Open Reduction For Developmental Dysplasia Research Articles

Evaluation of Test of Stability as an Aid for Osteotomy in Open Reduction for Developmental Dysplasia of Hip

Background: Developmental dysplasia of hip (DDH) represents a spectrum of anatomic abnormalities that can result in permanent disability. The goals of treatment are to create normal anatomy of the proximal femur and acetabulum and then to maintain that anatomy to allow normal development of hip. Our aim was to identify significance of the test of stability in planning of appropriate osteotomy during open reduction in order to achieve stable concentric reduction in DDH in terms of Severin’s clinical and radiological outcome. Materials and Methods: In this study, 50 children with DDH, which required open reduction and osteotomy for stable concentric reduction, were admitted in Orthopaedic department of SIMS/Services Hospital from Mar 2004 - May 2008. Clinical assessment and radiograph of pelvis with both hips in anteroposterior view was done for all the patients to confirm the diagnosis. After the confirmation of diagnosis surgery was planned and during surgery test of stability applied. Test of stability are the maneuvers which included flexion, internal rotation and abduction performed by the operating surgeon to assess the need for a concomitant osteotomy. If hip found stable in internal rotation and abduction, varus derotational femoral ostetomy was done and fixed with 1/3rd tubular plate. If hip required flexion it was treated with innominate osteotomy and fixed with K-wires. Those hips which required flexion, abduction and internal rotation for concentric reduction were treated with both ostetomies and fixed with K-wire & plate. Postoperatively all the patients were applied hip spica. A descriptive and analytical statistical analysis was performed on SPSS, version 13. Results: The mean age of patients was 4 years (Mean ± SD: 4 ± 1.31), youngest patient being 3 years of age and oldest 7 years. Sex distribution with female to male ratio was 1.8:1. On an average follow up of 3.2 years Severin’s clinical outcome for 42 (84%) patients was excellent, 7 (14%) was good and 1 (2%) was poor. P-value was 0.001. Research Article

Slotted Acetabular Augmentation With Concurrent Open Reduction for Developmental Dysplasia of the Hip in Older Children

The slotted acetabular augmentation procedure can never achieve a concentric and congruous reduction of the femoral head. The aim of this study was to review the results of the slotted acetabular augmentation procedure performed at the time of open reduction for developmental dysplasia of the hip in older children. Twenty-two patients with 27 hips underwent open reduction with concurrent slotted acetabular augmentation. The average age at the time of surgery was 8.5 years. The average follow-up was 8.3 years. Using modified McKay clinical criteria, 16 hips were classified as excellent, 8 hips as good, and 3 hips as fair. Using modified Severin radiographic criteria, 15 hips gave excellent results and 12 hips gave good results. Slotted acetabular augmentation with concurrent open reduction can be an effective procedure for developmental dysplasia of the hip in older children. The study of therapeutic studies investigating the results of the treatment is level II.

Preliminary Results after Reduction of DDH via Medial Approach

Purpose: We report the outcomes of medial open reduction for developmental dysplasia of the hip (DDH). Materials and Methods: This study reviewed the medical records and radiographs of 33 DDH cases treated by a medial open reduction and followed for at least two years. The mean age at surgery and follow-up duration was 11.4 months (range, 4 to 22) and 88 months (range, 24 to 168), respectively. The perioperative parameters, maintenance of reduction, and postoperative changes in the acetabular index and center-edge angle were recorded. Results: The acetabular index decreased from a preoperative average of 35 o to 16 o at the latest follow-up. o at postoperative 1 year to 22 o at the latest follow-up. A secondary bony procedure was performed in 15 cases at average age of 4.4 years. Avascular necrosis was noted in 8 cases, all of whom belonged to Kalamchi group I. Among the 21 patients over 6 years-old at the latest follow-up, 18 belonged to Severin groups I or II and the remaining 3 to group III. Redislocation occurred in one case. Conclusion: A medial open reduction is a minimal surgical procedure that can effectively release the structures obstructing a femoral head reduction. It should be a useful treatment modality for selected cases with DDH.

