Is capsulorrhaphy a necessary step during open reduction of developmental dysplasia of the hip? A randomized controlled trial

Badawy, Mohamed; Afifi, Ahmed M.; Shaker, Ezzat Samir; Elbarbary, Hassan; Hegazy, Mohamed; Mohamed, Mohamed Tageldeen; Arafa, Amr

doi:10.1007/s00264-021-05267-z

Cited by 6 publications

(5 citation statements)

References 22 publications

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“…In this study, the rate of re-dislocation after open reduction was 7.0%, and the majority of dislocations occurred within the first year after surgery. This is consistent with prior reported rates of re-dislocation ranging from 3% to 12% 4,13–20. These rates include those from previous large studies by Pospschill and colleagues, Luhmann and colleagues, and Wang and colleagues, with sample sizes of 78, 153, and 268 hips, respectively.…”

Section: Discussionsupporting

confidence: 91%

“…This is consistent with prior reported rates of re-dislocation ranging from 3% to 12%. 4,[13][14][15][16][17][18][19][20] These rates include those from previous large studies by Pospschill and colleagues, Luhmann and colleagues, and Wang and colleagues, with sample sizes of 78, 153, and 268 hips, respectively. On the basis of this study-the largest to date using prospective data-our study suggests that the rate of re-dislocation likely falls in the middle of the range found from prior research.…”

Section: Discussionmentioning

confidence: 93%

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A Prospective, Multicenter Study of Developmental Dysplasia of the Hip: What Can Patients Expect After Open Reduction?

Kiani

Gornitzky

Matheney

et al. 2023

Journal of Pediatric Orthopaedics

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Background: Although there are several predominantly single-center case series in the literature, relatively little prospectively collected data exist regarding the outcomes of open hip reduction (OR) for infantile developmental dysplasia of the hip (DDH). The purpose of this prospective, multi-center study was to determine the outcomes after OR in a diverse patient population. Methods: The prospectively collected database of an international multicenter study group was queried for all patients treated with OR for DDH. Minimum follow-up was 1 year. Proximal femoral growth disturbance (PFGD) was defined by consensus review using Salter’s criteria. Persistent acetabular dysplasia was defined as an acetabular index >90th percentile for age. Statistical analyses were performed to compare preoperative and operative characteristics that predicted re-dislocation, PFGD, and residual acetabular dysplasia. Results: A cohort of 232 hips (195 patients) was identified; median age at OR was 19 months (interquartile range 13 to 28) and median follow-up length was 21 months (interquartile range 16 to 32). Re-dislocation occurred in 7% of hips (n=16/228). The majority (81%; n=13/16) occurred in the first year after initial OR. Excluding patients with repeat dislocation, 94.5% of hips were IHDI 1 at most recent follow-up. On the basis of strict radiographic review, some degree of PFGD was present in 44% of hips (n=101/230) at most recent follow-up. Seventy-eight hips (55%) demonstrated residual dysplasia compared with established normative data. Hips that had a pelvic osteotomy at index surgery had about half the rate of residual dysplasia (39%; n=32/82) versus those without a pelvic osteotomy with at least 2 years follow-up (78%; n=46/59). Conclusions: In the largest prospective, multicenter study to date, OR for infantile DDH was associated with a 7% risk of re-dislocation, 44% risk of PFGD, and 55% risk of residual acetabular dysplasia at short term follow-up. The incidence of these adverse outcomes is higher than previous reports. Patients treated with concomitant pelvic osteotomy had lower rates of residual dysplasia. These prospectively collected, multicenter data provide better generalizable information to improve family education and appropriately set expectations. Level of Evidence: Level II, prospective comparative study.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 93%

A Prospective, Multicenter Study of Developmental Dysplasia of the Hip: What Can Patients Expect After Open Reduction?

