Developmental Dysplasia of the Hip in Twins

Pellegrin, Maurizio De; Moharamzadeh, Désirée

doi:10.1097/bpo.0b013e3181fc35c0

Cited by 21 publications

(13 citation statements)

References 21 publications

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“…Findings about multiple pregnancy as a risk factor for DDH are also controversial. Some authors did not recommend routine ultrasound screening for twins and triplets [24–26]. In our study, multiple pregnancy (twins or triplets) was found to be a risk factor for DDH.…”

Section: Discussionmentioning

confidence: 40%

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Risk Factor Assessment and a Ten-Year Experience of DDH Screening in a Well-Child Population

Kural

Karapinar

Yılmazbaş

et al. 2019

BioMed Research International

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Aim. Risk based screening for developmental dysplasia of the hip (DDH) with ultrasound is common. However, risk factors vary from one country to the other since data are insufficient to give clear recommendations. We aimed to evaluate the risk factors for developmental dysplasia of the hip (DDH). Methods. In this retrospective case-control study, the health records of all children, who were followed up between 2004 and 2014 at a well-child unit, were investigated for the diagnosis of DDH in Turkey. Of 9758 children, 57 children were found to have abnormal ultrasonographic findings (according to Graf classification) and these constituted the case group. As the control group, healthy 228 children who matched the case children in birth months were selected. Two groups were compared for the risk factors. Results. A total of 19516 hips of 9758 children were examined for DDH. 97 hips of 57 children were found to have abnormal ultrasonographic findings. When the two groups were compared, breech presentation, multiple pregnancy, and torticollis were identified as risk factors. The female sex was also found to have a significantly high prevalence among the children in the case group. Limited hip abduction, positive Ortolani, and Barlow signs were important clinical findings in the case group. Conclusion. According to our findings, breech presentation, female sex, torticollis, and multiple pregnancy were found to be the risk factors of this disorder. Infants with these risk factors should be investigated carefully for DDH.

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Section: Discussionmentioning

confidence: 40%

“…In our study, multiple pregnancy (twins or triplets) was found to be a risk factor for DDH. This may be due to the additional risk factors of multiple pregnancy[24].…”

Section: Discussionmentioning

confidence: 99%

Risk Factor Assessment and a Ten-Year Experience of DDH Screening in a Well-Child Population

Kural

Karapinar

Yılmazbaş

et al. 2019

BioMed Research International

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“…This may strengthen the theory that DDH is more likely when firstborn fetal movements are restricted by stiffer, less pliant maternal tissues, which have not before been stretched to the full extent during pregnancy ( Nowlan, 2015 , Wilkinson, 1963 ). Finally, it is known that twins are not at increased risk of DDH as compared to singletons, despite having reduced intra-uterine space available for movements ( De Pellegrin and Moharamzadeh, 2010 ). Our measurements indicate that while twin fetuses are approximately 35% smaller than singletons at 20 weeks (using femoral length as an indicator of size), the combined mass of both fetuses would in fact be 30% larger than a singleton.…”

Section: Discussionmentioning

confidence: 99%

“…While not an abnormal intra-uterine condition, primiparous (firstborn) pregnancies also carry a significantly greater risk of DDH when compared to subsequent pregnancies ( Chan et al, 1997 , de Hundt et al, 2012 , Stein-Zamir et al, 2008 , Yiv et al, 1997 ), which may be related to greater uterine muscle tone in primiparity ( Wilkinson, 1963 ). Interestingly, despite less available uterine space in twin pregnancies, the incidence of DDH in twins is no higher than in singletons ( De Pellegrin and Moharamzadeh, 2010 , Dezateux and Rosendahl, 2007 ). However, little is known of how the biomechanics of fetal movements change with intra-uterine environment or fetal position.…”

Section: Introductionmentioning

confidence: 98%

European Society of Biomechanics S.M. Perren Award 2018: Altered biomechanical stimulation of the developing hip joint in presence of hip dysplasia risk factors

