Can we Predict The Need for Secondary Procedures in Walking DDH?

Volume 6 | Issue 2 | May-August 2020 | Page: 53-58 | Hitesh Chauhan

Authors: Hitesh Chauhan [1]

[1] Pediatric Orthopaedic Surgeon, Radiant Children’s Hospital, Jodhpur, Rajasthan

Address of Correspondence
Dr. Hitesh Chauhan,
Pediatric Orthopaedic Surgeon,
Radiant Children’s Hospital, Jodhpur, Rajasthan
E-mail: hitsanu5@gmail.com

Abstract

In developmental dysplasia of the hip (DDH) diagnosed after walking age, primary intervention in the form of open reduction with or without femoral and innominate osteotomy is the mainstay of treatment. Even in those where the primary reduction has been successful, many will require Further Corrective Surgery (FCS) at a later date. This review article discusses the factors which are important in predicting the need for FCS.
Keywords: DDH; Hip joint arthritis; Hip impingement; Hipdysplasia; Osteotomies in hip dysplasia.

References 

1. Steppacher SD, Tannast M, Ganz R, Siebenrock KA. Mean 20-year followup of Bernese periacetabular osteotomy. Clin Orthop Relat Res. 2008;466(7):1633-1644.
2. Bache CE, Graham HK, Dickens DR, et al. Ligamentum teres tenodesis in medial approach open reduction for developmental dislocation of the hip. J Pediatr Orthop. 2008;28(6):607-613.
3. Kalamchi A, Schmidt TL, MacEwen GD. Congenital dislocation of the hip – Open reduction by the medial approach. Clin Orthop Relat Res. 1982 Sep;(169):127-132.
4. Kasser JR, Bowen JR, MacEwen GD. Varus derotation osteotomy in the treatment of persistent dysplasia in congenital dislocation of the hip. J Bone Joint Surg Am. 1985;67(2):195-202.
5. Luhmann SJ, Bassett GS, Gordon JE, Schootman M, Schoenecker PL. Reduction of a dislocation of the hip due to developmental dysplasia: implications for the need for future surgery. J Bone Joint Surg Am. 2003;85(2):239-243.
6. Malvitz TA, SLWeinstein SL. Closed reduction for congenital dysplasia of the hip. Functional and radiographic results after an average of thirty years. J Bone Joint Surg Am. 1994;76(12):1777-1792.
7. Powell EN, Gerratana FJ, Gage JR. Open reduction for congenital hip dislocation: the risk of avascular necrosis with three different approaches. J Pediatr Orthop. 1986;6(2):127-132.
8. Weinstein SL. Natural history of congenital hip dislocation (CDH) and hip dysplasia. Clin Orthop Relat Res. 1987;(225):62-76.
9. Ryan MG, Johnson LO, Quanbeck DS, Minkowitz B. One-stage treatment of congenital dislocation of the hip in children three to ten years old – Functional and radiographic results. J Bone Joint Surg Am. 1998;80:336–344.
10. Vitale MG, Skaggs DL. Developmental dysplasia of the hip from six months to four years of age. J Am Acad Orthop Surg. 2001;9(6):401-411.
11. Holman J, Carroll KL, Murray KA, Macleod LM, Roach JW. Long-term follow-up of open reduction surgery for developmental dislocation of the hip. J Pediatr Orthop. 2012;32(2):121-124.
12. Thomas SR. A review of long-term outcomes for late presenting developmental hip dysplasia. Bone Joint J. 2015;97-B(6):729-733.
13. Vallamshetla VR, Mughal E, O’Hara JN. Congenital dislocation of the hip – A re-appraisal of the upper age limit for treatment. J Bone Joint Surg Br. 2006;88(8):1076-1081.
14. Wang TM, Wu KW, Shih SF, Huang SC, Kuo KN. Outcomes of open reduction for developmental dysplasia of the hip: does bilateral dysplasia have a poorer outcome? J Bone Joint Surg Am. 2013;95(12):1081-1086.
15. Ponseti IV, Frigerio ER. Results of treatment of congenital dislocation of the hip. J Bone Joint Surg Am. 1959;41(5):823-876.
16. Brougham D, Broughton NS, Cole WG, Menelaus MB. The predictability of acetabular development after closed reduction for congenital dislocation of the hip. J Bone Joint Surg(Br). 1988;70(5):733-736.
17. Cherney DL, Westin G. Acetabular development in the infant’s dislocated hips. Clin Orthop Related Res. 1989;242:98-103.
18. Albinana J, Dolan LA, Spratt KF, Morcuende J, Meyer MD, Weinstein SL. Acetabular dysplasia after treatment for developmental dysplasia of the hip – Implications for secondary procedures. J Bone Joint Surg Br. 2004;86(6):876-886.
