MRI in Postreduction Evaluation of Developmental Dysplasia of the Hip: Our Experience

Dibello, Daniela; Odoni, Luca; Pederiva, Federica; Carlo, Valentina Di

doi:10.1097/bpo.0000000000001037

Cited by 24 publications

(35 citation statements)

References 17 publications

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“…The AI was measured on standard anteroposterior radiograph. Series MRI were performed before operation and regularly in follow-ups [19][20][21]. Cartilaginous acetabular index (CAI), cartilage coronal acetabular head index (CCAHI), and cartilage sagittal acetabular head index (CSAHI) were measured on the T1-W SE anatomic sequence in the coronal and sagittal planes that showed the largest diameter of the femoral head according to Douira's study [22].…”

Section: Image Measurementsmentioning

confidence: 99%

Anterior approach with mini-bikini incision in open reduction in infants with developmental dysplasia of the hip

Wang

Lian

et al. 2020

J Orthop Surg Res

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Purpose: The anterior and medial approaches in open reduction for developmental dysplasia of the hip (DDH) had been widely used. The former could not directly approach the intra-articular interposition, while the latter had been associated with injury to blood vessel and avascular necrosis (AVN) of the femoral head. Meanwhile, the bikini incision had also been mentioned in some studies. The purpose of this study was to introduce a modified anterior approach through a mini-bikini incision and report its short-term outcomes. Methods: Data of DDH patients younger than 2 years at the time of surgery who had received this mini-bikini incision between June 2013 and December 2018 were collected. The surgical technique, operation duration, intraoperative blood loss, and length of incision were recorded in detail. In the latest follow up, the objective measurement of the scar and the subjective feeling towards the scar were collected. X-ray and magnetic resonance imaging (MRI) were performed at the last follow-up, and the incidence of residual dysplasia, redislocation, and femoral head AVN was analyzed. Results: Forty-three cases (49 hips) were included with an averaged follow-up of 43 months. The operation duration was 22 min, and the blood loss was 9.8 ml on average. The length of the scar averaged 2.6 cm. The mean University of North Carolina "4P" scar scale (UNC4P) for the scar was 0.92, and no patients complained numbness. Overall, all the parents were satisfied with the cosmetic appearance. The mean acetabular index (AI) was 27.42°± 6.41°in dislocated hip in the last follow-up. One hip redislocated soon after the operation and was reduced in a closed manner right away. MRI showed improved coverage but still some residual dysplasia that was in accordance with the post-operative recovery nature. Four hips (8%) had signs of AVN in X-ray. Conclusion: Open reduction through the anterior approach with the mini-bikini incision was a safe procedure with comparable outcomes to classical approaches. It would be a complementary approach for DDH patients younger than 2 years old who need an open reduction.

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Section: Image Measurementsmentioning

confidence: 99%

Anterior approach with mini-bikini incision in open reduction in infants with developmental dysplasia of the hip

Wang

Lian

et al. 2020

J Orthop Surg Res

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“…With the rapid development of imaging technologies, MRI has been shown to be advantageous in the detection of bony structures as well as cartilaginous and soft-tissue structures. Although there are significant individual differences in the location and degree of acetabular dysplasia [11], MRI can provide superior soft tissue resolution in cross-sectional imaging profiles without ionizing radiation and has been advocated for the assessment of acetabular morphology and growth disturbance or deficiencies of the capital femoral epiphysis, the discrimination of ossified and unossified components, especially the identification of joint congruity and obstacles to prevent the reduction of hip dislocation, and the detection of unexpected complications after surgical reduction [12]. Benefit from MRI, it's convenient for clinicians, regardless of experience level, subspecialty, or geographic origin, to assess the quality of hip reduction and predict surgical reduction of avascular necrosis (AVN).…”

