One-stage treatment of congenital dislocation of the hip in older children, including femoral shortening.

Galpin, Robert; Roach, James W.; Wenger, Dennis R.; Herring, John A.; Birch, John G.

doi:10.2106/00004623-198971050-00015

Cited by 127 publications

(103 citation statements)

References 19 publications

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“…Despite various hypotheses regarding the superiority of each operative technique, none of the 66 reviewed studies included in our systematic review directly compared anterior versus medial osteonecrosis incidences using statistical procedures. In addition, this meta-analysis compared observational studies reporting results of anterior and open reduction without associated femoral shortening osteotomy that has been reported to relatively protect against osteonecrosis [31,73]. The rate of osteonecrosis after medial open reduction in our study was similar to the rate reported by Gardner et al [32].…”

Section: Discussionsupporting

confidence: 84%

“…Sufficient subject-level data were available to exclude the following ineligible cases: four dislocations of the hip secondary to neuromuscular or teratologic causes [15,67], 188 hips treated by open reduction with concomitant pelvic osteotomy [8,10,19,20,29,31,33,38,46,59,69,74,95,96], and 280 hips treated by other ineligible interventions [23,64,85,94]. Additionally, one study [13] included 12 hips treated by medial open reduction that at least partly overlapped with a more recently published article [49].…”

Section: Study Characteristicsmentioning

confidence: 99%

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Is Age or Surgical Approach Associated With Osteonecrosis in Patients With Developmental Dysplasia of the Hip? A Meta-analysis

Novais

Hill

Carry

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Osteonecrosis of the femoral head is a major complication that negatively impacts the clinical and radiographic long-term outcome after treatment of developmental hip dysplasia (DDH). There are conflicting results in the literature whether age at the time of closed or open reduction and a specific surgical approach are associated with osteonecrosis. Better understanding of the impact of age at reduction and surgical approach is important to reduce the risk of osteonecrosis in patients with DDH. Questions/purposes We aimed to evaluate the association between occurrence of osteonecrosis and (1) age at closed reduction; (2) age at open reduction; and (3) medial versus anterior operative approaches.Methods A systematic review identified studies reporting osteonecrosis occurrence after treatment of DDH and at least 2 years of followup. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Methodologic quality was assessed using the methodologic index for nonrandomized studies. Generalized logistic models were used to estimate pooled odds ratios (ORs) in the meta-analysis. Sixty-six studies were included in the systematic review and 24 in the meta-analysis. Data on 481 hips treated by closed reduction and 584 hips treated by open reduction were available to evaluate the association between osteonecrosis and age. The association between osteonecrosis and operative approach was assessed using data on 364 hips treated by medial open reduction and 220 hips treated by anterior open reduction. Results Age at reduction ([ 12 months versus B 12 months) was not associated with osteonecrosis after closed reduction (OR, 1.1; 95% confidence interval [CI], 0.4-3.2; p = 0.9) or open reduction (OR, 1.1; 95% CI, 0.7-1.9; p = 0.66). The overall, adjusted incidence of osteonecrosis (C Grade II) was 8.0% (95% CI, 2.8%-20.6%) among patients treated with closed reduction at or before 12 months of age and 8.4% (95% CI, 3.0%-21.

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Section: Discussionsupporting

confidence: 84%

Section: Study Characteristicsmentioning

confidence: 99%

Is Age or Surgical Approach Associated With Osteonecrosis in Patients With Developmental Dysplasia of the Hip? A Meta-analysis

Novais

Hill

Carry

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…Early treatment of DDH is desirable because results of treatment depend upon the age of the patient when treatment begins [3,4,[6][7][8]. We asked if age affected outcome in patients with neglected DDH with unilateral or bilateral dislocation who underwent one-stage combined procedures.…”

Section: Discussionmentioning

confidence: 99%

“…Large series of neglected DDH were presented by Ashley et al [1], Klisic et al [15,16], and Galpin et al [7], who advocate open reduction with concurrent shortening of the good results according to McKay and Severin criteria. They reported worse outcomes in patients older than 7 years at the time of surgery.…”

Section: Discussionmentioning

confidence: 99%

Outcome in Unilateral or Bilateral DDH Treated with One-stage Combined Procedure

Subaşı

Arslan

Cebesoy

et al. 2008

Clinical Orthopaedics &Amp; Related Research

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“…Numerous authors have described excision of the ligamentum teres as a part of open hip reduction in DDH [9][10][11]. This may parallel past thinking in meniscal surgery-the ''problem'' tissue was discarded.…”

Section: Introductionmentioning

confidence: 99%

Ligamentum teres maintenance and transfer as a stabilizer in open reduction for pediatric hip dislocation: Surgical technique and early clinical results

Wenger

Mubarak

Henderson

et al. 2008

Journal of Children's Orthopaedics

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Purpose The ligamentum teres has primarily been considered as an obstruction to reduction in children with developmental dislocation of the hip (DDH). In the early surgical descriptions of both the medial (Ludloff) approach and the anterior (Salter) approach to the hip, it was generally accepted that the ligamentum teres was an obstruction to reduction and was excised (similar to the discarding of menisci for knee surgery in our orthopedic history). Because of the known propensity for early re-dislocation following open reduction, we developed surgical methods for maintaining the ligamentum teres when performing open reduction for hip dislocation in young children. This study presents the surgical methods developed for ligament maintenance and transfer, and analyzes the early clinical and radiographic results in a study group. Methods The techniques for open reduction by both the medial Ludloff approach and the anterior open reduction were developed and refined. Twenty-one children (23 hips) had ligamentum teres shortening and transfer performed as part of either a medial Ludloff or anterior open reduction for hip dislocation. Complete pre-operative and postoperative clinical and radiographic analysis was performed.

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One-stage treatment of congenital dislocation of the hip in older children, including femoral shortening.

Cited by 127 publications

References 19 publications

Is Age or Surgical Approach Associated With Osteonecrosis in Patients With Developmental Dysplasia of the Hip? A Meta-analysis

Is Age or Surgical Approach Associated With Osteonecrosis in Patients With Developmental Dysplasia of the Hip? A Meta-analysis

Outcome in Unilateral or Bilateral DDH Treated with One-stage Combined Procedure

Ligamentum teres maintenance and transfer as a stabilizer in open reduction for pediatric hip dislocation: Surgical technique and early clinical results

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