1
|
Tadlock JC, Rupp GE, Farnsworth CL, Bomar JD, Caffrey JP, Upasani VV. The Anterior Modified San Diego Acetabuloplasty Does Not Increase Superior-Anterior Coverage in Patient-Specific 3D-Printed Models. J Pediatr Orthop 2024; 44:316-321. [PMID: 38385205 DOI: 10.1097/bpo.0000000000002640] [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: 02/23/2024]
Abstract
BACKGROUND Patients with developmental dysplasia of the hip may require pelvic osteotomies to improve acetabular coverage. The purpose of this study was to compare the changes in acetabular version, tilt, and regional coverage angles following the San Diego acetabuloplasty (SDA), the modified San Diego acetabuloplasty (mSDA), and the Pemberton acetabuloplasty (PA). METHODS Fourteen patients with developmental dysplasia of the hip and computed tomography (CT) imaging were identified. From CT images, 2 identical pelvises were 3-dimensional-printed for each patient. Bone was printed with rigid material, and cartilage with flexible material. For each model pair, the SDA was performed on one and the PA was performed on the other. CT scans were obtained before and after acetabuloplasties. Next, the bone graft in the SDA model was moved anteriorly, representing the mSDA, and the model was rescanned. Acetabular version, tilt, and coverage angles (posterior, superior-posterior, superior, superior-anterior, and anterior) were calculated. Preoperative to postoperative differences were compared (repeated measures analysis of variance or Wilcoxon signed rank test). The significance was set to P <0.05. RESULTS The mean age at CT was 5.8±1.2 years (range: 3.9 to 7.5 y). All 3 procedures (SDA, mSDA, and PA) significantly increased acetabular tilt; P <0.045), with a similar change observed for all 3 ( P =0.868). PA was the only procedure to significantly decrease relative acetabular version (6.5±6.5 degrees, preoperative: 12.9±5.3 degrees; P =0.004). Both the SDA and mSDA procedures significantly increased coverage in the superior-posterior octant (SDA: 92.6±9.3 degrees, mSDA: 92.3±9.8 degrees, preoperative: 81.9±9.5 degrees; P <0.02), with a similar percent change among the 2 ( P =1.0). All 3 procedures significantly increased superior coverage ( P <0.04); the increase was similar among the 3 ( P =0.205). The PA was the only procedure to produce a significant increase in coverage in the superior-anterior octant (91.0±16.7 degrees, preoperative: 74.0±12.1 degrees; P =0.005) or the anterior octant (50.7±11.7 degrees, preoperative: 45.8±8.9 degrees; P =0.012). CONCLUSIONS The SDA and mSDA procedures produced similar postoperative changes, primarily in the superior and superior-posterior acetabular octants. Placing the graft more anteriorly did not increase anterior coverage in the mSDA, and only the PA increased coverage in the superior and superior-anterior acetabular octants.
Collapse
|
2
|
Stavinoha TJ, Pun SY, McGlothlin JD, Uzosike MB, Segovia NA, Imrie MN. No Delay in Age of Crawling, Standing or Walking with Pavlik Harness Treatment: A Prospective Cohort Study. J Am Acad Orthop Surg 2024; 32:390-395. [PMID: 37862341 DOI: 10.5435/jaaos-d-21-00249] [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] [Received: 04/25/2021] [Accepted: 09/15/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Pavlik harness treatment is the standard of care for developmental dysplasia of the hip in infants younger than 6 months. The effect of Pavlik harness treatment on the achievement of motor milestones has not previously been reported. METHODS In this prospective cohort study, 35 patients were prospectively enrolled to participate and received questionnaires with sequential clinical visits monitoring treatment of their developmental dysplasia of the hip. One-sample Student t -tests assessed differences in milestone attainment age, and the Benjamini-Hochberg procedure was conducted to decrease the false discovery rate. Post hoc power analyses of each test were conducted. The age of achievement of eight early motor milestones were recorded and compared with a previously published cohort of healthy infants. RESULTS Infants treated with a Pavlik harness achieved four early motor milestones markedly later than the reported age of achievement in a historical control group. These milestones included "roll supine" (5.3 vs. 4.5 months; P = 0.039), "roll prone" (5.7 vs. 5.0 months; P = 0.039), "sit" (6.4 vs. 5.2 months; P < 0.001), and "crawl on stomach" (7.7 vs. 6.6 months; P = 0.039). However, there was no difference in time to achievement of later motor milestones of "crawl on knees," "pull to stand," and "independent walking." CONCLUSION Several early motor milestones were achieved at a statistically significantly later time than historical control subjects not treated in a Pavlik harness. Despite statistical significance, the small delays in early motor milestones were not thought to be clinically significant. No differences were observed in the later motor milestones, including knee crawling, standing, and independent walking. Clinicians and parents may be reassured by these findings. LEVEL OF EVIDENCE Therapeutic Level II-prospective study.
Collapse
Affiliation(s)
- Tyler J Stavinoha
- From the Department of Orthopaedic Surgery, Stanford Hospital and Clinics, Lucile Packard Children's Hospital at Stanford, Stanford, CA
| | | | | | | | | | | |
Collapse
|
3
|
Ulziibat M, Munkhuu B, Schmid R, Wyder C, Baumann T, Essig S. Comparison of quality and interpretation of newborn ultrasound screening examinations for developmental dysplasia of the hip by basically trained nurses and junior physicians with no previous ultrasound experience. PLoS One 2024; 19:e0300753. [PMID: 38635681 PMCID: PMC11025947 DOI: 10.1371/journal.pone.0300753] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/04/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND We are obliged to give babies the chance to profit from a nationwide screening of developmental dysplasia of the hip in very rural areas of Mongolia, where trained physicians are scarce. This study aimed to compare the quality and interpretation of hip ultrasound screening examinations performed by nurses and junior physicians. METHODS A group of 6 nurses and 6 junior physician volunteers with no previous ultrasound experience underwent Graf's standard training in hands-on practice. Newborns were examined before discharge from the hospital, according to the national guideline. Two standard documentation images of each hip were saved digitally. The groups were compared on the proportion of good quality of sonograms and correct interpretation. Two Swiss supervisors' agreed diagnosis according to Graf was considered the final reference for the study purposes. RESULTS A total of 201 newborns (402 hips or 804 sonograms) were examined in the study, with a mean age of 1.3±0.8 days at examination. Junior physicians examined 100 newborns (200 hips or 400 sonograms), while nurses examined 101 newborns (202 hips or 404 sonograms). The study subjects of the two groups were well balanced for the distribution of baseline characteristics. The study observed no statistically significant difference in the quality of Graf's standard plane images between the providers. Eventually, 92.0% (92) of the physician group and 89.1% (90) of the nurse group were correctly diagnosed as "Group A" (Graf's Type 1 hip) or "Non-Group A" hips (p = 0.484). The most common errors among the groups were a missing lower limb, wrong measurement lines, and technical problems. CONCLUSION Our study provides evidence that while there might be a trend of slightly more technical mistakes in the nurse group, the overall diagnosis accuracy is similar to junior physicians after receiving standard training in Graf's hip ultrasound method. However, after basic training, regular quality control is a must and all participants should receive refresher trainings. More specifically, nurses need training in the identification of anatomical structures.
Collapse
Affiliation(s)
- Munkhtulga Ulziibat
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- National Center for Maternal and Child Health, Ulaanbaatar, Mongolia
| | - Bayalag Munkhuu
- National Center for Maternal and Child Health, Ulaanbaatar, Mongolia
| | | | | | - Thomas Baumann
- Center of Primary and Community Care, Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Stefan Essig
- Center of Primary and Community Care, Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| |
Collapse
|
4
|
Matheney T, Shore B, Miller P, Barnewolt C, Kim YJ, Paltiel H. Comparison of Contrast-enhanced Ultrasound and Contrast-enhanced Magnetic Resonance Imaging in the Assessment of Infant Hip Perfusion and Prediction of Proximal Femoral Growth Disturbance Following Closed and Open Reduction for Developmental Dysplasia of the Hip: A Preliminary Study. J Pediatr Orthop 2024; 44:e335-e343. [PMID: 38193395 DOI: 10.1097/bpo.0000000000002614] [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: 01/10/2024]
Abstract
OBJECTIVE Proximal femoral growth disturbance (PFGD) is a significant complication associated with surgical treatment of infant hip dislocation. Contrast-enhanced magnetic resonance imaging (CEMRI) has been utilized to assess perfusion in these hips and avoid PFGD. Contrast-enhanced ultrasound (CEUS) is an imaging technique utilized to evaluate perfusion in other organs. The aims of this study were to compare perfusion of dysplastic infant hips with CEUS and CEMRI after surgical treatment and to determine whether CEUS was as effective as CEMRI at predicting PFGD. METHODS A retrospective analysis of patients undergoing closed or open reduction for infant hip dislocation between 2012 and 2019 was performed. All patients underwent intraoperative CEUS and postoperative CEMRI to assess femoral epiphyseal perfusion using intravenous contrast. Perfusion status was rated as normal, partially decreased, or globally decreased in both modalities. Agreement in perfusion status between CEUS and CEMRI was assessed. Patients were followed for a minimum of 2 years postoperatively and assessed for PFGD. RESULTS Eighteen patients (28% males) underwent closed or open reduction at an average age of 8 months (3 to 16 mo). The agreement in perfusion status between CEUS and CEMRI was substantial (α = 0.74). Patients were followed for a median of 3 years. PFGD developed in 3 hips (17%). For the detection of PFGD, both imaging modalities performed very well and with no difference in the diagnostic utility of CEUS compared with CEMRI. Considering normal perfusion alone the accuracy, sensitivity, and specificity for CEUS were 83%, 100%, and 80%, and for CEMRI were 78%, 100%, and 73%, respectively. Considering global decreased perfusion alone, the accuracy, sensitivity, and specificity for CEUS were 94%, 67%, and 100%, and for CEMRI were 89%, 67%, and 93%, respectively. CONCLUSIONS CEUS is a viable intraoperative method to assess infant hip perfusion. This pilot study appears to be comparable to CEMRI at visualizing perfusion of infant hips and as good or better in predicting PFGD after hip reduction. Prospective studies of this imaging technique should be performed to confirm the findings of this retrospective review. LEVEL OF EVIDENCE Level II-development diagnostic criteria on the basis of consecutive patients (with generally preferred standard).
Collapse
|
5
|
Gross PW, Chipman DE, Nagra K, Tracey OC, Jones RH, Blanco JS, Sink EL, Scher DM, Dodwell ER, Doyle SM. Incidence of Nerve Palsies During Pavlik Harness Treatment for Developmental Dysplasia of the Hip: A Retrospective Cohort Study. J Bone Joint Surg Am 2024; 106:525-530. [PMID: 38506721 DOI: 10.2106/jbjs.23.00948] [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: 03/21/2024]
Abstract
BACKGROUND The Pavlik harness has been used for approximately a century to treat developmental dysplasia of the hip (DDH). Femoral nerve palsy is a documented complication of Pavlik harness use, with an incidence ranging from 2.5% to 11.2%. Rare reports of brachial plexus palsy have also been documented. The primary purpose of the current study was to evaluate the incidence of various nerve palsies in patients undergoing Pavlik harness treatment for DDH. Secondary aims were to identify patient demographic or hip characteristics associated with nerve palsy. METHODS We performed a retrospective review of patients diagnosed with DDH and treated with a Pavlik harness from February 1, 2016, to April 1, 2023, at a single tertiary care orthopaedic hospital. Hip laterality, use of a subsequent rigid abduction orthosis, birth order, breech positioning, weight, and family history were collected. The median (and interquartile range [IQR]) or mean (and standard deviation [SD]) were reported for all continuous variables. Independent 2-sample t tests and Mann-Whitney U tests were conducted to identify associations between the variables collected at the initiation of Pavlik harness treatment and the occurrence of nerve palsy. RESULTS Three hundred and fifty-one patients (547 hips) were included. Twenty-two cases of femoral nerve palsy (4% of all treated hips), 1 case of inferior gluteal nerve palsy (0.18%), and 2 cases of brachial plexus palsy (0.37%) were diagnosed. Patients with nerve palsy had more severe DDH as measured by the Graf classification (p < 0.001) and more severe DDH as measured on physical examination via the Barlow and Ortolani maneuvers (p = 0.003). CONCLUSIONS Nerve palsies were associated with more severe DDH at the initiation of Pavlik harness use. Upper and lower-extremity neurological status should be scrutinized at initiation and throughout treatment to assess for nerve palsies. The potential for femoral, gluteal, and brachial plexus palsies should be included in the discussion of risks at the beginning of treatment. Families may be reassured that nerve palsies associated with Pavlik harness can be expected to resolve with a short break from treatment. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
|
6
|
Stock J, Deshpande SA. Are term breech babies who undergo successful external cephalic version still at increased risk of developmental dysplasia of the hip? Arch Dis Child 2024; 109:351-353. [PMID: 38049995 DOI: 10.1136/archdischild-2023-326394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 11/22/2023] [Indexed: 12/06/2023]
Affiliation(s)
- Joanne Stock
- Medical School, Keele University, Keele, UK
- Neonatal Unit, Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK
| | | |
Collapse
|
7
|
Lv X, Yu S, Zhang T, Yang X, Xu Y, Li T. The outcome of early screening and treatment of developmental dysplasia of the hip in infants and toddlers in the Northern Guizhou region. Medicine (Baltimore) 2024; 103:e37540. [PMID: 38489682 PMCID: PMC10939535 DOI: 10.1097/md.0000000000037540] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 03/17/2024] Open
Abstract
This study is an observation of the early screening and treatment effect of infant developmental dysplasia of the hip (DDH) in an area in China. From January 2016 to December 2017, we selected infants and toddlers with high-risk factors for DDH, such as asymmetric gluteal folds, unequal length of lower limbs, and limited hip joint abduction, who visited the Department of Child Health Care and the Outpatient Clinic of Pediatric Orthopedics at the Affiliated Hospital of Zunyi Medical University. In total, 1485 cases were divided into age groups, examined using Graf ultrasound and X-ray, and the results were analyzed. Meanwhile, early interventions were actively adopted for cases with abnormalities during the screening. The detection rates of DDH were 24.0%, 2.8%, 9.3%, and 12.2% among those with 0 to 6 months, 7 to 12 months, 13 to 18 months, and 19 to 24 months of age, respectively. Early and individualized corrective conservative treatment was considered for children with abnormalities, and the cure rates were 87.0%, 65.7%, 41.0%, and 16.7% among those with 0 to 6 months, 7 to 12 months, 13 to 18 months, and 19 to 24 months of age, respectively. There was a statistically significant difference in the detection and cure rates of DDH in infants and toddlers of different ages (P < .01).