19. Kitoh H, Kitakoji T, Katoh M, Ishiguro N. Prediction of acetabular development after closed reduction by overhead traction in developmental dysplasia of the hip. J Orthop Sci. 2006;11(5):473-477.
20. Spence G, Hocking R, Wedge JH, Roposch A. Effect of innominate and femoral varus derotation osteotomy on acetabular development in developmental dysplasia of the hip. J Bone Joint Surg Am. 2009;91(11):2622-2636.
21. Gillingham BL, Sanchez AA, Wenger DR. Pelvic osteotomies for the treatment of hip dysplasia in children and young adults. J Am Acad Orthop Surg. 1999;7(5):325-337.
22. Wakabayashi K, Wada I, Horiuchi O, Mizutani J, Tsuchiya D, Otsuka T. MRI findings in residual hip dysplasia. J Pediatr Orthop. 2011;31(4):381-387.
23. Galpin RD, Roach JW, Wenger DR, Herring JA, Birch JG. One-stage treatment of congenital dislocation of the hip in older children, including femoral shortening. J Bone Joint Surg Am. 1989;71(5):734-741.
24. Dora C, Mascard E, Mladenov K, Seringe R. Retroversion of the acetabular dome after Salter and triple pelvic osteotomy for congenital dislocation of the hip. J Pediatr Orthop B. 2002;11(1):34-40.
25. Weiner LS, Kelley MA, Ulin RI, Wallach D. Development of the acetabulum and hip: computed tomography analysis of the axial plane. J Pediatr Orthop. 1993;13(4):421-425.
26. Browning W, Rosenkrantz H, Tarquinio T. Computed tomography in congenital hip dislocation – The role of acetabular anteversion. J Bone Joint Surg Am. 1982;64(1):27-31.
27. Lee DY, Choi IH, Lee CK, Cho TJ. Assessment of complex hip deformity using three-dimensional CT image. J Pediatr Orthop. 1991;11(1):13-19.
28. Mootha AK, Saini R, Dhillon MS, Aggarwal S, Kumar V, Tripathy SK. MRI evaluation of femoral and acetabular anteversion in developmental dysplasia of the hip. A study in an early walking age group. Acta Orthop Belg. 2010;76(2):174-180.
29. Günal T, Muratli HH, Hapa O, Celebi L, Gülçek S, Biçimoğlu A. Residual axial plane deformities after hip reconstruction for developmental dysplasia of the hip after walking age. J Pediatr Orthop B. 2007;16(2):84-89.
30. Tönnis D, Andreas A, Michael B, Achim H, Klaus K. Triple pelvic osteotomy. J Pediatr Orthop B. 1994;3(1):54-67.
31. Sarban S, Ozturk A, Tabur H, Isikan UE. Anteversion of the acetabulum and femoral neck in early walking age patients with developmental dysplasia of the hip. J Pediatr Orthop B. 2005;14(6):410-414.
32. Steppacher SD, Tannast M, Werlen S, Siebenrock KA. Femoral morphology differs between deficient and excessive acetabular coverage. Clin Orthop Relat Res. 2008;466(4):782.
33. Sankar WN, Neubuerger CO, Moseley CF. Femoral head sphericity in untreated developmental dislocation of the hip. J Pediatr Orthop. 2010;30(6):558-561.
34. Gholve PA, John MF, Matthew RG, Michael BM, Young-Jo K. Predictors for secondary procedures in walking DDH. J Pediatr Orthop. 2012;32(3):282-289.
35. Wenger DR, Lee CS, Kolman B. Derotational femoral shortening for developmental dislocation of the hip: special indications and results in the child younger than 2 years. J Pediatr Orthop. 1995;15(6):768-779.
36. Mootha AK, Saini R, Dhillon M, Aggarwal S, Wardak E, Kumar V. Do we need femoral derotation osteotomy in DDH of early walking age group? A clinico-radiological correlation study. Arch Tr Orthop Surg. 2010;130(7):853-858.
37. Fixsen J. Anterior and posterior subluxation of the hip following innominate osteotomy. J Bone Joint Surg Br. 1987;69:361-364.
38. Connolly P, Weinstein SL. The course and treatment of avascular necrosis of the femoral head in developmental dysplasia of the hip. Acta Tr Orth Turc. 2007;41:54.
39. Terjesen T, Halvorsen V. Long-term results after closed reduction of late detected hip dislocation: 60 patients followed up to skeletal maturity. Acta Orth. 2007;78(2):236-246.
40. Brougham D, Broughton NS, Cole WG, Menelaus MB. Avascular necrosis following closed reduction of congenital dislocation of the hip. Review of influencing factors and long-term follow-up. J Bone Joint Surg Br. 1990;72(4):557-562.
41. Roposch A, Liu LQ, Offiah AC, Wedge JH. Functional outcomes in children with osteonecrosis secondary to treatment of developmental dysplasia of the hip. J Bone Joint Surg Br. 2011;93(24):145.

