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Tomaru Y, Kamegaya M, Saisu T, Murakami R, Sakuma A, Oikawa Y, Kakizaki J, Segawa Y, Tsukagoshi Y, Kamada H, Yamazaki M. Reapplication of the Pavlik Harness for Treatment of Developmental Dysplasia of the Hip After Initial Pavlik Harness Failure. J Pediatr Orthop 2024; 44:69-75. [PMID: 37981894 DOI: 10.1097/bpo.0000000000002572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
OBJECTIVE The Pavlik harness (PH) has been widely used as the standard treatment for infants with developmental dysplasia of the hip (DDH). When the initial application of the PH fails, alternative treatments, such as closed reduction, open reduction, and reapplication of the PH will be considered. Compared with other treatments, reapplication of the PH offers certain advantages, including simplicity and reduced physical, and psychological stress, on both infants and caregivers. This study aims to investigate the effectiveness of reapplying the PH in patients with DDH. METHODS This study included patients with DDH (complete dislocation) who were treated by reapplication of PH between 1988 and 2012. Patients who were able to follow-up for more than 5 years were included. We examined the reduction rate and several factors to identify indicators associated with successful reduction during reapplication, including age, sex, side of hip dislocation, and the presence of the Ortolani sign. At the final follow-up, hip development was assessed using the Severin classification, whereas avascular necrosis (AVN) was evaluated using the Kalamchi classification and the Salter criteria. RESULTS A total of 56 patients (48 females and 8 males) and 57 hips were included in this study. The mean age at first and second application of PH was 4.2 months old (range: 0.12 to 6.4), and 5.8 months old (3.0 to 11.4), respectively. The reduction rate was 49% (28 out of 57 hips). Among the successfully reduced hips, the AVN rate was 3.6% (1 out of 28 hips). The Severin classification revealed 27 hips in class I and 1 hip in class III. Statistical analysis indicated a significantly higher proportion of left hip involvement in the reduction group (85% vs 41%, χ 2 test, P < 0.001). Although not statistically significant, the rate of positive Ortolani sign tended to be higher in the reduction group (61% vs 38%, χ 2 test, P = 0.06). CONCLUSION The reapplication method demonstrated a 49% reduction rate and a low AVN rate of 3.6% in our study. It is worth considering for patients who fail the initial PH treatment, particularly in cases of left-side dislocation and a positive Ortolani sign during the initial application.
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Affiliation(s)
- Yohei Tomaru
- Chiba Child & Adult Orthopaedic Clinic, Chiba
- Department of Orthopaedic Surgery, University of Tsukuba, Tsukuba
| | | | | | - Reiko Murakami
- Division of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata
| | - Akitoshi Sakuma
- Department of Orthopaedic Surgery, Chiba Children's Hospital, Chiba
| | - Yasuhiro Oikawa
- Department of Orthopaedic Surgery, Chiba Children's Hospital, Chiba
| | - Jun Kakizaki
- Department of Orthopaedic Surgery, Chiba Children's Hospital, Chiba
| | - Yuko Segawa
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuta Tsukagoshi
- Department of Orthopaedic Surgery, University of Tsukuba, Tsukuba
| | - Hiroshi Kamada
- Department of Orthopaedic Surgery, University of Tsukuba, Tsukuba
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, University of Tsukuba, Tsukuba
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Kheiri S, Tahririan MA, Shahnaser S, Ardakani MP. Avascular necrosis predictive factors after closed reduction in patients with developmental dysplasia of the hip. J Res Med Sci 2023; 28:81. [PMID: 38292338 PMCID: PMC10826850 DOI: 10.4103/jrms.jrms_288_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 09/09/2023] [Accepted: 09/27/2023] [Indexed: 02/01/2024]
Abstract