Collapse
Affiliation(s)
- Xin Lv
- Department of Pediatric Surgery, Affiliated Hospital of Zun Yi Medical University, Zun Yi, Guizhou, China
- Department of Pediatric Surgery, Guizhou Children’s Hospital, Zunyi City, Guizhou, China
| | - Song Yu
- Department of Pediatric Surgery, Affiliated Hospital of Zun Yi Medical University, Zun Yi, Guizhou, China
- Department of Pediatric Surgery, Guizhou Children’s Hospital, Zunyi City, Guizhou, China
| | - Tianjiu Zhang
- Department of Pediatric Surgery, Affiliated Hospital of Zun Yi Medical University, Zun Yi, Guizhou, China
- Department of Pediatric Surgery, Guizhou Children’s Hospital, Zunyi City, Guizhou, China
| | - Xiaohong Yang
- Department of Pediatric Surgery, Affiliated Hospital of Zun Yi Medical University, Zun Yi, Guizhou, China
- Department of Pediatric Surgery, Guizhou Children’s Hospital, Zunyi City, Guizhou, China
| | - Yanpeng Xu
- Department of Pediatric Surgery, Affiliated Hospital of Zun Yi Medical University, Zun Yi, Guizhou, China
- Department of Pediatric Surgery, Guizhou Children’s Hospital, Zunyi City, Guizhou, China
| | - Tangjiang Li
- Department of Pediatric Surgery, Affiliated Hospital of Zun Yi Medical University, Zun Yi, Guizhou, China
- Department of Pediatric Surgery, Guizhou Children’s Hospital, Zunyi City, Guizhou, China
| |
Collapse
|
8
|
Tamaki Y, Goto T, Wada K, Omichi Y, Hamada D, Sairyo K. Robotic arm-assisted total hip arthroplasty via a minimally invasive anterolateral approach in the supine position improves the precision of cup placement in patients with developmental dysplasia of the hip. J Orthop Sci 2024; 29:559-565. [PMID: 36801090 DOI: 10.1016/j.jos.2023.01.012] [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] [Received: 09/14/2022] [Revised: 12/02/2022] [Accepted: 01/31/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND This study evaluated the accuracy of the cup alignment angles and spatial cup positioning on computed tomography (CT) images in patients with osteoarthritis secondary to developmental dysplasia of the hip (DDH) who underwent total hip arthroplasty (THA) using a minimally invasive technique via an anterolateral approach in the supine position according to whether a robotic arm-assisted system or a CT-based navigation system was used. METHODS We reviewed 60 robotic arm-assisted (RA)-THA cases and 174 navigation-assisted (NA)-THA cases. After propensity score matching, there were 52 hips in each group. Postoperative cup alignment angles and position were assessed by superimposition of a three-dimensional cup template onto the actual implanted cup using postoperative CT images with pelvic coordinates matching the preoperative planning. RESULTS The mean absolute error of the inclination angle and the anteversion angle between the preoperative planning and the postoperative measurement was significantly smaller in the RA-THA group (inclination, 1.1° ± 0.9; anteversion, 1.3° ± 1.0) than in the NA-THA group (inclination, 2.2° ± 1.5; anteversion, 3.3° ± 2.5). For acetabular cup positioning, the mean discrepancy between the preoperative planning and the postoperative measurement was 1.3 ± 1.3 mm on the transverse axis, 2.0 ± 2.0 mm on the longitudinal axis, and 1.3 ± 1.7 mm on the sagittal axis in the RA-THA group and 1.6 ± 1.4 mm, 2.6 ± 2.3 mm, and 1.8 ± 1.3 mm, respectively, in the NA-THA group. High precision of cup positioning was observed in both groups with no statistically significant difference. CONCLUSION Robotic arm-assisted THA using a minimally invasive technique via an anterolateral approach in the supine position allows accurate cup placement in patients with DDH.
Collapse
Affiliation(s)
- Yasuaki Tamaki
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima City, Tokushima 770-8503, Japan
| | - Tomohiro Goto
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima City, Tokushima 770-8503, Japan.
| | - Keizo Wada
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima City, Tokushima 770-8503, Japan
| | - Yasuyuki Omichi
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima City, Tokushima 770-8503, Japan
| | - Daisuke Hamada
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima City, Tokushima 770-8503, Japan
| | - Koichi Sairyo
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima City, Tokushima 770-8503, Japan
| |
Collapse
|
9
|
Gahleitner M, Pisecky L, Gotterbarm T, Högler W, Luger M, Klotz MC. Long-term Results of Developmental Hip Dysplasia Under Therapy With Pavlik Harness. J Pediatr Orthop 2024; 44:135-140. [PMID: 38073187 DOI: 10.1097/bpo.0000000000002575] [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: 02/08/2024]
Abstract
INTRODUCTION The Pavlik harness is a commonly used treatment for developmental dysplasia of the hip (DDH) of types IIc or worse, based on the Graf classification. This study aimed to assess the long-term follow-up outcomes after treating DDH with the Pavlik harness. METHODS Between 1995 and 2006, ultrasound screening was conducted on 7372 newborns within the first days of life. Among them, 203 dysplastic hips in 152 patients, whose sonograms were Graf type IIc or worse, were treated with Pavlik harness. Treatment was discontinued if the measurement indicated Graf type Ia/b. More than 20 years later (mean: 20.46 y), patients were invited for clinical evaluation (Oxford Hips Score, Schulthess Hip Score, Harris Hip Score) and radiologic examination (center-edge angle according to Wiberg and the Severis classification, the rate of roofing of the femoral head via the Reimers migration percentage, and the Sharp angle). RESULTS Of the 152 patients, 60 (39.5%) participants with 80 (39.4%) affected hips (57.7% type IIc, 7.9% type D, and 15.6% type IIIa/b) were reexamined. The average follow-up duration was 20.5 years, with a maximum of 25.9 years. According to the Severin's classification, only 2 (3.77%) patients, each with one affected hip, showed slight residual dysplasia. The Reimer's migration percentage indicated an average of almost 90% canopy cover in the patient collective studied. No avascular necrosis was found, and the Sharp angle showed an average of almost 38 degrees. Only 4 participants with each one affected hip showed residual dysplasia according to the Sharp angle. The clinical results were quite satisfying, as none of the patients experienced hip pain that significantly limited their everyday activities or sports engagement, requiring medical attention before this study.Conclusions:Conservative therapy of DDH (Graf type IIc, D, III) with the Pavlik harness has demonstrated very good therapeutic success and a very low rate of residual dysplasia (2.81%). Both the radiologic and clinical outcomes were highly satisfactory. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
| | | | | | - Wolfgang Högler
- Paediatrics and Adolescent Medicine, Johannes Kepler University Linz, Kepler University Hospital GmbH, Linz, Austria
| | | | - Matthias C Klotz
- Department for Orthopaedics and Traumatology, Marienkrankenhaus Soest GmbH, Soest, Germany
| |
Collapse
|
10
|
Ellsworth BK, Lee JY, Sankar WN. Femoral Head Remodeling After Surgical Reduction of Developmental Hip Dislocations. J Pediatr Orthop 2024; 44:e211-e217. [PMID: 38145396 DOI: 10.1097/bpo.0000000000002597] [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: 12/26/2023]
Abstract
OBJECTIVE Developmental dysplasia of the hip is prevalent and is associated with dysplasia of both the femoral head and acetabulum. There is a paucity of literature describing femoral head remodeling after surgical reduction of developmentally dislocated hips. The purpose of this study was to describe and quantify changes in femoral head sphericity after closed or open reduction for developmental dysplasia of the hip. METHODS A retrospective cohort study was performed including patients with typical developmental hip dislocations who underwent closed or open reduction from 2009 to 2022 at a single institution and had immediate postoperative and average 3-week follow-up magnetic resonance imaging (MRI) scans. A subset of patients also had 3-year follow-up MRI scans. Patients with insufficient imaging or bony procedures at the time of reduction were excluded. We developed a technique to quantify femoral head "sphericity" by comparing differences in measured radii of the femoral head on axial and coronal plane MRI slices. We then calculated the variance of the radii for each plane and averaged these to calculate a combined variance. The variance was used to represent "sphericity," with a larger variance indicating a wider distribution of radii and thus a less spherical shape. RESULTS A total of 74 patients (69 females) with 96 hips were included in this series. The median age of the child at the time of reduction was 8.7 months [interquartile range (IQR): 2.2]. Over half (58.3%) of the hips had a closed reduction, whereas the remaining were open reduced (41.7%). Immediately postoperatively, at the 3-week time point, and at the 3-year time point the median combined variance was 1.1 (IQR: 3.93), 0.51 (IQR: 1.32), and 0.31 (IQR: 0.50), respectively, indicating improved sphericity over time. CONCLUSIONS Sphericity of the femoral head in developmental hip dislocations improves in both the immediate postoperative period, as well as the first few years after reduction. Further research is needed to evaluate the mechanism of remodeling, the ideal timing of reduction, and the relationship between femoral head and acetabular remodeling. LEVEL OF EVIDENCE Level IV-case series, therapeutic study.
Collapse
Affiliation(s)
- Bridget K Ellsworth
- Department of Pediatric Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, PA
| | | | | |
Collapse
|
11
|
Jenner EA, Chauhan GS, Burahee A, Choudri J, Gardner A, Bache CE. Comparison of clinical and radiological outcomes for the anterior and medial approaches to open reduction in the treatment of bilateral developmental dysplasia of the hip: a systematic review protocol. Syst Rev 2024; 13:72. [PMID: 38396003 PMCID: PMC10885537 DOI: 10.1186/s13643-023-02444-6] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 12/21/2023] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Developmental dysplasia of the hip (DDH) affects 1-3% of newborns and 20% of cases are bilateral. The optimal surgical management strategy for patients with bilateral DDH who fail bracing, closed reduction or present too late for these methods to be used is unclear. There are proponents of both medial approach open reduction (MAOR) and anterior approach open reduction (AOR); however, there is little evidence to inform this debate. METHODS We will perform a systematic review designed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocol. We will search the medical and scientific databases including the grey and difficult to locate literature. The Medical Subject Headings "developmental dysplasia of the hip", "congenital dysplasia of the hip", "congenital hip dislocation", "developmental hip dislocation", and their abbreviations, "DDH" and "CDH" will be used, along with the qualifier "bilateral". Reviewers will independently screen records for inclusion and then independently extract data on study design, population characteristics, details of operative intervention and outcomes from the selected records. Data will be synthesised and a meta-analysis performed if possible. If not possible we will analyse data according to Systematic Review without Meta-Analysis guidance. All studies will be assessed for risk of bias. For each outcome measure a summary of findings will be presented in a table with the overall quality of the recommendation assessed using the Grading of Recommendations Assessment Development and Evaluation approach. DISCUSSION The decision to perform MAOR or AOR in patients with bilateral DDH who have failed conservative management is not well informed by the current literature. High-quality, comparative studies are exceptionally challenging to perform for this patient population and likely to be extremely uncommon. A systematic review provides the best opportunity to deliver the highest possible quality of evidence for bilateral DDH surgical management. SYSTEMATIC REVIEW REGISTRATION The protocol has been registered in the International Prospective Register of Systematic Reviews (PROSPERO ID CRD42022362325).
Collapse
Affiliation(s)
- Edward Alan Jenner
- Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK.
| | | | - Abdus Burahee
- Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP, UK
- University of Birmingham, College of Medical & Dental Sciences, Birmingham, UK
| | - Junaid Choudri
- Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP, UK
| | - Adrian Gardner
- Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP, UK
- University of Birmingham, College of Medical & Dental Sciences, Birmingham, UK
| | | |
Collapse
|
12
|
Almutairi FF. Incidence and characteristics of developmental dysplasia of the hip in a Saudi population: A comprehensive retrospective analysis. Medicine (Baltimore) 2024; 103:e36872. [PMID: 38335415 PMCID: PMC10860996 DOI: 10.1097/md.0000000000036872] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/04/2023] [Accepted: 12/15/2023] [Indexed: 02/12/2024] Open
Abstract
Developmental dysplasia of the hip (DDH) is a common hip disorder in infants. Ultrasonographic screening is considered the most reliable method for early detection of DDH in newborn infants. This study aimed to determine the incidence of DDH at King Abdulaziz University Hospital. From January 2017 to December 2018, this retrospective study analyzed the data of 8031 infants who underwent an early clinical examination of the hips. At the initial evaluation, 212 infants referred to the ultrasound department had risk factors for DDH and/or clinical instability. Different well-known risk factors of DDH have been identified including breech position, skeletal deformities, positive family history, hip side, sex and clicky hip. The findings revealed an incidence rate of 93 cases of DDH among 8031 infants (11.58 per 1000) births. Among the infants diagnosed with DDH, 55 were females (59.14 %), and 38 were males (40.86%). The results of the current study revealed that 45% of infants with DDH exhibited bilateral involvement. Moreover, results showed that the IIa hip joint was more prevalent in female than in male newborns, but without any significant difference. The incidence rate of DDH in this study was 11.58 per 1000 live births, and it was more prevalent among female than male newborns. Ultrasonography (US) should be used as a complementary imaging modality for clinical examination of DDH. Infants with breech presentation, clicky hip, and skeletal deformity should be scanned by US. Further prospective studies are recommended.
