Intraoperative Arthrogram Predicts Residual Dysplasia after Successful Closed Reduction of <scp>DDH</scp>

Zhang, Zhongli; Fu, Zhe; Yang, Jianping; Wang, Kan; Xie, Li-wei; Deng, Shu-zhen; Chen, Zhaoqiang

doi:10.1111/os.12273

Cited by 16 publications

(22 citation statements)

References 25 publications

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“…21 It has been demonstrated that DDH with initial eccentric reduction achieved by way of CR can also lead to normal development. [8][9][10][11][12] This is because an eccentric reduction, successfully maintained in a spica cast, can be transformed into a concentric one through FHD. However, the degree of eccentric reduction which would be acceptable in CR treatment remains controversial.…”

Section: Discussionmentioning

confidence: 99%

“…7 Dysplastic hips which undergo initial eccentric CR can develop normally, though residual dysplasia is common. [8][9][10][11][12][13][14] It is generally believed that the quality of initial CR is significantly associated with long-term outcomes. 8,9,11,14 Changes to the femoral head and LACC secondary to CR are well visualized by MRI.…”

Section: Cite This Article: Bone Joint J 2023;105-b(2):140-147 Introd...mentioning

confidence: 99%

“…[8][9][10][11][12][13][14] It is generally believed that the quality of initial CR is significantly associated with long-term outcomes. 8,9,11,14 Changes to the femoral head and LACC secondary to CR are well visualized by MRI. Watanabe et al 15 reported the use of MRI to observe changes in femoral head position and intraarticular soft-tissue over a three-week period following CR in a single DDH patient.…”

Section: Cite This Article: Bone Joint J 2023;105-b(2):140-147 Introd...mentioning

confidence: 99%

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MRI assessment of femoral head docking following closed reduction of developmental dysplasia of the hip

Zhang

Deng

et al. 2023

The Bone & Joint Journal

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Aims Eccentric reductions may become concentric through femoral head ‘docking’ (FHD) following closed reduction (CR) for developmental dysplasia of the hip (DDH). However, changes regarding position and morphology through FHD are not well understood. We aimed to assess these changes using serial MRI. Methods We reviewed 103 patients with DDH successfully treated by CR and spica casting in a single institution between January 2016 and December 2020. MRI was routinely performed immediately after CR and at the end of each cast. Using MRI, we described the labrum-acetabular cartilage complex (LACC) morphology, and measured the femoral head to triradiate cartilage distance (FTD) on the midcoronal section. A total of 13 hips with initial complete reduction (i.e. FTD < 1 mm) and ten hips with incomplete MRI follow-up were excluded. A total of 86 patients (92 hips) with a FTD > 1 mm were included in the analysis. Results At the end of the first cast period, 73 hips (79.3%) had a FTD < 1 mm. Multiple regression analysis showed that FTD (p = 0.011) and immobilization duration (p = 0.028) were associated with complete reduction. At the end of the second cast period, all 92 hips achieved complete reduction. The LACC on initial MRI was inverted in 69 hips (75.0%), partly inverted in 16 hips (17.4%), and everted in seven hips (7.6%). The LACC became everted-congruent in 45 hips (48.9%) and 92 hips (100%) at the end of the first and second cast period, respectively. However, a residual inverted labrum was present in 50/85 hips (58.8%) with an initial inverted or partly inverted LACC. Conclusion An eccentric reduction can become concentric after complete reduction and LACC remodelling following CR for DDH. Varying immobilization durations were required for achieving complete reduction. A residual inverted labrum was present in more than half of all hips after LACC remodelling. Cite this article: Bone Joint J 2023;105-B(2):140–147.

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Section: Discussionmentioning

confidence: 99%

Section: Cite This Article: Bone Joint J 2023;105-b(2):140-147 Introd...mentioning

confidence: 99%

Section: Cite This Article: Bone Joint J 2023;105-b(2):140-147 Introd...mentioning

confidence: 99%

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MRI assessment of femoral head docking following closed reduction of developmental dysplasia of the hip

Zhang

Deng

et al. 2023

The Bone & Joint Journal

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“…To establish early and reliable predictors of RAD, several radiographic parameters have been investigated such as the acetabular index (AI), central edge angle (CEA), etc. But, determination of the time when a further procedure is required remains controversial because these parameters need to be observed over a long time period and have some limitations (11)(12)(13)(14)(15)(16)(17)(18)(19). Surgeons need some more reliable and easier radiographic parameters that will predict future changes in RAD after CR.…”

Section: B Amentioning

confidence: 99%

Teardrop and sourcil line (TSL): a novel radiographic sign that predicts residual acetabular dysplasia (RAD) in DDH after closed reduction