Background Developmental dysplasia of the hip (DDH) is a common pediatric orthopedic condition. Closed reduction (CR) is the conservative treatment approach with high success rates for DDH. However, avascular necrosis (AVN) is a severe potential complication after this procedure. This study retrospectively assessed the potential risk factors for AVN occurrence after CR and Spica cast immobilization. Materials and Methods In a retrospective observational study, 71 patients (89 hips) with DDH aged 6-24 months old undergoing CR were enrolled. All patients were followed up for 3 years, and their demographic data, initial Tönnis grade, pre-reduction procedures, abduction angle in the Spica cast, and the AVN presence (based on Bucholz and Ogden classification [3rd-4th class]) were documented. Results Of 71 patients (89 hips) with a mean age of 12.5 ± 3.9 months, 13 patients (18 hips) developed AVN. The mean age of patients in the AVN and non-AVN groups was 14.3 ± 4.9 and 12.2 ± 3 months (P = 0.07); also, the mean abduction angle in patients with and without AVN was 51.86 ± 3.66 and 58.46 ± 3.91 (P < 0.001) in univariate analysis. The distribution of initial Tönnis grade, and previous conservative procedures, adductor tenotomies during the CR were comparable between the two groups (P > 0.05). We found age 12 months and 54° in abduction angle as the best cutoff values for differentiating AVN patients from non-AVN and the risk of experiencing AVN for patients older than 12 months was odds ratio (OR) =4.22 (P = 0.06) and patients with abduction angle greater than 54 was OR = 34.88 (P < 0.001). Conclusion In this study, older age at the time of intervention and larger abduction angle in the hip Spica cast were two predictors of experiencing AVN in DDH patients after undergoing CR treatment approach. Performing CR at a younger age and keeping the abduction angle lower than 54° in the hip Spica cast could help to have the best possible prognosis. Level of Evidence IV, retrospective, observational, cross-sectional study.
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Affiliation(s)
- Sara Kheiri
- Department of Orthopedic Surgery, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Soheil Shahnaser
- Department of Orthopedic Surgery, Isfahan University of Medical Sciences, Isfahan, Iran
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Aslam F, Jamil K, Htwe O, Yuliawiratman BS, Natarajan E, Elamvazuthi I, Naicker AS. Postsurgical Analysis of Gait, Radiological, and Functional Outcomes in Children with Developmental Dysplasia of the Hip. Sensors (Basel) 2023; 23:3386. [PMID: 37050445 PMCID: PMC10098631 DOI: 10.3390/s23073386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/09/2023] [Accepted: 03/16/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Children undergoing DDH correction surgery may experience gait abnormalities following soft tissue releases and bony procedures. The purpose of this study was to compare the residual gait changes, radiological outcomes, and functional outcomes in children who underwent DDH surgery with those in healthy controls. METHODS Inertial motion sensors were used to record the gait of 14 children with DDH and 14 healthy children. Pelvic X-ray was performed to determine the Severin classification and the presence of femoral head osteonecrosis (Bucholz-Odgen classification). For functional evaluation, the Children's Hospital Oakland Hip Evaluation Scale (CHOHES) was used. RESULTS There was no difference in spatial parameters between the two groups. In terms of temporal parameters, the DDH-affected limbs had a shorter stance phase (p < 0.001) and a longer swing phase (p < 0.001) than the control group. The kinematic study showed that the affected limb group had smaller hip adduction angle (p = 0.002) and increased internal rotation (p = 0.006) with reduced upward pelvic tilt (p = 0.020). Osteonecrosis was graded II, III, and IV in five, three, and one patients, respectively. Five patients had no AVN changes. The Severin classification was grade I, II, and III for six, three, and five patients, respectively. Most patients had good functional outcomes on the CHOHES, with a mean total score of 96.64 ± 5.719. Multivariate regression analysis revealed that weight, height, and femoral osteotomy were independent predictors for gait, radiological and functional outcome. CONCLUSION Despite good functional scores overall, some children had poor radiological outcomes and gait abnormalities. Our results identified the risk factors for poor outcomes, and we recommend specified rehabilitative strategies for long-term management.
