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, Y. H.; Xu, Hongyan; Li, Y. Q.; Hong, Kai; Li, J. C.; Pereira, Bruno; Xun, FuXing; Canavese, Federico

doi:10.1302/1863-2548.13.190045

Cited by 8 publications

(3 citation statements)

References 26 publications

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“…The hip abduction angle in the spica cast was the complementary angle between the axis of the femoral shaft and the horizontal line tangent to bilateral ischial tuberosity through CT on cross section. These complementary angle values were expressed in degrees [ 10 ].…”

Section: Methodsmentioning

confidence: 99%

Modified Smith–Petersen approach with rectus-sparing reduces severe avascular necrosis for developmental dysplasia of the hip at walking age: minimum 5-year follow-up

et al. 2022

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Background Developmental dysplasia of the hip (DDH) is one of the most common orthopedic malformations in children. Open reduction for DDH at walking age remains a major concern. The goal of this study is to evaluate the mid-term effect of a modified Smith–Petersen approach which preserves the rectus femoris on DDH at walking age, in particular avascular necrosis (AVN). Methods A retrospective review of DDH patients aged between 12 and 24 months was carried out between January 2010 and June 2016. Open reduction through the Smith–Petersen approach (Group A) and modified Smith–Petersen approach, which preserves the rectus femoris (Group B), were both used. Measurement of hip geometry included acetabular index, the International Hip Dysplasia Institute classification, and AVN degree. Clinical records included operation time, bleeding volume, and abduction angle. Results There were 101 children (119 hips) with DDH who met the inclusion criteria. There were 66 hips in Group A and 53 in Group B. The mean surgical age at open reduction was 17.0 ± 2.4 months, with a mean 104.9 ± 19.5 months at last follow-up. There was no statistical difference in surgical age between the two groups (17.2 vs. 16.4 months). There was no significant difference in the incidence of all types of clinically significant AVN between group A and group B (27.3 vs. 18.9%), but the incidence of severe AVN was lower in group B (19.7 vs. 5.7%, P = 0.026). In addition, the lower the age at the time of open reduction, the lower the severity of AVN (P = 0.002). Conclusions These mid-term data suggest that the modified Smith–Petersen approach with rectus-sparing could reduce severe AVN more than the classical Smith–Peterson approach in open reduction in DDH at walking age. In addition, early open reduction can reduce the postoperative degree of AVN.

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Section: Methodsmentioning

confidence: 99%

Modified Smith–Petersen approach with rectus-sparing reduces severe avascular necrosis for developmental dysplasia of the hip at walking age: minimum 5-year follow-up

et al. 2022

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“…11,12 Otra opción para realizar con este grupo de pacientes es la reducción abierta de la cadera femoral más la liberación de tejidos blandos, con una media de edad de seis meses para la reducción cerrada y de 12 meses para la reducción abierta. 13,14 Muchos autores refieren la necesidad de liberar los tejidos blandos mediales con miotomías del aductor mediano y el iliopsoas para poder reducir la cadera y disminuir el riesgo de reluxación. 1,10,[15][16][17] El rango de movimiento en el que la cadera permanece reducida se compara con el rango de movimiento máximo.…”

Section: Introductionunclassified

Diferencias entre las técnicas quirúrgicas utilizadas sobre el aductor mediano en pacientes entre 18 y 36 meses de edad con displasia del desarrollo de cadera

Ledezma Reyes,

Gómez Chavarría,

Fuentes Figueroa

et al. 2023

Ortho-Tips

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Introducción: la displasia del desarrollo de la cadera presenta complicaciones catastróficas si no es tratada a tiempo. El objetivo del tratamiento es obtener una cadera reducida y concéntrica. Se reporta de 8-20% de reluxación en caderas tratadas por primera vez; la falla en la técnica quirúrgica al tratar de obtener una cabeza concéntrica y estable es de las principales causas. Objetivo: definir si existe diferencia entre los procedimientos quirúrgicos sobre el músculo aductor mediano que influyan en la recidiva de la luxación de cadera en pacientes mayores de 18 meses. Material y métodos: se incluyeron pacientes consecutivos entre 18 y 36 meses con diagnóstico de displasia del desarrollo de la cadera intervenidos quirúrgicamente por primera vez de enero de 2019 a agosto de 2022 en el Hospital Shriners para Niños de México. Se agrupó en tres conjuntos según la técnica quirúrgica realizada sobre el músculo aductor mediano. Grupo 1: sin miotomía al aductor mediano, grupo 2: miotomía percutánea y grupo 3: miotomía abierta. Toda la información fue tomada de los expedientes clínicos del hospital. Resultados: se obtuvieron un total de 135 caderas operadas. Se evidenció un predominio en el sexo femenino (88%) y de la cadera izquierda (58.5%). Con media de seguimiento de 29 meses. Dentro del análisis estadístico se encontró un aumento del riesgo de reluxación en las miotomías percutáneas versus las abiertas OR: 1.132, (IC 95% 1.015-1.261), p = 0.025. Conclusión: existe un aumento del riesgo de reluxación de cadera con los pacientes atendidos con miotomía del músculo aductor mediano percutánea a diferencia de la miotomía del aductor mediano abierta.Palabras clave: luxación de cadera, ortopedia, displasia congénita de cadera, pediátrica.Nivel de evidencia: II-2 (cohorte).