Femoral Head Deformity after Open Reduction by Ludloff's Medial Approach

Ludloff's medial approach has been described as a simple procedure for open reduction of developmental dysplasia of the hip (DDH) requiring minimal dissection and tissue disruption. Many patients undergo subsequent reconstruction of the acetabulum after skeletal maturity for residual dysplasia. Femoral head deformity reportedly influences the long-term outcome of these osteotomies. The literature suggests this deformity may be related to the patient's age at the time of a medial approach. We therefore asked whether femoral head deformity (roundness index, femoral head enlargement) at skeletal maturity correlates with patient age at surgery. We assessed the radiographs of 40 patients (42 hips). Their mean age at surgery was 14.3 months (range, 6-31 months); the minimum followup was 10 years (mean, 15.8 years; range, 10-27 years). The mean roundness index at skeletal maturity correlated with increased age at the time of the operation (mean index, 58.3; range, 47-79) while enlargement did not. Using a medial approach for correction of DDH in older patients increases the risk of femoral head deformity at skeletal maturity.

Re-dislocation following open reduction for developmental dysplasia of the hip

We have reviewed 17 patients (18 hips) who required repeat open reduction for recurrent or persistent dislocation after a previous attempt at open reduction for developmental dysplasia of the hip (DDH). The mean follow-up was 5.5 (3-15) years. At the review, five patients were limping and had limited hip motion but no pain. Six hips were classified as Severin class III or more, and avascular necrosis was evident in 11. We suggest that technical failure is usually the cause for re-dislocation in unilateral cases, as we discovered at repeat open reduction in five of six patients with unilateral dislocation. The biological behaviour of bilateral dislocations may in some way be different since in nine of 11 patients with bilateral dislocations, no obvious cause could be attributed. The outcome is usually poor.

The ferguson medial approach for open reduction of developmental dysplasia of the hip. A clinical and radiological review of 49 hips.

The results of the Ferguson medial approach for open reduction of developmental dysplasia of the hip (DDH) were reviewed for 49 hips with a follow-up of more than 48 months. The mean age at operation was 12.3 months (6 to 23). The mean length of clinical and radiological follow-up was 82 months (48 to 148). Three redislocations occurred. Group I avascular necrosis according to the classification of Kalamchi and MacEwen was seen in four hips, group II in two hips and group III in one hip; 92% of the hips were classified as Severin class I and II. The acetabular index and centre edge (CE) angles were within normal limits at final follow-up, but were still significantly different from the unaffected side. We conclude that the Ferguson procedure is safe and reliable for low dislocations in children aged six to 18 months.

Test of stability as an aid to decide the need for osteotomy in association with open reduction in developmental dysplasia of the hip

The Journal of Bone and Joint Surgery. British volumeVol. 82-B, No. 6 CorrespondenceFree AccessTest of stability as an aid to decide the need for osteotomy in association with open reduction in developmental dysplasia of the hipH. ÖMEROÐLUH. ÖMEROÐLUSearch for more papers by this authorPublished Online:21 Feb 2018https://doi.org/10.1302/0301-620X.82B6.0820933AboutSectionsPDF/EPUB ToolsAdd to FavouritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetails Vol. 82-B, No. 6 Metrics History Published online 21 February 2018 Published in print 1 August 2000 InformationCopyright © 2000, The British Editorial Society of Bone and Joint Surgery: All rights reservedPDF download

Test of stability as an aid to decide the need for osteotomy in association with open reduction in developmental dysplasia of the hip.

