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.

Soft-tissue interposition after closed reduction in developmental dysplasia of the hip

1999 ◽  
Vol 81-B (3) ◽  
pp. 385-391 ◽  
Author(s):  
T. Hattori ◽  
Y. Ono ◽  
T. Kitakoji ◽  
S. Takashi ◽  
H. Iwata
Keyword(s):  
Soft Tissue ◽  
Closed Reduction ◽  
Developmental Dysplasia ◽  
Dysplasia Of The Hip

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.

scholarly journals Should closed reduction of the dislocated hip be attempted after failed Pavlik harness treatment in developmental dysplasia of the hip?

2021 ◽  
Vol 2 (8) ◽  
pp. 584-588
Author(s):  
Matthew Arneill ◽  
Aidan Cosgrove ◽  
Elaine Robinson
Keyword(s):  
Northern Ireland ◽  
Surgical Procedures ◽  
Closed Reduction ◽  
Developmental Dysplasia ◽  
General Anaesthetic ◽  
Pavlik Harness ◽  
Total Cohort ◽  
Clinically Significant ◽  
Dysplasia Of The Hip

Aims To determine the likelihood of achieving a successful closed reduction (CR) of a dislocated hip in developmental dysplasia of the hip (DDH) after failed Pavlik harness treatment We report the rate of avascular necrosis (AVN) and the need for further surgical procedures. Methods Data was obtained from the Northern Ireland DDH database. All children who underwent an attempted closed reduction between 2011 and 2016 were identified. Children with a dislocated hip that failed Pavlik harness treatment were included in the study. Successful closed reduction was defined as a hip that reduced in theatre and remained reduced. Most recent imaging was assessed for the presence of AVN using the Kalamchi and MacEwen classification. Results There were 644 dislocated hips in 543 patients initially treated in Pavlik harness. In all, 67 hips failed Pavlik harness treatment and proceeded to arthrogram (CR) under general anaesthetic at an average age of 180 days. The number of hips that were deemed reduced in theatre was 46 of the 67 (69%). A total of 11 hips re-dislocated and underwent open reduction, giving a true successful CR rate of 52%. For the total cohort of 67 hips that went to theatre for arthrogram and attempted CR, five (7%) developed clinically significant AVN at an average follow-up of four years and one month, while none of the 35 hips whose reduction was truly successful developed clinically significant AVN. Conclusion The likelihood of a successful closed reduction of a dislocated hip in the Northern Ireland population, which has failed Pavlik harness treatment, is 52% with a clinically significant AVN rate of 7%. As such, we continue to advocate closed reduction under general anaesthetic for the hip that has failed Pavlik harness. Cite this article: Bone Jt Open 2021;2(8):584–588.

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 Role of intraoperative arthrogram in decision making of closed versus medial open reduction of developmental hip dysplasia

2019 ◽  
Vol 5 (6) ◽  
pp. 1037
Author(s):  
Amin A. Ahmed ◽  
Mohie El Din Fadel
Keyword(s):  
Soft Tissue ◽  
Closed Reduction ◽  
Open Reduction ◽  
Developmental Dysplasia ◽  
Developmental Hip Dysplasia ◽  
Hip Arthrography ◽  
Unilateral Involvement ◽  
Medial Open Reduction ◽  
Dysplasia Of The Hip

<p class="abstract"><strong>Background:</strong> Hip arthrography in developmental dysplasia of the hip (DDH) has the advantages of viewing the shape and size of the cartilaginous part of both the femoral head and acetabulum, besides the soft tissue obstacles. The aim of the work was to assess the role of arthrogram in evaluation of closed reduction of developmental dysplasia of the hip.</p><p class="abstract"><strong>Methods:</strong> This prospective study included 30 patients with 36 involved hips who presented with DDH. This study included 7 males (23.3%) and 23 females (76.7%). There were 6 patients with bilateral hip involvement (20.0%) and 24 patients with unilateral involvement (80.0%). In this study we used 3 ml Urografin 76% diluted in 7 ml saline and 3 to 5 ml of diluted Urografin was injected into the hip joint.<strong></strong></p><p class="abstract"><strong>Results:</strong> Out of the 36 hips, closed reduction was successful in 33 hips (91.7%) and failed in 3 (8.3%). After the interpretation of the arthrogram we considered the reduction of 7 (21.2%) reduced hips nonconcentric because of the soft tissue obstacles. In the 7 hips with nonconcentric reduction besides the 3 hips with failed closed reduction, we proceeded to open reduction of the hip through medial approach. At the end of follow up, all hips (100%) showed concentric reduction without re-dislocation in any case.</p><p class="abstract"><strong>Conclusions:</strong> Hip arthrogram is a very reliable method in diagnosing hip concentricity and the presence of soft tissue obstacles in management of DDH by closed reduction. Arthrogram helps the operator to decide open reduction in such cases achieving excellent results in all cases.</p>

scholarly journals MODIFIED DEGA OSTEOTOMY IN TREATING DEVELOPMENTAL DYSPLASIA OF THE HIP

2018 ◽  
Vol 26 (1) ◽  
pp. 30-32
Author(s):  
ROBERTO GUARNIERO ◽  
FERNANDO BARBOSA SANCHEZ ◽  
BRUNO SERGIO FERREIRA MASSA ◽  
NEI BOTTER MONTENEGRO ◽  
PATRÍCIA MORENO GRANGEIRO ◽  
...  
Keyword(s):  
Case Series ◽  
Developmental Dysplasia ◽  
Level Of Evidence ◽  
Average Decrease ◽  
Center Edge ◽  
Joint Congruence ◽  
Dysplasia Of The Hip ◽  
Initial Results ◽  
Center Edge Angle

ABSTRACT Objective: To retrospectively evaluate the preliminary postoperative results of modified Dega-type acetabular osteotomy to treat developmental dysplasia of the hip, confirming the efficacy and reproducibility of this technique. Methods: This retrospective study included patients older than 18 months. A total of 19 hips underwent modified Dega osteotomy. Results: Satisfactory results were obtained, with an average decrease of the acetabular index from 39.2 to 20.6 degrees. The final average center edge angle was 29.6 degrees. Hip joint congruence was reestablished in all cases, and as of this writing, only one case developed necrosis in the femoral head during follow-up. Conclusion: Modified Dega osteotomy demonstrated good initial results, as well as the potential for use in treating developmental dysplasia of the hip. Level of Evidence IV; Case series.

Sign in / Sign up

Export Citation Format

Share Document