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Affiliation(s)
- Firdaus Aslam
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Universiti Kebangsaan Malaysia (UKM), Cheras, Kuala Lumpur 56000, Malaysia
| | - Kamal Jamil
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Universiti Kebangsaan Malaysia (UKM), Cheras, Kuala Lumpur 56000, Malaysia
| | - Ohnmar Htwe
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Universiti Kebangsaan Malaysia (UKM), Cheras, Kuala Lumpur 56000, Malaysia
| | - Brenda Saria Yuliawiratman
- IHT Rehabilitation Centre, Jalan Bioteknologi 1, Persiaran SILC, Kawasan Perindustrian SILC, lskandar Puteri 79200, Johor, Malaysia
| | - Elango Natarajan
- Faculty of Engineering, Technology and Built Environment, UCSI University, Kuala Lumpur 56000, Malaysia
| | - Irraivan Elamvazuthi
- Department of Electrical & Electronic Engineering, Universiti Teknologi Petronas, Seri Iskandar 32610, Perak, Malaysia
| | - Amaramalar Selvi Naicker
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Universiti Kebangsaan Malaysia (UKM), Cheras, Kuala Lumpur 56000, Malaysia
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Jamil K, Saharuddin R, Abd Rasid AF, Abd Rashid AH, Ibrahim S. Outcome of Open Reduction Alone or with Concomitant Bony Procedures for Developmental Dysplasia of the Hip (DDH). Children (Basel) 2022; 9:children9081213. [PMID: 36010103 PMCID: PMC9406436 DOI: 10.3390/children9081213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 07/28/2022] [Accepted: 07/30/2022] [Indexed: 11/16/2022]
Abstract
Introduction: Developmental dysplasia of the hip (DDH) is commonly managed in a tertiary centre and regularly involves surgical treatment. The aim of this study is to determine the surgical outcome of DDH patient treated with either open reduction alone or combined with bony procedures in our institution. Methods: Medical records of DDH patients treated surgically were reviewed. Patients were divided into two groups: Group A: underwent open reduction (OR) only; and Group B: underwent open reduction with additional bony procedures (ORB), such as pelvic or femoral osteotomy. Modified McKay classification was used to evaluate the clinical outcome, and Severin classification for the radiological outcome. Presence of avascular necrosis and other post-operative complications were recorded. Results: A total of 66 patients (76 hips) were reviewed with the mean age of 11.9 ± 4.8 years. Mean duration of follow up was 8.6 ± 4.7 years (ranged 2 to 23 years). From our sample, 50/66 patients (75.8%) achieved satisfactory clinical outcome, whereas 48/66 patients (72.7%) had satisfactory radiological outcome. A higher proportion of patients achieved satisfactory outcomes in the OR group compared to the ORB group (p < 0.05), but no difference was seen in terms of radiological outcome (p = 0.80). Overall, 23 hips (34.8%) developed radiographic evidence of avascular necrosis (AVN). Nineteen hips had undergone ORB, although they were mainly (63.2%) Grade I AVN. Incidence of AVN was comparable in both groups (p = 0.63), but presence of AVN led to a higher proportion of unsatisfactory clinical and radiological outcome (p < 0.05). Other complications included redislocation/subluxation (13.6%) and bleeding (0.1%). Conclusions: Good overall outcome of DDH surgery was achieved in our centre. The OR group may produce a better clinical outcome, but with similar radiological results and AVN rate with the ORB group. The presence of AVN is associated with unsatisfactory clinical and radiological outcomes.
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Mazaleyrat M, Lacroix R, Lakhal W, Morel B, Bonnard C, Odent T. Petit-Morel method for hip development dysplasia in toddlers: A retrospective observational study in 34 patients. Orthop Traumatol Surg Res 2022; 108:103127. [PMID: 34700059 DOI: 10.1016/j.otsr.2021.103127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 02/06/2021] [Accepted: 02/11/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND The Petit-Morel method allows the treatment of developmental hip dysplasia in toddlers by combining gradual traction to achieve reduction followed by immobilisation during which pelvic osteotomy is performed. The objective of this study was to assess the radiographic and clinical outcomes in a retrospective cohort of patients. HYPOTHESIS The Petit-Morel method is associated with low rates of avascular necrosis and residual acetabular dysplasia at skeletal maturity, as well as with satisfactory medium-term clinical outcomes. MATERIAL AND METHODS We conducted a single-centre retrospective study of 34 patients (35 hips) treated between 1997 and 2014. The radiological assessment criteria included an evaluation for avascular necrosis classified according to Kalamchi and MacEwan, the vertical centre edge (VCE) angle, femoral head sphericity according to Mose, and acetabular dysplasia at skeletal maturity according to Severin. Hip function was assessed by determining the Postel-Merle d'Aubigné (PMA) score. RESULTS Mean age at treatment was 19±4 months (range, 14-29). Mean follow-up was 11 years (range, 5-20). There were two failures including one case of recurrent dislocation requiring surgical reduction. Group II avascular necrosis occurred in 1 (3%) patient. Tönnis Grade IV dysplasia was significantly associated with resolving irregularity of the ossification centre, seen in 19 (54%) cases (p=0.002). In the 18 patients followed-up to skeletal maturity, with a mean follow-up of 15 years (range, 12-20 years), 17 hips were Severin Class I. The mean VCE angle was 29° (range, 15°-38°), and the head was spherical for 34 (98%) hips. The PMA score at last follow-up was excellent (17-18). The mean VCE angle was greater in all 5 patients who experienced pain during long walks (35° [range, 32°-37°]) than in the asymptomatic patients (28° [range, 15°-38°]) (p=0.009). DISCUSSION The Petit-Morel method is a reliable treatment that provides good clinical and radiological outcomes. Overcorrection of the VCE angle was noted in the patients who experienced walking-related pain in adulthood. LEVEL OF EVIDENCE IV, retrospective observational cohort study.
