An improved method for measuring hip abduction in spica after surgical reduction for developmental dysplasia of the hip

DeFrancesco, Christopher J.; Blumberg, Todd J.; Chauvin, Nancy A.; Sankar, Wudbhav N.

doi:10.1302/1863-2548.11.170038

Cited by 7 publications

(5 citation statements)

References 19 publications

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“…Although we used the traditional method to assess abduction, all hips were immobilized with at least 90° of flexion. According to DeFrancesco et al 16 hip flexion ≤ 40° exhibits ≥ 10° of error.…”

Section: Discussionmentioning

confidence: 95%

“…Therefore, our results should be considered preliminary and longer follow-up is needed to validate these findings. Third, DeFrancesco et al 16 have pointed out that traditional method for measuring hip abduction using axial imaging does not reflect the true angle, which usually lies in an oblique plane. They found that the traditional method is most accurate at 90° of flexion, but it increasingly overestimates abduction as hip flexion decreases.…”

Section: Discussionmentioning

confidence: 99%

“…Hip abduction angle was the angle between the axis of the femoral shaft and the horizontal line tangent to ischial tuberosity, bilaterally. 16 Values were expressed in degrees.…”

Section: Methodsmentioning

confidence: 99%

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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

Liu

et al. 2019

Journal of Children's Orthopaedics

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PurposeThe 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.MethodsA 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.ResultsThe 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).ConclusionAbduction 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 evidenceIII.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

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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

Liu

et al. 2019

Journal of Children's Orthopaedics

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“…Previous studies have highlighted the surgical approach and excessive abduction as major contributors to iatrogenic avascular necrosis (AVN). Several researchers have suggested that excessive hip abduction could compress the medial femoral circumflex artery or elevate hip joint pressure, potentially compromising the blood supply to the femoral head and leading to AVN [ 20 , 21 ]. In our study, we found no statistically significant difference between abduction angle and AVN incidence.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for avascular necrosis of the femoral head after developmental hip dislocation reduction surgery and construction of Nomogram prediction model

Tang,

Li,

et al. 2024

BMC Musculoskelet Disord

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Background To analyze the risk factors for the development of avascular necrosis (AVN) of the femoral head after reduction surgery in children with developmental hip dysplasia (DDH), and to establish a prediction nomogram. Methods The clinical data of 134 children with DDH (169 hips) treated with closure reduction or open reduction from December 2016 to December 2019 were retrospectively analyzed. Independent risk factors for AVN after DDH reduction being combined with cast external immobilization were determined by univariate analysis and multivariate logistic regression and used to generate nomograms predicting the occurrence of AVN. Results A total of 169 hip joints in 134 children met the inclusion criteria, with a mean age at surgery of 10.7 ± 4.56 months (range: 4–22 months) and a mean follow-up duration of 38.32 ± 27.00 months (range: 12–94 months). AVN developed in 42 hip joints (24.9%); univariate analysis showed that the International Hip Dysplasia Institute (IHDI) grade, preoperative development of the femoral head ossification nucleus, cartilage acetabular index, femoral head to acetabular Y-shaped cartilage distance, residual acetabular dysplasia, acetabular abduction angle exceeding 60°, and the final follow-up acetabular index (AI) were associated with the development of AVN (P < 0.05). Multivariate logistic regression analysis showed that the preoperative IHDI grade, development of the femoral head ossification nucleus, acetabular abduction angle exceeding 60°, and the final follow-up AI were independent risk factors for AVN development (P < 0.05). Internal validation of the Nomogram prediction model showed a consistency index of 0.833. Conclusion Preoperative IHDI grade, preoperative development of the femoral head ossification nucleus, final AI, and acetabular abduction angle exceeding 60° are risk factors for AVN development. This study successfully constructed a Nomogram prediction model for AVN after casting surgery for DDH that can predict the occurrence of AVN after casting surgery for DDH.

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“…At 90° hip flexion, an axial image is orthogonal to the plane of hip flexion, therefore it is appropriate to measure abduction angle on axial plane. If the hip flexion angle is less than 90°, axial images are not orthogonal to the plane of hip flexion and it should be considered that abduction angle might be overestimated [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

MRI risk factors for development of avascular necrosis after closed reduction of developmental dysplasia of the hip: Predictive value of contrast-enhanced MRI

et al. 2021

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Purpose The purpose of this study was to identify imaging risk factors on contrast-enhanced hip MRI after closed reduction of developmental dysplasia of the hip (DDH) that could predict future development of avascular necrosis (AVN) of the femoral head. Materials and methods Fifty-eight infants (F: M = 53: 5, aged 3–18 months) who underwent immediate postoperative contrast-enhanced hip MRI after closed reduction of DDH were included in this study. Quality of reduction (concentric vs eccentric reduction with or without obstacles), abduction angle of the hip, presence of ossific nucleus, and pattern of contrast enhancement of the femoral head were retrospectively evaluated on MRI. Interobserver agreement of contrast enhancement pattern on MRI were evaluated by two radiologists. Development of AVN was determined through radiographic findings at 1 year after reduction. Results AVN of the femoral head developed in 13 (22%) of 58 patients. Excessive abduction of the hip joint (OR 4.65, [95% CI 1.20, 18.06] and global decreased enhancement of the femoral head (OR 71.66, [95% CI 10.54, 487.31]) exhibited statistically significant differences between the AVN and non-AVN groups (P < 0.05). Eccentric reduction (P = 0.320) did not show statistically significant difference between two groups and invisible ossific nucleus (P = 0.05) showed borderline significance. Multi-variable logistic regression indicated that global decreased enhancement of the femoral head was a significant risk factor of AVN (OR 27.92, 95% CI [4.17, 350.18]) (P = 0.0031). Interobserver agreement of contrast enhancement pattern analysis and diagnosis of AVN were good (0.66, 95% CI [0.52, 0.80]). Conclusion Contrast-enhanced hip MRI provides accurate anatomical assessment of the hip after closed reduction of DDH. Global decreased enhancement of the femoral head could be used as a good predictor for future development of AVN after closed reduction of DDH.

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An improved method for measuring hip abduction in spica after surgical reduction for developmental dysplasia of the hip

Cited by 7 publications

References 19 publications

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

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

Risk factors for avascular necrosis of the femoral head after developmental hip dislocation reduction surgery and construction of Nomogram prediction model

MRI risk factors for development of avascular necrosis after closed reduction of developmental dysplasia of the hip: Predictive value of contrast-enhanced MRI

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