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Rajbhandari A, Banskota B, Bhusal R, Banskota AK. Effect of Infrapatellar Fat Pad Preservation vs Resection on Clinical Outcomes After Total Knee Arthroplasty in Patient with End-Stage Osteoarthritis. Indian J Orthop 2023; 57:863-867. [PMID: 37214378 PMCID: PMC10192471 DOI: 10.1007/s43465-023-00865-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 03/10/2023] [Indexed: 05/24/2023]
Abstract
Purpose The management of infrapatellar fat pad (IPFP) during total knee arthroplasty (TKA) is the subject of ongoing debate. There is conflicting evidence whether IPFP should be preserved or resected during TKA to improve clinical outcomes. This study sought to establish if there is a benefit of one over another in terms of clinical function & patient satisfaction. Material & Methods Total of 67 patients (96 knees), 11 males & 56 females with a mean age of 66.29 years, who underwent TKA between 2016 and 2020 were included in the study. The planning for IPFP preservation (IPFP-P) on right side (50 knees) & IPFP resection (IPFP-R) on left side (46 knees) was done prospectively. We prospectively evaluated clinical outcomes post-TKA, comparing the right knee to the left knee in terms of IPFP-P vs IPFP-R using the oxford knee scoring (OKS) system. The SF-12 was used to evaluate and compare patient satisfaction between the two groups. Results The mean OKS in the IPFP-P group was 42.86 ± 2.63 & in the IPFP-R group was 44.22 ± 2.40. The OKS differed significantly between the two groups (p < 0.05). Patient with IPFP-R group had significantly better OKS. The mean Sf-12 (physical & mental component) in the IPFP-P was 51.05 ± 4.15 & 59.29 ± 2.53 & in IPFP-R was 51.23 ± 4.74 & 59.24 ± 2.78, showing no significant differences. Conclusion Our study shows that IPFP-R gave marginally better patient-reported functional outcome scores (OKS), but there was no difference in patient satisfaction (SF-12 scores) between the two groups.
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Affiliation(s)
| | - Bibek Banskota
- Department of Orthopaedics, B&B Hospital, Gwarko, Lalitpur, Nepal
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Huang P, Wang D, Mo Y, Zheng Y, Ning B. Teardrop and sourcil line (TSL): a novel radiographic sign that predicts residual acetabular dysplasia (RAD) in DDH after closed reduction. Transl Pediatr 2022; 11:458-465. [PMID: 35558977 PMCID: PMC9085947 DOI: 10.21037/tp-21-401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 02/17/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Residual acetabular dysplasia (RAD) is a major problem of developmental dysplasia of the hip (DDH) after closed reduction (CR). Several parameters have been investigated as ways of predicting RAD; however, prediction of RAD remains controversial. The purpose of this study was to evaluate the radiographic sign of teardrop and sourcil line (TSL) in pediatric patients with DDH to enable prediction of RAD after CR. METHODS One hundred and twenty-five hips with DDH treated with CR and followed up for at least 2 years were included in this study. The mean age at CR was 18.3 months (range, 9 to 32 months) and the average follow-up time was 50.2 months (range, 24 to 89 months). The acetabular index (AI) was measured at different time points. The cases were divided into two groups according to whether TSL became continuous or not. The relationships among TSL, AI and RAD were analyzed. RESULTS The RAD incidence was 73.6% (92/125) at the last follow-up. AI at CR and TSL were the prognostic factors for RAD (P=0.017 and 0.001, respectively). Thirty-four hips showed a continuous TSL. There was a lower RAD rate in the TSL continuous group (P<0.001). There was no statistical difference in the AI at CR between the TSL continuous and discontinuous groups; however, the level of AI after CR was lower in the TSL continuous group. The TSL of 74% (20/27) hips became continuous after acetabular osteotomy surgery. CONCLUSIONS The TSL continuous group had a lower AI and incidence of RAD than the discontinuous group. The TSL can be a predictive factor of RAD in DDH after CR and restore the continuous of TSL maybe a potential parameter that can help surgeons to make a judgment intra-operation.
