Femoral Head Deformity after Open Reduction by Ludloff's Medial Approach

Okano, Kunihiko; Enomoto, Hiroshi; Osaki, Makoto; Takahashi, Kazuhiro; Shindo, Hiroyuki

doi:10.1007/s11999-008-0266-8

Cited by 23 publications

(16 citation statements)

References 21 publications

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“…We believe the anterior and medial approaches are comparable; in long-term followups, the rate of AVN is lower in patients who had the anterior approach, mainly with femoral shortening osteotomy, whereas the number of additional surgeries is much lower in patients who had the medial approach. At the last radiographic followup, minor deformities of the femoral head were observed in 88.2% of the hips in patients who had open reduction after 16 months of age [53]. We might speculate that mild deformity of the femoral head may be caused by minor degrees of AVN not described in any of the current AVN classifications [50,63].…”

Section: Discussionmentioning

confidence: 91%

“…Anterior open reduction has been recommended in children with complete hip dislocation who are older than 24 months [84]. This same recommendation was made by many authors who advocated medial open reduction in children younger than 24 months [11,16,21,40,46,49,50,52,53,77,85,88]. Although we were aware of this general trend in favor of anterior open reduction that provides capsulorrhaphy and avoids medial circumflex vessels, the good preliminary results we obtained in children older than 24 months encouraged us to increase the upper age limit for medial open reduction to 36 months.…”

Section: Discussionmentioning

confidence: 92%

“…Although medial versus anterior open reduction is debated with complete dislocations [11,16,21,40,46,49,50,52,53,64,77,84,85,88], open medial reduction after preliminary traction gave us good results. All hips in our patients remained stable after completion of treatment and the acetabular index normalized in all of them.…”

Section: Discussionmentioning

confidence: 99%

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Developmental Dislocation of the Hip Successfully Treated by Preoperative Traction and Medial Open Reduction: A 22-year Mean Followup

Farsetti

Caterini

Potenza

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background During the last 35 years, the medial approach has been reported more frequently than the anterior approach for open reduction of developmental dislocation of the hip (DDH), however, few studies have followed children treated by medial open reduction to adulthood. Questions/purposes The purposes of our study were: (1) to assess the development of 71 completely dislocated hips after medial open reduction, the incidence of additional surgery and avascular necrosis during the followup period, and the long-term radiographic and functional results; and (2) to compare our results with those obtained by others who performed open reduction either by the medial or anterior approach. Patients and Methods We retrospectively evaluated, after the end of growth, 71 hips in 52 patients who underwent open reduction by the medial approach. The mean age of the patients was 16 months (range, 3-36 months). After surgery, the hips were immobilized in 100°flexion, 60°a bduction, and neutral rotation for an average of 6 months. All patients had staged clinical and radiographic followups until skeletal maturity. The length of followup averaged 22 years (range, 13-32 years). Results In all the surgically treated hips, the acetabular index normalized by the end of growth, the incidence of avascular necrosis was 18%, and additional surgery was required in 15% of our cases. At the last followup, 93% of the hips were classified as Severin Classes I or II and 7% as Class III; 76% of the hips had an excellent result, 17% had a good result, and 7% had a fair result according to the McKay scale as modified by Barrett and colleagues. Conclusions Open reduction of DDH through a medial approach provided good long-term radiographic and functional results in patients 3 to 36 months old and it was the only surgery performed in 85% of our cases. Future comparative studies are needed to confirm our results, especially in older children. Level of evidence Level IV, therapeutic study.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 92%

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Developmental Dislocation of the Hip Successfully Treated by Preoperative Traction and Medial Open Reduction: A 22-year Mean Followup

Farsetti

Caterini

Potenza

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…Acetabular depth and femoral head shape are considered to be mutually dependent. 15,16 The dysplastic hip, which experiences joint laxity and instability, has been characterized as having an elliptical shaped femoral head, [16][17][18][19] increased femoral neck waist, 16 and decreased epiphyseal extension towards the femoral neck. 16,20 Hip dysplasia is well understood to result in increased joint contact stress on the acetabulum and labrum.…”

mentioning

confidence: 99%

Novel model for the induction of postnatal murine hip deformity

Killian

Locke

James

et al. 2018

Journal Orthopaedic Research

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Acetabular dysplasia is a common, multi-etiological, pre-osteoarthritic (OA) feature that can lead to pain and instability of the young adult hip. Despite the clinical significance of acetabular dysplasia, there is a paucity of small animal models to investigate structural and functional changes that mediate morphology of the dysplastic hip and drive the subsequent OA cascade. Utilizing a novel murine model developed in our laboratory, this study investigated the role of surgically induced unilateral instability of the postnatal hip on the initiation and progression of acetabular dysplasia and impingement up to 8-weeks post-injury. C57BL6 mice were used to develop titrated levels of hip instability (i.e., mild, moderate, and severe instabillity or femoral head resection) at weaning. Joint shape, acetabular coverage, histomorphology, and statistical shape modeling were used to assess quality of the hip following 8 weeks of destabilization. Acetabular coverage was reduced following severe, but not moderate, instability. Moderate instability induced lateralization of the femur without dislocation, whereas severe instability led to complete dislocation and pseudoacetabulae formation. Mild instability did not result in morphological changes to the hip. Removal of the femoral head led to reduced hip joint space volume. These data support the notion that hip instability, driven by mechanical loss-of-function of soft connective tissue, can induce morphometric changes in the growing mouse hip. This work developed a new mouse model to study hip health in the murine adolescent hip and is a useful tool for investigating the mechanical and structural adaptations to hip instability during growth.

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“…As the medial circumflex vessel, the main blood supply to the femoral head, may be endangered and because of a lack of familiarity with this exposure, most surgeons prefer to expose the lesser trochanter through a Hueter-Schede approach or through the posterior approach [5,6]. We used Fig.…”

Section: Discussionmentioning

confidence: 99%

Ludloff approach for osteochondroma in the lesser trochanter in a young middle-distance runner

Chana-Rodríguez

López-Capapé

Rojo-Manaute

et al. 2011

Eur Orthop Traumatol

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Ludloff's approach was described for open reduction of congenital dislocation of the hip. We describe the preoperative planning and the surgical procedure for removing an osteochondroma in the lesser trochanter performed by an anteromedial approach. At follow-up, the patient was asymptomatic and had no limitations in his hip motion, with no radiological relapse. This approach can be used without complications, avoiding more aggressive approaches that force to dislocate the hip and lead to sacrifice more soft tissues.

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Femoral Head Deformity after Open Reduction by Ludloff's Medial Approach

Abstract: Abstract

Cited by 23 publications

References 21 publications

Developmental Dislocation of the Hip Successfully Treated by Preoperative Traction and Medial Open Reduction: A 22-year Mean Followup

Developmental Dislocation of the Hip Successfully Treated by Preoperative Traction and Medial Open Reduction: A 22-year Mean Followup

Novel model for the induction of postnatal murine hip deformity

Ludloff approach for osteochondroma in the lesser trochanter in a young middle-distance runner

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