Closed Reduction as Therapeutic Gold Standard for Treatment of Congenital Hip Dislocation

Abstract

Background Congenital hip dislocation (luxation) has an incidence of 0.4 – 0.7% and is regarded as a prearthrotic deformity. Thus, if not being diagnosed and treated at a very early age, extensive surgical measures are inevitable in childhood and early adulthood. Methods In the time between 01/2013 and 02/2019 we performed 28 600 hips sonographies in babies as part of general screening measures at U2 or U3. There were 71 instable, dysplastic or dislocated hips diagnosed that were treated by arthrographic, closed reduction. After a hip spica cast was applied, reposition was controlled by MRI, estimating the acetabular head index (ACI), the head coverage index (HCI) as well as the femoral headʼs sphericity or by sonography using the Graf method. Results Overall success rate was 91.6% for primary closed reduction. Patients with primarily irreducible hips were significantly older (p < 0.003) than patients with primarily successful reducible hips. Congenital dislocated hips had significantly higher ACIs (p < 0.001) and HCIs (p = 0.03) as well as significantly less well rounded femoral heads (sphericity; p < 0.001) compared to stable hips. Conclusion Early diagnosis and treatment of congenital dislocated hips by closed reduction is essential for a sufficient and regular maturation of the hips without further surgical interventions.

Correlation of postoperative magnetic resonance image measurements with persisting acetabular dysplasia in open reduction of developmental hip dysplasia

“…On the first postoperative day, the acetabular head index (AHI), head coverage index (HCI), and sphericity were measured, as previously described. [14,16] The bony acetabular index (BAI) and cartilage acetabular index (CAI) were measured, as described by Huber et al [17] The anterior acetabular index (AAI), posterior acetabular index (PAI), and abduction angle (AA) were measured on axial images. [13] The reliability of the indices measured on infant hip MRI scans was previously evaluated.…”

“…[13] The reliability of the indices measured on infant hip MRI scans was previously evaluated. [14,[16][17][18] For the measurement of the acetabular medial wall thickness (AMWT), the section in which the femoral head is widest in the axial plane, on the T2 pelvis MRI image, was used. The distance between the deepest point where the femoral head touches the acetabulum and the medial wall of the acetabulum was measured (Figure 1).…”

Developmental Dysplasia of the Hip: How Does Social Media Influence Patients and Caregivers Seeking Information?

“…DDH refers to a continuum of abnormalities in the immature hip that can range from subtle dysplasia to dislocation, making it an important cause of childhood disability [2]. Bracing has historically been considered first-line treatment in children younger than six months; however, more recent literature has revealed advantages in proceeding directly to surgery in patients with severe DDH and in patients with congenitally dislocated hips [2,3]. In patients with milder DDH who are initially managed with bracing, surgery is considered when bracing fails [2].…”

Mid- and long-term outcome of Salter’s, Pemberton’s and Dega’s osteotomy for treatment of developmental dysplasia of the hip: a systematic review and meta-analysis

“…1 Actually, early diagnosis by clinical and ultrasound screening according to Graf as well as early treatment ranging from conservative treatment by different splints to closed or open reduction have become the gold standard for treatment of DDH. 2 –7 The goal of treatment of DDH is to obtain a concentric hip reduction and to allow an acetabular and femoral remodelling. The correct treatment timing, during the first months of life, is essential to increase the chances of normalisation and prevent further surgical interventions.…”