Collapse
Affiliation(s)
- Fahad F. Almutairi
- Department of Radiologic Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
- Animal House Unit, King Fahd Medical Research Centre, King Abdulaziz University, Jeddah, Saudi Arabia
- Smart Medical Imaging Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
- Medical Imaging and Artificial Intelligence Research Unit, Center of Modern Mathematical Sciences and its Applications, King Abdulaziz University, Jeddah, Saudi Arabia
| |
Collapse
|
13
|
Weisberg E, Doyle N, Booser A. Response to 'opioid sparing effect of PENG block in open reduction of pediatric developmental dysplasia of the hip: a case series,' by Yörükoğlu et al. Reg Anesth Pain Med 2024; 49:151-152. [PMID: 37169488 DOI: 10.1136/rapm-2023-104631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 05/13/2023]
Affiliation(s)
- Emily Weisberg
- Department of Anesthesiology, Children's Mercy Kansas City, Kansas City, MO, USA
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Nichole Doyle
- Department of Anesthesiology, Children's Mercy Kansas City, Kansas City, MO, USA
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Adam Booser
- Department of Anesthesiology, Children's Mercy Kansas City, Kansas City, MO, USA
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| |
Collapse
|
14
|
Dragonas CG, Kottaridou E, Vampertzis T, Abbakr L, Taha N, Manoukian D. Length of treatment and ultrasound timing in infants with developmental dysplasia of the hip. Eur J Orthop Surg Traumatol 2024; 34:1079-1086. [PMID: 37934277 DOI: 10.1007/s00590-023-03771-z] [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] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 10/23/2023] [Indexed: 11/08/2023]
Abstract
PURPOSE Developmental dysplasia of the hip (DDH) joint is a complex condition that may lead to severe problems. Ultrasound scan (USS) in the first four-to-six weeks of life is considered the gold-standard for diagnosis while the Pavlik harness (PH) is a widely utilized method as first-line treatment. The purpose of this study is to compare clinical outcomes of infants with DDH in relation to the timing and frequency of USS following application of the PH. METHODS Retrospective data were collected over a 5-year period from February 2017 to February 2022. We included patients who underwent the first USS post-diagnosis and PH application in two, three, four and six weeks. Two-hundred-twenty-five patients were included and divided in four groups according to timing of the first follow-up: week-2, n = 13; week-3, n = 66; week-4, n = 95; and week-6, n = 51. For every patient Graf classification, treatment length and number of follow-ups were documented. RESULTS Week-3 and week-4 groups displayed a statistically significant shorter treatment length compared to week-6 group (p value < 0.001), while also demonstrating a lower number of sonographic follow-ups per patient compared to both week-6 (p value < 0.001) and week-2 (p value = 0.002 vs week-3; p value < 0.001 vs week 4). Week-4 group presented the highest treatment completion (56%) on first visit post-diagnosis. Conservative treatment with PH failed in 1.8% (4/225) and displayed no significant difference among all subgroups. CONCLUSIONS Differences in timing of first USS post-DDH diagnosis and initiation of treatment can lead to discrete outcomes with implications to the clinical outcome and cost effectiveness.
Collapse
Affiliation(s)
| | | | - Themistoklis Vampertzis
- The Royal London Hospital, Barts Health Trust, London, UK
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Lina Abbakr
- Princess Alexandra Hospital NHS Trust, Hamstel Road, Harlow, Essex, CM20 1QX, UK
| | - Narmeen Taha
- Princess Alexandra Hospital NHS Trust, Hamstel Road, Harlow, Essex, CM20 1QX, UK
| | - Dimitrios Manoukian
- Princess Alexandra Hospital NHS Trust, Hamstel Road, Harlow, Essex, CM20 1QX, UK
- The Royal London Hospital, Barts Health Trust, London, UK
| |
Collapse
|
15
|
Batley MG, Gornitzky AL, Sarkar S, Sankar WN. What Are the Psychosocial Effects of Pavlik Harness Treatment? A Prospective Study on Perceived Impact on Families and Maternal-Infant Bonding. J Pediatr Orthop 2024; 44:e109-e114. [PMID: 37807604 DOI: 10.1097/bpo.0000000000002542] [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: 10/10/2023]
Abstract
BACKGROUND The Pavlik harness (PH) is the most common treatment for infants with developmental dysplasia of the hip. Although success rates are high when used appropriately, brace treatment may impact family function and parental bonding. The purpose of this study was to prospectively determine how PH treatment affected these psychosocial variables. METHODS This is a prospective, single-surgeon study at a tertiary-care, urban, academic children's hospital between November 2022 and March 2023. All patients newly treated with a Pavlik were eligible. Caregivers were administered the Postpartum Bonding Questionnaire and the Revised Impact on Family Scale (rIOFS) at the baseline visit and 2- and 6 weeks following treatment initiation. Demographic and treatment-specific information was collected through surveys and retrospective chart review. Descriptive statistics and bivariate analysis were used. RESULTS A total of 55 caregiver-child dyads were included in the final analysis. Most patients were female (89%) and/or first-born (73%). Forty (73%) hips were diagnosed as having stable dysplasia. rIOFS scores steadily improved from baseline, through 2- and 6 weeks posttreatment initiation. Six-week rIOFS scores were significantly lower than both baseline ( P= 0.002) and 2 weeks ( P =0.018). Average parental bonding scores also improved steadily throughout treatment and did not surpass the threshold of clinical concern at any time. Neither full-time harness use (24 h/d vs. 23 h/d based upon clinical stability) nor age at treatment initiation had a statistically significant effect on parental bonding or family functioning (all P >0.05). Additional demographic variables such as birth order, parental history of anxiety/depression, and relative socioeconomic disadvantage also had no significant effect on psychosocial outcomes. CONCLUSION PH treatment did not significantly impact maternal-fetal bonding or family dynamics. Relative to other pediatric diseases, PH treatment has an impact on family life greater than that of single-leg spica, but less than that of school-age children with chronic medical illnesses. As PH treatment is a widely used treatment for infantile developmental dysplasia of the hip, this study provides information that clinicians may use to more accurately counsel families and assuage parental concerns. LEVELS OF EVIDENCE Level IV-prospective uncontrolled cohort study.
Collapse
Affiliation(s)
- Morgan G Batley
- Department of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Alex L Gornitzky
- Department of Orthopaedic Surgery, University of Michigan Hospital, Ann Arbor, MI
| | - Sulagna Sarkar
- Department of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Wudbhav N Sankar
- Department of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, PA
| |
Collapse
|
16
|
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.
Collapse
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
| |
Collapse
|
17
|
Hockett C, Mayfield LM, Gill CS, Kim HKW, Sucato DJ, Podeszwa DA, Jo CH, Morris WZ. Does Screening Ultrasound Timing in Developmental Dysplasia of the Hip Need to be Adjusted for Moderate Preterm and Near-term Infants: A Prospective Study. J Pediatr Orthop 2024; 44:e25-e29. [PMID: 37773040 DOI: 10.1097/bpo.0000000000002540] [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: 09/30/2023]
Abstract
INTRODUCTION An initial screening ultrasound is essential for patients at higher risk of developmental dysplasia of the hip (DDH) due to breech presentation or a family history of DDH. The American Academy of Pediatrics recommends screening ultrasounds to be performed after 6 weeks of age to reduce the rate of false positives. However, there is limited evidence regarding whether these screening ultrasounds need to be adjusted for gestational age in prematurity. The purpose of this study was to evaluate the influence of moderate preterm and near-term births on screening hip ultrasounds for high-risk DDH populations. METHODS We identified all prospectively enrolled patients in a single-center database referred for screening hip ultrasound for DDH. We included those hips referred for risk factors of DDH, including breech presentation, family history of DDH, or hip click, and excluded those with known dysplasia or referral for hip instability. Each ultrasound was measured by a pediatric radiologist to determine the alpha angle and femoral head coverage. Patients were classified as "premature" if born at <37 weeks gestation or "full term" if born at ≥37 weeks gestation. All patients underwent screening hip ultrasound between 5 and 8 weeks of age. Sonographic markers of dysplasia and the incidences of abnormal ultrasound and Pavlik harness treatment were compared between cohorts. Significance was set at P <0.05. RESULTS A total of 244 hips in 122 patients were included, 58 hips in the premature cohort and 186 hips in the full-term cohort. The premature cohort had a significantly decreased gestational age compared with the full-term cohort (35.4 ± 1.1 vs 38.5 ± 1.1 wk, respectively, P < 0.001). However, there was no difference between premature and full-term cohorts in sex distribution (69% vs 75%, females, P = 0.39), unadjusted age at the time of ultrasound (6.6 ± 0.7 vs 6.8±0.7 wk, respectively, P = 0.07), or referral reason ( P = 0.14). On hip ultrasound, there was no difference between premature and full-term cohorts with respect to alpha angle (62.6 ± 3.3 vs 62.2 ± 5.3 degrees, P = 0.41), femoral head coverage (54.9 ± 6.3 vs 55.1 ± 10.6, P = 0.19), rate of abnormal ultrasound (18.3% vs 20.7%, respectively, P = 0.68), or the rate of Pavlik harness treatment (0% vs 5.3%, respectively, P = 0.12). DISCUSSION There was no significant difference in alpha angle or femoral head coverage between premature and full-term patients at 5 to 8 weeks of unadjusted age. This preliminary data suggests that screening ultrasounds can be performed without adjusting for prematurity. LEVEL OF EVIDENCE Level II, prognostic study.
Collapse
Affiliation(s)
- Claire Hockett
- Department of Orthopaedic Surgery, Scottish Rite for Children
| | | | - Corey S Gill
- Department of Orthopaedic Surgery, Scottish Rite for Children
- Department of Orthopaedic Surgery, University of Texas, Southwestern Medical Center, Dallas, TX
| | - Harry K W Kim
- Department of Orthopaedic Surgery, Scottish Rite for Children
- Department of Orthopaedic Surgery, University of Texas, Southwestern Medical Center, Dallas, TX
| | - Daniel J Sucato
- Department of Orthopaedic Surgery, Scottish Rite for Children
- Department of Orthopaedic Surgery, University of Texas, Southwestern Medical Center, Dallas, TX
| | - David A Podeszwa
- Department of Orthopaedic Surgery, Scottish Rite for Children
- Department of Orthopaedic Surgery, University of Texas, Southwestern Medical Center, Dallas, TX
| | - Chan-Hee Jo
- Department of Orthopaedic Surgery, Scottish Rite for Children
- Department of Orthopaedic Surgery, University of Texas, Southwestern Medical Center, Dallas, TX
| | - William Z Morris
- Department of Orthopaedic Surgery, Scottish Rite for Children
- Department of Orthopaedic Surgery, University of Texas, Southwestern Medical Center, Dallas, TX
| |
Collapse
|
18
|
Abstract
Coxa Magna (CM) is defined as a condition in which the horizontal (transverse) diameter of the femoral head is larger on the affected side than on the intact side. CM can occur as a manifestation of avascular necrosis (AVN) following treatment for the developmental dysplasia of the hip (DDH). Alternatively, it can also be secondary to other hip disorders, such as Perthes' disease. This study aimed to determine the prevalence and indicators of CM and AVN of the femoral head that can be detected during follow-up in patients with unilateral DDH treated with closed reduction (CR) or open reduction (OR) surgery. The files of 143 patients treated for unilateral DDH between January 1997 and December 2017 were reviewed retrospectively. A total of 104 patients, including Group 1 ( n = 49) patients who underwent CR under general anesthesia and Group 2 ( n = 55) patients who underwent OR were included in the study. CM; It was considered as the case where the femoral head was 15% or more larger than the intact side. A total of 104 patients were followed up for 77.27 ± 13.96 months, with a mean age of 15.43 ± 7.76 months. When Group 1 and Group 2 were compared, there was no statistical difference in terms of sex, side, adductor tenotomy, and AVN ( P > 0.05). CM developed in 22.4% ( n = 11) of the patients in Group 1 and in 49.1% ( n = 27) in Group 2, and the difference was statistically significant ( P = 0.008). When the effect of independent variables on the development of CM is evaluated with the multivariate logistic regression model, the risk of developing CM is 3474 times higher in those who underwent iliopsoas tenotomy compared with those who did not. The primary outcome of this study is that CM is more frequent in patients treated with OR for DDH. CM may be a nonpathological condition that occurs in connection with iliopsoas tenotomy or surgical treatment. Prospective studies with a larger number of cases, designed to minimize confounding factors, are required.
Collapse
Affiliation(s)
- Duran Topak
- Department of Orthopaedic Surgery, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras
| | - Ahmet Aslan
- Department of Orthopedic Surgery, School of Medicine, Alanya Alaaddin Keykubat University, Antalya
| | | |
Collapse
|
19
|
Martino R, Carry P, Adams J, Brandt A, Sink E, Selberg C. The Optimal Age for Surgical Management of DDH Differs by Treatment Method. J Pediatr Orthop 2024; 44:7-14. [PMID: 37970702 DOI: 10.1097/bpo.0000000000002569] [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: 11/17/2023]
Abstract
BACKGROUND There is a lack of consensus on the optimal age for specific surgical interventions for developmental dysplasia of the hip. We compared radiographic and clinical outcomes among patients who were treated with closed reduction (CR), open reduction (OR), and open reduction with concomitant pelvic osteotomy (ORP) for the treatment of a dislocated hip. We sought to identify the optimal age at treatment within each of these groups. METHODS We retrospectively reviewed 256 hips (n=195 patients) who underwent CR (n=96), OR (n=116), or an ORP (n=44) as their index procedure at a single institution between January 1, 2004 and September 23, 2020. Radiographic outcomes included acetabular index, The International Hip Dysplasia Institute classification, and acetabular depth ratio. The incidence of further corrective surgery (FCS), defined as the need for an additional femoral and/or pelvic osteotomy before skeletal maturity, and the optimal age cutoffs for index surgery within each surgical group were determined. RESULTS After adjusting for age and sex, the incidence of FCS was 13.8% in the CR group, 29.2% in the OR group, and 9.2% in the ORP group. Earlier surgery was protective against FCS in the CR and OR groups. In contrast, patients in the ORP group who were older at index procedure were less likely to undergo FCS. Optimal age at surgery was 9.9 months (CR), 11.5 months (OR), and 21.4 months (ORP). Compared with older patients, younger patients were associated with a larger average decrease in the acetabular index and a larger average increase in acetabular width during the first 5 years post surgery. CONCLUSIONS Age at index surgical procedure was correlated with both clinical and radiographic outcomes. Age at index procedure did impact the risk of subsequent FCS, particularly in the CR and ORP groups. Based on our analysis, CR should be considered before 9.9 months of age and OR considered before 11.5 months of age to minimize the risk of FCS during childhood. This work highlights the importance of considering age-related heterogeneity in developmental dysplasia of the hip treatment outcomes. LEVEL OF EVIDENCE Level III-retrospective comparative study.
