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

Fu, Zhe; Zhang, Zhongli; Deng, Shu-zhen; Yang, Jianping; Li, Bing; Zhang, Huadong; Li, Jun

doi:10.1302/0301-620x.105b2.bjj-2022-0547.r2

Cited by 5 publications

(12 citation statements)

References 31 publications

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“…According to a population screening study, the incidence rate of bilateral DDH is lower than that of unilateral DDH. The ratio is ~1:4 26 . Thus, RAL can benefit about 80% of patients with DDH.…”

Section: Discussionmentioning

confidence: 99%

Prediction of the Labrum Shape in Patients With Developmental Dysplasia of the Hip Based on Pelvic Radiography

Huang,

Cheng,

Gao

et al. 2024

Journal of Pediatric Orthopaedics

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Background: The shape of the labrum is strongly correlated with outcomes of developmental dysplasia of the hip (DDH). Magnetic resonance imaging (MRI) is the generally preferred imaging technique for observing the labrum. Purpose: We aimed to find a correlation between the labrum shape and anterior–posterior (AP) pelvic measurements in children with DDH. Methods: Preoperative AP pelvic x-ray radiographs and MRI of patients with DDH from January 2019 to December 2021 were retrospectively collected and divided into three groups by labrum shape on MRI: everted, partly inverted, and inverted. The acetabular length ratio (RAL) in patients with unilateral DDH and the ratio of acetabular length to interpedicular distance (RALI) in all patients were calculated. T-tests were used to analyze differences between the groups. Receiver operating characteristic curve (ROC) analysis was performed between the everted group and the partly inverted and inverted groups. Results: We found significant differences in RAL between the everted and partly inverted groups, everted and inverted groups, and everted and combined groups. The ROC analysis showed that the best cutoff value for RAL was 0.945 between the everted and combined groups, with an area under the curve (AUC) of 88.4%. The sensitivity at the best RAL value was 0.783, and the specificity was 0.887. Moreover, we observed a significant difference in RALI between the everted, partly inverted, and inverted groups, as well as between the everted and combined groups. The optimal cutoff value for RALI between the everted and combined groups was 0.575, with an AUC of 74.5%. The sensitivity at the best RALI value was 0.765, and the specificity was 0.674. Conclusion: The RAL or RALI values on pelvic AP radiographs can be used to predict the shape of the labrum. Level of Evidence: III.

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Section: Discussionmentioning

confidence: 99%

Prediction of the Labrum Shape in Patients With Developmental Dysplasia of the Hip Based on Pelvic Radiography

Huang,

Cheng,

Gao

et al. 2024

Journal of Pediatric Orthopaedics

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“…This "docking" phenomenon specifically means that as time passes, the femoral head may move deeper into the acetabulum, thus facilitating more growth and development of the femoral head and acetabulum. 4,19 In the past, the gradual "docking" of the femoral head after reduction was mostly assessed by AP radiographs of the hip, CT, and MRI. As mentioned previously, they have individual disadvantages.…”

Section: Discussionmentioning

confidence: 99%

“…The current clinical view is that not all these cases can achieve concentric repositioning immediately after reduction, and a certain degree of joint space widening is acceptable; after a period of cast immobilization, the femoral head can gradually “dock” and achieve concentric reduction. This “docking” phenomenon specifically means that as time passes, the femoral head may move deeper into the acetabulum, thus facilitating more growth and development of the femoral head and acetabulum 4,19 …”

Section: Discussionmentioning

confidence: 99%

Follow-up Value of Hip Medial Ultrasound in Infants and Children With Developmental Dysplasia of the Hip Treated With Reduction and Spica Casting

