Quality of Reduction and Prognosis of Developmental Dysplasia of the HIP: A Retrospective Study

Ge, Yihua; Cai, Haiqing; Wang, Zhigang

doi:10.5301/hipint.5000348

Cited by 18 publications

(9 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This confirms prior work demonstrating the importance of a deep concentric reduction for minimizing the risk of residual dysplasia. 31 However, we did not find a significant difference in the prevalence of residual dysplasia between those with and without an inverted limbus. A report by Liu et al 14 indicates that a persistently inverted limbus following closed reduction is associated with increased AI.…”

Section: Discussioncontrasting

confidence: 72%

MRI Predictors of Residual Dysplasia in Developmental Dysplasia of the Hip Following Open and Closed Reduction

Johnson

Gohel²,

Nguyen

et al. 2022

Journal of Pediatric Orthopaedics

View full text Add to dashboard Cite

Background: Following open or closed reduction for children with developmental dysplasia of the hip, there remains a significant risk of residual acetabular dysplasia which can compromise the long-term health of the hip joint. The purpose of this study was to use postoperative in-spica magnetic resonance imaging (MRI) data to determine factors predictive of residual acetabular dysplasia at short-term follow-up. Methods: We retrospectively reviewed 63 hips in 48 patients which underwent closed or open reduction and spica casting for developmental dysplasia of the hip. MRI performed in-spica at ∼3-week follow-up were used to assess 11 validated metrics and 2 subjective factors. Acetabular index (AI) was measured on anteroposterior pelvic radiographs at 2-year postoperative followup. Binary logistic regression was then used to identify variables predictive of residual dysplasia, defined as an AI greater than the 90th percentile for age based on historic normative data. Results: Average age at surgical reduction was 9.3 ± 3.2 months. 58.7% (37/63) of reductions were open. A total of 43 (68.3%) hips demonstrated residual acetabular dysplasia at 2 years postoperatively based on normative values. In those with persistent dysplasia, patients were on average older at the time of reduction (10.0 mo ± 3.2 vs. 8.0 mo ± 2.8, P = 0.010) and more likely female (88.4% vs. 60.0%, P = 0.010). Patients with residual dysplasia were more likely to have mild subluxation on postoperative MRI (40.0% vs. 10.5%, P = 0.022). Hips with a cartilaginous acetabular index (CAI) of > 23 degrees were 7.6 times more likely to develop residual dysplasia. Type of reduction (ie, closed vs. open) did not appear to influence the rate of residual dysplasia (P = 0.682). Conclusion:In this series, the rate of residual dysplasia after surgical reduction was higher than most previous reports, with no appreciable difference between closed and open reductions. Older age, female sex, and a higher CAI were associated with a greater risk of persistent radiographic dysplasia. In particular, hips with a CAI > 23 degrees were 7.6 times more likely to be dysplastic at 2-year follow-up.

show abstract

Section: Discussioncontrasting

confidence: 72%

MRI Predictors of Residual Dysplasia in Developmental Dysplasia of the Hip Following Open and Closed Reduction

Johnson

Gohel²,

Nguyen

et al. 2022

Journal of Pediatric Orthopaedics

View full text Add to dashboard Cite

show abstract

“…The poorer outcome and higher rates of AVN in some studies might be associated with older age at time of immobilization [ 39 , 41 , 42 , 43 ]. The absence of AVN in our population may also be due to short cast immobilization period compared to the literature and younger age of our patients [ 21 , 36 , 44 , 45 ].…”

Section: Discussionmentioning

confidence: 75%

Outcome Prognostic Factors in MRI during Spica Cast Therapy Treating Developmental Hip Dysplasia with Midterm Follow-Up

