Diagnosis and treatment of developmental dysplasia of the hip: A current practice of paediatric orthopaedic surgeons

Al-Essa, Rakan S; Al-Jahdali, Fares; Al-Khilaiwi, Rakan M; Philip, Winnie; Jawadi, Ayman H.; Khoshhal, Khalid I.

doi:10.1177/2309499017717197

Cited by 32 publications

(31 citation statements)

References 36 publications

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“…25,36-39 However, so far, there is no standard algorithm for control examinations after successfully treated DDH. 6 Some authors also recommend other control examinations such as ultrasound and CT. 40,41…”

Section: Discussionmentioning

confidence: 99%

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Poorer radiological outcome after delayed diagnosis and treatment in human position in Fettweis plaster cast in 93 unstable hip joints type D, III and IV according to Graf

Kubo

Pilge

et al. 2018

Journal of Children's Orthopaedics

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PurposeIn this study the course of unstable hips after successful treatment with Fettweis plaster of Paris (POP) is examined. Special focus will be given to age at beginning of treatment and initial hip type.MethodsThe development of 93 unstable hips treated between November 2001 and April 2015 was examined. Inclusion criteria were: 1) unstable hips with successful treatment with Fettweis POP; 2) presence of two pelvic radiographs (12 to 24 months and 24 to 48 months). We analyzed: 1) the initial ultrasound hip type according to Graf; 2) the average age at first and second radiograph; 3) the Tönnis classification: normal findings (< 1 SD), slightly (1 SD to 2 SD) and severely dysplastic hips (> 2 SD).ResultsIn all, there were 14 hips type D, 41 hips type III and 38 hips type IV. Mean age of the first radiograph was 13.9 months and of the second 28.5 months. The first radiograph showed: (< 1 SD): 36, (1 SD to 2 SD): 34, (> 2 SD): 23 hips, the second radiograph: (< 1 SD): 33, (1 SD to 2 SD): 19, (> 2 SD): 30 hips. With subdivision at the start of treatment at age eight or fewer weeks 2/16 hips (12.5%) and with initiation of the treatment more than eight weeks 22/77 (26.0%) deteriorated. During the course between first and second radiograph a total of 35.7% of initial hip type D, 19.5% of type III and 23.7% of type IV deteriorated.ConclusionRadiograph controls after treatment with Fettweis POP show poorer outcome after delaying the start of treatment more than 8 weeks. These findings were independent of the initial ultrasound hip type. Regular radiograph controls of all hip types treated for unstable hips are justified to detect residual dysplasia.Level of evidence:IV

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Section: Discussionmentioning

confidence: 99%

“…Furthermore, the prevalence in Central Europe and Asia is higher in comparison with African countries. 4-6 Recognized risk factors for DDH are: 1) breech position; 2) family history; 3) oligohydramnion; 4) female gender; 5) firstborn; and 6) presence of musculoskeletal diseases e.g. club foot.…”

Section: Introductionmentioning

confidence: 99%

Poorer radiological outcome after delayed diagnosis and treatment in human position in Fettweis plaster cast in 93 unstable hip joints type D, III and IV according to Graf

Kubo

Pilge

et al. 2018

Journal of Children's Orthopaedics

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“…Despite the lack of standardized screening methods to detect DDH in early age, neonatal physical examination and ultrasonography (U/S) play a crucial role to detect early conditions and decrease the risk of complications (Figure 1, Figure 2 and Figure 3). Approximately 97% of orthopedic surgeons use U/S to diagnose DDH before the age of three, however, pelvic radiography is a better imaging tool for children after the age of 3 years [15].…”

Section: Diagnosis and Pathologymentioning

confidence: 99%

Developmental Dysplasia of Hip: Perspectives in Genetic Screening

et al. 2019

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Development dysplasia of the hip (DDH) is a complex developmental disorder despite being a relatively common condition mainly caused by incompatibility of the femoral head and the abnormal joint socket. Development dysplasia of the hip describes a wide spectrum of disorders ranging from minor acetabular dysplasia to irreducible dislocation of the hip. Modern medicine still suffers from lack of information about screening and precise genetic examination. Genome wide linkage and association studies have brought significant progress to DDH diagnosis. Association studies managed to identify many candidate (susceptible) genes, such as PAPPA2, COL2A1, HOXD9, GDF-5, and TGFB1, which play a considerable role in the pathogenesis of DDH. Early detection of DDH has a big chance to help in preventing further disability and improve the psychological health and quality of life in those children. This emphasizes the importance to establish a universal screening program along with the genetic counseling.

