vertical axis or due to bony impaction. Neglected locked patellar dislocations are extremely rare injuries presenting additional challenges. Case Report: We are reporting a case of a 24-year female who presented to us 4 months after suffering a knee injury for which she received native treatment initially. On presentation, patient was able to walk with a limp and some discomfort but was unable to squat or sit cross-legged. Clinical examination revealed a patellar dislocation which was irreducible. On open reduction, the patella was found to be locked in the lateral gutter with rotation along its vertical axis and with an osteochondral fracture of its medial margin. There were a lot of fibrotic adhesions which required extensive release, following which the patella could be derotated and reduced into the trochlear groove. The medial retinaculum was repaired using transosseous sutures. Postoperatively, the patient developed wound edge necrosis which was managed with debridement and secondary suturing. At 1-year follow-up patient had almost full knee range of motion without any signs of patellar pain or instability and was able to squat and sit cross-legged. Conclusion: Unlike acute irreducible patellar dislocations which can be managed easily with open reduction, a neglected dislocation necessitates wider surgical exposure and a lot of soft tissue releases, which may jeopardize vascularity of the soft tissues leading to wound healing problems. Release of all adhesions while taking care to prevent further chondral injury, adequate lateral retinacular release, derotation of patella to relocate it into trochlear groove, and meticulous medial retinacular repair is essential for a successful outcome. Keywords

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