After open reduction for developmental dysplasia of the hip (DDH), a pelvic or femoral osteotomy may be required to maintain a stable concentric reduction. We report the clinical and radiological outcome in 82 children (95 hips) with DDH treated by open reduction through an anterior approach in which a test of stability was used to assess the need for a concomitant osteotomy. The mean age at the time of surgery was 28 months (9 to 79) and at the latest follow-up, 17 years (12 to 25). All patients have been followed up until closure of the triradiate cartilage with a mean period of 15 years (8 to 23). At the time of open reduction before closure of the joint capsule, the position of maximum stability was assessed. A hip which required flexion with abduction for stability was considered to need an innominate osteotomy. If only internal rotation and abduction were required, an upper femoral derotational and varus osteotomy was carried out. For a 'double-diameter' acetabulum with anterolateral deficiency, a Pemberton-type osteotomy was used. A hip which was stable in the neutral position required no concomitant osteotomy. Overall, 86% of the patients have had a satisfactory radiological outcome (Severin groups I and II) with an incidence of 7% of secondary procedures for persistent dysplasia including one hip which redislocated. The results were better (p = 0.04) in children under the age of two years. Increased leg length on the affected side was associated with poor acetabular development and recurrence of joint dysplasia (p = 0.01). The incidence of postoperative avascular necrosis was 7%. In a further 18%, premature physeal arrest was noted during the adolescent growth spurt (Kalamchi-MacEwen types II and III). Both of these complications were also associated with recurrence of joint dysplasia (p = 0.01). Studies with a shorter follow-up are therefore likely to underestimate the proportion of poor radiological results.

Test of stability as an aid to decide the need for osteotomy in association with open reduction in developmental dysplasia of the hip

After open reduction for developmental dysplasia of the hip (DDH), a pelvic or femoral osteotomy may be required to maintain a stable concentric reduction. We report the clinical and radiological outcome in 82 children (95 hips) with DDH treated by open reduction through an anterior approach in which a test of stability was used to assess the need for a concomitant osteotomy. The mean age at the time of surgery was 28 months (9 to 79) and at the latest follow-up, 17 years (12 to 25). All patients have been followed up until closure of the triradiate cartilage with a mean period of 15 years (8 to 23). At the time of open reduction before closure of the joint capsule, the position of maximum stability was assessed. A hip which required flexion with abduction for stability was considered to need an innominate osteotomy. If only internal rotation and abduction were required, an upper femoral derotational and varus osteotomy was carried out. For a ‘double-diameter’ acetabulum with anterolateral deficiency, a Pemberton-type osteotomy was used. A hip which was stable in the neutral position required no concomitant osteotomy. Overall, 86% of the patients have had a satisfactory radiological outcome (Severin groups I and II) with an incidence of 7% of secondary procedures for persistent dysplasia including one hip which redislocated. The results were better (p = 0.04) in children under the age of two years. Increased leg length on the affected side was associated with poor acetabular development and recurrence of joint dysplasia (p = 0.01). The incidence of postoperative avascular necrosis was 7%. In a further 18%, premature physeal arrest was noted during the adolescent growth spurt (Kalamchi-MacEwen types II and III). Both of these complications were also associated with recurrence of joint dysplasia (p = 0.01). Studies with a shorter follow-up are therefore likely to underestimate the proportion of poor radiological results.

Laser Doppler flowmetry during open reduction for developmental dysplasia of the hip.

Laser Doppler flowmetry was used intraoperatively to monitor femoral head perfusion during open reduction of 13 congenital hip dislocations in 11 patients. Laser Doppler determinations ranged from 12 to 400 mV before reduction and 30 to 300 mV after reduction. Three patients had magnitude changes in excess of 50%. One had increased perfusion, and two had decreased blood flow. Avascular necrosis of the hip occurred in one patient that was not predicted by laser Doppler flowmetry. Femoral head perfusion measured 175 mV for the dislocated hip and 180 mV after reduction of the femoral head and completion of the pelvic osteotomy. The authors conclude that laser Doppler flowmetry is not a reliable method for monitoring femoral head perfusion during open reduction of the hip for developmental hip dysplasia.