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Affiliation(s)
- Peng Huang
- Department of Orthopaedics Surgery, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
| | - Dahui Wang
- Department of Orthopaedics Surgery, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
| | - Yueqiang Mo
- Department of Orthopaedics Surgery, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
| | - Yiming Zheng
- Department of Orthopaedics Surgery, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
| | - Bo Ning
- Department of Orthopaedics Surgery, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
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Exploring the experiences of parents caring for infants with developmental dysplasia of the hip attending a dedicated clinic. Int J Orthop Trauma Nurs 2016; 25:48-53. [PMID: 27979662 DOI: 10.1016/j.ijotn.2016.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 10/11/2016] [Accepted: 10/20/2016] [Indexed: 11/20/2022]
Abstract
Specialised DDH (developmental dysplasion of the hip) clinics are developing around Ireland but are, however, variable in how they are operated. A DDH clinic was set up in the South-east of Ireland in 2002 with the goal of achieving an integrated care pathway between the orthopaedic surgical team and nursing team, working to an explicit protocol while also fostering a strong collaboration with the ultrasound department. This paper aims to explore the effectiveness of this dedicated clinic in the Southeast of Ireland.
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Anuar R, Mohd-Hisyamudin HP, Ahmad MH, Zulkiflee O. The Economic Impact of Managing Late Presentation of Developmental Dysplasia of Hip (DDH). Malays Orthop J 2015; 9:40-43. [PMID: 28611908 PMCID: PMC5393133 DOI: 10.5704/moj.1511.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Delayed presentation of Developmental Dysplasia of Hip (DDH) comes with challenges in treatment as well as high surgical cost. Therefore the objective of this study is to quantify the economic impact of management of late presentation of DDH during a last 3-year period. We conducted a retrospective study with analysis of DDH cases managed between years 2012 to 2014. Early and late presentations of DDH were identified and cost management for both was estimated. Out of twenty-four DDH cases, thirteen cases fulfilled the inclusion criteria. All were female with majority of them presenting with unilateral DDH predominantly of the left hip. Most patients presented after age of six months and the principal complaint was abnormal or limping gait. The grand total cost for managing DDH during the three years period was USD 12,385.51, with 86% of the amount having been used to manage late presentation of DDH that was mostly contributed by the cost of surgery. We concluded that delayed presentation of DDH contributes heavily to high national expenditure. Early detection of DDH cases with systematic neonatal screening may help to minimize the incidence of the late presenting DDH and subsequently reduce the economic burden to the government.
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Affiliation(s)
- Rim Anuar
- Department of Orthopaedics, Penang Hospital, Georgetown, Malaysia
| | | | - M H Ahmad
- Department of Orthopaedics, Penang Hospital, Georgetown, Malaysia
| | - O Zulkiflee
- Department of Orthopaedics, Penang Hospital, Georgetown, Malaysia
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Developmental dysplasia of the hip: incidence and treatment outcomes in the Southeast of Ireland. Ir J Med Sci 2014; 184:411-5. [DOI: 10.1007/s11845-014-1133-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Accepted: 05/05/2014] [Indexed: 10/25/2022]
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Ahmed E, Mohamed AH, Wael H. Surgical treatment of the late - presenting developmental dislocation of the hip after walking age. ACTA ORTOPEDICA BRASILEIRA 2014; 21:276-80. [PMID: 24453682 PMCID: PMC3874998 DOI: 10.1590/s1413-78522013000500007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Accepted: 03/01/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE: Cases of developmental dislocation of the hip (DDH) still occur after walking age because of late or missed diagnosis and failed conservative treatment. The choice of treatment for DDH after walking age continues to be controversial, and one of the options is open reduction combined with innominate osteotomy. METHODS: Twenty patients with 26 surgically treated hips with DDH, were evaluated from 2005 to 2008, using innominate osteotomy by Salter's technique after open reduction and capsulorraphy. The age of patients, fifteen females and five males, at time of surgery ranged from 12 to 18 months (mean age 14.7 months). Six patients had bilateral dislocation and in the remaining, nine had their left hip dislocated and five had their right hip dislocated. RESULTS: The results were evaluated according to modified McKay criteria and to Severin radiological criteria, after a mean follow-up of 46.7 months. Eighty - nine percent of hips were rated as excellent or good by McKay criteria. There were no poor results. According to Severin criteria, 77% were type I and II while 23% showed type III and IV, no hips were rated as Severin's group V or VI. There was one case (3.8%) of re-dislocation, but revision surgery resulted in stable, concentric, and permanent reduction. No cases of infection, graft fracture and vascular or nervous injury were reported. CONCLUSION: Open reduction combined with Salter osteotomy does not hurt the hip with regard to acetabular remodeling for children between 12 and 18 months of age. Level of Evidence IV, Case Series.