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Affiliation(s)
- Matthieu Mazaleyrat
- Service de chirurgie orthopédique pédiatrique, Hôpital Gatien de Clocheville, CHU de Tours - Université François Rabelais de Tours, PRES Centre-Val de Loire Université, Tours, France
| | - Richard Lacroix
- Service de chirurgie orthopédique pédiatrique, Hôpital Gatien de Clocheville, CHU de Tours - Université François Rabelais de Tours, PRES Centre-Val de Loire Université, Tours, France
| | - Walid Lakhal
- Nouvelle Clinique Bordeaux Tondu (NCBT), 46, avenue Jean Alfonséa, 33270 Floirac, France
| | - Baptiste Morel
- Service de radiologie pédiatrique, Hôpital Gatien de Clocheville, CHU de Tours - Université François Rabelais de Tours, PRES Centre-Val de Loire Université, Tours, France
| | - Christian Bonnard
- Service de chirurgie orthopédique pédiatrique, Hôpital Gatien de Clocheville, CHU de Tours - Université François Rabelais de Tours, PRES Centre-Val de Loire Université, Tours, France
| | - Thierry Odent
- Service de chirurgie orthopédique pédiatrique, Hôpital Gatien de Clocheville, CHU de Tours - Université François Rabelais de Tours, PRES Centre-Val de Loire Université, Tours, France.
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Canavese F, Castañeda P, Hui J, Li L, Li Y, Roposch A. Developmental dysplasia of the hip: Promoting global exchanges to enable understanding the disease and improve patient care. Orthop Traumatol Surg Res 2020; 106:1243-1244. [PMID: 33069603 DOI: 10.1016/j.otsr.2020.09.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 09/15/2020] [Indexed: 02/03/2023]
Affiliation(s)
- Federico Canavese
- Lille University Center, Jeanne de Flandres Hospital, Department of Pediatric Orthopedics, Avenue Eugène-Avinée, 59037 Lille cedex, France; Nord-de-France Lille University, Faculty of Medicine, 59000 Lille, France.
| | - Pablo Castañeda
- Elly and Steven Hammerman, NYU School of Medicine, Pediatric Orthopaedic Surgery, NYU Langone Health/Hassenfeld Children's Hospital, 301 East 17th Street, New York, NY, 10003 USA; NYU Langone Health/Hassenfeld Children's Hospital, 301 East 17th Street, New York, NY, 10003 USA
| | - James Hui
- Department of Orthopaedic Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Department of Orthopaedic Surgery, National University Health System, Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228 Singapore
| | - LianYong Li
- Pediatric Orthopaedic Professor of China Medical University, Chief of Department of Pediatric Orthopaedics, Shengjing Hospital of China Medical University, No.36 Sanhao Street, Heping District, Shenyang City, Liaoning Province, 110004 PR China
| | - YiQiang Li
- Department of Pediatric Orthopaedic, GuangZhou Women and Children's Medical Center, 9th JinSui Road, GuangZhou, 510623 PR China
| | - Andreas Roposch
- University College London, Great Ormond Street Institute of Child Health 30 Guildford St, London WC1N 3EH UK
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