Section: Introductionmentioning

confidence: 99%

Assessment of irreducible aspects in developmental hip dysplasia by magnetic resonance imaging

et al. 2020

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Background The developmental dysplasia of the hip (DDH) can cause a wide range of pathological changes, and often requires surgical treatment. Preoperative evaluation is very important for DDH. We aimed to assess the diagnostic capability of magnetic resonance imaging (MRI) for irreducible aspects preventing hip reduction in DDH. Methods A total of 39 pediatric patients who received DDH evaluation in pediatric orthopedics from January 2015 to December 2019 were included. The samples included 4 cases of bilateral DDH and 35 cases of unilateral DDH, a total of 43 hip joint samples. All patients underwent surgical treatment, pathological examination and MRI of hip joint. Results With pathological results or intraoperative findings as the gold standard, the sensitivity and specificity of MRI were 90.3% and 83.3% for the affected labrum, 92% and 83.3% for thickening of the round ligament, 90.0% and 91.3% for atrophy of the iliopsoas muscle, and 100% and 100% for fibrofatty pulvinar tissue and joint effusion, respectively. Conclutions The MRI showed an extraordinary capability of detecting these irreducible factors and helped surgeon choose the appropriate treatment strategies.

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“…In particular, the more unstable the hip joint is, the higher the hip abduction angle required to preserve reduction. Although there is some controversy regarding the abduction angle of the hip after CR 14,19,21,22 as to the ideal amount of abduction, it has come to be accepted that reduced hips should be immobilized in < 55° to 60° of abduction in order to prevent potential compromise of the vascular supply to the proximal femoral epiphysis with resulting epiphyseal osteonecrosis. 13,21-23 On the other hand, some researchers think that in order to obtain a stable reduction, hip abduction angle can be increased without increasing the risk of AVN.…”

Section: Discussionmentioning

confidence: 99%

“…In the years following, this has been corroborated in more reports. Dibello et al 14 reviewed 25 patients with Graf’s type IV DDH (29 hips) who underwent CR and spica cast immobilization at a mean age of 3.4 months. They found that none of them developed AVN during follow-up, and they concluded that abduction angle should be < 70° in order to maintain the hip reduction and to preserve the femoral head perfusion, thus avoiding the risk of AVN.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

Journal of Children's Orthopaedics

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PurposeThe purpose of this study was to explore whether increasing the hip abduction angle would increase the incidence of avascular necrosis (AVN) in patients with late- detected developmental dysplasia of the hip (DDH) treated by closed reduction (CR) and spica cast immobilization.MethodsA total of 55 patients (59 hips) with late-detected DDH underwent MRI after CR. Hip abduction angle and hip joint distance were measured on postoperative MRI transverse sections. The acetabular index and centre-edge angle were measured on plain radiographs at the last follow-up. The presence of AVN according to Kalamchi and McEwen’s classification was assessed. We retrospectively analyzed the associations among abduction angles, hip joint distances, radiographic parameters, AVN and final outcomes, exploring the relationship between hip joint abduction angle and AVN rate.ResultsThe mean age at the time of CR was 14.4 months SD 5.5 (6 to 28), and the mean follow-up was 26.2 months SD 8.1 (12.4 to 41.7). The mean hip abduction angle was 70.2° SD 7.2° (53° to 85°) on the dislocated side and 63.7° SD 8.8° (40° to 82°) on the normal side; the mean hip joint distance was 5.1 mm SD 1.9 (1.3 to 9.1) on the dislocated side and 2.2 mm SD 0.6 on the normal side (1.3 to 3.3). Eight of 59 hips (13.6%) developed AVN. Neither the amount of abduction nor hip joint distance increased the AVN rate (p = 0.97 and p = 0.65, respectively) or the dislocation rate (p = 0.38 and p = 0.14, respectively).ConclusionAbduction angle up to 70.2° following CR did not increase the AVN rate in children aged six to 28 months with late-detected DDH treated by CR.Level of evidenceIII.

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MRI in Postreduction Evaluation of Developmental Dysplasia of the Hip: Our Experience

Abstract: On the basis of our experience, MRI is an excellent, safe and, reliable modality to confirm maintenance of adequate femoral head position and to evaluate soft tissue interposition. We agree that MRI is the gold standard to early depict dislocation after closed reduction of DDH.

Cited by 24 publications

References 17 publications

Anterior approach with mini-bikini incision in open reduction in infants with developmental dysplasia of the hip

Anterior approach with mini-bikini incision in open reduction in infants with developmental dysplasia of the hip

Assessment of irreducible aspects in developmental hip dysplasia by magnetic resonance imaging

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

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