Acetabular development after open reduction to treat dislocation of the hip after walking age

Kagawa, Yutaka; Endo, Hidenori; Tetsunaga, Tomonori; Fujii, Yosuke; Miyake, Takamasa; Ozaki, Toshifumi

doi:10.1016/j.jos.2016.07.007

Cited by 7 publications

(8 citation statements)

References 25 publications

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“…Our findings were similar to previous reports that show~30% of closed reduced hips need future osteotomy. 1,2 Unsatisfactory outcome following open reduction is previously reported as 36% 4 and 49%, 15,16 which is higher than the findings in this study (19% had outcome AI 30). In cases when outcome AI was 30 and no pelvic osteotomy was performed (1 hip in the closed reduction group and 2 hips in the open reduction group; Table 3), the family elected to wait and monitor remodeling.…”

Section: Discussioncontrasting

confidence: 72%

Closed vs open reduction in developmental dysplasia of the hip: The short-term effect on acetabular remodeling

Abousamra

Deliberato

Singh

et al. 2020

Journal of Clinical Orthopaedics and Trauma

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Background: This study aims to assess acetabular remodeling following closed vs, open hip reduction in children younger than 2 years of age. Methods: Records of children with DDH, who underwent closed or open reduction, were reviewed. Acetabular index (AI) was measured on radiographs taken prior to reduction and on outcome radiographs taken at age 4 years. Radiographic outcomes were analyzed and residual dysplasia (outcome AI 30) degrees recorded. Results: 42 hips had closed reduction; and 26 hips had open reduction. A higher percentage of hips treated with successful closed reduction, had outcome AI 30 (29% vs. 19% p ¼ 0.387). Residual dysplasia was more common in IHDI-IV hips than IHDI-III hips for both groups. A higher incidence of AVN was seen in the open reduction group (13% vs. 7%; p ¼ 0.43). Conclusion: In children with DDH under the age of two, open reduction with capsulorrhaphy may benefit acetabular remodeling more so than closed reduction despite maintenance of reduction. Although AVN remains a risk, higher remodeling might be expected with open reduction.

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Section: Discussioncontrasting

confidence: 72%

Closed vs open reduction in developmental dysplasia of the hip: The short-term effect on acetabular remodeling

Abousamra

Deliberato

Singh

et al. 2020

Journal of Clinical Orthopaedics and Trauma

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“…It should be noted that this study found higher rates of overall residual dysplasia following open and closed reduction than has typically been reported in the literature. 8,9,33,34 In this series, almost 70% of patients showed an AI greater than the 90th percentile at 2 years postoperative. While AI has been shown to improve in hips for up to 7 years postoperatively in patients with satisfactory outcomes, patients with an AI of > 25 degrees at 2 to 4 years have a high likelihood of demonstrating long-term residual dysplasia.…”

Section: Discussionmentioning

confidence: 53%

MRI Predictors of Residual Dysplasia in Developmental Dysplasia of the Hip Following Open and Closed Reduction

Johnson

Gohel²,

Nguyen

et al. 2022

Journal of Pediatric Orthopaedics

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Background: Following open or closed reduction for children with developmental dysplasia of the hip, there remains a significant risk of residual acetabular dysplasia which can compromise the long-term health of the hip joint. The purpose of this study was to use postoperative in-spica magnetic resonance imaging (MRI) data to determine factors predictive of residual acetabular dysplasia at short-term follow-up. Methods: We retrospectively reviewed 63 hips in 48 patients which underwent closed or open reduction and spica casting for developmental dysplasia of the hip. MRI performed in-spica at ∼3-week follow-up were used to assess 11 validated metrics and 2 subjective factors. Acetabular index (AI) was measured on anteroposterior pelvic radiographs at 2-year postoperative followup. Binary logistic regression was then used to identify variables predictive of residual dysplasia, defined as an AI greater than the 90th percentile for age based on historic normative data. Results: Average age at surgical reduction was 9.3 ± 3.2 months. 58.7% (37/63) of reductions were open. A total of 43 (68.3%) hips demonstrated residual acetabular dysplasia at 2 years postoperatively based on normative values. In those with persistent dysplasia, patients were on average older at the time of reduction (10.0 mo ± 3.2 vs. 8.0 mo ± 2.8, P = 0.010) and more likely female (88.4% vs. 60.0%, P = 0.010). Patients with residual dysplasia were more likely to have mild subluxation on postoperative MRI (40.0% vs. 10.5%, P = 0.022). Hips with a cartilaginous acetabular index (CAI) of > 23 degrees were 7.6 times more likely to develop residual dysplasia. Type of reduction (ie, closed vs. open) did not appear to influence the rate of residual dysplasia (P = 0.682). Conclusion:In this series, the rate of residual dysplasia after surgical reduction was higher than most previous reports, with no appreciable difference between closed and open reductions. Older age, female sex, and a higher CAI were associated with a greater risk of persistent radiographic dysplasia. In particular, hips with a CAI > 23 degrees were 7.6 times more likely to be dysplastic at 2-year follow-up.

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“…[12] In the present study, the mean age of the patients was 25.09 ± 4.6 months. Kagawa et al [18] evaluated 43 hips of 38 children with Tönnis grade 3 and 4 hip displacements treated by an OR after walking age. In their study, it was observed that radiologically the hip joint development continued to improve until 6 years and, in some cases, up to 7-8 years.…”

Section: Discussionmentioning

confidence: 99%

Acetabular development after open reduction to treat developmental dysplasia of the hip after walking age

Bakarman

Alsiddiky

Zamzam

et al. 2023

JMSR

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Objectives: Treatment of developmental dysplasia of the hip (DDH) with high hip dislocation in children using a one-stage operation appears tedious and associated with complications. This study aimed to assess a less traumatic approach for the surgical treatment of irreducible hips among children with DDH after walking age. The treatment strategy involved open reduction (OR) alone and non-invasive monitoring of acetabular development. Methods: This was a retrospective analysis of 22 hips of 20 female patients with complete dislocation of the hip and a mean age of 25.09 ± 4.6 months, performed between February 2013 and February 2018. All DDH patients underwent OR alone and had an irreversible hip dislocation. After surgery, a spica cast was applied for 6 weeks and then reduced to a broomstick cast for a considerable period. Finally, night abduction brace was placed until a normal acetabular index (AI) was obtained. The mean follow-up was 44.60 ± 12.36 months. Results: Out of 20 patients with DDH, 18 (90%) were successfully treated by OR alone. The main pre-operative AI of 41.82° ± 5.54° decreased to 16.19° ± 7.09° at the final follow-up (P < 0.001). An initial negative center-edge angle at the pre-operative stage gradually increased to a mean of 26.86° ± 6.56° during the follow-up period. Conclusion: Relatively less invasive approach adopted in this study not only obviated the need for an additional procedure but also had a favorable effect on the acetabular and hip joint development.

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Acetabular development after open reduction to treat dislocation of the hip after walking age

Cited by 7 publications

References 25 publications

Closed vs open reduction in developmental dysplasia of the hip: The short-term effect on acetabular remodeling

Closed vs open reduction in developmental dysplasia of the hip: The short-term effect on acetabular remodeling

MRI Predictors of Residual Dysplasia in Developmental Dysplasia of the Hip Following Open and Closed Reduction

Acetabular development after open reduction to treat developmental dysplasia of the hip after walking age

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