Verbruggen

Kainz

Shelmerdine

et al. 2018

Journal of Biomechanics

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Fetal kicking and movements generate biomechanical stimulation in the fetal skeleton, which is important for prenatal musculoskeletal development, particularly joint shape. Developmental dysplasia of the hip (DDH) is the most common joint shape abnormality at birth, with many risk factors for the condition being associated with restricted fetal movement. In this study, we investigate the biomechanics of fetal movements in such situations, namely fetal breech position, oligohydramnios and primiparity (firstborn pregnancy). We also investigate twin pregnancies, which are not at greater risk of DDH incidence, despite the more restricted intra-uterine environment. We track fetal movements for each of these situations using cine-MRI technology, quantify the kick and muscle forces, and characterise the resulting stress and strain in the hip joint, testing the hypothesis that altered biomechanical stimuli may explain the link between certain intra-uterine conditions and risk of DDH. Kick force, stress and strain were found to be significantly lower in cases of breech position and oligohydramnios. Similarly, firstborn fetuses were found to generate significantly lower kick forces than non-firstborns. Interestingly, no significant difference was observed in twins compared to singletons. This research represents the first evidence of a link between the biomechanics of fetal movements and the risk of DDH, potentially informing the development of future preventative measures and enhanced diagnosis. Our results emphasise the importance of ultrasound screening for breech position and oligohydramnios, particularly later in pregnancy, and suggest that earlier intervention to correct breech position through external cephalic version could reduce the risk of hip dysplasia.

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“…Shifting the distal segment downwards causes decrease in the acetabular volume cavity and increase in the pressure on the femoral head, leading to increase in the risk of chondrolysis and avascular necrosis (AVN) of the femoral head. Furthermore, there is a possible displacement of the inserted graft in the gap between the distal and proximal segments, leading to displacement of the distal segment upwards and inwards and decrease in or destroying the primary coverage of femoral head [9, 10].…”

Section: Introductionmentioning

confidence: 99%

A Newly Modified Salter Osteotomy Technique for Treatment of Developmental Dysplasia of Hip That Is Associated with Decrease in Pressure on Femoral Head and Triradiate Cartilage

Esmaeilnejad-Ganji

Zamani

et al. 2019

BioMed Research International

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Background and Purpose. The Salter innominate osteotomy has been an effective method to treat the developmental dysplasia of hip (DDH) over the past decades; however, several postoperative complications and deficiencies were reported. In this study, we evaluated outcome of a newly modified Salter osteotomy in patients presenting with DDH. Methods. We reviewed retrospectively 76 patients (90 hips) with DDH aged ≥ 18 months, who underwent open reduction and a modified osteotomy by a single surgeon. The distal osteotomy segment of pelvis was shifted anterolaterally in the amount of osteotomy cross-section, but not downwards. The mean age at surgery was 2 years and 11 months (1.5 to 16 years). Femoral shortening was conducted when necessary. The duration of operation varied between 60 and 90 minutes. The mean follow-up was 4 years and one month (range 15 months to 7 years and 9 months). All patients were followed up both clinically (based on the modified MacKay criteria) and radiologically (based on the modified Severin criteria). Results. Clinically, 94.5% of hips had excellent and good results at final follow-up, and only 5.5% had a fair condition. Radiographically, at the final follow-up 77.8% of hips were grade IA (excellent), 12.2% were grade IB, 6.7% were grade II, and 3.3% were grade III (fair). The preoperative mean acetabular index was 47.85° (41° to 59), which decreased to 17.16° (13° to 22°) immediately after the surgery (p<0.0001) and progressed to 11.24° (7° to 19°) at the final follow-up (p<0.0001). The mean initial postoperative center-edge angle was 30.3° (25° to 42°) significantly improved to 39.1 (31° to 56°) at the final follow-up (p<0.0001). Avascular necrosis of femoral head occurred in 4.4% of hips (4 patients). Conclusion. The results show that our modified Salter osteotomy is safe and associated with significant benefit for the management of patients suffering from DDH.

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Developmental Dysplasia of the Hip in Twins

Abstract: Retrospective study. Level 2 study.

Cited by 21 publications

References 21 publications

Risk Factor Assessment and a Ten-Year Experience of DDH Screening in a Well-Child Population

Risk Factor Assessment and a Ten-Year Experience of DDH Screening in a Well-Child Population

European Society of Biomechanics S.M. Perren Award 2018: Altered biomechanical stimulation of the developing hip joint in presence of hip dysplasia risk factors

A Newly Modified Salter Osteotomy Technique for Treatment of Developmental Dysplasia of Hip That Is Associated with Decrease in Pressure on Femoral Head and Triradiate Cartilage

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