Docking Phenomenon and Subsequent Acetabular Development after Gradual Reduction using Overhead Traction for Developmental Dysplasia of the Hip over Six Months of Age

Kaneko, Hiroshi; Kitoh, Hiroshi; Kitamura, Akiko; Sawamura, Kenta; Hattori, Tadashi

doi:10.1302/1863-2548.15.210143

Cited by 6 publications

(4 citation statements)

References 37 publications

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“…Eighty hips (72.7%) had labral inversion in this study; however, the incidence of RAD in patients with labral inversion was not significantly different from that in patients without labral inversion. Previous studies have also shown that most DDH patients with closed reduction have (19,27) labral inversion, although residual labral inversion increases the risk of RAD. Kaneko et al (27) treated 40 patients (42 hips) with DDH with closed reduction and confirmed the presence or absence of residual labral inversion by MRI immediately after surgery and at 5 weeks after surgery, and the results showed that labral inversion was present in 40 hips (95.2%), but only 19 hips still had residual labral inversion at 5 weeks after surgery.…”

Section: Discussionmentioning

confidence: 94%

Hip arthrogram parameters predict radiographic outcomes of patients with developmental dysplasia of the hip treated by closed reduction

Tan,

Zhao,

Wei

et al. 2024

Front. Pediatr.

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ObjectiveThis study aimed to investigate the relationship between intraoperative hip arthrogram parameters and residual acetabular dysplasia (RAD) and avascular necrosis of the femoral head (AVN) in children with developmental dysplasia of the hip (DDH) treated by closed reduction.MethodsWe retrospectively analyzed the data of 102 patients (110 hips; mean age, 14.6 months ± 4.7 months) with DDH treated by closed reduction. A hip arthrogram was routinely performed during the operation. The femoral head coverage rate (FHC), medial pool distance of the hip (MPD), labral inversion, and reduction quality classification were evaluated under the hip arthrogram. The presence of RAD and AVN was assessed on radiographs at the last follow-up. The relationship between each arthrogram parameter and RAD as well as AVN was investigated using a t-test, chi-square test, and logistic regression.ResultsThe overall FHC and medial pool distance of the hip (MDP) averaged 42.2% ± 12% and 8.1% ± 11.7%, respectively. There were 80 hips (72.7%) with labral inversion and 30 hips (27.2%) without. The reduction quality was type A in 57 hips (51.8%), type B in 28 hips (25.4%), and type C in 25 hips (22.7%). A total of 32 hips (29%) were in the RAD group, and 78 hips (71%) were in the recovered group according to whether pelvic osteotomy was performed or not and according to the last Severin grade. The FHC was significantly higher in the recovered group than that in the RAD group (P = 0.014). No significant difference was observed in sex, age at reduction, side, preoperative acetabular index, International Hip Dysplasia Institute classification, follow-up time, quality of reduction, MDP, and proportion of labral inversion between the recovered and RAD groups. Logistic regression analysis showed that only the FHC was a risk factor for RAD. The incidence of AVN above type II was 11.8% in this group of patients, and the incidence of AVN was significantly higher in patients with labral inversion (23.2%) than that in those without (7.5%; P = 0.041). Logistic regression analysis showed that labral inversion was a risk factor for AVN.ConclusionThe FHC measured under arthrogram can predict the occurrence of RAD after closed reduction of DDH, whereas MDP, reduction quality classification, and labral inversion are of little significance. Labral inversion is a risk factor for AVN.

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Section: Discussionmentioning

confidence: 94%

Hip arthrogram parameters predict radiographic outcomes of patients with developmental dysplasia of the hip treated by closed reduction

Tan,

Zhao,

Wei

et al. 2024

Front. Pediatr.

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“…As demonstrated in this study, we are thus able to observe the complete FHD process using serial MRIs. Some studies have also observed the changes in femoral head position and LACC morphology over a three-week period, 15,16 or a five-week period 23 following CR; however, they did not observe the achievement of concentric reduction. Our study represents the first attempt to observe the detailed changes during the FHD process on serial MRI scans, and showed the transition from an eccentric to a concentric reduction.…”

Section: Discussionmentioning

confidence: 99%

MRI assessment of femoral head docking following closed reduction of developmental dysplasia of the hip