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Gümüştaş SA, Orak MM, Onay T, Bulut G. Late Developmental Dysplasia of the Hip That Was Sonographically Determined to Be Stable at First Examination: A Case Report. JBJS Case Connect 2013; 3:e114. [PMID: 29252277 DOI: 10.2106/jbjs.cc.m.00148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Seyit Ali Gümüştaş
- Orthopedics and Traumatology Department, Adiyaman Education and Research Hospital, Turgut Reis Street 02200, Adiyaman, Turkey.
| | - Mehmet Müfit Orak
- Orthopedics and Traumatology Department, Fatih Sultan Mehmet Education and Research Hospital. E-5 Highway 34752, Bostanci, Istanbul, Turkey.
| | - Tolga Onay
- Orthopedics and Traumatology Department, Tatvan State Hospital, Saray Street 13200, Tatvan, Bitlis, Turkey.
| | - Güven Bulut
- Orthopedics and Traumatology Department, Dr. Lütfi Kirdar Kartal Education and Research Hospital, Şemsi Denizer Street 34890, Kartal, Istanbul, Turkey.
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Congenital dislocation of the hip, with late diagnosis after 1 year of age: update and management. Orthop Traumatol Surg Res 2012; 98:S154-8. [PMID: 22579508 DOI: 10.1016/j.otsr.2012.04.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Accepted: 02/27/2012] [Indexed: 02/02/2023]
Abstract
When congenital dislocation of the hip (CDH) is diagnosed only after walking age, management is greatly complicated. In view of the increasing number of such cases treated by members of the French Society of Paediatric Orthopaedics (SOFOP) in recent years, a 3-part study was conducted within the Society to shed light on the reasons for late diagnosis, to give an update on treatment strategies currently implemented in France, and to report long-term outcomes.
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Molony DC, Harty JA, Burke TE, D'Souza LG. Popliteal angle as an indicator for successful closed reduction of developmental dysplasia of the hip. J Orthop Surg (Hong Kong) 2011; 19:46-9. [PMID: 21519075 DOI: 10.1177/230949901101900110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To evaluate the use of the popliteal angle as an indicator for successful closed reduction of developmental dysplasia of the hip (DDH) in children with delayed presentation. METHODS 29 patients aged 6 to 18 months underwent successful closed reduction for unilateral DDH under general anaesthesia. Using a graduated goniometer, the popliteal angle was measured with the hip abducted within the safe zone (to avoid redislocation and injury to the femoral capital epiphysis) before and after reduction and after 6 weeks of spica casting. RESULTS The mean popliteal angles before and after reduction and after 6 weeks of spica casting were 5.1, 37.5, and 17.9 degrees, respectively (p<0.0001, paired t test). Because of discomfort, the spica casts were altered in 3 patients (2 at week 1 and one at week 3). CONCLUSION Reduction of the hip in DDH results in an increased popliteal angle of >20 degree. This may be used to indicate the diagnosis and safe closed reduction.