Huang¹,

Wang²,

Mo³

et al. 2022

Transl Pediatr

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Background: Residual acetabular dysplasia (RAD) is a major problem of developmental dysplasia of the hip (DDH) after closed reduction (CR). Several parameters have been investigated as ways of predicting RAD; however, prediction of RAD remains controversial. The purpose of this study was to evaluate the radiographic sign of teardrop and sourcil line (TSL) in pediatric patients with DDH to enable prediction of RAD after CR.Methods: One hundred and twenty-five hips with DDH treated with CR and followed up for at least 2 years were included in this study. The mean age at CR was 18.3 months (range, 9 to 32 months) and the average follow-up time was 50.2 months (range, 24 to 89 months). The acetabular index (AI) was measured at different time points. The cases were divided into two groups according to whether TSL became continuous or not. The relationships among TSL, AI and RAD were analyzed. Results:The RAD incidence was 73.6% (92/125) at the last follow-up. AI at CR and TSL were the prognostic factors for RAD (P=0.017 and 0.001, respectively). Thirty-four hips showed a continuous TSL.There was a lower RAD rate in the TSL continuous group (P<0.001). There was no statistical difference in the AI at CR between the TSL continuous and discontinuous groups; however, the level of AI after CR was lower in the TSL continuous group. The TSL of 74% (20/27) hips became continuous after acetabular osteotomy surgery. Conclusions:The TSL continuous group had a lower AI and incidence of RAD than the discontinuous group. The TSL can be a predictive factor of RAD in DDH after CR and restore the continuous of TSL maybe a potential parameter that can help surgeons to make a judgment intra-operation.

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“…The patient needs an intraoperative X-ray arthrography to evaluate whether CR is successful and to detect abnormal soft tissue structures in the hip, such as hypertrophied acetabular cartilage, narrowed capsule, and labral inversion [ 4 , 5 ]. A plain pelvic film was typically used for follow-up after CR.…”

Section: Introductionmentioning

confidence: 99%

Magnetic resonance imaging follow-up can screen for soft tissue changes and evaluate the short-term prognosis of patients with developmental dysplasia of the hip after closed reduction

2021

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Background Magnetic resonance imaging (MRI) can show the architecture of the hip joint clearly and has been increasingly used in developmental dysplasia of the hip (DDH) confirmation and follow-up. In this study, MRI was used to observe changes in the hip joints before and after closed reduction (CR) and to explore risk factors of residual acetabular dysplasia (RAD). Methods This is a prospective analysis of unilateral DDH patients with CR and spica cast in our hospital from October 2012 to July 2018. MRI and pelvic plain radiography were performed before and after CR. The labro-chondral complex (LCC) of the hip was divided into four types on MRI images. The variation in the thickening rate of the ligamentum teres, transverse ligaments, and pulvinar during MRI follow-up was analyzed, and the difference in cartilaginous acetabular head index was evaluated. The “complete relocation” rate of the femoral head was analyzed when the cast was changed for the last time, and the necrotic rate of the femoral head was evaluated after 18 months or more after CR. Lastly, the risk factors of RAD were analyzed. Results A total of 63 patients with DDH and CR were included. The LCC was everted before CR and inverted after CR, and the ligamentum teres, transverse ligaments, and pulvinar were hypertrophic before and after CR, and then gradually returned to normal shape. The cartilaginous acetabular head index gradually increased to normal values. Complete relocation was observed in 58.7% of femoral heads, while 8.6% had necrosis. The abnormalities in LCC was related to RAD (OR: 4.35, P = 0.03), and the rate of type 3 LCC in the RAD group was higher. However, the IHDI classification (P = 0.09); the “complete relocation” of femoral heads (P = 0.61); and hypertrophy of the ligamentum teres (P = 1.00), transverse ligaments (P = 1.00), and pulvinar (P = 1.00) were not related to RAD. Conclusions In this study, MRI can observe the variations of the abnormal soft tissue structures of the diseased hips after CR and spica casting, and can evaluate which hips will have RAD after CR. Therefore, we can utilize MRI in DDH patients appropriately.

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Intraoperative Arthrogram Predicts Residual Dysplasia after Successful Closed Reduction of DDH

Abstract: Intraoperative arthrogram-determined FHC is an alternative predictor of residual hip dysplasia after CR of DDH and FHC ≤30% can be considered the criterion for unacceptable reduction.

Cited by 16 publications

References 25 publications

MRI assessment of femoral head docking following closed reduction of developmental dysplasia of the hip

MRI assessment of femoral head docking following closed reduction of developmental dysplasia of the hip

Teardrop and sourcil line (TSL): a novel radiographic sign that predicts residual acetabular dysplasia (RAD) in DDH after closed reduction

Magnetic resonance imaging follow-up can screen for soft tissue changes and evaluate the short-term prognosis of patients with developmental dysplasia of the hip after closed reduction

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