Utility of immediate postoperative hip MRI in developmental hip dysplasia: closed vs. open reduction

Jadhav, Siddharth P.; More, Snehal R.; Shenava, Vinitha R.; Zhang, Wei; Kan, J. Herman

doi:10.1007/s00247-018-4143-7

Cited by 13 publications

(14 citation statements)

References 13 publications

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“…We achieved a good outcome compared to the literature, which may be a result of the younger patient age when initializing treatment. Furthermore, 1 of 49 patients underwent surgery and 3 of 49 had residual dysplasia requiring treatment during our follow-up (8.1% in total, 4/49), which is comparable to the literature, reporting unsuccessful closed reduction in 9–31.16% of cases [ 11 , 37 , 40 , 46 ]. The girl who underwent surgery had a normal history with treatment beginning at 6 weeks of age for an unstable 2c hip on the left side.…”

Section: Discussionsupporting

confidence: 87%

“…The goal of treatment in these cases is to achieve and maintain concentric reduction of the hip joint to promote femoral head coverage, and congruent acetabular and femoral head development. Treatment is guided by the age at presentation and the severity of the disease [ 11 ]. Later, once the ossification center has formed in the femoral head, the sonographic possibilities become limited and AP X-ray of the pelvis provides superior diagnostic information [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

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Outcome Prognostic Factors in MRI during Spica Cast Therapy Treating Developmental Hip Dysplasia with Midterm Follow-Up

et al. 2022

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Closed reduction followed by spica casting is a conservative treatment for developmental dysplasia of the hip (DDH). Magnetic resonance imaging (MRI) can verify proper closed reduction of the dysplastic hip. Our aim was to find prognostic factors in the first MRI to predict the possible outcome of the initial treatment success by means of ultrasound monitoring according to Graf and the further development of the hip dysplasia or risk of recurrence in the radiological follow-up examinations. A total of 48 patients (96 hips) with DDH on at least one side, and who were treated with closed reduction and spica cast were included in this retrospective cohort study. Treatment began at a mean age of 9.9 weeks. The children were followed for 47.4 months on average. We performed closed reduction and spica casting under general balanced anaesthesia. This was directly followed by MRI to control the position/reduction of the femoral head without anaesthesia. The following parameters were measured in the MRI: hip abduction angle, coronal, anterior and posterior bony axial acetabular angles and pelvic width. A Graf alpha angle of at least 60° was considered successful. In the radiological follow-up controls, we evaluated for residual dysplasia or recurrence. In our cohort, we only found the abduction angle to be an influencing factor for improvement of the DDH. No other prognostic factors in MRI measurements, such as gender, age at time of the first spica cast, or treatment involving overhead extension were found to be predictive of mid-term outcomes. This may, however, be due to the relatively small number of treatment failures.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Outcome Prognostic Factors in MRI during Spica Cast Therapy Treating Developmental Hip Dysplasia with Midterm Follow-Up

et al. 2022

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“…[32] and Jadhav et al . [33] proposed MRI with fewer sequences [32-34], which meant that only the hip joint needed to be scanned to reduce examination time. In addition, a few studies compared MRI with anteroposterior pelvic radiographs [14,15].…”

Section: Discussionmentioning

confidence: 99%

Anteroposterior pelvic radiograph is not sufficient to confirm hip reduction after conservative treatment of developmental dysplasia of the hip

Fan¹,

Wang²,

Pang³

et al. 2022

Journal of Pediatric Orthopaedics B

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The purpose of this study was to investigate whether an anteroposterior pelvic radiograph alone is sufficient to confirm hip reduction after conservative treatment or whether MRI could be alternatively performed. A total of 133 children (145 hips) were enrolled. All children were examined by anteroposterior pelvic radiographs and MRI. Three experts interpreted anteroposterior pelvic radiographs and then verified these results on MRI. For patients with inconsistent results between anteroposterior pelvic radiographs and MRI, the continuity of Shenton’s line and Calve’s line was recorded, and the medial clear space of bilateral hips was measured for unilateral cases. There was complete agreement between the three experts in the interpretation of anteroposterior pelvic radiographs of 111 (76.55%) hips; there was disagreement in the remaining 34 hips, with two experts diagnosing satisfactory reduction in 13 hips and dislocation in 21 hips. Assuming that the judgment of two or more doctors on anteroposterior pelvic radiographs was taken as the final result, 17 hips (11.72%) were misjudged. There was no statistically significant difference between the actual in-position group and the actual dislocation group in terms of the continuity of Shenton’s line (P = 0.62) and Calve’s line (P = 0.10) and the medial clear space of bilateral hips (P = 0.08). In children less than 1 year of age with developmental dysplasia of the hip treated conservatively, the use of anteroposterior pelvic radiographs alone to judge hip reduction might result in misdiagnosis and missed diagnosis. MRI could be alternatively used to detect hip reduction after conservative treatment, especially when the doctor was not familiar with ultrasound in the presence of plaster.

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Section: Discussionmentioning

confidence: 99%

“…Future developments of this method may include closed reduction combined with open psoas and adductor releases in selected cases 29 and MRI after cast achievement in order to analyze the perfusion of the femoral epiphysis and the quality of the reduction. 30 Finally, mental aspects and inconvenience of traction duration for both children and family should be the focus of a future study.…”

Section: Closed Reduction Traction and Early Reductionmentioning

confidence: 99%

Closed reduction in late-detected developmental dysplasia of the hip: Indications, results and complications

Wicart

Seringe

Glorion

et al. 2018

Journal of Children's Orthopaedics

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PurposeThe aim of the study was a review of the literature in order to evaluate the results and complications of closed reduction in late-detected developmental dysplasia of the hip (DDH).MethodsThis study consisted of an analysis of the literature relative to late-detected DDH treatment options considering hip congruency, rates of re-dislocation and of avascular necrosis.ResultsGradual closed reduction (Petit-Morel method) appears to be an effective method concerning joint congruency restitution. Dislocation relapse and avascular necrosis are more efficiently prevented with closed versus open reduction. The tendency for spontaneous correction of acetabular dysplasia decreases if closed reduction is performed after 18 months of age. Patient age at the beginning of traction should be considered for the prognosis, with a lower rate of satisfactory results showing after the age of 3 years.ConclusionIn our opinion, the Petit-Morel method is a suitable treatment option for children aged between six months and three years with idiopathic DDH.

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Utility of immediate postoperative hip MRI in developmental hip dysplasia: closed vs. open reduction

Abstract: Post intervention hip spica MRI is useful in determining the need for re-intervention after closed hip reduction, but its role after open reduction is questionable.

Cited by 13 publications

References 13 publications

Outcome Prognostic Factors in MRI during Spica Cast Therapy Treating Developmental Hip Dysplasia with Midterm Follow-Up

Outcome Prognostic Factors in MRI during Spica Cast Therapy Treating Developmental Hip Dysplasia with Midterm Follow-Up

Anteroposterior pelvic radiograph is not sufficient to confirm hip reduction after conservative treatment of developmental dysplasia of the hip

Closed reduction in late-detected developmental dysplasia of the hip: Indications, results and complications

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