What’s New in Pediatric Hip?

Schmitz, Matthew R.; Blumberg, Todd J.; Nelson, Susan E.; Sees, Julieanne P.; Sankar, Wudbhav N.

doi:10.1097/bpo.0000000000001166

Cited by 13 publications

(18 citation statements)

References 39 publications

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“…As indications for hip arthroscopy have evolved to include pediatric hip conditions, there has been a lack of studies in the literature investigating the safety of its use. 10,13,15 Neurapraxia or nerve injury is a potential complication from traction in hip arthroscopy, as documented in the literature. 16 While this complication can still occur, it was more frequent during the early days of hip arthroscopy when traction times were longer.…”

Section: Discussionmentioning

confidence: 99%

“…16 Few studies have examined the frequency and risk for iatrogenic neurologic complications during hip arthroscopy in the pediatric population, despite the fact that its use has expanded to include treatment for sequelae of developmental dysplasia of the hip, Legg-Calve-Perthes disease, slipped capital femoral epiphysis (SCFE), epiphyseal dysplasia, femoral acetabular dysplasia, septic arthritis, and trauma, as the alternative for these pathologies may include open surgical hip dislocation. 10,13,15 Although the rate of pediatric pudendal nerve injury has been noted to range from \1% to 9% after hip arthroscopy for labral debridement in structurally normal hips, 5,10,14 no studies have either examined the rate of neuromonitoring changes of the sciatic nerve due to traction or assessed the risk factors for sciatic nerve injury in the pediatric population.…”

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confidence: 99%

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What Neuromonitoring Changes Can Be Expected During Hip Arthroscopy in the Pediatric Population?

et al. 2019

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Background: As its indications have evolved, hip arthroscopy is now performed more frequently in pediatric patients. However, despite this increase, there is a lack of evidence in the literature about its safety in this population in regard to traction injury of the nerves of the lower extremity. Purpose: To determine neuromonitoring changes of the sciatic, femoral, and obturator nerves during hip arthroscopy in the pediatric population and determine the rate of and risk factors for clinical neurapraxia. Study Design: Case series; Level of evidence, 4. Methods: A retrospective review was performed of all pediatric patients who underwent hip arthroscopy with neuromonitoring from December 2013 to October 2018. Neuromonitoring included somatosensory evoked potentials (SSEPs) in the peroneal and posterior tibial nerves and electromyography (EMG) signal for the obturator, femoral, and peroneal and posterior tibial nerves. Traction was applied using a radiolucent traction table. We recorded total traction time, surgery time, SSEP changes >50% after traction application, and EMG activity. We also recorded whether there was a clinical neurapraxia and when nerve function returned, and analyzed surgical and patient characteristic data for risk factors for neurapraxia. Results: A total of 89 patients had hip arthroscopy (median traction time, 69 minutes). SSEP changes >50% occurred in 78% of patients in the peroneal nerve and 73% in the posterior tibial nerve. EMG activity was observed in 9% of patients in the obturator nerve, 8% in the femoral nerve, 12% in the peroneal nerve, and 8% in the posterior tibial nerve. Clinical neurapraxia was seen in 19% of patients in either the peroneal nerve or posterior tibial nerve but resolved by 2 days postoperatively. Those who sustained a neurapraxia had a 32-minute longer surgery and 6-minute longer traction time. The clinical rate of neurapraxia of the pudendal nerve was 0%. Conclusion: Neuromonitoring changes are common during hip arthroscopy and nearly 1 in 5 pediatric patients will have some decreased sensation in either the peroneal or the posterior tibial nerve that resolves within 1 to 2 days after surgery. In pediatric patients, longer surgery and traction times during hip arthroscopy are associated with a higher rate of neurapraxia than that reported for adults.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

What Neuromonitoring Changes Can Be Expected During Hip Arthroscopy in the Pediatric Population?

et al. 2019

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“…В ведущих зарубежных изданиях традиционно публикуются аналитические статьи, содержащие обзор результатов текущих исследований по различным направлениям нашей специальности [5][6][7][8], и обсуждаются способы улучшения контроля качества научной продукции [9][10][11]. однако в отечественной травматологии и ортопедии аналитических обзоров соответствующего профиля нам найти не удалось.…”

Section: таблица 3 сведения о характере и уровнях кандидатских и доктunclassified