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“…Typically, treatment for DDH in a child less than 6 months of age is with a Pavlik harness and/or a fixed abduction brace. 4 If the child is over 6 months of age or if the aforementioned holding devices fail, then closed reduction (CR) under general anaesthesia followed by hip spica casting is generally attempted. 4 Some surgeons/centres employ hip traction prior to CR, but there is currently no consensus on whether this prereduction hip traction is beneficial.…”

Section: Introductionmentioning

confidence: 99%

“… 4 If the child is over 6 months of age or if the aforementioned holding devices fail, then closed reduction (CR) under general anaesthesia followed by hip spica casting is generally attempted. 4 Some surgeons/centres employ hip traction prior to CR, but there is currently no consensus on whether this prereduction hip traction is beneficial. Historical papers suggested prereduction traction was associated with lower rates of avascular necrosis (AVN) of the femoral head and reduced requirement for open reduction (OR).…”

Section: Introductionmentioning

confidence: 99%

Evaluating the role of prereduction hip traction in the management of infants and children with developmental dysplasia of the hip (DDH): protocol for a systematic review and planned meta-analysis

et al. 2018

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IntroductionDevelopmental dysplasia of the hip (DDH) affects 4–6 per 1000 live births in developed countries. Effective treatment to realign the hip is necessary to avoid long-term morbidities and maximise functional outcome. Treatment options depend on patient age but typically involve hip bracing and/or reduction under general anaesthetic. Some centres also employ prereduction hip traction. Historical papers suggest traction reduces risk of avascular necrosis (AVN) femoral head and reduces requirement for open reduction. However, several studies including a large retrospective cohort study, dispute this. We propose to perform the first systematic review and meta-analysis to clarify the value of prereduction hip traction in the management of DDH in children under the age of 3 years by identifying whether it impacts on the rate of successful closed reduction (CR) and risk of AVN.Methods and analysisWe will search MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials to identify potentially relevant studies. Studies reporting on incidence of successful CR, AVN femoral head and complications associated with prereduction hip traction in children of less than 3 years with DDH will be eligible for inclusion. Only randomised controlled trials, prospective and retrospective case–control and comparative cohort studies will be included in quantitative review. There will be no study design restrictions for inclusion in qualitative review. Following study selection, full-text paper retrieval, data extraction and synthesis, studies will be assessed for risk of bias and heterogeneity. If the included studies are sufficiently homogeneous, then we will perform meta-analysis. A narrative synthesis of the systematic review’s results will also be presented.Ethics and disseminationFormal ethical approval is not required as primary patient data will not be collected. The systematic review’s results will be disseminated through a peer-reviewed publication.Trial registration numberCRD42017064254; Pre-results.

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Diagnosis and treatment of developmental dysplasia of the hip: A current practice of paediatric orthopaedic surgeons

Cited by 32 publications

References 36 publications

Poorer radiological outcome after delayed diagnosis and treatment in human position in Fettweis plaster cast in 93 unstable hip joints type D, III and IV according to Graf

Poorer radiological outcome after delayed diagnosis and treatment in human position in Fettweis plaster cast in 93 unstable hip joints type D, III and IV according to Graf

Developmental Dysplasia of Hip: Perspectives in Genetic Screening

Evaluating the role of prereduction hip traction in the management of infants and children with developmental dysplasia of the hip (DDH): protocol for a systematic review and planned meta-analysis

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