Yu,

Chen,

et al. 2024

Journal of Pediatric Orthopaedics

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Objective: Closed or open reduction and spica casting are common treatments for children aged 6 to 18 months, as well as infants aged 0 to 6 months whose harness treatment for developmental dysplasia of the hip (DDH) was unsuccessful. The study aimed to quantify the distance between the femoral head and the acetabulum after closed or open reduction and evaluate the dynamic docking progression of the femoral head using serial hip medical ultrasound. Methods: We retrospectively reviewed the medical records and hip medial ultrasound images of a consecutive series of patients with DDH who underwent spica casting after reduction and compared images obtained immediately after reduction and at follow-up. The first cast (stage I) was maintained for 2 to 3 months and scheduled for outpatient repeat ultrasound in 4 to 8 weeks. Then the second cast was placed (stage II), lasting for another 2 to 3 months. The triradiate cartilage-femoral head distance (TFD) was measured in the acetabulum coronal mid-sectional plane. The Wilcoxon signed-rank test was used to compare the TFD values. Results: This study included 49 patients. All patients underwent hip medial ultrasound 0 to 3 days after stage I (time 1) and 4 to 8 weeks (time 2) postoperatively, with 24 patients reviewed again 0 to 7 days after stage II. The TFD values in time 1 and time 2 were 6.0 (5.0, 9.0) mm and 5.0 (3.6, 7.0) mm, respectively. There was a statistically significant difference between times 1 and 2 regarding TFD values in 49 close-reduction hips (6.0 vs 5.0 mm, P < 0.001). Similar findings were also observed in 13 open-reduction hips (6.0 vs 5.0 mm, P = 0.023). Conclusions: Hip medial ultrasonography during the period of cast immobilization after reduction in children with DDH can objectively and quantitatively show the dynamic change of the distance between the femoral head and the acetabulum, and can be used to assess reduction of the hip and progression of femoral head docking. Level of Evidence: Level II—prognostic study.

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“…Previous studies have shown that the inverted labrum could be remodeled after reduction. Fu et al (29) investigated the morphology of the labral acetabular cartilage complex (LACC) on MRI images in 103 DDH patients treated with closed reduction, and they found that the morphology of the LACC would be shaped after closed reduction and some patients with labral inversion could become labral eversion. However, in patients with labral inversion initially, 58.8% of patients eventually had residual labral inversion (29).…”

Section: Discussionmentioning

confidence: 99%

Hip arthrogram parameters predict radiographic outcomes of patients with developmental dysplasia of the hip treated by closed reduction

Tan,

Zhao,

Wei

et al. 2024

Front. Pediatr.

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ObjectiveThis study aimed to investigate the relationship between intraoperative hip arthrogram parameters and residual acetabular dysplasia (RAD) and avascular necrosis of the femoral head (AVN) in children with developmental dysplasia of the hip (DDH) treated by closed reduction.MethodsWe retrospectively analyzed the data of 102 patients (110 hips; mean age, 14.6 months ± 4.7 months) with DDH treated by closed reduction. A hip arthrogram was routinely performed during the operation. The femoral head coverage rate (FHC), medial pool distance of the hip (MPD), labral inversion, and reduction quality classification were evaluated under the hip arthrogram. The presence of RAD and AVN was assessed on radiographs at the last follow-up. The relationship between each arthrogram parameter and RAD as well as AVN was investigated using a t-test, chi-square test, and logistic regression.ResultsThe overall FHC and medial pool distance of the hip (MDP) averaged 42.2% ± 12% and 8.1% ± 11.7%, respectively. There were 80 hips (72.7%) with labral inversion and 30 hips (27.2%) without. The reduction quality was type A in 57 hips (51.8%), type B in 28 hips (25.4%), and type C in 25 hips (22.7%). A total of 32 hips (29%) were in the RAD group, and 78 hips (71%) were in the recovered group according to whether pelvic osteotomy was performed or not and according to the last Severin grade. The FHC was significantly higher in the recovered group than that in the RAD group (P = 0.014). No significant difference was observed in sex, age at reduction, side, preoperative acetabular index, International Hip Dysplasia Institute classification, follow-up time, quality of reduction, MDP, and proportion of labral inversion between the recovered and RAD groups. Logistic regression analysis showed that only the FHC was a risk factor for RAD. The incidence of AVN above type II was 11.8% in this group of patients, and the incidence of AVN was significantly higher in patients with labral inversion (23.2%) than that in those without (7.5%; P = 0.041). Logistic regression analysis showed that labral inversion was a risk factor for AVN.ConclusionThe FHC measured under arthrogram can predict the occurrence of RAD after closed reduction of DDH, whereas MDP, reduction quality classification, and labral inversion are of little significance. Labral inversion is a risk factor for AVN.

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

Cited by 5 publications

References 31 publications

Prediction of the Labrum Shape in Patients With Developmental Dysplasia of the Hip Based on Pelvic Radiography

Prediction of the Labrum Shape in Patients With Developmental Dysplasia of the Hip Based on Pelvic Radiography

Follow-up Value of Hip Medial Ultrasound in Infants and Children With Developmental Dysplasia of the Hip Treated With Reduction and Spica Casting

Hip arthrogram parameters predict radiographic outcomes of patients with developmental dysplasia of the hip treated by closed reduction

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