Traumatology and Orthopedics Research Speciality in 2017: Dissertations Analysis

Решетов

Тихилов

Кочиш

et al. 2018

Traumatology and Orthopedics of Russia

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The authors present a short analysis of autoabstracts of all theses in traumatology and orthopedics speciality (14.01.15), 10 doctoral and 59 candidate theses, that were defended at 11 dedicated dissertation boards starting mid of October 2016 until mid of October 2017 and underwent expert reviews during 2017 in expert council of the Higher certifying commission on surgical science.The absolute majority of 26 papers in traumatology (16 candidate and 5 doctoral theses) were dedicated to treatment of patients with different fractures and another 5 candidate theses examined issues of arthroscopic procedures in case of a trauma. 25 dissertations in orthopedics mainly reviewed aspects of large joints replacement (6 candidate and 3 doctoral these) and treatment of periprosthetic infection (4 candidate theses). Spine pathologies (5 candidate theses) and oncology orthopedics (2 candidate theses) prevailed among dissertation topics on paediatric orthopedics. The only doctoral thesis on paediatric orthopaedics was dedicated to clubfoot.In accordance with recommended criteria of clinical Orthopaedics and Related Research journal 40 (67,8%) candidate theses and 2 (20%) doctoral theses corresponded to evidence level III, 17 (28,8%) candidate and 8 (80%) doctoral theses were classified as evidence level IV and only 2 candidate theses (3,4%) formally corresponded to evidence level II.

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“…The complication rate after SCFE treatment is difficult to assess [18], given the lack of standardized clinical data reporting and multicentre studies. A recent study reported an overall 29.4% AVN rate in a cohort of patients with stable SCFE treated with modified Dunn procedure [2], compared to a cohort of patients with unstable slips, who experienced a 6% AVN rate [19]. A 4% incidence of anterolateral hip instability was also found after modified Dunn procedure [20].…”

Section: Introductionmentioning

confidence: 99%

“…Osteoarthritis of the hip may be the end result of congenital or acquired hip conditions occurred during the juvenile age [1]. Developmental dysplasia of the hip (DDH), Legg-Calvé-Perthes disease (LCPD), slipped capital femoral epiphysis (SCFE) and hip joint infections are the most common cause of juvenile hip osteoarthritis (JHOA) [2]. The complex management and the catastrophic consequences of these conditions justify the active research interest in this field [3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Medium-term outcomes of total hip arthroplasty in juvenile patients

Luceri

Morelli

Sinicato³

et al. 2020

J Orthop Surg Res

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Background Juvenile hip osteoarthritis is often the end result of congenital conditions or acquired hip ailments occurred during the paediatric age. This study evaluated the middle term results of total hip arthroplasty for end-stage juvenile hip osteoarthritis. Materials and methods This is a retrospective analysis of prospectively collected data on a cohort of 10 consecutive patients (12 hips), aged between 14 and 20 at operation, who underwent cementless total hip arthroplasty for end-stage juvenile secondary hip osteoarthritis in two orthopaedic tertiary referral centres between 2009 and 2018. Results Juvenile hip osteoarthritis occurred as a consequence of developmental dysplasia of the hip, Legg-Calvé-Perthes disease, femoral head necrosis or slipped capital femoral epiphysis. All patients showed a significant improvement in Harris Hip Score (p < 0.01) at 3.3 years average follow-up (range 0.7–10.1 years). Conclusion The management of juvenile hip osteoarthritis following developmental dysplasia of the hip, Legg-Calvé-Perthes disease, femoral head necrosis or slipped capital femoral epiphysis is still challenging. Careful preoperative planning is essential to achieve good outcomes and improve the Harris Hip Score in these young patients. Total hip arthroplasty is a suitable option for end-stage secondary juvenile hip osteoarthritis, when proximal femoral osteotomies and conservative treatments fail to improve patients’ symptoms and quality of life. Level of evidence IV

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What’s New in Pediatric Hip?

Abstract: Level V.

Cited by 13 publications

References 39 publications

What Neuromonitoring Changes Can Be Expected During Hip Arthroscopy in the Pediatric Population?

What Neuromonitoring Changes Can Be Expected During Hip Arthroscopy in the Pediatric Population?

Traumatology and Orthopedics Research Speciality in 2017: Dissertations Analysis

Medium-term outcomes of total hip arthroplasty in juvenile patients

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