Die kindliche Hüftdysplasie und ihre Behandlungsmöglichkeiten

Hefti, F.

doi:10.1007/3-540-26857-x_5

Cited by 1 publication

(5 citation statements)

References 56 publications

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“…In the literature osteonecrosis is reported in 6% to 48%. 5,[17][18][19][20] Better results for arthroscopic reduction are also confirmed by some authors 10,12 who assume that a reduction in osteonecrosis can be achieved by a more gentle, arthroscopic approach (Fig. 2).…”

Section: Discussionmentioning

confidence: 79%

“…An unstable joint centring with a long persistent sub-or dislocation position can lead to residual dysplasia due to the loss of the stimulating relationship between femoral head and acetabulum. 30 Since the optimal development of the roof of the acetabulum essentially depends on successful depth adjustment of the femoral head, 5,31 patients whose hip joints are off-centre are particularly at risk of developing residual dysplasia. The strong remodelling potential of the hip joint within the first six weeks of life must also be considered.…”

Section: Discussionmentioning

confidence: 99%

“…The open reductions were performed by five surgeons (without intraoperative arthrography) according to the procedures already described in the literature. 5,6,14 Postoperatively, a ventral ultrasound was performed, but no MRI. The arthroscopic reduction was performed by only two surgeons following a newer procedure as described in Figure 2.…”

Section: Methodsmentioning

confidence: 99%

“…[1][2][3][4] Successful conservative treatment is impossible due to pronounced anatomical changes in the form of obstacles to reduction such as hypertrophic ligamentum teres and transverse ligament, capsular constriction or hypertrophic pulvinar. [1][2][3][5][6][7] In 1.3% to 4.4% of the cases, no closed reduction can be achieved with comprehensive hip screening. In these cases, early open reduction must be sought.…”

Section: Introductionmentioning

confidence: 99%

“…7 Surgical reduction of the hip can lead to severe complications such as osteonecrosis and dislocated hips with multiple operations. 5,8,9 In addition to the standardized open reduction of the dislocated hip, arthroscopic reductions are increasingly discussed. [10][11][12] The literature describes the process of various new arthroscopic procedures with a comparison of their advantages and disadvantages.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of arthroscopic and open reduction of conservatively irreducible dislocated hips of children

Presch

Eberhardt

Wirth

et al. 2019

Journal of Children's Orthopaedics

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Purpose Children with sonographic grade IV hip dysplasia according to Graf and with failed conservative treatment usually need surgical reduction afterwards. Surgical reduction of the hip can lead to severe complications, the occurrence of residual acetabular dysplasia, osteonecrosis, redislocation and other postoperative complications. This paper investigates whether arthroscopic reduction is a promising alternative to open reduction. Methods We retrospectively examined 66 patients (78 hips) who were not older than two years at the first time of surgery. Arthroscopic reduction was performed on 17 children (19 hips) and open reduction on 49 children (59 hips). Patient records were used to determine redislocation, postoperative complication and residual dysplasia. Radiographs were used to determine Tönnis classification for osteonecrosis and pathological acetabular (AC) angle for residual dysplasia. We considered data up to a two-year follow-up. Statistical evaluation was performed with binary logistic regression. Results After arthroscopic reduction, 6% showed osteonecrosis, compared with 20% with open reduction (p = 0.334). Redislocation was not observed after arthroscopic reduction but for 29% after open reduction (p = 0.005). An improvement of femoral head coverage was achieved with residual dysplasia of 23.5% after arthroscopic reduction, compared with 62% after open reduction (p = 0.002). Conclusion The arthroscopic procedure represents a meaningful alternative to the open procedure due to a lower complication rate, a safe setting, a lower rate of residual dysplasia, no observed redislocation and occurrence of osteonecrosis only once in the arthroscopic group of developmental dysplasia of the hip. The arthroscopic procedure should be tested in further studies and in other clinics in order to broaden the empirical base. Level of Evidence: Level III (retrospective cohort study)

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