scholarly journals Dynamic and Static Splinting for Treatment of Developmental Dysplasia of the Hip: A Systematic Review

Children ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. 104
Author(s):  
Vito Pavone ◽  
Claudia de Cristo ◽  
Andrea Vescio ◽  
Ludovico Lucenti ◽  
Marco Sapienza ◽  
...  
Keyword(s):  
Systematic Review ◽  
Therapeutic Option ◽  
Developmental Dysplasia ◽  
Level Of Evidence ◽  
Advantages And Disadvantages ◽  
Developmental Dysplasia Hip ◽  
Dynamic Splinting ◽  
Effective Option ◽  
Dynamic Splint ◽  
Dysplasia Of The Hip

Background: Developmental dysplasia of the hip (DDH) is one of the most common pediatric conditions. The current gold-standard treatment for children under six months of age with a reducible hip is bracing, but the orthopedic literature features several splint options, and each one has many advantages and disadvantages. The aim of this review is to analyze the available literature to document the up-to-date evidence on DDH conservative treatment. Methods: A systematic review of PubMed and Science Direct databases was performed by two independent authors (C.d.C. and A.V.) using the keywords “developmental dysplasia hip”, “brace”, “harness”, “splint”, “abduction brace” to evaluate studies of any level of evidence that reported clinical or preclinical results and dealt with conservative DDH treatment. The result of every stage was reviewed and approved by the senior investigators (V.P. and G.T.). Results: A total of 1411 articles were found. After the exclusion of duplicates, 367 articles were selected. At the end of the first screening, following the previously described selection criteria, we selected 29 articles eligible for full text reading. The included articles mainly focus on the Pavlik harness, Frejka, and Tubingen among the dynamic splint applications as well as the rhino-style brace, Ilfeld and generic abduction brace among the static splint applications. The main findings of the included articles were summarized. Conclusions: Dynamic splinting for DDH represents a valid therapeutic option in cases of instability and dislocation, especially if applied within 4–5 months of life. Dynamic splinting has a low contraindication. Static bracing is an effective option too, but only for stable hips or residual acetabular dysplasia.

scholarly journals Arthroscopic Treatment of Femoroacetabular Impingement in Patients With and Without Borderline Developmental Dysplasia of the Hip: A Systematic Review and Meta-analysis

2021 ◽  
Vol 9 (8) ◽  
pp. 232596712110159
Author(s):  
Yoichi Murata ◽  
Naomasa Fukase ◽  
Grant Dornan ◽  
Maitland Martin ◽  
Rui Soares ◽  
...  
Keyword(s):  
Systematic Review ◽  
Femoroacetabular Impingement ◽  
Meta Analysis ◽  
Developmental Dysplasia ◽  
Level Of Evidence ◽  
Center Edge ◽  
Conversion Rates ◽  
Arthroscopic Findings ◽  
Patient Reported ◽  
Dysplasia Of The Hip

Background: Based on previous studies, it is difficult to discern whether patients who have femoroacetabular impingement (FAI) with borderline developmental dysplasia of the hip (BDDH) would benefit from arthroscopy when compared with patients without BDDH. Purpose: To evaluate the existing comparative literature on arthroscopic findings, procedures, patient-reported outcomes (PROs), and failures in patients who have FAI with BDDH compared with those without BDDH. Study Design: Systematic review; Level of evidence, 3. Methods: The PubMed, Embase, and Ovid databases were searched for studies published up to August 31, 2019, that reported outcomes after arthroscopy to treat patients who had FAI with BDDH. Included studies were required to have patients diagnosed with FAI and BDDH who were treated arthroscopically and compared with control patients (FAI without BDDH). Arthroscopic findings, PROs, and revision or total hip arthroplasty (THA) conversion rates were compared between groups. Results: Included in the review were 4 articles (933 patients). Patients who had FAI with BDDH were defined as having a lateral center-edge angle (LCEA) of either 18° to 25° or 20° to 25°; for control patients, the maximum LCEA was 40°. Across the studies, there were 224 patients who had FAI with BDDH compared with 709 control patients; the mean follow-up time ranged from 21.6 to 31.3 months among the groups. Improvements were shown across all PROs in each study. Random-effects meta-analysis indicated no statistically significant differences in postoperative PROs, the risk for revision surgery, or conversion to THA between the patients who had FAI with versus without BDDH. Conclusion: The results of the current review indicated that hip arthroscopy produced similar short-term outcomes between patients who had FAI with versus without BDDH.