Collapse
Affiliation(s)
- Rachael Martino
- Children's Hospital Colorado
- Orthopedics Institute, University of Colorado Anschutz, Aurora, CO
| | - Patrick Carry
- Orthopedics Institute, University of Colorado Anschutz, Aurora, CO
| | - Jordyn Adams
- Children's Hospital Colorado
- Orthopedics Institute, University of Colorado Anschutz, Aurora, CO
| | | | | | - Courtney Selberg
- Children's Hospital Colorado
- Orthopedics Institute, University of Colorado Anschutz, Aurora, CO
| |
Collapse
|
20
|
Kwart A, Pacana M, Otsuka N, Piazza B, Armstrong D, Shaw B, S Segal L, Sorenson S, Fortuna K, Abzug J, Hennrikus W. Developmental dysplasia of the hip and ultrasound reading by pediatric orthopedic surgeons: a pilot study. J Pediatr Orthop B 2024; 33:16-20. [PMID: 36943679 DOI: 10.1097/bpb.0000000000001070] [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: 03/23/2023]
Abstract
Ultrasound is an imaging modality utilized for early detection and follow-up of developmental dysplasia of the hip (DDH) in infants. Traditionally, pediatric orthopedic surgeons have relied on radiologists to perform ultrasound examinations and interpret the imaging. Today, however, many orthopedic surgeons are performing and interpreting ultrasound themselves. The purpose of this paper was to evaluate the reliability of pediatric orthopedic surgeons in interpreting ultrasound imaging of infant hips. This was a prospective observational pilot study. After reading an instructional handout about the Graf method of hip ultrasonography, eight pediatric orthopedic surgeons measured 28 hip ultrasound images to determine the alpha angle and percent femoral head coverage. On the basis of cited intraclass correlation coefficient cutoff values, interrater reliability was found to be 'good' for percent femoral head coverage and 'fair' for alpha angle. These findings are equivalent to findings of similar studies using radiologists as examiners. Pediatric orthopedic surgeons can interpret ultrasound exams for diagnosing DDH.
Collapse
Affiliation(s)
- Ariel Kwart
- Department of Orthopaedics and Rehabilitation, Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Matthew Pacana
- Department of Orthopaedics and Rehabilitation, Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Norman Otsuka
- Department of Orthopedic Surgery and Musculoskeletal Science, Children's Mercy Hospital, Kansas City, Missouri
| | - Brian Piazza
- Department of Orthopaedics and Rehabilitation, Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Douglas Armstrong
- Department of Orthopaedics and Rehabilitation, Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Brian Shaw
- Department of Orthopaedic Surgery, Children's Hospital Colorado, Aurora, Colorado
| | - Lee S Segal
- Accreditation Council for Graduate Medical Education (ACGME), Chicago, Illinois, eWyoming Orthopaedics and Spine Center, Gillette, Wyoming
| | - Scott Sorenson
- Department of Orthopaedics and Rehabilitation, Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Kristine Fortuna
- Department of Orthopaedics and Rehabilitation, Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Joshua Abzug
- Division of Pediatric Orthopaedics, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - William Hennrikus
- Department of Orthopaedics and Rehabilitation, Milton S. Hershey Medical Center, Hershey, Pennsylvania
| |
Collapse
|
21
|
Kizawa F, Suzuki D, Nagoya S, Kanaizumi A, Shimizu T, Irie T, Takahashi D, Iwasaki N. Joint instability in patients with borderline developmental dysplasia of the hip. Clin Biomech (Bristol, Avon) 2024; 111:106136. [PMID: 38065038 DOI: 10.1016/j.clinbiomech.2023.106136] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 10/08/2023] [Accepted: 10/27/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND The treatment strategy for developmental dysplasia of the hip is determined based on the lateral center-edge angle. Nonetheless, an evaluation of joint instability may be important in determining the treatment strategy. This study classified the displacement patterns of the femoral head center during hip abduction. METHODS Ten patients with borderline developmental dysplasia of the hip, 10 patients with developmental dysplasia of the hip, and 10 patients with normal hips were analyzed. Image matching was performed using X-ray images of hip abduction with a three-dimensional hip model. The displacement of the femoral head center and its trajectory length were measured. A cluster analysis was conducted to classify the displacement pattern of the femoral head center, and trajectory lengths were compared. FINDINGS Displacement was classified into three patterns: medialization, hinge abduction, and centering. Patients with borderline developmental hip dysplasia exhibited all three patterns. Almost all patients with developmental dysplasia of the hip showed medialization and hinge abduction, whereas all normal patients had the centering type. The mean trajectory length indices for the medialization and hinge abduction types were significantly longer than those for the centering type (P = 0.01 and P = 0.016, respectively). INTERPRETATION Borderline developmental dysplasia of the hip is a heterogeneous condition characterized by varying hip instability levels. Our findings suggest that uniform evaluation based on the lateral center-edge angle is inappropriate and that joint instability must be evaluated in each patient with borderline developmental dysplasia of the hip.
Collapse
Affiliation(s)
- Fumiya Kizawa
- Division of Rehabilitation, Hokkaido University Hospital, Kita-14, Nishi-5, Kita-ku, Sapporo 060-8648, Japan; Department of Musculoskeletal Biomechanics and Surgical Development, Sapporo Medical University, Minami-1, Nishi-17, Chuo-ku, Sapporo 060-8556, Japan.
| | - Daisuke Suzuki
- Department of Musculoskeletal Biomechanics and Surgical Development, Sapporo Medical University, Minami-1, Nishi-17, Chuo-ku, Sapporo 060-8556, Japan; Department of Health Sciences, Hokkaido Chitose College of Rehabilitation, Satomi 2-10, Chitose 066-0055, Japan.
| | - Satoshi Nagoya
- Department of Musculoskeletal Biomechanics and Surgical Development, Sapporo Medical University, Minami-1, Nishi-17, Chuo-ku, Sapporo 060-8556, Japan.
| | - Arata Kanaizumi
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Minami-1, Nishi-17, Chuo-ku, Sapporo 060-8556, Japan
| | - Tomohiro Shimizu
- Department of Orthopaedic Surgery, Faculty of Medicine, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo 060-8638, Japan.
| | - Tohru Irie
- Department of Orthopaedic Surgery, Faculty of Medicine, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo 060-8638, Japan
| | - Daisuke Takahashi
- Department of Orthopaedic Surgery, Faculty of Medicine, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo 060-8638, Japan.
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo 060-8638, Japan.
| |
Collapse
|
22
|
Shahbazi P, Ghaseminejad-Raeini A, Sheikhvatan M, Shafiei SH. Response to letter on risk factors for dislocation following total hip arthroplasty in developmental dysplasia of the hip: a systematic review and meta-analysis. Int Orthop 2024; 48:311-313. [PMID: 37981589 DOI: 10.1007/s00264-023-06040-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 11/10/2023] [Indexed: 11/21/2023]
Affiliation(s)
- Parmida Shahbazi
- Orthopedic Department, Orthopaedic Subspecialty Research Center (OSRC), Sina University Hospital, Tehran University of Medical Sciences, Hassan Abad Square, Imam Khomeini Avenue, Po Box: 1136746911, Tehran, Iran
| | - Amirhossein Ghaseminejad-Raeini
- Orthopedic Department, Orthopaedic Subspecialty Research Center (OSRC), Sina University Hospital, Tehran University of Medical Sciences, Hassan Abad Square, Imam Khomeini Avenue, Po Box: 1136746911, Tehran, Iran
| | - Mehrdad Sheikhvatan
- Orthopedic Department, Orthopaedic Subspecialty Research Center (OSRC), Sina University Hospital, Tehran University of Medical Sciences, Hassan Abad Square, Imam Khomeini Avenue, Po Box: 1136746911, Tehran, Iran
- Heidelberg Medical Hospital, Heidelberg, Germany
| | - Seyyed Hossein Shafiei
- Orthopedic Department, Orthopaedic Subspecialty Research Center (OSRC), Sina University Hospital, Tehran University of Medical Sciences, Hassan Abad Square, Imam Khomeini Avenue, Po Box: 1136746911, Tehran, Iran.
| |
Collapse
|
23
|
Xiang D, Liu X, Xia Z. Letter to: risk factors for dislocation following total hip arthroplasty in developmental dysplasia of the hip: a systematic review and meta-analysis. Int Orthop 2024; 48:309-310. [PMID: 37857857 DOI: 10.1007/s00264-023-06007-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 10/04/2023] [Indexed: 10/21/2023]
Affiliation(s)
- Dong Xiang
- Joint Surgery Treatment Center, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, 445000, Hubei, China
| | - Xing Liu
- Joint Surgery Treatment Center, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, 445000, Hubei, China
| | - Zhongnan Xia
- Internal Medicine Cardiovascular Center, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, 445000, Hubei, China.
| |
Collapse
|
24
|
Alhussainan TS, Alahmari MS, Essa Ahmed F, Alshwieer MA, Aloqail TSA. Surgical Treatment of Late Developmental Dysplasia of the Hip in Bladder Exstrophy: A Case Report. JBJS Case Connect 2024; 14:01709767-202403000-00042. [PMID: 38452165 DOI: 10.2106/jbjs.cc.23.00635] [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] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
CASE We present a case of an 8-year-old boy with classical bladder exstrophy and a neglected right hip dislocation, exemplifying the risk of missed developmental dysplasia of the hip (DDH) in patients with exstrophy requiring careful orthopaedic oversight. CONCLUSIONS When treating patients with bladder exstrophy, physicians and surgeons should be vigilant not to miss associated DDH. If this condition requires surgical treatment, preoperative planning with computed tomography scans is vital to uncovering the complexities arising from abnormal pelvic and acetabular anatomy and ensuring successful treatment outcomes.
Collapse
Affiliation(s)
- Thamer S Alhussainan
- Department of Orthopedic Surgery, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Mousa Saeed Alahmari
- Department of Orthopedic Surgery, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Faris Essa Ahmed
- Department of Orthopedic Surgery, Al-Imam Abdulrahman Al-Faisal Hospital, First Health Cluster, Ministry of Health, Riyadh, Saudi Arabia
| | | | | |
Collapse
|
25
|
Lankinen V, Vuorinen RL, Helminen M, Bakti K, Välipakka J, Laivuori H, Hyvärinen A. Costs of abduction treatment in developmental dysplasia of the hip. Analysis of 900 patients. Ann Med 2023; 55:2290694. [PMID: 38065688 PMCID: PMC10836239 DOI: 10.1080/07853890.2023.2290694] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/27/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Developmental dysplasia of the hip (DDH) is a disorder of hip development that leads to dysplasia, subluxation, or total hip dislocation. Early detection of DDH is important, and early initiation of abduction treatment is key to successful correction of the hip joint. However, mild forms of DDH, including hip instability without complete dislocation, have good spontaneous healing potential, and a watchful waiting strategy in mild DDH has been found to be safe. In this study, we aimed to evaluate the cost differences between different treatment strategies for DDH. MATERIAL AND METHODS Data were collected retrospectively from the medical records of all children diagnosed with diagnosis and treatment of DDH in Tampere University hospital between 1998 and 2018. In total, 948 patients were included in the study. Patients who underwent casting or operative treatment (n = 48) were excluded from the analysis. All Ortolani positive children were subjected to early abduction treatment. Children with Ortolani negative DDH were subjected to either watchful waiting or early abduction treatment, based on the clinicians' decision. The regression model estimates for the number of clinical visits with and without ultrasound examination were assessed together with cost reports from Tampere University Hospital for the calculation of savings per patient in spontaneous recovery. RESULTS Alpha angles at one month of age (p < 0.001) and treatment method (p < 0.001) affected the number of clinical visits and ultrasound examinations during the treatment follow-up. A low alpha angle predicted closer follow-up, and children with spontaneous recovery had lower numbers of clinical visits and ultrasound examinations than children in abduction treatment. Spontaneous recovery was found to result in approximately 375€/patient savings compared to successful abduction treatment. CONCLUSION With correct patient selection, a watchful waiting strategy is cost-effective in treating mild developmental dysplasia of the hip, considering the high percentage of spontaneous recovery.
Collapse
Affiliation(s)
- Vilma Lankinen
- Department of Pediatric Surgery, Turku University Hospital, Turku, Finland
- Faculty of Medicine and Health Technology, Tampere University, Finland
| | - Riikka-Liisa Vuorinen
- Faculty of Medicine and Health Technology, Tampere University, Finland
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
| | - Mika Helminen
- Faculty of Social Sciences, Health Sciences, Tampere University, Finland
- Tays Research Services, Tampere University Hospital, Tampere, Finland
| | - Karim Bakti
- Faculty of Medicine and Health Technology, Tampere University, Finland
| | | | - Hannele Laivuori
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Center for Child, Adolescent, and Maternal Health Research, Tampere University, Tampere, Finland
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
- Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anna Hyvärinen
- Faculty of Medicine and Health Technology, Tampere University, Finland
- Tays Research Services, Tampere University Hospital, Tampere, Finland
- Department of Surgery, Mehiläinen Länsi-Pohja Oy, Kemi, Finland
- Department of Pediatric Surgery, Oulu University Hospital, Oulu, Finland
- Clinical Medicine Research Unit, Medical Research Center, University of Oulu, Oulu, Finland
| |
Collapse
|
26
|
Huang YY, Lee WC, Chang CH, Yang WE, Kao HK. Environmental factors associated with incidence of developmental dysplasia of the hip: a systematic review and meta-analysis. BMC Musculoskelet Disord 2023; 24:942. [PMID: 38053132 DOI: 10.1186/s12891-023-07073-7] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 11/27/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Established associated factors for DDH include female sex, breech presentation, family history, congenital malformations, oligohydramnios, and maternal hyperthyroidism. However, evidence for environmental factors that may contribute to DDH is limited and inconsistent. METHODS A systematic review of medical literature was conducted to collect data on environmental factors, including latitude, longitude, average yearly precipitation, average yearly temperature, minimum monthly temperature, and maximum monthly temperature, from all institutions that published articles on DDH. Univariate linear regression analysis was used to examine the correlation between environmental factors and DDH incidence, while multiple regression analysis was conducted to identify significant associated factors for DDH incidence. RESULTS Data from a total of 93 unique manuscripts were analyzed, revealing a significant negative correlation between DDH incidence and temperature, including average yearly temperature (r = -0.27, p = 0.008), minimum monthly temperature (r = -0.28, p = 0.006), and maximum monthly temperature (r = -0.23, p = 0.029). Additionally, there was a significant positive correlation between DDH incidence and latitude (r = 0.27, p = 0.009), and a significant negative correlation between DDH incidence and average yearly precipitation (r = -0.29, p = 0.004). In the final multiple regression analysis, temperature, including average yearly temperature, minimum monthly temperature, and maximum monthly temperature, were identified as significant associated factors for DDH incidence. CONCLUSION The findings of this study suggest an association between cold weather and DDH incidence. Further research should explore the link between cold weather and DDH incidence, offering insights into potential interventions for cold climates.
