Utility of magnetic resonance imaging (MRI) after closed reduction of developmental dysplasia of the hip

Bachy, Manon; Thévenin-Lemoine, Camille; Rogier, A.; Mary, P.; Pointe, Hubert Ducou Le; Vialle, Raphaël

doi:10.1007/s11832-012-0382-6

Cited by 26 publications

(28 citation statements)

References 29 publications

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“…Recent evidence has suggested MRI as a safe, effective, and reliable postreduction imaging modality [1,5]. Gadolinium-enhanced perfusion MRI (pMRI) can provide the surgeon with data regarding vascular perfusion to the femoral head [2,13].…”

Section: Introductionmentioning

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

Clinical Orthopaedics &Amp; Related Research

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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...

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Section: Introductionmentioning

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

Clinical Orthopaedics &Amp; Related Research

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“…MRI has been described as a safe and suitable method for evaluation of hip reduction after conservative treatment. Furthermore, it has been emphasized that MRI was still useful in situations when reduction was doubtful 4 . In a study in which 34 patients were examined by MRI the second day after reduction, 79.4% showed full reduction, 14.7% showed partial dislocation, and 5.9% showed full dislocation 14 .…”

Section: Discussionmentioning

confidence: 99%

“…US is helpful during early childhood but it is difficult to evaluate during late childhood and after plaster is applied. On the other hand, MRI provides fast and satisfactory imaging without requiring radiation or anesthesia 4 . In this study, the effectiveness and utility of MRI for monitoring and assessing patients with DDH after reduction treatment were investigated prospectively, and findings were compared with those of postreduction plain radiography.…”

Section: Introductionmentioning

confidence: 99%

MRI assessment of DDH after reduction

Pazarci

Bulut²,

Tezeren³

et al. 2017

Cumhuriyet Medical Journal

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SUMMARYObjective: In this study, the effectiveness of magnetic resonance imaging (MRI) in patients with developmental dysplasia of the hip (DDH) after reduction was examined. Method: Forty-two hips of 31 patients treated between 2003 and 2012 were examined prospectively. The femur head and acetabulum interaction were examined by MRI performed postreduction. Results: The average follow-up period was 40.47 ± 36.52 months. Eleven, 10 and 10 patients were diagnosed as bilateral (B), right (R) sided and left (L) sided, respectively. The average age on MRI was 13.1 months (min, 5; max, 24). MRI was obtained without sedation, except in three patients. The mean MRI duration was 5.21 min (range, 3.55-10.50 min). Concentric reduction was monitored in 19 hips of 15 patients. Postreduction redislocation was monitored in eight hips of six patients. Conclusions: MRI was beneficial in DDH because it was able to assess the hip extensively, did not require anesthesia, and did not use radiation. MRI provided advanced structural information that enabled the assessment of potential prevention of reduction. MRI was found to be an effective treatment scheduling method for DDH at an early period postreduction. MRI should be used more commonly in DDH.

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“…■ Abnormal epiphyseal perfusion may appear as well-demarcated geographic or patchy areas of decreased enhancement or as global nonenhancement of the femoral head; only the latter pattern has been associated with higher risk for osteonecrosis. can be used to reasonably assess joint congruity, acetabular morphology, and orthopedic hardware complications, but, like radiography, it does not adequately demonstrate the cartilaginous femoral head, the position of which must be inferred from that of the ossified proximal femoral metaphysis (17,22). Although low-dose scanning techniques may approximate the radiation dose of plain radiography (23), with gonadal exposure for a limited CT examination estimated as low as 1 mSv (24), the lack of ionizing radiation with MR imaging is still preferred in children, particularly because repeat imaging studies may be required if the initial reduction proves insufficient.…”

Section: Teaching Pointsmentioning

confidence: 99%

“…Sedation is generally not necessary for postreduction MR imaging because the anesthesia administered during surgical reduction produces a residual "postnarcotic state" that is sufficient for diagnostic imaging. The lack of need for sedation has been demonstrated across multiple studies (22). Younger patients may also be bottle fed immediately before the examination to induce a calming effect.…”

Section: Imaging Techniquementioning

confidence: 99%

MR Imaging in Postreduction Assessment of Developmental Dysplasia of the Hip: Goals and Obstacles

Rosenbaum

Servaes

Bogner³

et al. 2016

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Developmental dysplasia of the hip is a spectrum disorder of hip development that ranges in severity from abnormal acetabular morphology to complete hip dislocation. While treatment with a Pavlik harness is highly effective in infants younger than 6 months, older infants and children and those with orthotic failure often warrant surgical reduction and placement of a spica cast, which limits subsequent imaging evaluation. Magnetic resonance (MR) imaging has been described in the evaluation of the adequacy of hip reduction for more than 2 decades, but the practice is still not widespread and is performed routinely at relatively few centers. MR imaging is a robust tool for outcome assessment after hip reduction and placement of a spica cast, facilitating multiplanar confirmation of concentric reduction independent of an ossific nucleus or orthopedic hardware. Excellent image contrast of soft tissues allows identification of obstacles to concentric reduction, which may be extra-articular or intra-articular. Extra-articular obstacles include tightening of the adductor muscles and tightening of the iliopsoas tendon with constriction of the joint capsule. Intra-articular obstacles include limbus formation, labral inversion, an enlarged pulvinar, and hypertrophy of the ligamentum teres and/or the transverse acetabular ligament. Intravenous contrast material administration may demonstrate altered epiphyseal blood flow and help identify patients at risk for early ischemia. Imaging technique and image interpretation can be optimized to facilitate the performance of postreduction MR imaging studies where they may be of benefit. (©)RSNA, 2016.

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Utility of magnetic resonance imaging (MRI) after closed reduction of developmental dysplasia of the hip

Cited by 26 publications

References 29 publications

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

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

MRI assessment of DDH after reduction

MR Imaging in Postreduction Assessment of Developmental Dysplasia of the Hip: Goals and Obstacles

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