Surgical treatment of late developmental displacement of the hip

Angliss, Richard; Fujii, G.; Pickvance, E. A.; Wainwright, Andrew; Benson, MK

doi:10.1302/0301-620x.87b3.15247

Cited by 62 publications

(68 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…No hip in the group without OA had a CE angle \16°or MP over 31%. Long-term studies of patients previously treated for latedetected DDH have confirmed that residual subluxation is an important risk factor for later OA [2,8]. Hartofilakidis et al [17] followed the natural history of patients with subluxation (42 hips) who had not received any previous treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Although persistent acetabular dysplasia and subluxation are risk factors for the development of osteoarthritis (OA) later in life [4][5][6][7], there is no consensus with regard to the degree of dysplasia that is of clinical significance or how long a time it takes for OA to become clinically manifest. Another controversial question is to what degree residual dysplasia changes during long-term follow-up [2,8].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Residual hip dysplasia as a risk factor for osteoarthritis in 45 years follow-up of late-detected hip dislocation

Terjesen

2011

Journal of Children's Orthopaedics

View full text Add to dashboard Cite

Purpose The aim of the study was to assess the role of residual hip dysplasia as a risk factor for osteoarthritis (OA) in developmental dysplasia of the hip (DDH). Methods Fifty-one patients (60 hips) with late-detected DDH were studied. Reduction had been performed at a mean age of 19 months (range 4-65 months). On radiographs at age 8-10 years, at skeletal maturity, and at longterm follow-up, femoral head coverage was assessed using the migration percentage (MP) and centre-edge (CE) angle. OA was diagnosed if the minimum joint space width of the upper part of the joint was \2.0 mm. Results The mean age at the last follow-up was 45 years (range 43-49 years) in patients who had not undergone total hip replacement (THR). Ten patients had developed OA and eight of them had undergone THR at a mean age of 40 years (range 32-47 years). There was a clear association between OA and residual hip dysplasia. At the last follow-up, 37 hips had normal CE angles (20°or higher) and OA had developed in only two of them (5%; 95% confidence interval [CI] 1-18%). Hip dysplasia without subluxation (CE angle 10-19°) was seen in 18 hips, of which 14 hips had good outcome and four had OA (22%; 95% CI 6-48%). Subluxation occurred in five hips, of which one had a good long-term outcome and four had OA (80%; 95% CI 28-99%). In patients without late reconstructive surgery, MP increased from the age of 10 years to skeletal maturity; thereafter, no significant change occurred. The CE angle did not change significantly between the age of 10 years and the last follow-up.Conclusion Hip dysplasia without subluxation has a relatively good long-term prognosis. Subluxation is a risk factor for osteoarthritis. Thus, children with MP above 33% and CE angle under 10°should be evaluated for reconstructive surgery in order to improve the long-term outcome.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Residual hip dysplasia as a risk factor for osteoarthritis in 45 years follow-up of late-detected hip dislocation

Terjesen

2011

Journal of Children's Orthopaedics

View full text Add to dashboard Cite

show abstract

“…Thirty-nine studies [1, 4, 6-8, 11, 13, 14, 16, 18-20, 23, 27, 29, 30, 34, 38, 40, 41, 45, 53, 54, 56, 61, 64, 67, 69, 72, 74, 77, 79, 81, 83-85, 89, 94, 96] [54], older than 6 months [5], between 6 and 18 months old [95], younger than 18 months [43], and younger than 24 months [87]; an anterior approach for patients 12 months or older [57,69]; and no operative treatment at all before 9 months of age [7].…”

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

View full text Add to dashboard Cite

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.

show abstract

“…Others have reported this procedure is risky and is difficult to reliably accomplish in practice. In 2005, a report by Angliss et al [1] looked at the long-term followup of nearly 150 patients who previously received open reduction for DDH. This article tried to determine early indicators that would help predict postoperative outcomes.…”

Section: The Limbusmentioning

confidence: 99%