Collapse
Affiliation(s)
- Yu-Yi Huang
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Chun Lee
- Department of Pediatric Orthopaedics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Hsieh Chang
- Department of Pediatric Orthopaedics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wen-E Yang
- Department of Pediatric Orthopaedics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsuan-Kai Kao
- Department of Pediatric Orthopaedics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| |
Collapse
|
27
|
Morris WZ, Kak A, Mayfield LM, Kang MS, Jo CH, Kim HKW. Does brace treatment following closed reduction of developmental dysplasia of the hip improve acetabular coverage? Bone Joint J 2023; 105-B:1327-1332. [PMID: 38035597 DOI: 10.1302/0301-620x.105b12.bjj-2023-0255.r1] [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: 12/02/2023]
Abstract
Aims Abduction bracing is commonly used to treat developmental dysplasia of the hip (DDH) following closed reduction and spica casting, with little evidence to support or refute this practice. The purpose of this study was to determine the efficacy of abduction bracing after closed reduction in improving acetabular index (AI) and reducing secondary surgery for residual hip dysplasia. Methods We performed a retrospective review of patients treated with closed reduction for DDH at a single tertiary referral centre. Demographic data were obtained including severity of dislocation based on the International Hip Dysplasia Institute (IHDI) classification, age at reduction, and casting duration. Patients were prescribed no abduction bracing, part-time, or full-time wear post-reduction and casting. AI measurements were obtained immediately upon cast removal and from two- and four-year follow-up radiographs. Results A total of 243 hips underwent closed reduction and 82% (199/243) were treated with abduction bracing. There was no difference between those treated with or without bracing with regard to sex, age at reduction, severity of dislocation, spica duration, or immediate post-casting AI (all p > 0.05). There was no difference in hips treated with or without abduction brace with regard to AI at two years post-reduction (32.4° (SD 5.3°) vs 30.9° (SD 4.6°), respectively; p = 0.099) or at four years post-reduction (26.4° (SD 5.2°) vs 25.4° (SD 5.1°), respectively; p = 0.231). Multivariate analysis revealed only IHDI grade predicted AI at two years post-reduction (p = 0.004). There was no difference in overall rate of secondary surgery for residual dysplasia between hips treated with or without bracing (32% vs 39%, respectively; p = 0.372). However, there was an increased risk of early secondary surgery (< two years post-reduction) in the non-braced group (11.4% vs 2.5%; p = 0.019). Conclusion Abduction bracing following closed reduction for DDH treatment is not associated with decreased residual dysplasia at two or four years post-reduction but may reduce rates of early secondary surgery. A prospective study is indicated to provide more definitive recommendations.
Collapse
Affiliation(s)
- William Z Morris
- Scottish Rite for Children, Dallas, Texas, USA
- The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Arnav Kak
- The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | - Michael S Kang
- Scottish Rite for Children, Dallas, Texas, USA
- Asan Medical Center Children's Hospital, Seoul, South Korea
| | - Chan-Hee Jo
- Scottish Rite for Children, Dallas, Texas, USA
- The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Harry K W Kim
- Scottish Rite for Children, Dallas, Texas, USA
- The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| |
Collapse
|
28
|
Nicholson A, Dunne K, Taaffe S, Sheikh Y, Murphy J. Developmental dysplasia of the hip in infants and children. BMJ 2023; 383:e074507. [PMID: 37996104 DOI: 10.1136/bmj-2022-074507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Affiliation(s)
| | | | - Sarah Taaffe
- Irish College of General Practitioners, Dublin, Ireland
| | - Yusra Sheikh
- Department of Paediatric Radiology, Children's Health Ireland at Temple Street, Dublin, Ireland
| | - John Murphy
- Department of Neonatology, National Maternity Hospital, Dublin, Ireland
| |
Collapse
|
29
|
Nicholson A, Dunne K, Taaffe S, Sheikh Y, Murphy J. Developmental dysplasia of the hip in infants and children. BMJ 2023; 383:e074507. [PMID: 37996106 DOI: 10.1136/bmj-2023-074507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Affiliation(s)
| | | | - Sarah Taaffe
- Irish College of General Practitioners, Dublin, Ireland
| | - Yusra Sheikh
- Department of Paediatric Radiology, Children's Health Ireland at Temple Street, Dublin, Ireland
| | - John Murphy
- Department of Neonatology, National Maternity Hospital, Dublin, Ireland
| |
Collapse
|
30
|
Sha J, Huang L, Chen Y, Lin J, Fan Z, Li Y, Yan Y. A novel approach for screening standard anteroposterior pelvic radiographs in children. Eur J Pediatr 2023; 182:4983-4991. [PMID: 37615891 DOI: 10.1007/s00431-023-05164-0] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/04/2023] [Accepted: 08/13/2023] [Indexed: 08/25/2023]
Abstract
Anteroposterior pelvic radiography is the first-line imaging modality for diagnosing developmental dysplasia of the hip (DDH). Nonstandard radiographs with pelvic malposition make the correct diagnosis of DDH challenging. However, as the only method available for screening standard pelvic radiographs, traditional manual assessment is relatively laborious and potentially erroneous. We retrospectively collected 3,247 pelvic radiographs. There were 2,887 radiographs randomly selected to train and optimize the AI model. Then 362 radiographs were used to test the model's diagnostic performance. Its diagnostic accuracy was assessed using receiver operating characteristic (ROC) curves and measurement consistency using Bland-Altman plots. In 362 radiographs, the AI model's area under ROC curves, accuracy, sensitivity, and specificity for quality assessment was 0.993, 99.4% (360/362), 98.6% (138/140), and 100.0% (222/222), respectively. Compared with clinicians, the 95% limits of agreement (Bland-Altman analysis) for pelvic tilt index (PTI) and pelvic rotation index (PRI), as determined by the model, were -0.052-0.072 and -0.088-0.055, respectively. CONCLUSIONS The artificial intelligence-assisted method was more efficient and highly consistent with clinical experts. This method can be used for real-time validation of the quality of pelvic radiographs in current picture archiving and communications systems (PACS). WHAT IS KNOWN • Nonstandard pediatric radiographs with pelvic malposition make the correct diagnosis of developmental dysplasia of the hip (DDH) challenging. • Traditional manual assessment remains the only method available for screening standard pediatric pelvic radiographs, which is relatively laborious and potentially erroneous. WHAT IS NEW • This study proposed an artificial intelligence-assisted model to assess the quality of pediatric pelvic radiographs accurately and efficiently. • We recommend the integration of the model into current picture archiving and communications systems (PACS) for real-time screening of standard pediatric pelvic radiographs.
Collapse
Affiliation(s)
- Jia Sha
- Department of Orthopedics, Xijing Hospital, Air Force Medical University, No.15 Changle Xi Road, Xi'an, 710032, China
| | - Luyu Huang
- Department of Orthopedics, Xijing Hospital, Air Force Medical University, No.15 Changle Xi Road, Xi'an, 710032, China
| | - Yaopeng Chen
- School of Telecommunications Engineering, Xidian University, Xi'an, China
| | - Jincong Lin
- Department of Orthopedics, Xijing Hospital, Air Force Medical University, No.15 Changle Xi Road, Xi'an, 710032, China
| | - Zongzhi Fan
- Department of Orthopedics, Xijing Hospital, Air Force Medical University, No.15 Changle Xi Road, Xi'an, 710032, China
| | - Yi Li
- School of Telecommunications Engineering, Xidian University, Xi'an, China
| | - Yabo Yan
- Department of Orthopedics, Xijing Hospital, Air Force Medical University, No.15 Changle Xi Road, Xi'an, 710032, China.
| |
Collapse
|
31
|
Tarawneh OH, Quan T, Liu IZ, Pizzarro J, Marquardt C, Tabaie SA. Racial disparities in readmission rates following surgical treatment of pediatric developmental dysplasia of the hip. Eur J Orthop Surg Traumatol 2023; 33:2847-2852. [PMID: 36853514 DOI: 10.1007/s00590-023-03496-z] [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] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/13/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE Across orthopedic subspecialties, significant racial disparities have been identified with regard to postoperative outcomes. Despite these findings among adult patients, the literature assessing these disparities within pediatric orthopedics is limited. The purpose of this study was to determine the independent predictors for unplanned readmission following surgical treatment of developmental dysplasia of the hip. METHODS Pediatric patients undergoing hip dysplasia surgery from 2012 to 2019 were identified in the National Surgical Quality Improvement Program-Pediatric database. Two patient groups were defined: patients who had unplanned hospital readmission within 30 days of surgery and patients who were not readmitted. Clinical characteristics assessed included gender, race, and American Society of Anesthesiologists (ASA) class. Risk factors for complications were assessed using bivariate and multivariate analysis. RESULTS Of 6561 pediatric patients undergoing surgical treatment for hip dysplasia, 540 (8.2%) had unplanned readmission. On bivariate analysis, non-white race (Black, Asian, Hispanic, American Indian, and Native Hawaiian), an ASA class of III, IV, or V, pulmonary, renal, neurological, and gastrointestinal comorbidities, as well as immune disease, steroid use, and nutritional support were significantly associated with unplanned readmission (p < 0.05 for all). After controlling for confounding variables on multivariate analysis, non-white race (OR 1.46; p = 0.042) and ASA class of III-V (OR 2.21; p = 0.002) were found to be independent predictors for readmission. CONCLUSION Clinicians should be advised of the increased readmission rates observed in non-white patients and those of higher ASA scores. Further work is needed to combat existing disparities within pediatric orthopedics.
Collapse
Affiliation(s)
- Omar H Tarawneh
- School of Medicine, New York Medical College, 40 Sunshine Cottage Rd, Valhalla, NY, 10595, USA.
| | - Theodore Quan
- Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, 2300 M St, Washington DC, Washington, DC, 20037, USA
| | - Ivan Z Liu
- The Medical College of Georgia, Augusta University, 1120 15th St, GA, 30912, Augusta, USA
| | - Jordan Pizzarro
- Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, 2300 M St, Washington DC, Washington, DC, 20037, USA
| | - Caillin Marquardt
- Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, 2300 M St, Washington DC, Washington, DC, 20037, USA
| | - Sean A Tabaie
- Department of Orthopaedic Surgery, Children's National Hospital, 111 Michigan Avenue, Washington, NWDC, 20010, USA
| |
Collapse
|
32
|
Coleman J, Javed M, Khurshid S, Mahmood L. The use of X-ray as an effective adjunct to the national hip screening policy for developmental dysplasia of the hip: experience at an Irish paediatric unit. Ir J Med Sci 2023; 192:2435-2436. [PMID: 36729223 DOI: 10.1007/s11845-023-03295-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 01/23/2023] [Indexed: 02/03/2023]
Affiliation(s)
- John Coleman
- Department of Clinical Genetics, CHI (Children's Health Ireland) Crumlin Hospital, Dublin, Ireland.
| | - Mehwish Javed
- Department of Paediatrics, St. Luke's General Hospital Kilkenny, Kilkenny, Ireland
| | - Sundas Khurshid
- Department of Paediatrics, St. Luke's General Hospital Kilkenny, Kilkenny, Ireland
| | - Lubna Mahmood
- Department of Paediatrics, St. Luke's General Hospital Kilkenny, Kilkenny, Ireland
| |
Collapse
|
33
|
Kaya O, Gonder N, Demir DA, Demir IH, Akay O. Patients with developmental dysplasia of the hip shows higher digit ratio (2D:4D). Early Hum Dev 2023; 185:105857. [PMID: 37677892 DOI: 10.1016/j.earlhumdev.2023.105857] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Developmental dysplasia of the hip (DDH) encompasses a range of hip disorders, from dysplasia to dislocation. One key factor is sex, with women being four to eight times more susceptible to DDH than men. However, there have been no studies investigating the second-to-fourth digit ratio (2D:4D), a biomarker of prenatal sex steroid exposure, in DDH patients. This study aimed to explore whether there is an association between the 2D:4D ratio and DDH. METHODS Digital calipers were used to measure the second and fourth finger lengths of 250 patients treated for DDH and 200 patients in the healthy control group between January 2020 and January 2023. The Mann-Whitney U test was used for non-normally distributed variables and two-way analysis of variance to assess differences in measurements between DDH patients based on sex, side, and the interaction of sex and side. The intraclass correlation coefficient (ICC) was used to assess measurement repeatability. RESULTS The median (min-max) age was 10.00 (6-16) years in the DDH group, 12.00 (6-16) years in the control group, and 10 (6-16) years for the whole cohort. There was no significant difference in terms of age between the patient and control groups (p = 0.083). When comparing the DDH group with controls the former showed higher right 2D:4D and Δ2D:4D and these differences were significant in both males and females. Among the patients, controlling for side of dysplasia did not affect right 2D:4D, left 2D:4D or Δ2D:4D. CONCLUSION There was a significant association between higher 2D:4D ratios (both right and left hands) and DDH in both men and women. This indicates that the 2D:4D ratio, a marker of intrauterine estrogen/testosterone balance, is associated with DDH.
