Test of stability as an aid to decide the need for osteotomy in association with open reduction in developmental dysplasia of the hip

Zadeh, Hamid G.; Catterall, A.; Hashemi-Nejad, Aresh; Perry, Rachel

doi:10.1302/0301-620x.82b1.0820017

Cited by 39 publications

(38 citation statements)

References 19 publications

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“…Forlin et al [26] reported that there were no significant differences in outcome with regard to age at the initial reduction, treating 72 hips by CR. In contrast, Zadeh et al [27] treated 95 cases of DDH by OR combined with osteotomy and concluded that age 2 years at surgery is associated with a favourable outcome. Cıtlak et al [28] reported that acetabular development was better in patients treated before the age of 18 months, based on their evaluation of 110 hips treated by medial OR, while additional operations were performed on 32 hips (29%).…”

Section: Discussionmentioning

confidence: 96%

Acetabular development after open reduction to treat dislocation of the hip after walking age

Kagawa

Endo

Tetsunaga

et al. 2016

Journal of Orthopaedic Science

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a b s t r a c tBackground: Treatment of hip dislocation diagnosed after walking age is often difficult. We report the surgical treatment of these patients by open reduction with a soft tissue surgical procedure without osteotomy. Methods: Thirty-eight children (43 hips) diagnosed with complete dislocation of the hip after walking age were included in this study. We radiographically analysed postoperative hip joint development up to 6 years of age. To assess the predictors of acetabular development, we evaluated the radiographs, using an acetabular index of 35 and a centre-edge angle of >5 at 6 years of age as satisfactory outcomes, and evaluated the advance of acetabular development over time. Results: AI on the affected side was improved with time after open reduction. The diameter of the capital femoral ossific nucleus on the affected side was almost equivalent to that on the unaffected side at 6e12 months after surgery, after which the centre-edge angle improved gradually from one year after surgery. We compared hips classified as satisfactory to unsatisfactory at 6 years of age, and found that the centreedge angle at one year after open reduction was significantly associated with acetabular development (P ¼ 0.044). The cut-off value was À2 with sensitivity of 0.909 and specificity of 0.677. Conclusions:The results of the current study suggest that initial development of the capital femoral ossific nucleus after open reduction would be followed by improved joint congruity, and that this would facilitate acetabular development. The centre-edge angle at one year after surgery could be regarded as a potential predictor of acetabular development in open reduction surgery for late-diagnosed developmental dysplasia of the hip cases.

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Section: Discussionmentioning

confidence: 96%

Acetabular development after open reduction to treat dislocation of the hip after walking age

Kagawa

Endo

Tetsunaga

et al. 2016

Journal of Orthopaedic Science

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“…It was not possible to ascertain AVN rates, clinical and radiological results, and need for further operative intervention for all 18 articles, and where available, heterogeneity was noted in the reporting of results. Data were often pooled in mixed groups, which was adequate to quote the overall outcome rates for all surgery involving an anterior open reduction [5,26,30,32,45]. However, for subgroup analysis by specific surgical prescription, additional data were excluded, and fewer studies still had individual patient data for further analysis [3,28,30,31,39,40,46].…”

Section: Discussionmentioning

confidence: 99%

“…There are numerous advocates of a single-stage surgical approach to this problem combining open reduction and pelvic and femoral osteotomy, to minimize need for future intervention [11,12,39]. Others deem this too aggressive an approach and base management on intraoperative stability and subjective assessment of soft tissue tension [22,45]. Ultimately the surgical aim is to undertake the minimum amount of intervention necessary to obtain a stable concentric reduction, avoiding AVN or further surgical procedures to provide a pain-free hip that will last decades.…”

Section: Introductionmentioning

confidence: 99%

How Does Bony Surgery Affect Results of Anterior Open Reduction in Walking-age Children With Developmental Hip Dysplasia?

