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

<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>

Hip Arthrography

Chapter 101 describes the indications, technique, and imaging findings of hip arthrography. Hip arthrography is selectively performed in routine clinical practice for MRA, typically in younger patients. Indications include hip pain thought to be caused by acetabular labral injury, femoroacetabular impingement syndromes, as well as therapeutic steroid injections. Contrast should easily inject and disperse throughout the joint away from the needle, opacifying the femoral head and neck recesses and outlining the zona orbicularis. The technique can also be used for arthrocentesis with suspected infection, but contrast should not be injected. Contrast extension into the acetabular labral substance may be occasionally depicted on the standard arthrography images. However, it is nowadays evaluated by MRA or sometimes CTA. Complications include infection, bleeding (especially if arterial puncture), and femoral nerve injury.