Collapse
Affiliation(s)
- Oguz Kaya
- Department of Orthopaedics and Traumatology, Elazığ Fethi Sekin City Hospital, Elazığ 23280, Turkey
| | - Nevzat Gonder
- Department of Orthopaedics and Traumatology, Gaziantep Islam Science and Technology University, School of Medicine, Gaziantep 27010, Turkey.
| | - Dilsad Arisoy Demir
- Department of Histology and Embryology, Adıyaman Training and Research Hospital, Adıyaman 02200, Turkey
| | - Ibrahim Halil Demir
- Department of Orthopaedics and Traumatology, Şehitkamil State Hospital, Gaziantep 27310, Turkey
| | - Ozlem Akay
- Department of Biostatistics, Gaziantep Islam Science and Technology University, School of Medicine, Gaziantep 27010, Turkey
| |
Collapse
|
34
|
Wu L, Yang XC, Wu J, Zhao X, Lu ZD, Li P. Short-term outcome of artificial intelligence-assisted preoperative three-dimensional planning of total hip arthroplasty for developmental dysplasia of the hip compared to traditional surgery. Jt Dis Relat Surg 2023; 34:571-582. [PMID: 37750261 PMCID: PMC10546855 DOI: 10.52312/jdrs.2023.1076] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 07/22/2023] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVES This study aims to assess the short-term outcome of total hip arthroplasty for treating developmental dysplasia of the hip (DDH) using artificial intelligence (AI)-assisted three-dimensional (3D) preoperative planning technology. PATIENTS AND METHODS Between January 2020 and July 2022, a total of 61 patients with DDH (31 males, 30 females, mean age: 59.2±10.4 years; range, 35 to 78 years) were retrospectively analyzed. The patients were divided into two groups as those in the observation group of AI-assisted 3D preoperative planning technology (n=34) and the control group of traditional two-dimensional X-ray template planning technology (n=27). Perioperative data of the patients were recorded and analyzed. RESULTS All patients were followed for more than one year, and no hip dislocation, aseptic loosening, periprosthetic fracture, periprosthetic infection or revision occurred. The accuracy of the planning was based on the agreement between the preoperative planning model and the intraoperative model. The accuracy of preoperative planning for the acetabular prosthesis and femoral prosthesis in the observation group was significantly higher than in the control group. No statistically significant difference was found in the postoperative abduction (p=0.416) and anteversion (p=0.225) between the groups. In the observation group, 91.2% of the acetabular cups were implanted within the Lewinnek safe zone (66.7% in the control group) and 88.2% were within the Callanan safe zone (63% in the control group). There was a statistically significant difference between the two groups in terms of the postoperative lower-limb length discrepancy (p=0.004), which was significantly improved in both groups compared to preoperative values (p<0.01 for all). The postoperative Harris hip score in both groups was significantly improved compared to preoperative scores (p<0.01); however, there was no statistically significant difference between the two groups (p=0.098). CONCLUSION Our study results suggest that AI-assisted 3D preoperative planning is evidently more successful than traditional 2D X-ray template planning for predicting prosthesis size. This method seems to be advantageous in acetabular cup positioning, as well as in lower-limb length restoration.
Collapse
Affiliation(s)
| | | | | | | | | | - Peng Li
- Department of Orthopedics, General Hospital of Ningxia Medical University, No. 804 of Shengli South Street, Xingqing District, Yinchuan 750001, China.
| |
Collapse
|
35
|
Yamamoto Y, Saisu T, Harada Y, Inoue R, Aoki M, Ishibashi Y. Simultaneous open reduction and Z-shaped modified Salter osteotomy for developmental dysplasia of the hip: A report of two cases. J Orthop Sci 2023; 28:1184-1188. [PMID: 33558101 DOI: 10.1016/j.jos.2020.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/16/2020] [Accepted: 12/16/2020] [Indexed: 11/21/2022]
Affiliation(s)
- Yuji Yamamoto
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
| | - Takashi Saisu
- Chiba Child and Adult Orthopaedic Clinic, Chiba, Japan
| | - Yoshifumi Harada
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Ryo Inoue
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Megumi Aoki
- Department of Orthopedic Surgery, Aomori Prefectural Asunaro Care and Welfare Center, Aomori, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| |
Collapse
|
36
|
Abdulla N, Ashoor M, Heinz N, Alexopoulos V, Majid I, Morakis E, Khamis AH, Alshryda S. Prognostic factors for failed Pavlik harness treatment in infants with developmental dysplasia of the hip: a retrospective cohort study. Int Orthop 2023; 47:2337-2345. [PMID: 37170027 DOI: 10.1007/s00264-023-05829-3] [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] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 04/26/2023] [Indexed: 05/13/2023]
Abstract
PURPOSE Pavlik harness treatment is the most common treatment in newborns diagnosed with developmental dysplasia of the hip (DDH). The success rates and predictors for failure have been debated over the last decade. In this study, we explored our treatment failure rate and potential prognostic factors that could predict the failure of Pavlik harness (PH) treatment in patients with DDH. METHODS Two hundred and sixty-five patients were treated with PH based on the Graf hip types of classification. Age, gender, first born status, family history, foot deformity, plagiocephaly, breech presentation, hip abduction, hip stability, Graf hip type, Galeazzi sign, bilateralism, and femoral nerve palsy were tested as predictors for failure in multivariate logistic regression mode. Success and failure were determined by the normalization of the hip based on the Graf hip classification. RESULTS The failure rate of patients treated with Pavlik harness was 16.6% which is within the reported range of failure rate. The mean age of patients who were successfully treated was 6.73 weeks in comparison to 8.84 weeks for those who failed. Age, plagiocephaly, hip instability, Graf classification, and the development of femoral nerve palsy were found to be predictors for failure of PH treatment upon univariate analysis only. However, only the presence of Galeazzi sign, hip instability, high grades of Graf hip classification, and the development of femoral nerve palsy proved to be independent predictors for failed PH treatment upon multivariate logistic regression analysis. CONCLUSIONS Pavlik harness treatment is a successful treatment with an average success of 83.4%. Several independent predictors for failure of PH treatment have been identified. These include a positive Galeazzi sign, a frankly dislocated hip, Graf types III and IV, and the development of femoral nerve palsy.
Collapse
Affiliation(s)
- Nada Abdulla
- Medical School, Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU), Dubai, United Arab Emirates
| | - Maryam Ashoor
- Al Jalila Children's Specialty Hospital, Dubai, United Arab Emirates
| | | | | | - Ibrar Majid
- Al Jalila Children's Specialty Hospital, Dubai, United Arab Emirates
| | | | - Amar Hassan Khamis
- Medical School, Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU), Dubai, United Arab Emirates
| | - Sattar Alshryda
- Al Jalila Children's Specialty Hospital, Dubai, United Arab Emirates.
| |
Collapse
|
37
|
Laborie LB, Rosendahl K, Dhouib A, Simoni P, Tomà P, Offiah AC. The effect of selective ultrasound screening on the incidence of late presentation of developmental hip dysplasia-a meta-analysis. Pediatr Radiol 2023; 53:1977-1988. [PMID: 37099154 PMCID: PMC10497659 DOI: 10.1007/s00247-023-05666-x] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/03/2023] [Accepted: 04/04/2023] [Indexed: 04/27/2023]
Abstract
Different screening strategies for developmental dysplasia of the hip (DDH) exist. Despite screening efforts, cases of late presentation continue to occur, often necessitating surgery. This systematic review and meta-analysis assess the effect of newborn selective ultrasound screening for DDH on the incidence of late presentation in infants and children, compared to a universal ultrasound strategy. A systematic search across Medline and EMBASE databases was performed between January 1950 and February 2021. A consensus-based evaluation of abstracts led to retrieval of relevant full text, original articles or systematic reviews in English only. These were assessed according to agreed eligibility criteria, and their reference lists were reviewed to identify additional eligible publications. Following final consensus on included publications, data was extracted, analysed and reported as per PRISMA and Prospero (CRD42021241957) guidelines. The 16 eligible studies consisted of 2 randomised controlled trials and 14 cohort studies, published between 1989 and 2014, with a total of 511,403 participants. In total, 121,470 (23.8%) received a neonatal hip ultrasound, of whom 58,086 and 63,384 were part of a selective or a universal ultrasound screening strategy, respectively. The difference in the proportion of late presentation between the universal and selective strategies was 0.0904 per 1,000 (P = 0.047). The time effect, i.e. the difference between early and late presentation defined respectively, as less than and more than 3 months of age, regardless of screening strategy, was not significant (P = 0.272). Although there was variability in study design and reporting, the quality of the evidence, based on the critical appraisal skills programme appraisal tools, was generally good. Compared to universal ultrasound screening for DDH, selective screening resulted in a slightly higher rate of late presentation. Uniformity in design and reporting of DDH studies and a cost-effectiveness analysis are needed.
Collapse
Affiliation(s)
- Lene B Laborie
- Section for Pediatric Radiology, Department of Radiology, Haukeland University Hospital, Jonas Lies vei 65, 5021, Bergen, Norway.
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.
| | - Karen Rosendahl
- Department of Clinical Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromso, Norway
- Section of Paediatric Radiology, University Hospital of North Norway, Tromso, Norway
| | - Amira Dhouib
- Department of Radiology, Reseau hospitalier Neuchatelois, Neuchatel, Switzerland
| | - Paolo Simoni
- Paediatric Imaging Department, 'Reine Fabiola' University Children's Hospital, Université libre de Bruxelles, Brussels, Belgium
| | - Paolo Tomà
- Department of Imaging, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy
| | - Amaka C Offiah
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
- Department of Radiology, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| |
Collapse
|
38
|
Türközü T. Does epinephrine use reduce perioperative blood loss during pelvic and femoral osteotomy with open reduction of the patients with developmental dysplasia of the hip? Jt Dis Relat Surg 2023; 34:694-699. [PMID: 37750275 PMCID: PMC10546857 DOI: 10.52312/jdrs.2023.1282] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 07/31/2023] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVES In this study, we aimed to investigate whether the use of epinephrine solution-impregnated gauzes and irrigation fluid with epinephrine could reduce perioperative blood loss during the combined surgical treatment of developmental dysplasia of the hip (DDH) patients. PATIENTS AND METHODS Between January 2018 and June 2023, a total of 68 pediatric patients (8 males, 60 females; mean age: 32.4±13.2 months; range, 18 to 98 months) who underwent combined surgery for DDH were retrospectively analyzed. The patients were divided into two groups as those who used topical epinephrine in the surgical sites during combined surgical treatment (n=34) and those who did not (n=34). Demographic and clinical characteristics and pre-, intra-, and postoperative data were recorded. To avoid transfusion complications, blood transfusion was performed in only symptomatic patients in the postoperative period. RESULTS Age, sex, weight, and surgical duration were similar between the two groups (p>0.05). No statistically significant difference was found between the groups in terms of preoperative hemoglobin and hematocrit levels (p>0.05) There were statistically significantly differences between the groups in terms of postoperative hemoglobin and hematocrit levels, perioperative amount of blood loss, and postoperative length of hospital stay (p<0.001). No significant difference was found between the groups in terms of intraoperative hemodynamic parameters (p>0.05). The differences in perioperative and estimated intraoperative blood loss amounts and length of hospital stay were statistically significant between the groups (p<0.001). There was a significant relationship between the groups in terms of perioperative and estimated intraoperative blood loss, and transfusion of blood products (p<0.01). Blood transfusion was administered to five patients in the no epinephrine group. No local complications were observed in any group; however, one patient had transfusion-related fever and one patient had allergic skin lesions in the no epinephrine group. CONCLUSION The intraoperative topical use of epinephrine irrigation solution and epinephrine solution-impregnated gauze dressings is effective and safe in reducing blood loss in DDH patients.
Collapse
Affiliation(s)
- Tülin Türközü
- Van Yüzüncü Yıl Üniversitesi Tıp Fakültesi Ortopedi ve Travmatoloji Anabilim Dalı, 65080 Van, Türkiye.
| |
Collapse
|
39
|
Burkhart RJ, McNassor R, Acuña AJ, Kamath AF. Is prematurity a risk factor for developmental dysplasia of the hip? A systematic review and meta-analysis. J Pediatr Orthop B 2023; 32:305-311. [PMID: 36445370 DOI: 10.1097/bpb.0000000000001021] [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: 11/30/2022]
Abstract
Developmental dysplasia of the hip (DDH) is the most common orthopedic disorder in newborns. Early recognition and diagnosis are critical to prevent long-term complications. While several risk factors have been established, the association between prematurity and DDH remains unclear. Our analysis sought to analyze the literature exploring the relationship between prematurity and DDH. Articles evaluating the relationship between prematurity and DDH published between 1 January 2000 and 1 February 2022 were queried, with 11 studies included for analysis. Overall, a total of 8720 patients were included. The gestational age ranged from 23 to 36 weeks for preterm and ≥37 weeks for term births. Seven studies agreed that gestational age did not have a significant impact on DDH. Pooled analysis of available data demonstrated no significant difference in DDH among preterm and term infants (OR, 1.11; 95% CI, 0.82-1.51; P = 0.49). Sub-group analysis of two studies reporting data on very preterm (≤32 weeks) and term infants revealed no significant difference in the occurrence of DDH (OR, 4.58; 95% CI, 0.09-244.78; P = 0.45). Four studies found early gestational age is associated with a significantly higher incidence of mature hips compared to late preterm or term babies. Similarly, pooled analysis demonstrated significantly lower Graf classification among preterm infants (OR, 0.13; 95% CI, 0.03-0.61; P = 0.009). Based on the current literature, our analysis found that prematurity is not strongly associated with DDH. Furthermore, early gestational age was associated with a significantly higher incidence of mature hips measured by Graf classification.
