Reliability of a New Radiographic Classification for Developmental Dysplasia of the Hip

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Background Little information exists concerning the variability of presentation and differences in treatment methods for developmental dysplasia of the hip (DDH) in children \ 18 months. The inherent advantages of prospective multicenter studies are well documented, but data from different centers may differ in terms of important variables such as patient demographics, diagnoses, and treatment or management decisions. The purpose of this study was to determine whether there is a difference in baseline data among the nine centers in five countries affiliated with the International Hip Dysplasia Institute to establish the need to consider the center as a key variable in multicenter studies. Questions/purposes (1) How do patient demographics differ across participating centers at presentation? (2) How do patient diagnoses (severity and laterality) differ across centers? (3) How do initial treatment approaches differ across participating centers? Methods A multicenter prospective hip dysplasia study database was analyzed from 2010 to April 2015. Patients younger than 6 months of age at diagnosis were included if at least one hip was completely dislocated, whereas patients between 6 and 18 months of age at diagnosis were included with any form of DDH. Participating centers (academic, urban, tertiary care hospitals) span five countries across three continents. Baseline data (patient demographics, diagnosis, swaddling history, baseline International Hip Dysplasia Institute classification, and initial treatment) were compared among all nine centers. A total of 496 patients were enrolled with site enrolment ranging from 10 to 117. The proportion of eligible patients who were enrolled and followed at the nine participating centers was 98%. Patient enrollment rates were similar across all sites, and data collection/completeness for relevant variables at initial presentation was comparable. 123 Clin Orthop Relat Res (2016) 474:1138-1145 DOI 10.1007/s11999-016-4746-y Clinical Orthopaedics and Related Research ® A Publication of The Association of Bone and Joint Surgeons®Results In total, 83% of all patients were female (410 of 496), and the median age at presentation was 2.2 months (range, 0-18 months). Breech presentation occurred more often in younger (\6 months) than in older (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) Conclusions With the lack of strong prognostic indicators for DDH identified to date, the center is an important variable to include as a potential predictor of treatment success or failure.

Section: Discussionmentioning

confidence: 99%

What Is the Impact of Center Variability in a Multicenter International Prospective Observational Study on Developmental Dysplasia of the Hip?

Mulpuri

Schaeffer

Kelley

et al. 2016

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“…4) [22] for hip location. These outcomes were measured in a blinded fashion simultaneously to the evaluation for AVN.…”

Section: Methodsmentioning

confidence: 99%

Does Perfusion MRI After Closed Reduction of Developmental Dysplasia of the Hip Reduce the Incidence of Avascular Necrosis?

Gornitzky

Georgiadis

Seeley

et al. 2016

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Background Gadolinium-enhanced perfusion MRI (pMRI) after closed reduction/spica casting for developmental dysplasia of the hip (DDH) has been suggested as a potential means to identify and avoid avascular necrosis (AVN). To date, however, no study has evaluated the effectiveness of pMRI in clinical practice or compared it with other approaches (such as postreduction CT scan) to show a difference in the proportion of AVN. Questions/purposes (1) Can a pMRI-based protocol be used immediately post closed reduction to minimize the risk that AVN would develop? (2) What are the overall hiprelated outcomes after closed reduction/spica casting using this protocol? (3) Do any patient-specific factors at the time of closed reduction predict future AVN? Methods This was a retrospective cohort study at a large tertiary care children's hospital. Between 2009 and we treated 43 patients with closed reduction/spica casting for DDH, of whom 33 (77%) received a postreduction pMRI. All patients were indicated for pMRI per treating surgeon preference. A convenience sample totaling 25 hips in 22 patients treated with pMRI was then established using the following exclusion criteria: DDH of neuromuscular/ syndromic origin, failed initial closed reduction, less than 1 year of clinical and radiographic followup, and subsequent open reduction. Next, the 40 patients treated with closed reduction between 2004 and 2009 were screened until the chronologically most recent 25 hips (after applying the previously mentioned exclusion criteria) were identified in 21 of the first 34 patients (62%) screened. Although termed the CT group, specific postreduction imaging was not a defined inclusion criterion in this group with the majority (21 of 25 [84%]) receiving postreduction CT and the remainder (four of 25 [16%]) receiving only postreduction radiographs. All hips with globally decreased femoral head perfusion on postreduction pMRI were treated with immediate cast removal followed by repeat closed reduction or open reduction, as per surgeon preference, with two of 33 (6%) requiring such further interventions. Salter criteria were then used to determine the proportion of AVN on radiographs at 1-year and final followup. Secondary outcomes including residual dysplasia and the need for further corrective surgery were ascertained through radiographic and retrospective chart review. 049). No patient with normal perfusionEach author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved the human protocol for this investigation and that all investigations were conducted in conform...

“…Included patients were divided into two age groups: younger than 3 months and those 3 months to 18 months of age. All included hips were verified as dislocated by ultrasound (percent coverage of the femoral head less than 35%) or radiography (IHDI grade of 3 or above [26]) before treatment.…”

Section: Inclusion and Exclusion Criteriamentioning

confidence: 99%

What Risk Factors and Characteristics Are Associated With Late-presenting Dislocations of the Hip in Infants?

Mulpuri

Schaeffer

Andrade

et al. 2016

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Background Most infants with developmental dysplasia of the hip (DDH) are diagnosed within the first 3 months of life. However, late-presenting DDH (defined as a diagnosis after 3 months of age) does occur and often results in more complex treatment and increased long-term complications. Specific risk factors involved in late-presenting DDH are poorly understood, and clearly defining an associated set of factors will aid in screening, detection, and prevention of this condition. Questions/purposes Using a multicenter database of patients with DDH, we sought to determine whether there were differences in (1) risk factors or (2) the nature of the dislocation (laterality and joint laxity) when comparing patients with early versus late presentation. Methods A retrospective review of prospectively collected data from a multicenter database of patients with dislocated hips was conducted from 2010 to 2014. Baseline demographics for fetal presentation (cephalic/breech), birth presentation (vaginal/cesarean), birth weight, maternal age, maternal parity, gestational age, family history, and swaddling history of patients were compared among nine different sites for patients who were enrolled at age younger than 3 months and those enrolled between 3 and 18 months of age. A total of 392 patients were enrolled at baseline between 0 and 18 months of age with at least one dislocated hip. Of that group, 259 patients were youngerThe contributing members of the IHDI study group are: Pablo Castañeda, Nicholas M. P. Clarke, Bruce K. Foster, José A. HerreraSoto, James R. Kasser, Simon P. Kelley, Young-Jo Kim, Colin F. Moseley, Unni G. Narayanan, Ernest L. Sink, Vidyadhar Upasani, and John H. Wedge. One author (KM) has received funding from the International Hip Dysplasia Institute for REDCap database coordination, maintenance, and support (http://hipdysplasia.org). All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. Included patients were recruited from all listed sites as well as Centro Médico ABC Santa Fe, Mexico City, Mexico; Hospital for Sick Children, Toronto, Ontario, Canada; and Southampton General Hospital, Southampton, UK. Data analysis and review were carried out at BC Children's Hospital, Vancouver, British Columbia, Canada. Clinical Orthopaedics and Related Research ®A Publication of The Association of Bone and Joint Surgeons® than 3 months of age and 133 were 3 to 18 months of age. The proportion of patients with DDH who were enrolled and followed at the nine participating centers was 98%. Results A univariate/multivariate analysis was performed comparing key baseline demographics between early-and late-presenting patient...