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“…225 Femoral head AVN rates may be up to 13%. 226,227 If bracing alone fails, or the infant is over six months of age and DDH has progressed, then closed reduction with subsequent bracing is utilized. 228 Closed reduction of the hip is a manual manipulation of the femoral head into correct position within the acetabulum.…”

Section: F: Treatmentsmentioning

confidence: 99%

Pathobiological analysis of developmental dysplasia of the hip and its progression to osteoarthritis

Wolfe¹

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Developmental dysplasia of the hip (DDH) is recognized as one of the leading causes of early-onset hip osteoarthritis and a primary reason for undergoing total hip arthroplasty prior to 50 years of age. Even with an increase in awareness and focus on infant screening and early diagnosis, approximately 15-25 percent of DDH cases remain undiagnosed into early adulthood when prevention is no longer possible, interventions are more invasive, and joint degeneration has begun. To improve screening and early diagnosis methods for DDH, the pathobiological mechanisms associated with this disorder must be further characterized. Therefore, the programmatic research plan for this dissertation investigated molecular biology, mechanobiology, biomechanics, and cell- and tissue-based disease mechanisms associated with DDH during its development and progression to secondary hip osteoarthritis. The primary objective for this body of work was to comprehensively characterize these stages of DDH in order to elucidate mechanistic biomarkers for diagnosis, staging, and treatment monitoring as well as targets for novel prevention and treatment strategies. The first experiment in the dissertation research focused on clinically relevant biomechanics of the hip in order to characterize the relevant contributions from key soft tissue structures in maintaining hip stability. The data from this experiment indicated that the ligamentum teres of the femoral head and the acetabular labrum each play important and unique roles in hip joint stability. The ligamentum teres primarily supported anterior stability during increased hip flexion while the labrum primarily supported lateral stability during hip flexion and abduction. The second set of experiments focused on the molecular biology of key intra-articular tissues of the hip by analyzing mechanistic metabolic responses in cell and tissue culture. First, metabolic responses related to hip osteoarthritis were characterized and analyzed for trends with histopathology severity scoring. The results indicated that each tissue type has a unique metabolic profile. Interestingly, the acetabular labrum was associated with robust inflammatory, degradative, immune cell recruitment, and anabolic responses during early degeneration followed by a pronounced anti-degradative response in late degeneration. Subsequent experiments used cells from canine DDH tissues to investigate mechanobiology-related responses prior to the onset of hip osteoarthritis. The results indicated that the ligamentum teres is a primary producer of inflammatory and immune cell recruitment proteins with labral cells also producing significant amounts of these proteins in response to supraphysiologic tensile loading. Interestingly, physiologic loading of dysplastic cells normalized their metabolic response profiles to match those of healthy hips, indicating that dysplastic metabolic responses can be reversible in earlier stages of disease. The final set of experiments for the dissertation focused on analysis of serum and urine from age-matched healthy individuals and those with symptomatic DDH prior to degeneration in order to elucidate mechanistic biomarker panels for differentiating hip status prior to the development of osteoarthritis. Patients with DDH prior to degeneration had significantly different serum and urine biomarker profiles compared to healthy-hip controls and patients with hip osteoarthritis. The primary differences involved increases in inflammatory biomarkers and decreases in bone metabolism, degradation, and anabolism biomarkers. When these proteins were combined into panels, there was excellent discriminatory capability for multiple serum and urine protein panels. Taken together, this series of experiments provides novel molecular biology, mechanobiology, biomechanics, and cell- and tissue-based disease mechanisms data for characterizing DDH during its development and progression to secondary hip osteoarthritis. These data suggest that soft tissue structures in the hip, including the ligamentum teres and acetabular labrum, play key biomechanical and biologic roles in maintaining joint homeostasis and responding to the pathomechanisms involved in the development and progression of DDH. The experiments comprising this dissertation provide the foundation for additional translational and clinical studies designed to comprehensively characterize DDH development and progression and elucidate mechanistic biomarkers that can consistently identify individuals with hip dysplasia at its earliest stages such that progression to hip osteoarthritis can be prevented.

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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

Cited by 8 publications

References 26 publications

Modified Smith–Petersen approach with rectus-sparing reduces severe avascular necrosis for developmental dysplasia of the hip at walking age: minimum 5-year follow-up

Modified Smith–Petersen approach with rectus-sparing reduces severe avascular necrosis for developmental dysplasia of the hip at walking age: minimum 5-year follow-up

Diferencias entre las técnicas quirúrgicas utilizadas sobre el aductor mediano en pacientes entre 18 y 36 meses de edad con displasia del desarrollo de cadera

Pathobiological analysis of developmental dysplasia of the hip and its progression to osteoarthritis

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