Collapse
Affiliation(s)
- Robert J Burkhart
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | | | | | | |
Collapse
|
40
|
Hsu KH, Chang WC, Feng CK, Su YP. Implementing the AAOS Guidelines for Screening of Developmental Dysplasia of the Hip Before the Age of 6 Months in Taiwan. J Pediatr Orthop 2023; 43:e416-e420. [PMID: 37043437 PMCID: PMC10234313 DOI: 10.1097/bpo.0000000000002414] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
BACKGROUND The prevalence of developmental dysplasia of the hip (DDH) has been considered to be low in East Asia, but this may be incorrect because of inconsistent diagnostic definitions and testing criteria. In 2015, the AAOS released guidelines for systematic screening for DDH in newborns. We implemented these guidelines and compared DDH incidence and outcomes before and after their implementation. METHODS We used a historic comparison cohort of newborns with DDH between July 2015 and May 2017 before guideline implementation (the preguideline group); their data were retrieved using electronic medical records. In this group, the newborns received general hip screening without systemic follow-up. The postguideline group included newborns who were screened for hip dysplasia and followed up per the AAOS guidelines between July 2017 and May 2019. Their data were prospectively collected. The primary outcome in the postguideline group was DDH incidence. Other outcomes included rates of referral, surgery, and complications, and DDH prognosis. RESULTS The preguideline and postguideline groups included 3534 and 2663 newborns, respectively, of whom 49 (1.1%) and 225 (8.4%), respectively, were referred to the pediatric orthopaedic clinic enrolled. In the postguideline group, 35 patients were diagnosed as having DDH (incidence: 1.3%, 95% CI: 0.8%-1.9%). Both the incidence and referral rates were significantly higher in the postguideline group than in the preguideline group. Furthermore, the mean age at referral was 6.7±10.06 months and 0.9±0.25 months in the preguideline and postguideline groups, respectively, indicating a potential for early treatment in the postguideline group. Finally, the female sex was identified as a risk factor for residual hip dysplasia at 6 months of age. CONCLUSION DDH incidence in East Asia seems comparable to that in Western countries. Implementing the AAOS guidelines increased the diagnosis rate and opportunity for early treatment initiation, thus potentially avoiding surgical intervention. Nevertheless, residual DDH may be detected in some patients at 6 months of age, particularly in female infants. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Kuei-Hsiang Hsu
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wen-Chieh Chang
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chi-Kuang Feng
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yu-Ping Su
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| |
Collapse
|
41
|
Fan ZZ, Yan YB, Sha J, Xu HF, Li C, Liu ZC, Liu J, Huang LY. Risk factors for misdiagnosis in children with developmental dysplasia of the hip: a retrospective single centre study. BMJ Paediatr Open 2023; 7:e001909. [PMID: 37290920 PMCID: PMC10254984 DOI: 10.1136/bmjpo-2023-001909] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 05/01/2023] [Indexed: 06/10/2023] Open
Abstract
OBJECTIVE To investigate risk factors of misdiagnosis at the first visit of children with developmental dysplasia of the hip (DDH) who did not participate in hip ultrasound screening. METHODS A retrospective review was conducted on children with DDH admitted to a tertiary hospital in northwestern China between January 2010 and June 2021. We divided the patients into the diagnosis and misdiagnosis groups according to whether they were diagnosed at the first visit. The basic information, treatment process and medical information of the children were investigated. We made a line chart of the annual misdiagnosis rate to observe the trend in the annual misdiagnosis rate. Univariate and multivariate logistic regression analyses were used to identify significant risk factors for missed diagnosis. RESULTS A total of 351 patients met the inclusion criteria, including 256 (72.9%) patients in the diagnosis group and 95 (27.1%) patients in the misdiagnosis group. The line chart of the annual rate of misdiagnoses among children with DDH from 2010 to 2020 showed no significant change trend. Multiple logistic regression analysis showed that the paediatrics department (v the paediatric orthopaedics department: OR 0.21, p<0.001), the general orthopaedics department (v the paediatric orthopaedics department: OR 0.39, p=0.006) and the senior physician (v the junior physician: OR 2.47, p=0.006) on the misdiagnosis at the first visit of children were statistically significant. CONCLUSION Children with DDH without hip ultrasound screening are prone to be misdiagnosed at their first visit. The annual misdiagnosis rate has not been significantly reduced in recent years. The department and title of the physician are independent risk factors for misdiagnosis.
Collapse
Affiliation(s)
- Zong-Zhi Fan
- Department of Orthopedics, Xijing Hospital,Air Force Military Medical University, Xian, Shaanxi, China
- Department of Orthopedics, No 988th Hospital of Joint Logistic Support Force of PLA, Zhengzhou, Henan, China
| | - Ya-Bo Yan
- Department of Orthopedics, Xijing Hospital,Air Force Military Medical University, Xian, Shaanxi, China
| | - Jia Sha
- Department of Orthopedics, Xijing Hospital,Air Force Military Medical University, Xian, Shaanxi, China
| | - Hui-Fa Xu
- Department of Orthopedics, Xijing Hospital,Air Force Military Medical University, Xian, Shaanxi, China
| | - Chao Li
- Department of Orthopedics, Xijing Hospital,Air Force Military Medical University, Xian, Shaanxi, China
| | - Zhi-Chen Liu
- Department of Orthopedics, Xijing Hospital,Air Force Military Medical University, Xian, Shaanxi, China
| | - Jing Liu
- Department of Orthopedics, Xijing Hospital,Air Force Military Medical University, Xian, Shaanxi, China
| | - Lu-Yu Huang
- Department of Orthopedics, Xijing Hospital,Air Force Military Medical University, Xian, Shaanxi, China
| |
Collapse
|
42
|
Huang B, Xia B, Qian J, Zhou X, Zhou X, Liu S, Chang A, Yan Z, Tang Z, Xu N, Tao H, He X, Yu W, Zhang R, Huang R, Ni D, Yang X. Artificial Intelligence-Assisted Ultrasound Diagnosis on Infant Developmental Dysplasia of the Hip Under Constrained Computational Resources. J Ultrasound Med 2023; 42:1235-1248. [PMID: 36445006 DOI: 10.1002/jum.16133] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 10/31/2022] [Accepted: 11/06/2022] [Indexed: 05/18/2023]
Abstract
OBJECTIVES Ultrasound (US) is important for diagnosing infant developmental dysplasia of the hip (DDH). However, the accuracy of the diagnosis depends heavily on expertise. We aimed to develop a novel automatic system (DDHnet) for accurate, fast, and robust diagnosis of DDH. METHODS An automatic system, DDHnet, was proposed to diagnose DDH by analyzing static ultrasound images. A five-fold cross-validation experiment was conducted using a dataset containing 881 patients to verify the performance of DDHnet. In addition, a blind test was conducted on 209 patients (158 normal and 51 abnormal cases). The feasibility and performance of DDHnet were investigated by embedding it into ultrasound machines at low computational cost. RESULTS DDHnet obtained reliable measurements and accurate diagnosis predictions. It reported an intra-class correlation coefficient (ICC) on α angle of 0.96 (95% CI: 0.93-0.97), β angle of 0.97 (95% CI: 0.95-0.98), FHC of 0.98 (95% CI: 0.96-0.99) and PFD of 0.94 (95% CI: 0.90-0.96) in abnormal cases. DDHnet achieved a sensitivity of 90.56%, specificity of 100%, accuracy of 98.64%, positive predictive value (PPV) of 100%, and negative predictive value (NPV) of 98.44% for the diagnosis of DDH. For the measurement task on the US device, DDHnet took only 1.1 seconds to operate and complete, whereas the experienced senior expert required an average 41.4 seconds. CONCLUSIONS The proposed DDHnet demonstrate state-of-the-art performance for all four indicators of DDH diagnosis. Fast and highly accurate DDH diagnosis is achievable through DDHnet, and is accessible under constrained computational resources.
Collapse
Affiliation(s)
- Bingxuan Huang
- Ultrasonography Department, Affiliated Shenzhen Children's Hospital, College of Medicine, Shantou University, Shenzhen, China
| | - Bei Xia
- Ultrasonography Department, Affiliated Shenzhen Children's Hospital, College of Medicine, Shantou University, Shenzhen, China
| | - Jikuan Qian
- R&D Department, Shenzhen RayShape Medical Technology Co. Ltd., Shenzhen, China
| | - Xinrui Zhou
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
| | - Xu Zhou
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
| | - Shengfeng Liu
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
| | - Ao Chang
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
| | - Zhongnuo Yan
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
| | - Zijian Tang
- Ultrasonography Department, Affiliated Shenzhen Children's Hospital, College of Medicine, Shantou University, Shenzhen, China
| | - Na Xu
- Ultrasonography Department, Affiliated Shenzhen Children's Hospital, College of Medicine, Shantou University, Shenzhen, China
| | - Hongwei Tao
- Ultrasonography Department, Affiliated Shenzhen Children's Hospital, College of Medicine, Shantou University, Shenzhen, China
| | - Xuezhi He
- Ultrasonography Department, Affiliated Shenzhen Children's Hospital, College of Medicine, Shantou University, Shenzhen, China
| | - Wei Yu
- Ultrasonography Department, Affiliated Shenzhen Children's Hospital, College of Medicine, Shantou University, Shenzhen, China
| | - Renfu Zhang
- Ultrasound Department, EDAN Instruments, Inc., Shenzhen, China
| | - Ruobing Huang
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
| | - Dong Ni
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
| | - Xin Yang
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
| |
Collapse
|
43
|
Jóźwiak M, Grzegorzewski A, Napiontek M, Woźniak Ł. The significance of the Dega osteotomy. J Pediatr Orthop B 2023; 32:207-210. [PMID: 36125907 DOI: 10.1097/bpb.0000000000001005] [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: 11/26/2022]
Abstract
Wiktor Dega has significantly impacted contemporary pediatric orthopedics by developing transiliac osteotomy - Dega's pelvic osteotomy. The global implementation of the surgery technique gained dynamism in the 2000s after being published by Ward and Grudziak. Since then, derivative operative techniques called Dega, Dega-like or Dega family osteotomies have been developed. We analyzed the original articles published by Dega between 1929 and 1974 concerning transiliac osteotomy technique development and articles about its derivatives. The epidemiological significance of developmental hip dysplasia focused Wiktor Dega's attention in the 1920s. At that time, he treated patients according to König's idea of acetabular roof plastic surgery. The osteotomy depth gradually increased, which allowed deeper graft placement to perform what we nowadays call acetabuloplasty. In 1958, Dega coined the name 'supraacetabular semicircular osteotomy'. It differed from the final concept of the transiliac osteotomy by not assuming the cut of the inner cortex of the iliac bone. The hinge for the acetabular rotation was located at the inner cortex's whole length, disallowing the excessive redirection. The final concept of osteotomy allows for simultaneous acetabuloplasty and redirection to change the shape, location and acetabular volume. Dega derivatives are Mubarak (San Diego) and high Dega osteotomies. Dega osteotomy and its derivates are routinely implemented to treat developmental hip dysplasia and spastic hip disorders. It might be considered an option in Legg-Calve-Perthes disease, congenital deficiencies, and flaccid hip displacement in neurological conditions.
Collapse
Affiliation(s)
- Marek Jóźwiak
- Department of Pediatric Orthopaedics and Traumatology, Poznan University of Medical Sciences (Dega Hospital)
| | | | | | - Łukasz Woźniak
- Department of Pediatric Orthopaedics and Traumatology, Poznan University of Medical Sciences (Dega Hospital)
| |
Collapse
|
44
|
Şendur AB, Şendur HN. Role of ultrasound as a screening tool for the diagnosis of developmental dysplasia of the hip. J Clin Ultrasound 2023; 51:663-664. [PMID: 36807107 DOI: 10.1002/jcu.23443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 02/10/2023] [Indexed: 05/03/2023]
Affiliation(s)
| | - Halit Nahit Şendur
- Faculty of Medicine, Department of Radiology, Gazi University, Ankara, Turkey
| |
Collapse
|
45
|
Mori Y, Ueno K, Chiba D, Hashimoto K, Kawai Y, Baba K, Tanaka H, Aki T, Ogasawara M, Shibasaki N, Tokunaga K, Aizawa T, Nagasaki M. Genome-Wide Association Study and Transcriptome of Japanese Patients with Developmental Dysplasia of the Hip Demonstrates an Association with the Ferroptosis Signaling Pathway. Int J Mol Sci 2023; 24:ijms24055019. [PMID: 36902448 PMCID: PMC10003185 DOI: 10.3390/ijms24055019] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/28/2023] [Accepted: 03/04/2023] [Indexed: 03/08/2023] Open
Abstract
This study examined the association between developmental dysplasia of the hip (DDH) and disease-associated loci in a Japanese cohort. A genome-wide association study (GWAS) of 238 Japanese patients with DDH and 2044 healthy individuals was performed. As a replicate, GWAS was also conducted on the UK Biobank data with 3315 cases and matched 74,038 controls. Gene set enrichment analyses (GSEAs) of both the genetics and transcriptome of DDH were performed. Transcriptome analysis of cartilage specimens from DDH-associated osteoarthritis and femoral neck fractures was performed as a control. Most of the lead variants were very low-frequency ones in the UK, and variants in the Japanese GWAS could not be replicated with the UK GWAS. We assigned DDH-related candidate variants to 42 and 81 genes from the Japanese and UK GWASs, respectively, using functional mapping and annotation. GSEA of gene ontology, disease ontology, and canonical pathways identified the most enriched pathway to be the ferroptosis signaling pathway, both in the Japanese gene set as well as the Japanese and UK merged set. Transcriptome GSEA also identified significant downregulation of genes in the ferroptosis signaling pathway. Thus, the ferroptosis signaling pathway may be associated with the pathogenic mechanism of DDH.
Collapse
Affiliation(s)
- Yu Mori
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan
| | - Kazuko Ueno
- Genome Medical Science Project, National Center for Global Health and Medicine, Tokyo 162-8655, Japan
| | - Daisuke Chiba
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan
| | - Ko Hashimoto
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan
| | - Yosuke Kawai
- Genome Medical Science Project, National Center for Global Health and Medicine, Tokyo 162-8655, Japan
| | - Kazuyoshi Baba
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan
| | - Hidetatsu Tanaka
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan
| | - Takashi Aki
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan
| | - Masanori Ogasawara
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan
| | - Naoto Shibasaki
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan
| | - Katsushi Tokunaga
- Genome Medical Science Project, National Center for Global Health and Medicine, Tokyo 162-8655, Japan
| | - Toshimi Aizawa
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan
| | - Masao Nagasaki
- Human Biosciences Unit for the Top Global Course Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto 606-8507, Japan
- Correspondence:
| |
Collapse
|
46
|
Uemura K, Hiraiwa T, Okamoto M, Tokunaga K, Anderson AE. The anterior center edge angle has limited ability to predict three-dimensional coverage of the femoral head in patients with developmental dysplasia of the hip undergoing curved periacetabular osteotomy. Arch Orthop Trauma Surg 2023; 143:1323-1330. [PMID: 34977962 PMCID: PMC9250550 DOI: 10.1007/s00402-021-04258-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 11/12/2021] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Femoral head coverage in patients with hip dysplasia (DDH) is typically quantified using 2D measurements of the lateral center edge angle (LCEA) and anterior center edge angle (ACEA). However, as the morphology of DDH is complex and varies between patients, 2D measurements may not predict the true 3D femoral head coverage. Herein, 2D and 3D coverage were quantified before and after curved periacetabular osteotomy (CPO) and their relationships were assessed. MATERIALS AND METHODS Forty-three hips that underwent CPO for DDH were analyzed. For 2D evaluation, LCEA was quantified from X-rays and CT images. The ACEA was measured from CT images (CT-ACEA) and digitally reconstructed radiographs generated from CT images (DRR-ACEA). Three-dimensional coverage was quantified from CT reconstructions of the hip and evaluated in the anterior, superior, posterior, and inferior regions of the femoral head. Two-dimensional measurements were correlated to 3D coverage to assess their relationships. RESULTS The median preoperative 3D percent coverage was 17.7, 36.1, 56.1, and 14.6% for the anterior, superior, posterior, and inferior region, respectively. After CPO, all LCEAs and ACEAs increased significantly (all p < 0.001). For the 3D coverage, anterior and superior coverage significantly increased while the posterior and inferior coverage decreased (all p < 0.001). Moderate to strong correlations were detected between the two LCEAs and the 3D superior coverage in both the preoperative and postoperative period. For the correlation between 3D anterior coverage, no significant correlation was found between the CT-ACEA while a moderate correlation was found between the DRR-ACEA (rs = 0.41, p = 0.023). CONCLUSIONS Our results indicate that the LCEA can be used to predict 3D coverage in the superior region of the femoral head. However, as the CT-ACEA or DRR-ACEA had no or only moderate correlation between the 3D anterior coverage, these measurements are not recommended for evaluating/estimating the 3D anterior coverage in patients with DDH.
