Obstacles to reduction in infantile developmental dysplasia of the hip

Studer, Katrin; Williams, Nicole; Studer, Patrick; Baker, Markus; Glynn, Aaron; Foster, Bruce K.; Cundy, Peter

doi:10.1302/1863-2548.11.170031

Cited by 26 publications

(24 citation statements)

References 35 publications

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“…pulvinar fat, teres ligament, labrum, psoas tendon, anteromedial capsule) or perform a capsulorrhaphy. 67 Open reduction is more often needed as the child gets older.…”

Section: Treatmentmentioning

confidence: 99%

Developmental dysplasia of the hip: update of management

et al. 2019

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The term ‘developmental dysplasia of the hip’ (DDH) includes a wide spectrum of hip alterations: neonatal instability; acetabular dysplasia; hip subluxation; and true dislocation of the hip. DDH alters hip biomechanics, overloading the articular cartilage and leading to early osteoarthritis. DDH is the main cause of total hip replacement in young people (about 21% to 29%). Development of the acetabular cavity is determined by the presence of a concentrically reduced femoral head. Hip subluxation or dislocation in a child will cause an inadequate development of the acetabulum during the remaining growth. Clinical screening (instability manoeuvres) should be done universally as a part of the physical examination of the newborn. After two or three months of life, limited hip abduction is the most important clinical sign. Selective ultrasound screening should be performed in any child with abnormal physical examination or in those with high-risk factors (breech presentation and positive family history). Universal ultrasound screening has not demonstrated its utility in diminishing the incidence of late dysplasia. Almost 90% of patients with mild hip instability at birth are resolved spontaneously within the first eight weeks and 96% of pathologic changes observed in echography are resolved spontaneously within the first six weeks of life. However, an Ortolani-positive hip requires immediate treatment. When the hip is dislocated or subluxated, a concentric and stable reduction without forceful abduction needs to be obtained by closed or open means. Pavlik harness is usually the first line of treatment under the age of six months. Hip arthrogram is useful for guiding the decision of performing a closed or open reduction when needed. Acetabular dysplasia improves in the majority due to the stimulus provoked by hip reduction. The best parameter to predict persistent acetabular dysplasia at maturity is the evolution of the acetabular index. Pelvic or femoral osteotomies should be performed when residual acetabular dysplasia is present or in older children when a spontaneous correction after hip reduction is not expected. Avascular necrosis is the most serious complication and is related to: an excessive abduction of the hip; a force closed reduction when obstacles for reduction are present; a maintained dislocated hip within the harness or spica cast; and a surgical open reduction.Cite this article: EFORT Open Rev 2019;4:548-556. DOI: 10.1302/2058-5241.4.180019

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“…pulvinar fat, teres ligament, labrum, psoas tendon, anteromedial capsule) or perform a capsulorrhaphy. 67 Open reduction is more often needed as the child gets older.…”

Section: Treatmentmentioning

confidence: 99%

Developmental dysplasia of the hip: update of management

et al. 2019

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“…More recently, MRI is being used in the diagnosis of the anatomical obstructions to reduction, such as brofatty pulvinar tissue, joint effusion, thickened ligamentum teres, inversed and thickened labrum, and iliopsoas muscle atrophy. Most of these studies evaluated one of these characteristics and con rmed the role of MRI in the diagnosis of DDH [20][21][22]. In these papers, the diagnostic values of MRI are evaluated comprehensively.…”

Section: Discussionmentioning

confidence: 99%

Assessment of irreducible aspects in developmental hip dysplasia by magnetic resonance imaging

Jia

Wang

Chang

et al. 2020

Preprint

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Background: The developmental dysplasia of the hip (DDH) can cause a wide range of pathological changes, and often requires surgical treatment. Preoperative evaluation is very important for DDH. We aimed to assess the diagnostic capability of magnetic resonance imaging (MRI) for irreducible aspects preventing hip reduction in DDH. Methods: A total of 39 pediatric patients who received DDH evaluation in pediatric orthopedics from January 2015 to December 2019 were included. The samples included 4 cases of bilateral DDH and 35 cases of unilateral DDH, a total of 43 hip joint samples. All patients underwent surgical treatment, pathological examination and MRI of hip joint. Results: With pathological results or intraoperative findings as the gold standard, the sensitivity and specificity of MRI were 90.3% and 83.3% for the affected labrum, 92% and 83.3% for thickening of the round ligament, 90.0% and 91.3%for atrophy of the iliopsoas muscle, and 100% and 100% for fibrofatty pulvinar tissue and joint effusion, respectively. Conclutions: The MRI showed an extraordinary capability of detecting these irreducible factors and helped surgeon choose the appropriate treatment strategies.

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“…In DDH-affected hips, the acetabular articular cartilage is thicker than in healthy hips ( Figure 1 ). This phenomenon can be observed already during infancy and is used as a sign in the early diagnosis of DDH ( 49 , 50 ). Cartilage collagenous fibrils in DDH are rare and disorganized, similar to decreased and scattered fibrils in OA patients.…”

Section: Histology Of the Articular Cartilage In Ddhmentioning

confidence: 99%

Current knowledge on the genetic background of developmental dysplasia of the hip and the histomorphological status of the cartilage

Bohaček¹,

Plečko²,

Duvančić³

et al. 2020

Croat Med J

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Developmental dysplasia of the hip (DDH) represents a morphological abnormality characterized by the incongruity of femoral head and acetabulum. It ranges from mild dysplastic changes to complete dislocation. DDH has been associated with several hereditary and environmental risk factors, which could explain the incidence variability among different countries. Numerous genes may be involved in the disease etiology and progression. However, there are controversies in the literature regarding some of these genes. DDH-induced secondary osteoarthritis (OA) is characterized by changes in the macromolecule content of the cartilage and the expression of cartilage degradation markers. In addition, it exhibits a pattern of specific histological changes, with several reported differences between primary and DDH-induced secondary OA. The articular cartilage of patients with DDH shows specific radiological characteristics, including changes visible already in infancy, but also at pre-arthritic stages, early stages of OA, and in fully developed DDH-induced secondary OA. Although DDH has been extensively researched in different disease stages, the etiology of the disorder still remains uncertain. This review focuses on the current knowledge on the histomorphological status of the cartilage and the genetic background of DDH.

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Obstacles to reduction in infantile developmental dysplasia of the hip

Cited by 26 publications

References 35 publications

Developmental dysplasia of the hip: update of management

Developmental dysplasia of the hip: update of management

Assessment of irreducible aspects in developmental hip dysplasia by magnetic resonance imaging

Current knowledge on the genetic background of developmental dysplasia of the hip and the histomorphological status of the cartilage

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