et al. 2022

View full text Add to dashboard Cite

Closed reduction followed by spica casting is a conservative treatment for developmental dysplasia of the hip (DDH). Magnetic resonance imaging (MRI) can verify proper closed reduction of the dysplastic hip. Our aim was to find prognostic factors in the first MRI to predict the possible outcome of the initial treatment success by means of ultrasound monitoring according to Graf and the further development of the hip dysplasia or risk of recurrence in the radiological follow-up examinations. A total of 48 patients (96 hips) with DDH on at least one side, and who were treated with closed reduction and spica cast were included in this retrospective cohort study. Treatment began at a mean age of 9.9 weeks. The children were followed for 47.4 months on average. We performed closed reduction and spica casting under general balanced anaesthesia. This was directly followed by MRI to control the position/reduction of the femoral head without anaesthesia. The following parameters were measured in the MRI: hip abduction angle, coronal, anterior and posterior bony axial acetabular angles and pelvic width. A Graf alpha angle of at least 60° was considered successful. In the radiological follow-up controls, we evaluated for residual dysplasia or recurrence. In our cohort, we only found the abduction angle to be an influencing factor for improvement of the DDH. No other prognostic factors in MRI measurements, such as gender, age at time of the first spica cast, or treatment involving overhead extension were found to be predictive of mid-term outcomes. This may, however, be due to the relatively small number of treatment failures.

show abstract

“…The decreased secondary failure rates is shown to have an association with younger age groups at the time of reduction 6 , and also with the initial reduction whether it is congruent or not 2,14 . 2,14 The rate of secondary failure didn't have a relation to an increasing age at the time of the closed reduction, which is normally anticipated, but to a younger age. Failure of four out of five Tönnis 4 hips occured, with the remaining patient needed operation later.…”

Section: Discussionmentioning

confidence: 96%

“…We had 16% failure rate, that is failed to maintain a closed reduction which was successful at the beginning. Numerous studies that involve reduction closely [1][2][3][4][5][6] do not mention rates of their failed treatments and doesn't mix rates of primary failure (that couldn't acquire adequately reduced position initially) with secondary ones: we think that the two matters should be divided, an inability to gain an accepted reduction and an inability maintaining that reduction.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of closed reduction in patients with developmental dysplasia of the hip incorporating open psoas and adductor release and using short leg cast

Abdulqader¹,

Khorsheed²,

Hwaizi³

2021

PJMHS

View full text Add to dashboard Cite

Background and objectives: Closed reduction and short leg spica casting are the preferred treatment options for children with developmental dysplasia of the hip. This study aimed to show the efficacy behind a standardized closed reduction for managing patients with developmental dysplasia of the hip with concomitant soft tissue releases when indicated and using a short leg plaster of Paris cast to maintain reduction and reporting mid-term results. Methods: A case series of 95 hips in 84 children aged 6-18 months who had closed reduction, with five years follow up or until next operation, involved in this study. The protocol defines acceptable concentric reduction criteria and the indications for an associated soft tissue release. All the patients were immobilized in a short leg cast for three months. Multiple follow-up radiographs were taken to assess Tönnis grade, Severin grade, acetabular index, and osteonecrosis signs. Results: A total of 48 hips were Tönnis grade 3/4 hips. At one year, 15 reductions couldn’t be maintained, and these patients needed open reduction. Of these 15 failed reductions, 7 patients were Severin 1; others were Severin 2. Of the 80 successful closed reductions, 70 hips were Severin 1. Surgical management for residual dysplasia was offered for 8 hips. Osteonecrosis was seen in 23 hips but was transient in 20. Bilateral hip dislocations and most Tönnis 4 hips were more likely to fail. Two children had severe osteonecrosis. Conclusions: Closed reduction, with subsequent adductor and psoas releases, when indicated and using a short leg plaster of Paris cast for three months, brings about good mid-term results in children with developmental dysplasia of the hip aged 6-18 months. Keywords: Developmental dysplasia of the hip, closed hip reduction, open psoas release, short leg cast.

show abstract

Quality of Reduction and Prognosis of Developmental Dysplasia of the HIP: A Retrospective Study

Abstract: Limited MRI enables effective determination of the quality of reduction immediately after closed reduction. The prognosis of the deep concentric reduction group was better than the group with incomplete concentric reduction.

Cited by 18 publications

References 13 publications

MRI Predictors of Residual Dysplasia in Developmental Dysplasia of the Hip Following Open and Closed Reduction

MRI Predictors of Residual Dysplasia in Developmental Dysplasia of the Hip Following Open and Closed Reduction

Outcome Prognostic Factors in MRI during Spica Cast Therapy Treating Developmental Hip Dysplasia with Midterm Follow-Up

Outcomes of closed reduction in patients with developmental dysplasia of the hip incorporating open psoas and adductor release and using short leg cast

Contact Info

Product

Resources

About