Collapse
Affiliation(s)
- Keisuke Uemura
- Department of Orthopaedics, University of Utah, 590 Wakara Way Rm A100, Salt Lake City, UT, 84108, USA
| | - Toshihito Hiraiwa
- Niigata Hip Joint Center, Kameda Daiichi Hospital, Niigata City, Niigata, 9500165, Japan
| | - Masashi Okamoto
- Department of Radiology, Kameda Daiichi Hospital, Niigata City, Niigata, 9500165, Japan
| | - Kunihiko Tokunaga
- Niigata Hip Joint Center, Kameda Daiichi Hospital, Niigata City, Niigata, 9500165, Japan
| | - Andrew E Anderson
- Department of Orthopaedics, University of Utah, 590 Wakara Way Rm A100, Salt Lake City, UT, 84108, USA.
- Department of Bioengineering, University of Utah, Salt Lake City, UT, 84112, USA.
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, 84112, USA.
- Department of Physical Therapy, University of Utah, Salt Lake City, UT, 84108, USA.
| |
Collapse
|
47
|
Grzybowski G, Bliven E, Wu L, Schaeffer EK, Gibbard M, Zomar BO, Casagrande Cesconetto A, Mundy C, Mulpuri K. Caregiver Experiences Using Orthotic Treatment Options for Developmental Dysplasia of the Hip in Children. J Pediatr Orthop 2023; 43:105-110. [PMID: 36607922 PMCID: PMC9812410 DOI: 10.1097/bpo.0000000000002312] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Developmental dysplasia of the hip (DDH) is a common condition affecting 5 in 1000 newborns. The standard first line of treatment is the use of an orthotic, which has generally high success rates, but can pose substantial difficulties and put undue burden on caregivers. The general experience of caregivers using these orthotics has not been well documented on an orthotic-specific basis. The purpose of this study was to investigate caregiver experience using prescribed DDH orthotics to identify challenges, differences between treatment options, and areas of improvement. METHODS A survey assessing treatment prescription, respondent demographics, and caregiver experience was distributed online to caregivers whose child/children were treated for DDH with an orthotic. Seven-point positively phrased Likert scale statements and open-ended questions were included to assess caregiver experience. The results were analyzed using summary statistics and orthotics with more than 30 responses were selected for more in-depth analysis. RESULTS A total of 530 survey responses were collected with 63% (334/530) of respondents using a Pavlik harness, 45% (236/530) a Rhino brace, and 13% (67/530) a Denis Browne Bar. The overall weighted average score across all Likert Scale statements was positive for the Pavlik harness, Rhino brace, and Denis Browne Bar at 4.19 (95% CI, 3.83 to 4.54), 4.63 (95% CI, 4.27 to 4.99) and 4.91 (95% CI, 4.58 to 5.24), respectively. In the open-ended responses, all 3 orthotics were perceived as easy to use and not hindering child-caregiver bonding, but raised concerns of discomfort and skin irritation, as well as preventing the ability to cuddle their child the way they desired. The Pavlik harness respondents consistently brought up concerns regarding cleanability. CONCLUSIONS The results show that the DDH orthotics analyzed are generally easy to use and perceived positively by caregivers, but have orthotic-specific challenges that should be a focus of future improvement work. CLINICAL RELEVANCE This study evaluated opinions and attitudes of caregivers for children being treated with DDH orthotics, revealing experiences, concerns, and challenges associated with the use of commonly prescribed options.
Collapse
Affiliation(s)
| | | | - Luke Wu
- BC Children’s Hospital Research Institute
| | - Emily K. Schaeffer
- Department of Orthopaedics, University of British Columbia
- Department of Orthopaedic Surgery, BC Children’s Hospital, Vancouver, BC, Canada
| | | | - Bryn O. Zomar
- Department of Orthopaedics, University of British Columbia
- Department of Orthopaedic Surgery, BC Children’s Hospital, Vancouver, BC, Canada
| | | | | | - Kishore Mulpuri
- Department of Orthopaedics, University of British Columbia
- Department of Orthopaedic Surgery, BC Children’s Hospital, Vancouver, BC, Canada
| | | |
Collapse
|
48
|
Gaytán-Fernández S, Barragán-Hervella RG, Quiroz-Williams J, Valle-Cortés EMD, Castillo-Ramírez IO, Montiel-Jarquín ÁJ. Timely radiographic detection of developmental dysplasia of the hip in family medicine residents. Educative intervention. CIR CIR 2023; 91:703-708. [PMID: 37844899 DOI: 10.24875/ciru.21000797] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 04/14/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Developmental dysplasia of the hip (DDH) is a complex clinical entity that is usually underdiagnosed, if not detected and managed early, will turn the affected individual into a disabled being, with negative social, economic and emotional effects. OBJECTIVE To determine the capacity for the timely radiographic detection of DDH before and after an educational intervention. METHOD An educational intervention is carried out in family medicine resident, where they are given training on detection in DDH radiographic projections. Pre- and post-training evaluation is carried out. Statistical analysis is performed using Student's t and χ2, taking p ≤ 0.05 as significant. RESULTS 94 residents participated. In the pre-intervention evaluation, 87.2% had no knowledge of the early detection protocol (p = 0.525). It was observed that 98.9% incorrectly drew the Perkins line (p = 0.427), 96.8% the Hilgenreiner line (p = 0.177) and 87.2% did not consider the data of bilateral dysplasia (p = 0.956). After the educational intervention, 87.2% correctly drew the Perkins line (p = 0.926), 97.8% the Hilgenreiner line (p = 0.325) and 78.7% if they considered the data of bilateral dysplasia (p = 0.826). CONCLUSIONS After this training, 80% of family medicine residents were able to detect DDH in a timely manner.
Collapse
Affiliation(s)
- Suemmy Gaytán-Fernández
- Unidad Médica de Alta Especialidad, Hospital de Traumatología y Ortopedia Manuel Ávila Camacho, Instituto Mexicano del Seguro Social (IMSS)
| | - Rodolfo G Barragán-Hervella
- Unidad Médica de Alta Especialidad, Hospital de Traumatología y Ortopedia Manuel Ávila Camacho, Instituto Mexicano del Seguro Social (IMSS)
| | - Jorge Quiroz-Williams
- Unidad Médica de Alta Especialidad, Hospital de Traumatología y Ortopedia Manuel Ávila Camacho, Instituto Mexicano del Seguro Social (IMSS)
| | - Evelyn M Del Valle-Cortés
- Unidad Médica de Alta Especialidad, Hospital de Traumatología y Ortopedia Manuel Ávila Camacho, Instituto Mexicano del Seguro Social (IMSS)
| | - Isabel O Castillo-Ramírez
- Facultad de Medicina, Programa de Servicio Social en Investigación en Salud, Universidad Popular Autónoma del Estado de Puebla
| | - Álvaro J Montiel-Jarquín
- Unidad Médica de Alta Especialidad, Hospital de Especialidades Manuel Ávila Camacho, IMSS. Puebla, Puebla, México
| |
Collapse
|
49
|
Weinstein SL, Casteñada PG, Sankar WN, Campbell HT, Badrinath R. Developmental Dysplasia of the Hip From Birth to Adolescence: Clear Indications and New Controversies. Instr Course Lect 2023; 72:659-672. [PMID: 36534887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
It is important to be knowledgeable about the latest information on the diagnosis and the evidence-based management of developmental hip dysplasia and dislocation from birth through adolescence. The focus should be on the effect of the problem; normal growth and development of the hip joint; and the pathoanatomy, natural history, and long-term outcomes of developmental dysplasia of the hip, hip subluxation, and dysplasia. Many controversies exist in the management of this complex spectrum of disorders.
Collapse
|
50
|
Dwan K, Kirkham J, Paton RW, Morley E, Newton AW, Perry DC. Splinting for the non-operative management of developmental dysplasia of the hip (DDH) in children under six months of age. Cochrane Database Syst Rev 2022; 10:CD012717. [PMID: 36214650 PMCID: PMC9549867 DOI: 10.1002/14651858.cd012717.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/05/2022]
Abstract
BACKGROUND Developmental dysplasia of the hip (DDH) describes the abnormal development of a hip in childhood, ranging from complete dislocation of the hip joint to subtle immaturity of a hip that is enlocated and stable within the socket. DDH occurs in around 10 per 1000 live births, though only one per 1000 are completely dislocated. There is variation in treatment pathways for DDH, which differs between hospitals and even between clinicians within the same hospital. The variation is related to the severity of dysplasia that is believed to require treatment, and the techniques used to treat dysplasia. OBJECTIVES To determine the effectiveness of splinting and the optimal treatment strategy for the non-operative management of DDH in babies under six months of age. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, seven other electronic databases, and two trials registers up to November 2021. We also checked reference lists, contacted study authors, and handsearched relevant meetings abstracts. SELECTION CRITERIA Randomised controlled trials (RCTs), including quasi-RCTs, as well as non-RCTs and cohort studies conducted after 1980 were included. Participants were babies with all severities of DDH who were under six months of age. Interventions included dynamic splints, static splints or double nappies (diapers), compared to no splinting or delayed splinting. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, extracted data and performed risk of bias and GRADE assessments. The primary outcomes were: measurement of acetabular index at years one, two and five, as determined by radiographs (angle): the need for operative intervention to achieve reduction and to address dysplasia; and complications. We also investigated other outcomes highlighted by parents as important, including the bond between parent and child and the ability of mothers to breastfeed. MAIN RESULTS We included six RCTs or quasi-RCTs (576 babies). These were supported by 16 non-RCTs (8237 babies). Five studies had non-commercial funding, three studies stated 'no funding' and 14 studies did not state funding source. The RCTs were generally at unclear risk of bias, although we judged three RCTs to be at high risk of bias for incomplete outcome data. The non-RCTs were of moderate and critical risk of bias. We did not undertake meta-analysis due to methodological and clinical differences between studies; instead, we have summarised the results narratively. Dynamic splinting versus delayed or no splinting Four RCTs and nine non-RCTs compared immediate dynamic splinting and delayed dynamic splinting or no splinting. Of the RCTs, two considered stable hips and one considered unstable (dislocatable) hips and one jointly considered unstable and stable hips. No studies considered only dislocated hips. Two RCTs (265 babies, very low-certainty evidence) reported acetabular index at one year amongst stable or dislocatable hips. Both studies found there may be no evidence of a difference in splinting stable hips at first diagnosis compared to a strategy of active surveillance: one reported a mean difference (MD) of 0.10 (95% confidence interval (CI) -0.74 to 0.94), and the other an MD of 0.20 (95% CI -1.65 to 2.05). Two RCTs of stable hips (181 babies, very low-certainty evidence) reported there may be no evidence of a difference between groups for acetabular index at two years: one study reported an MD of -1.90 (95% CI -4.76 to 0.96), and another study reported an MD of -0.10 (95% CI -1.93 to 1.73), but did not take into account hips from the same child. No study reported data at five years. Four RCTs (434 babies, very low-certainty evidence) reported the need for surgical intervention. Three studies reported that no surgical interventions occurred. In the remaining study, two babies in the dynamic splinting group developed instability and were subsequently treated surgically. This study did not explicitly state if this treatment was to achieve concentric reduction or address residual dysplasia. Three RCTs (390 babies, very low-certainty evidence) reported no complications (avascular necrosis and femoral nerve palsy). Dynamic splinting versus static splinting One RCT and five non-RCTs compared dynamic versus static splinting. The RCT (118 hips) reported no occurrences of avascular necrosis (very low-certainty evidence) and did not report radiological outcomes or need for operative intervention. One quasi-RCT compared double nappies versus delayed or no splinting but reported no outcomes of interest. Other comparisons No RCTs compared static splinting versus delayed or no splinting or staged weaning versus immediate removal. AUTHORS' CONCLUSIONS There is a paucity of RCT evidence for splinting for the non-operative management of DDH: we included only six RCTs with 576 babies. Moreover, there was considerable heterogeneity between the studies, precluding meta-analysis. We judged the RCT evidence for all primary outcomes as being of very low certainty, meaning we are very uncertain about the true effects. Results from individual studies provide limited evidence of intervention effects on different severities of DDH. Amongst stable dysplastic hips, there was no evidence to suggest that treatment at any stage expedited the development of the acetabulum. For dislocatable hips, a delay in treatment onset to six weeks does not appear to result in any evidence of a difference in the development of the acetabulum at one year or increased risk of surgery. However, delayed splinting may reduce the number of babies requiring treatment with a harness. No RCTs compared static splinting with delayed or no splinting, staged weaning versus immediate removal or double nappies versus delayed or no splinting. There were few operative interventions or complications amongst the RCTs and the non-randomised studies. There's no apparent signal to indicate a higher frequency of either outcome in either intervention group. Given the frequency of this disease, and the fact that many countries undertake mandatory DDH screening, there is a clear need to develop an evidence-based pathway for treatment. Particular uncertainties requiring future research are the effectiveness of splinting amongst stable dysplastic hips, the optimal timing for the onset of splinting, the optimal type of splint to use and the need for 'weaning of splints'. Only once a robust pathway for treatment is established, can we properly assess the cost-effectiveness of screening interventions for DDH.
Collapse
Affiliation(s)
- Kerry Dwan
- Editorial & Methods Department, Cochrane Central Executive, London, UK
| | - Jamie Kirkham
- Centre for Biostatistics, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Robin W Paton
- East Lancashire Hospitals NHS Trust, Burnley, UK
- School of Medicine, University of Central Lancashire, Preston, Lancashire, UK
| | | | | | - Daniel C Perry
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
- Department of Orthopaedic Surgery, Alder Hey Hospital, Liverpool, UK
| |
Collapse
|