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

Interposition Arthroplasty in the Treatment of End-Stage Hallux Rigidus: A Systematic Review

2021 ◽  
pp. 193864002110539
Author(s):  
Francesco Di Caprio ◽  
Massimiliano Mosca ◽  
Francesco Ceccarelli ◽  
Silvio Caravelli ◽  
Marco Di Ponte ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hallux Rigidus ◽  
Prosthetic Replacement ◽  
Interposition Arthroplasty ◽  
Level Of Evidence ◽  
Advantages And Disadvantages ◽  
Number Of Patients ◽  
Pubmed Search ◽  
End Stage

Purpose Patients affected by moderate to severe hallux rigidus may opt for interposition arthroplasty to avoid the movement restrictions of arthrodesis and the complications related to prosthetic replacement. The propose of this article was to review the current literature about interposition arthroplasty to examine the overall outcomes and to evaluate the advantages and disadvantages of different types of technique, compared with more consolidated procedures. Methods A literature PubMed search was performed. Studies reporting the results of interposition arthroplasty in moderate to severe hallux rigidus were included. The data were pooled and weighted for number of patients in every study. Results The overall results for interposition arthroplasties are comparable to other alternatives for end-stage hallux rigidus, providing better plantar load distribution than arthrodesis and avoiding the drawbacks of prosthetic replacement. Among the various interposition arthroplasty techniques, the Modified Oblique Keller Capsular Interposition Arthroplasty technique preserves toe length and flexor hallucis brevis function, showing the highest satisfaction rate, with lowest metatarsalgia and revision rate. Conclusion Although long-term randomized controlled trials are lacking for interposition arthroplasty, it represents a valid alternative for the treatment of end-stage hallux rigidus also in the young active patient who wants to avoid a definitive intervention immediately. Level of evidence III (systematic review of level III-IV-V studies)

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

scholarly journals 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?

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

scholarly journals Correlations and Reproducibility Between Radiographic and Radial Alpha Angles in the Evaluation of Cam Morphology

2020 ◽  
Vol 8 (7) ◽  
pp. 232596712093292
Author(s):  
Naomi Kobayashi ◽  
Kosuke Sumi ◽  
Shota Higashihira ◽  
Hyonmin Choe ◽  
Taro Tezuka ◽  
...  
Keyword(s):  
Alpha Angle ◽  
Developmental Dysplasia ◽  
Lateral View ◽  
Level Of Evidence ◽  
3 Dimensional ◽  
Recent Developments ◽  
The Cross ◽  
Magnetic Resonance Imaging Mri ◽  
Cam Morphology ◽  
Dysplasia Of The Hip

Background: The alpha angle used to evaluate cam morphology can be determined on different imaging views; however, 2-dimensional (2D) imaging can present limitations in terms of the reproducibility of the radial alpha angle. Recent developments in 3-dimensional (3D) high-resolution magnetic resonance imaging (MRI) have allowed detailed evaluations of the radial alpha angle. Purpose: To determine whether there are any correlations or discrepancies between the 2D alpha angle on plain radiography and the maximum radial alpha angle on 3D MRI. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: A total of 42 hips from 39 patients (19 males, 20 females) were analyzed, including 22 hips with femoroacetabular impingement (FAI; mean age, 41 years) and 20 hips with borderline developmental dysplasia of the hip (BDDH; mean age, 43 years). Radial images were reconstructed from 3D multiple echo recombined gradient echo (MERGE) MRI. Differences in the maximum radial alpha angle on MRI between hips with FAI and BDDH were evaluated. Correlations and discrepancies between the maximum radial alpha angle on MRI and alpha angles on the anteroposterior, cross-table lateral, and 45° Dunn views of radiography were also evaluated. Results: The maximum radial alpha angle was significantly higher for hips with FAI than for hips with BDDH. On average, the greatest alpha angle on radial MRI was higher than the alpha angle on each of the 3 radiographic views for both FAI and BDDH. The 45° Dunn view revealed the smallest discrepancy for both FAI ( P = .005) and BDDH ( P = .002). The cross-table lateral view had the highest correlation with the maximum radial alpha angle for BDDH ( P < .001). Conclusion: We reconfirmed the utility of the 45° Dunn view, with it presenting the best reproducibility for the maximum radial alpha angle in the evaluation of cam morphology, while the cross-table lateral view revealed the best correlation with the maximum radial alpha angle, particularly for hips with BDDH.

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