Role of intraoperative arthrogram in decision making of closed versus medial open reduction of developmental hip dysplasia

BACKGROUND: Developmental dislocation of the hip includes femoral head subluxation or dislocation and/or acetabular dysplasia. Closed reduction of the hip should be performed under general anesthesia. Appropriate performance and interpretation of closed reduction are difficult and require experience. The role of computed tomography (CT) in different aspects of treatment of developmental hip dysplasia is well established. It was an accurate way to assess the adequacy of reduction of dislocated hips for patients in spica casts. AIM: This study aimed to assess the role of CT in the evaluation of closed reduction of developmental hip dislocation in infants and children immobilized in spica casts. MATERIALS AND METHODS: This study included 16 patients with 20 involved hips who presented with developmental hip dysplasia. The youngest patient was 12 months old, and the oldest was 24 months old, with a mean age of 19.62 4.27 months. There were 15 girls (93.75%) and one boy (6.25%). There were four patients with bilateral hip involvement (25%), and the right side was involved in five hips (31.25%), whereas the left side was affected in 7 (43.75%) hips. RESULTS: Closed reduction was performed in 20 hips, and according to the post-reduction CT evaluation, the final results were satisfactory in 16 (80%) hips and unsatisfactory in 4 (20%) hips. On the coronal CT cuts, the modified Shentons line gave a sensitivity of 75%, specificity of 81.25%, and accuracy of 80%. Second, the calculation of femoral head coverage on coronal CT cuts showed the highest sensitivity of 100%, specificity of 50%, and accuracy of 60%. Lastly, the posterior neck line identified on the axial CT cuts gave a sensitivity of 75%, specificity of 87%, and accuracy of 85%. On comparing and evaluating the three methods, the method that gave the best level of reliability for the adequacy of the reduction was the posterior neckline (82.23 %), followed by modified Shentons line (78.75%), and finally femoral head coverage (70%). CONCLUSIONS: The posterior neck line is the preferred method to confirm the adequacy of hip relocation on multi-slice post-reduction axial CT.

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Comparison between magnetic resonance imaging and intraoperative arthrogram in detection of soft tissue obstacles to reduction in developmental dysplasia of the hip

Youssef,

Mosa,

Elsharkawi

et al. 2023

EGOJ

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Background The spectrum of abnormalities in developmental dysplasia of the hips (DDH) is not limited to osseous changes, but extends to include periarticular soft tissue changes, which could not be visualized by conventional radiographs or computed tomography (CT). Both MRI and conventional arthrogram can evaluate those soft tissue obstacles to reduction. Patients and methods In total, 16 children with DDH (21 hips), dated for surgical management by open reduction, were chosen. All patients were examined by preoperative MRI as well as intraoperative arthrogram. Both modalities were used to assess different obstacles to reduction, such as the labrum, pulvinar, ligamentum teres (LT), iliopsoas tendon interposition, and the transverse acetabular ligament (TAL). Results Both MRI and conventional arthrogram showed similar sensitivity (100%) for detection of ligamentum teres pathology, labral inversion, and hypertrophied pulvinar. MRI showed higher sensitivity than arthrogram for detection of the iliopsoas tendon interposition (100% vs. 64.5%) and for detection of the thickened transverse acetabular ligament (85.7% vs. 19%). Conclusions Both MRI and conventional arthrogram can visualize the soft tissue obstacles to reduction in dysplastic hips. MRI is a noninvasive technique, requiring sedation in the pediatric population. Conventional arthrogram is an invasive technique. However, significant complications can be readily avoided.

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Role of intraoperative arthrogram in decision making of closed versus medial open reduction of developmental hip dysplasia

Cited by 3 publications

References 13 publications

Narrative Review on the Role of Imaging in DDH

Narrative Review on the Role of Imaging in DDH

Reliability of the computed tomography criteria after closed reduction of developmental dislocation of the hip

Comparison between magnetic resonance imaging and intraoperative arthrogram in detection of soft tissue obstacles to reduction in developmental dysplasia of the hip

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