Kothari

Grammatopoulos

Hopewell

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Anterior open reduction is commonly used to treat hip subluxation or dislocation in developmental dysplasia of the hip (DDH) in walking-age children. Pelvic and/ or femoral osteotomy may be used in addition, but it is unclear how this affects avascular necrosis (AVN) risk and radiological and clinical results. Questions/purposes The purpose of this study was to review studies of walking-age patients treated either with an open reduction alone or combined with pelvic and/or femoral osteotomies and determine whether there is a difference between groups in the proportion of patients: (1) developing clinically relevant femoral head AVN (Kalamchi & MacEwen Types II to IV or equivalent); (2) achieving a satisfactory radiological result (Severin Grade I/II or equivalent); (3) achieving a satisfactory clinical result (McKay excellent or good rating or equivalent); and (4) requiring further nonsalvage surgery. Methods MEDLINE, Embase, the Cochrane Centre Register of Controlled Trials, and ClinicalTrials.gov were searched for studies of anterior open reduction for DDH in children aged 12 months to 6 years old. We assessed AVN, clinical and radiological results, and requirement for further procedures. The effect of failed conservative management, traction, age at operation, and followup duration was also assessed. Eighteen studies met the review eligibility criteria. Conclusions Open reduction with concomitant pelvic osteotomy is the most appropriate option to provide durable results with the lowest risk of AVN and best radiological and clinical results. There is no evidence that addition of a femoral osteotomy provides any additional benefit to the patient, although it may be necessary to achieve reduction. Level of Evidence Level III, therapeutic study.

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“…This simultaneous approach renders immediate stability to the surgically reduced hip and minimises the need for secondary procedures to correct residual acetabular dysplasia [14,15]. Surgical relocation of the hip in isolation renders adequate stability in only 2-37% of cases over 12 months of age [9,10]. The complication rate with combined treatment modalities compares favourably to that of staged surgical procedures [11][12][13].…”

Section: Discussionmentioning

confidence: 99%

“…Stability of the reduced hip is assessed intra-operatively. Should instability be present with the hip in extension, the acetabular deficiency is located mainly anterior, and if instability is present in adduction, the deficiency is more lateral [9,10]. This information helps to determine the amount and direction of the acetabulum roof displacement (acetabuloplasty) to render the required coverage of the femur head.…”

Section: Surgical Techniquementioning

confidence: 99%

Contoured iliac crest allograft interposition for pericapsular acetabuloplasty in developmental dislocation of the hip: Technique and short-term results

Wade

Alhussainan

Zayed

et al. 2010

Journal of Children's Orthopaedics

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Background Pericapsular acetabuloplasty procedures have been widely used as an integral component of combined surgery to treat developmental hip dislocation after walking age. The stability of the acetabuloplasty and the maintenance of the acetabular correction will depend on the structural integrity of the iliac crest autograft, which, traditionally, has been inserted as the interposition material. Problems related to the use of an autograft have been encountered by various surgeons—including the authors—namely, graft displacement and resorption, which may necessitate internal fixation or result in revision surgery. To overcome autograft failure, the use of an allograft as the interposition material has been introduced by some surgeons. This study describes the radiologic results of 147 hips treated for developmental hip dislocation by means of a standard protocol of open hip reduction and pericapsular acetabuloplasty with a contoured iliac crest allograft as the interposition material. Methods This retrospective study reviewed the radiographs of 147 hips presenting with late developmental dislocation which were treated by open reduction and a concomitant pericapsular acetabuloplasty using a contoured iliac crest allograft as the interposition material. The minimum follow up period was 2 years. Measurement of the acetabular index (AI) was the main variable. The efficacy of the interposed iliac crest allograft as the main stabiliser of the acetabuloplasty was reflected by the maintenance of the corrected AI during the follow up period. Loss of acetabular correction, graft extrusion or resorption, the need for osteotomy internal fixation, delayed or non union, infection, hip redislocation and avascular necrosis (AVN) as possible complications were documented. Results The treatment protocol of a combined open reduction of the hip and pericapsular acetabuloplasty, inserting a contoured iliac crest allograft as the interposition material, resulted in concentrically reduced and stable hips in 96.6% of our cases. The redislocation rate was 3.4%. All of the allografts were completely incorporated at 6 months post-surgery with no graft-related infections. In only two hips was the acetabular correction not maintained. None of the osteotomies required internal fixation for stability, even in older children. Conclusion We believe that a contoured iliac crest allograft as the pericapsular acetabuloplasty interposition material renders excellent osteotomy stability that eliminates the need for internal fixation and—in the short-term—maintains the correction of the acetabulum achieved intra-operatively.

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Test of stability as an aid to decide the need for osteotomy in association with open reduction in developmental dysplasia of the hip

Cited by 39 publications

References 19 publications

Acetabular development after open reduction to treat dislocation of the hip after walking age

Acetabular development after open reduction to treat dislocation of the hip after walking age

How Does Bony Surgery Affect Results of Anterior Open Reduction in Walking-age Children With Developmental Hip Dysplasia?

Contoured iliac crest allograft interposition for pericapsular acetabuloplasty in developmental dislocation of the hip: Technique and short-term results

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