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Affiliation(s)
- Diarmuid C Molony
- Department of Orthopaedic Surgery, Mid Western Regional Orthopaedic Hospital, Croom, Limerick, Ireland
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Luther AZ, Clarke NMP. Developmental dysplasia of the hip and occult neurologic disorders. Clin Orthop Relat Res 2008; 466:871-7. [PMID: 18231844 PMCID: PMC2504646 DOI: 10.1007/s11999-008-0118-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2007] [Accepted: 01/04/2008] [Indexed: 01/31/2023]
Abstract
UNLABELLED Developmental dysplasia of the hip (DDH) is a neonatal condition with various causes. Neuromuscular dysplasia of the hip (NDH) is a sequel of neuromuscular disease, and generally presents later in childhood than DDH. Some evidence, however, supports a concept of a neuromuscular etiology of DDH: (1) a high prevalence of spinal dysraphism in DDH; and (2) abnormal sensory evoked potentials in 31% of DDH patients. To explore this suggestion we ascertained the presence of neuromuscular disease within a cohort of DDH patients, and asked whether the neuromuscular condition is the initial etiology of the dysplasia or a coincidental finding. We retrospectively reviewed patients presenting with DDH. Only those with an initial diagnosis of DDH and a subsequent diagnosis of a neuromuscular condition were assessed. Fifteen of 560 patients fulfilled the criteria, however the presence of true DDH within this group was minimal, as several cases emerged as early presenting NDH. We therefore believe it unlikely DDH has a substantial neurological etiology. LEVEL OF EVIDENCE Level III, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- A. Z. Luther
- MP 817, Southampton General Hospital, University of Southampton, Tremona Road, Southampton, SO16 6YD UK
| | - N. M. P. Clarke
- MP 817, Southampton General Hospital, University of Southampton, Tremona Road, Southampton, SO16 6YD UK
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Papadimitriou NG, Papadimitriou A, Christophorides JE, Beslikas TA, Panagopoulos PK. Late-presenting developmental dysplasia of the hip treated with the modified Hoffmann-Daimler functional method. J Bone Joint Surg Am 2007; 89:1258-68. [PMID: 17545429 DOI: 10.2106/jbjs.e.01414] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The general consensus is that nonoperative treatment of developmental dysplasia of the hip should not be attempted for patients in whom previous treatment of the disease has failed, those in whom the disease was neglected, or those in whom the disease presented late. In such cases, it is believed that the optimum period for hip remodeling has passed and that operative methods are preferable. The purpose of the present study was to report the efficacy of a modified form of the Hoffmann-Daimler method for the treatment of late-presenting developmental dysplasia of the hip. MATERIALS We retrospectively reviewed the records of sixty-nine patients (ninety-five hips) with neglected developmental dysplasia of the hip who had been managed nonoperatively with a modification of the Hoffmann-Daimler method from 1971 to 2000. With this method, the patient wears a flexion harness (Phase A), during which time the femoral head is gradually reduced, followed by an abduction splint (Phase B), during which time the reduced hip remodels. We have modified the original method by introducing new treatment strategies. The study group included nine boys and sixty girls. The average age of the patients was sixteen months (range, six to forty-four months) at the start of treatment and 11.5 years (range, six to twenty-nine years) at the time of the latest follow-up. Radiographs were assessed to determine the acetabular index, the Severin classification, and the presence of evidence of osteonecrosis of the proximal femoral epiphysis. Hips that were rated as Severin class I or class II were classified as satisfactory, whereas those that were rated as Severin class III or class IV were classified as unsatisfactory. RESULTS On the basis of the most recent follow-up radiographs, eighty-eight (93%) of the dislocated hips were classified as satisfactory (sixty-seven were rated as Severin class I and twenty-one were rated as Severin class II) and seven were classified as unsatisfactory (six were rated as Severin class III and one was rated as Severin class IV). No hip was rated as Severin class V or VI. The average acetabular index was 40 degrees +/- 7.4 degrees prior to the onset of treatment and 24 degrees +/- 5.7 degrees at the end of treatment. No redislocations or other complications were noted. Osteonecrosis was noted in six of the ninety-five hips. CONCLUSIONS Late-presenting or neglected developmental dysplasia of the hip can be successfully treated with use of a modified Hoffmann-Daimler method. The high rate of successful reduction, the low prevalence of osteonecrosis and residual dysplasia, and the limited complications may make this modified method a safe alternative to surgical treatment. LEVEL OF EVIDENCE Therapeutic Level IV.
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Affiliation(s)
- Nikolaos G Papadimitriou
- Aristotle University of Thessaloniki, 2nd Orthopaedic Department, G. Gennimatas Hospital, Thessaloniki, Greece.
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