Zhang

Deng

et al. 2023

The Bone & Joint Journal

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Aims Eccentric reductions may become concentric through femoral head ‘docking’ (FHD) following closed reduction (CR) for developmental dysplasia of the hip (DDH). However, changes regarding position and morphology through FHD are not well understood. We aimed to assess these changes using serial MRI. Methods We reviewed 103 patients with DDH successfully treated by CR and spica casting in a single institution between January 2016 and December 2020. MRI was routinely performed immediately after CR and at the end of each cast. Using MRI, we described the labrum-acetabular cartilage complex (LACC) morphology, and measured the femoral head to triradiate cartilage distance (FTD) on the midcoronal section. A total of 13 hips with initial complete reduction (i.e. FTD < 1 mm) and ten hips with incomplete MRI follow-up were excluded. A total of 86 patients (92 hips) with a FTD > 1 mm were included in the analysis. Results At the end of the first cast period, 73 hips (79.3%) had a FTD < 1 mm. Multiple regression analysis showed that FTD (p = 0.011) and immobilization duration (p = 0.028) were associated with complete reduction. At the end of the second cast period, all 92 hips achieved complete reduction. The LACC on initial MRI was inverted in 69 hips (75.0%), partly inverted in 16 hips (17.4%), and everted in seven hips (7.6%). The LACC became everted-congruent in 45 hips (48.9%) and 92 hips (100%) at the end of the first and second cast period, respectively. However, a residual inverted labrum was present in 50/85 hips (58.8%) with an initial inverted or partly inverted LACC. Conclusion An eccentric reduction can become concentric after complete reduction and LACC remodelling following CR for DDH. Varying immobilization durations were required for achieving complete reduction. A residual inverted labrum was present in more than half of all hips after LACC remodelling. Cite this article: Bone Joint J 2023;105-B(2):140–147.

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“…According to the studies, gradual reduction treatment also has a certain proportion of residual deformity (19.2%–64%) ( 3 , 4 , 16 , 17 ). With this method, we hoped to reduce the residual deformity rate by enhancing the reduction quality.…”

Section: Discussionmentioning

confidence: 99%

The efficacy of gradual reduction using two-stage traction for developmental dysplasia of the hip in southern China

Chen,

Wang,

Chen

et al. 2024

Front. Pediatr.

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PurposeThis study aimed to report the preliminary outcome of gradual reduction (GR) utilizing two-stage traction (TST) compared with traditional traction (TT) in the treatment of developmental dysplasia of the hip (DDH) and to evaluate whether the prognosis of the TST is better than that of TT.MethodsThe following information on children diagnosed with DDH who underwent treatment with GR using two-stage traction or traditional traction between June 2016 and August 2017 was collected: sex, age, weight, acetabular index (AI), International Hip Dysplasia Institute (IHDI) classification, femoral head ossification, traction time, reduction quality, and labrum shape in arthrography. The AI, IHDI classification, second operation rate, and incidence of femoral head avascular necrosis (AVN) were analyzed after the final comprehensive 1-year follow-up.ResultsIn this study, 27 cases (31 hips: 18 left and 13 right) were enrolled, with 18 hips (16 cases) assigned to the TT group and 13 hips (11 cases) assigned to the TST group, with the corresponding average age at diagnosis of 5.56 ± 1.66 and 4.06 ± 1 months (p < 0.001). For both TT and TST groups, the average age at operation was 6.01 ± 1.67 and 65 ± 0.86 months (p = 0.435), the distribution of affected left and right sides was 10/8 and 8/5 hips (p = 1), and the average initial AI was 37.11 ± 3.26 and 36.77 ± 4.34 (p = 0.804), respectively. IHDI classification III/IV was observed in 15/3 and 11/2 hips, respectively (p = 1). Femoral head ossification was present in 6/18 hips in the TT group and 2/13 hips in the TT group (p = 0.412). The total traction time was 13.22 ± 2.6 days for the TT group and 49.23 ± 25.77 days for the TST group (p < 0.001). After GR, IHDI classification III/IV was observed in 9/9 and 12/1 hips, respectively (p = 0.02). AVN was present in 5/18 hips in the TT group and 0/13 hips in the TST group (p = 0.048), while the need for a second operation was approved in 5/18 hips in the TT group and 1/13 hips in the TST group (p = 0.359) at the final follow-up.ConclusionsTwo-stage traction can significantly decrease the ratios of IHDI classifications III and IV and the incidence of AVN compared to traditional traction; also, it significantly reduces the total traction time.

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Docking Phenomenon and Subsequent Acetabular Development after Gradual Reduction using Overhead Traction for Developmental Dysplasia of the Hip over Six Months of Age

Cited by 6 publications

References 37 publications

Hip arthrogram parameters predict radiographic outcomes of patients with developmental dysplasia of the hip treated by closed reduction

Hip arthrogram parameters predict radiographic outcomes of patients with developmental dysplasia of the hip treated by closed reduction

MRI assessment of femoral head docking following closed reduction of developmental dysplasia of the hip

The efficacy of gradual reduction using two-stage traction for developmental dysplasia of the hip in southern China

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