Treatment of Developmental Dislocation of the Hip in Children after Walking Age: Indications from Two-Directional Arthrography

Mitani, Shigeru; Nakatsuka, Yoichi; Akazawa, Hirofumi; Aoki, Kiyoshi; Inoue, Hajime

doi:10.1302/0301-620x.79b5.7728

Cited by 13 publications

(9 citation statements)

References 14 publications

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“…Good postoperative results with open reduction using an extensive anterolateral approach in patients with severe hip dislocation or arthrogryposis multiplex congenita have been reported. 6,11,22 Patients treated after reaching walking age showed adhesion of the posterosuperior region of the capsular ligament and shortening of the external rotators caused by weight bearing. 7 If adhesion release is insufficient during surgery, the femoral head shifts laterally due to shear stress.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of the labrum on postoperative magnetic resonance images: a predictor of acetabular development in developmental dysplasia of the hip

et al. 2021

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Introduction: Residual acetabular dysplasia of the hip after open reduction can complicate the treatment of developmental dysplasia of the hip (DDH) due to the potential need for corrective surgery. This retrospective study aimed to determine the predictive factors for acetabular development using postoperative radiographs and magnetic resonance imaging (MRI). Methods: We retrospectively investigated 74 hips of patients with DDH who underwent open reduction after reaching walking age and were followed up radiologically until skeletal maturity. We evaluated the cartilaginous acetabulum and labrum using a new method that measures the cartilaginous and labral landmarks on coronal and axial MR T2*-weighted images in patients aged 5 years. The mean age at the time of surgery was 22 months and that at the final survey was 20 years. Severin classification was determined at the final follow-up. Groups with good (53 hips) and poor (21 hips) outcomes were compared using the postoperative radiographic and MRI parameters recorded at 5 years of age. Factors predicting acetabular development were identified using univariate and multiple logistic analyses. Results: There were no significant differences in the bony-acetabular index (AI) and centre-edge (CE) angle between the good and poor outcome groups. However, the poor outcome group had significantly larger cartilaginous- and labral-AIs but significantly smaller cartilaginous- and labral-CE angles than the good outcome group (both p < 0.05). Multiple logistic regression analysis showed that labral-AI and labral-CE angle were predictors of acetabular development after open reduction for DDH, and their optimal cut-offs were 4° (77% sensitivity, 76% specificity) and 37° (68% sensitivity, 85% specificity), respectively. Discussion: Normal cartilaginous acetabulum development occurs in childhood, and evaluation using only radiographs is difficult. However, labral-AI ⩾4° and labral-CE angle <37° on MRI at 5 years of age offer useful indications for corrective surgery in patients with DDH.

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Section: Discussionmentioning

confidence: 99%

“…Even if dislocated hips are successfully treated with open reduction, additional surgery is required for future acetabular dysplasia in 4.7-11.1% of the cases. [6][7][8] The labrum plays an important role in hip joint stabilisation. 9 It disperses the load applied to the acetabular cartilage and increases the femoral head coverage.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the labrum on postoperative magnetic resonance images: a predictor of acetabular development in developmental dysplasia of the hip

et al. 2021

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“…At our hospital, children who are diagnosed after walking age or who have undergone failed CR are evaluated by two-directional arthrography. Any unreduced hips or hips with inverted limbus are treated by Tanabe's methods [8,25]. Any preoperative conservative treatment would increase the risk of avascular necrosis of the femoral head and deformity of the labrum.…”

Section: Discussionmentioning

confidence: 99%

Acetabular development after open reduction to treat dislocation of the hip after walking age

Kagawa

Endo

Tetsunaga

et al. 2016

Journal of Orthopaedic Science

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a b s t r a c tBackground: Treatment of hip dislocation diagnosed after walking age is often difficult. We report the surgical treatment of these patients by open reduction with a soft tissue surgical procedure without osteotomy. Methods: Thirty-eight children (43 hips) diagnosed with complete dislocation of the hip after walking age were included in this study. We radiographically analysed postoperative hip joint development up to 6 years of age. To assess the predictors of acetabular development, we evaluated the radiographs, using an acetabular index of 35 and a centre-edge angle of >5 at 6 years of age as satisfactory outcomes, and evaluated the advance of acetabular development over time. Results: AI on the affected side was improved with time after open reduction. The diameter of the capital femoral ossific nucleus on the affected side was almost equivalent to that on the unaffected side at 6e12 months after surgery, after which the centre-edge angle improved gradually from one year after surgery. We compared hips classified as satisfactory to unsatisfactory at 6 years of age, and found that the centreedge angle at one year after open reduction was significantly associated with acetabular development (P ¼ 0.044). The cut-off value was À2 with sensitivity of 0.909 and specificity of 0.677. Conclusions:The results of the current study suggest that initial development of the capital femoral ossific nucleus after open reduction would be followed by improved joint congruity, and that this would facilitate acetabular development. The centre-edge angle at one year after surgery could be regarded as a potential predictor of acetabular development in open reduction surgery for late-diagnosed developmental dysplasia of the hip cases.

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“…Most DDH cases before walking age can be managed using closed methods, with stable concentric reduction of the hip. On the contrary, an open reduction becomes necessary in some patients with DDH after walking age [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Acetabular depth, an early predictive factor of acetabular development: MRI in patients with developmental dysplasia of the hip after open reduction

Kawamura

Tetsunaga

Akazawa³

et al. 2020

Journal of Pediatric Orthopaedics B

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Early prediction of future acetabular development is important to determine an additional surgery for developmental dysplasia of the hip (DDH). The purpose of this study was to investigate the predictive factors of acetabular development using MRI. We retrospectively investigated dislocated 40 hips and 34 normal hips in 37 pediatric patients (9 males and 28 females) with DDH who underwent open reduction after walking age. We evaluated the cartilaginous acetabulum and labrum of the patients using coronal MRI T2*-weighted images at 5 years of age. The mean age at the time of surgery was 22 months, and the mean age at the final survey was 19 years. We divided patients into two groups in accordance with the Severin classification at the final follow-up. Groups with good outcomes (affected 26 hips and unaffected 27 hips) and poor outcomes (14 hips and 7 hips) were compared using the MRI parameters on each side. Predictive factors of acetabular development were identified using univariate and multiple logistic regression analyses. Using multiple logistic regression analysis, labral acetabular roof depth and labral hip center distance at 5 years of age represented predictors after open reduction (odds ratio 0.27, P = 0.035; odds ratio 3.4, P = 0.028, respectively) on the affected side, and bony hip center distance represented a predictor on the unaffected side (odds ratio 2.6, P = 0.049). Acetabular development in the unaffected side could be predicted by bony assessment, while acetabular development in the affected side had to be assessed by labrum using MRI.

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Treatment of Developmental Dislocation of the Hip in Children after Walking Age: Indications from Two-Directional Arthrography

Cited by 13 publications

References 14 publications

Evaluation of the labrum on postoperative magnetic resonance images: a predictor of acetabular development in developmental dysplasia of the hip

Evaluation of the labrum on postoperative magnetic resonance images: a predictor of acetabular development in developmental dysplasia of the hip

Acetabular development after open reduction to treat dislocation of the hip after walking age

Acetabular depth, an early predictive factor of acetabular development: MRI in patients with developmental dysplasia of the hip after open reduction

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