Treatment of Failed Open Reduction for Congenital Dislocation of the Hip

McCluskey, William P.; Bassett, George S.; Mora-Garcia, G; Gd, MacEwen

doi:10.1097/01241398-198911000-00001

Cited by 50 publications

(37 citation statements)

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“…Sufficient subject-level data were available to exclude the following ineligible cases: four dislocations of the hip secondary to neuromuscular or teratologic causes [15,67], 188 hips treated by open reduction with concomitant pelvic osteotomy [8,10,19,20,29,31,33,38,46,59,69,74,95,96], and 280 hips treated by other ineligible interventions [23,64,85,94]. Additionally, one study [13] included 12 hips treated by medial open reduction that at least partly overlapped with a more recently published article [49].…”

Section: Study Characteristicsmentioning

confidence: 99%

Is Age or Surgical Approach Associated With Osteonecrosis in Patients With Developmental Dysplasia of the Hip? A Meta-analysis

Novais

Hill

Carry

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Osteonecrosis of the femoral head is a major complication that negatively impacts the clinical and radiographic long-term outcome after treatment of developmental hip dysplasia (DDH). There are conflicting results in the literature whether age at the time of closed or open reduction and a specific surgical approach are associated with osteonecrosis. Better understanding of the impact of age at reduction and surgical approach is important to reduce the risk of osteonecrosis in patients with DDH. Questions/purposes We aimed to evaluate the association between occurrence of osteonecrosis and (1) age at closed reduction; (2) age at open reduction; and (3) medial versus anterior operative approaches.Methods A systematic review identified studies reporting osteonecrosis occurrence after treatment of DDH and at least 2 years of followup. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Methodologic quality was assessed using the methodologic index for nonrandomized studies. Generalized logistic models were used to estimate pooled odds ratios (ORs) in the meta-analysis. Sixty-six studies were included in the systematic review and 24 in the meta-analysis. Data on 481 hips treated by closed reduction and 584 hips treated by open reduction were available to evaluate the association between osteonecrosis and age. The association between osteonecrosis and operative approach was assessed using data on 364 hips treated by medial open reduction and 220 hips treated by anterior open reduction. Results Age at reduction ([ 12 months versus B 12 months) was not associated with osteonecrosis after closed reduction (OR, 1.1; 95% confidence interval [CI], 0.4-3.2; p = 0.9) or open reduction (OR, 1.1; 95% CI, 0.7-1.9; p = 0.66). The overall, adjusted incidence of osteonecrosis (C Grade II) was 8.0% (95% CI, 2.8%-20.6%) among patients treated with closed reduction at or before 12 months of age and 8.4% (95% CI, 3.0%-21.

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Section: Study Characteristicsmentioning

confidence: 99%

Is Age or Surgical Approach Associated With Osteonecrosis in Patients With Developmental Dysplasia of the Hip? A Meta-analysis

Novais

Hill

Carry

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…Previous reports have highlighted the problems of management of this difficult problem [1,3,5,6]. We present our experience with 17 patients (18 hips) who had redislocation following open reduction for DDH, analyse the possible causes of failure and examine the outcome on both a clinical and radiological basis.…”

Section: Introductionmentioning

confidence: 99%

“…It would appear to depend upon the approach used, the age of the patient at the time of initial reduction and, perhaps, the expertise of the surgeon. It has been reported to occur in 0-8% following open reduction via an anterolateral approach [3,6],and when the medial approach is used, this figure rises to 5-14% [4,6,9].…”

Section: Introductionmentioning

confidence: 99%

Re-dislocation following open reduction for developmental dysplasia of the hip

Kamath

Bennet

2005

International Orthopaedics (SICOT)

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We have reviewed 17 patients (18 hips) who required repeat open reduction for recurrent or persistent dislocation after a previous attempt at open reduction for developmental dysplasia of the hip (DDH). The mean follow-up was 5.5 (3-15) years. At the review, five patients were limping and had limited hip motion but no pain. Six hips were classified as Severin class III or more, and avascular necrosis was evident in 11. We suggest that technical failure is usually the cause for re-dislocation in unilateral cases, as we discovered at repeat open reduction in five of six patients with unilateral dislocation. The biological behaviour of bilateral dislocations may in someway be different since in nine of 11 patients with bilateral dislocations, no obvious cause could be attributed. The outcome is usually poor.Résumé Nous avons examiné 17 malades (18 hanches) qui ont nécessité une réduction ouverte répétitive de la hanche pour une luxation récidivante ou persistante après une première réduction ouverte pour dysplasie congénitale (DDH). Le suivi moyen était de 5,5 ans (3-15). À la ré-vision cinq malades boitaient et avaient une limitation des amplitudes articulaires mais aucune douleur. Six hanches ont été classées comme Severin classe III ou plus et une nécrose avasculaire était présente dans 11 hanches. Nous suggérons que l'échec technique est la cause des luxations récidivantes dans les cas unilatéraux, comme nous l'avons constaté lors de la nouvelle réduction chez 5 des 6 malades avec luxation unilatérale. Le comportement des luxations bilatérales est différent puisque chez 9 des 11 malades avec luxation bilatérale aucune cause évidente ne pouvait être attribuée. Le résultat est habituellement mauvais.

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“…The presence of a stump of the ligamentum teres causing redislocation has also been found. This stresses the importance of complete removal of all obstacles to reduction including the need for complete release of the transverse acetabular ligament [4,[128][129][130] . Risk factors for failed open reduction were not thoroughly evaluated.…”

Section: Open Reduction and Hip Reconstructionmentioning

confidence: 99%