Kiani

Gornitzky

Matheney

et al. 2023

Journal of Pediatric Orthopaedics

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“…While regardless of hip's acceptable reduction [17], proper acetabular remodeling was observed more frequently after OR with capsulorrhaphy than after CR, some authors believed that stability of reduction depends on removal of soft tissue obstacles and proper correction of the bony configuration with or without osteotomy, and that capsulorrhaphy did not play an important role in the reduction stability, [18] and soft tissue procedure alone is associated with a high failure rate [19].…”

Section: Discussionmentioning

confidence: 99%

Predictive Factors for Requiring Salter Osteotomy in DDH

Valinejad,

Maleki,

Sabetian

et al. 2024

SVOAOR

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Purpose: Developmental dysplasia of the hip (DDH) is a wide spectrum condition, ranging from stable acetabular dysplasia to irreducible dislocation, with a variety of different treatment approaches. We aim to find any correlation between some of the most in use pre-operative values and requiring a concomitant salter osteotomy (SO). Methods: In our retrospective cohort study, all defined DDH over 12 months old, assessed between the years of 2017 and 2021 in our orthopedic hospital and categorized under two groups: open reduction, and salter group. Retrospectively, we compared age, gender, pre-operative acetabular index (AI) and medial gap (MG) between two groups. Results: There was no relationship between SO requirement and patient’s gender (p=0.186). There was a higher chance of requiring SO in bilateral cases without any significance (p=0.11). Also, the difference between the two groups, in MG terms, was not significant (p=0.91). With an AI over 30°, salter osteotomy requirement would increase 2.5-fold and 4.8-fold, with each year (age) and degree (AI) increase, respectively. And if we include age over 3.5 years in the matter, SO requirement would increase by 15.7-fold and 5.8-fold with each year and degree increase, respectively. Conclusions: OR with wide safe zone would be a safe treatment method. According to our analysis, pelvic osteotomy would be done more often when age or pre-operative AI increases, but exact determination of osteotomy requirement pre-operatively, is considered highly difficult.

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“…The unsutured joint capsule was confirmed to achieve healing at 24 weeks postoperatively [ 24 ]. Meanwhile, A randomized controlled trial also confirmed that the closure of the joint capsule is not necessary for open reduction surgery for DDH [ 25 ]. The usual direction of dislocation of the femoral head in children was lateral, posterior and superior.…”

Section: Discussionmentioning

confidence: 99%

Research on anterior minimally invasive approach in the treatment of children with developmental dysplasia of the hip

Tan

Mei

et al. 2023

BMC Musculoskelet Disord

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Objectives To investigate the clinical efficacy and safety of open reduction through anterior minimally invasive approach in the treatment of children with developmental dysplasia of the hip. Method A total of 23 patients (25 hips) less than 2 years with developmental dysplasia of the hip treated by open reduction through anterior minimally invasive approach were treated in our hospital from August 2016 to March 2019. Through the anterior minimally invasive approach, we enter from the gap between sartorius muscle and tensor fasciae lata without cutting off rectus femoris muscle, which can effectively expose the joint capsule and reduce the damage to medial blood vessels and nerves. The operation time, incision length, intraoperative bleeding, hospital stay and surgical complications were observed. The progression of developmental dysplasia of the hip and avascular necrosis of the femoral head were evaluated by imaging examination. Result All patients were performed with follow-up visit for an average of 22 months. The average incision length was 2.5 cm, the average operation time was 26 min, the average intraoperative bleeding was 12ml, and the average hospital stay was 4.9 days. All patients received concentric reduction immediately after operation, and no re-dislocation occurred. At the last follow-up visit, the acetabular index was (25.8 ± 6.4°). During the follow-up visit, X-ray showed avascular necrosis of the femoral head in 4 hips (16%). Conclusion open reduction through anterior minimally invasive approach can achieve good clinical effect in the treatment of infantile developmental dysplasia of the hip.

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Is capsulorrhaphy a necessary step during open reduction of developmental dysplasia of the hip? A randomized controlled trial

Cited by 6 publications

References 22 publications

A Prospective, Multicenter Study of Developmental Dysplasia of the Hip: What Can Patients Expect After Open Reduction?

A Prospective, Multicenter Study of Developmental Dysplasia of the Hip: What Can Patients Expect After Open Reduction?

Predictive Factors for Requiring Salter Osteotomy in DDH

Research on anterior minimally invasive approach in the treatment of children with developmental dysplasia of the hip

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