How to Cite this Article: Chauhan H | Can we Predict The Need for Secondary Procedures in Walking DDH? | International Journal of Paediatric Orthopaedics | May-August 2020; 6(2): 53-58.

(Abstract)      (Full Text HTML)      (Download PDF)

 

 

 

 

 

 

 

 

Re-dislocation After Primary Open Reduction in DDH-Management and Early Results

Volume 6 | Issue 2 | May-August 2020 | Page: 48-52 | Vivek Singh, Sunny Chaudhary, Ramapriya Yasam, Varun Garg, Sitanshu Barik

Authors : Vivek Singh [1], Sunny Chaudhary [1], Ramapriya Yasam [1], Varun Garg [1], Sitanshu Barik [1]

[1] Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.

Address of Correspondence
Dr. Vivek Singh,
Flat No-1/3,First floor,Type 2B,AIIMS Residential Complex,
Veerbhadra Marg, Rishikesh, Uttarakhand,India.
E-mail: singhvr27gmail.com

Abstract

Operative intervention is frequently required in children with developmental dysplasia of hip(DDH) who are >18 months old.The major early and delayed complications following operative intervention are redislocation, avascular necrosis, residual dysplasia and instability. Re-dislocation following primary successful reduction is a devastating
complication. The revision surgery is usually prolonged with more blood loss, risk of further complications and long term immobilisation in a spica cast. The revision surgery is technically demanding and require a lot of preoperative planning. There also remains a possibility of never achieving the reduction of femoral head. The authors present their experience of four cases of DDH which were successfully reduced by open reduction at index procedure but later re-dislocated and required secondary surgery. Careful preoperative planning with CT scan is a must,correcting the abnormal femoral version and providing the femoral head the coverage where exactly it is required is needed. The children after secondary procedure must always be kept under closed supervision till maturity.
Keywords: DDH; Re-dislocation; Open reduction.

References 

1. Hsiech SM, Huang SC. Treatment of developmental dysplasia of the hip after failed open reduction. J Formos Med Assoc, 1998; 97: 763–9.
2. McCluskey WP, Bassett GS, Mora-Garcia G, MacEwen GD (1989) Treatment of failed open reduction for congenital dislocation of the hip. J Paediatr Orthop, 1989; 9: 633–9.
3. Kamath SU, Bennet GC. Re-dislocation following open reduction for developmental dysplasia of the hip. Int Orthop. 2005; 29: 191–194
4. Kershaw CJ, Ware HE, Pattinson R, Fixsen JA. Revision of failed open reduction of congenital dislocation of the hip. J Bone Joint Surg Br, 1993; 75: 744-9
5. Chmielewski J, Albiñana J. Failures of open reduction in developmental dislocation of the hip. J Pediatr Orthop B, 2002; 11: 284-9
6. Vitale MG, Skaggs DL. Developmental dysplasia of the hip froms ix months to four years of age. J Am Acad Orthop Surg, 2001; 9: 401-11.
7. Sankar WN, Young CR, Lin AG, et al. Risk factors for failure after open reduction for DDH: a matched cohort analysis. J Pediatr Orthop, 2011; 31(3): 232-9.
8. Bhaskar A, Desai H, Jain G. Risk factors for early redislocation after primary treatment of developmental dysplasia of the hip: Is there a protective influence of the ossific nucleus? Indian J Orthop. 2016; 50(5): 479-85.

How to Cite this Article: Singh V, Chaudhary S, Yasam R, Garg V, Barik S | Re-dislocation After Primary Open Reduction in DDH-Management and Early Results | International Journal of Paediatric Orthopaedics | May-August 2020; 6(2): 48-52.

(Abstract)      (Full Text HTML)      (Download PDF)

 

 

 

 

 

 

 

 

Foreword

Volume 6 | Issue 2 | May-August 2020 | Page: 1 | Dhiren Ganjwala

Authors : Dhiren Ganjwala [1]

[1] Ganjwala Orthopedic Hospital, 302, Anshi Avenue, Polytechnic, Ahmedabad 380015, Gujarat, India.

Address of Correspondence
Dr. Dhiren Ganjwala,
Director, Ganjwala Orthopedic Hospital
302, Anshi Avenue, Polytechnic, Ahmedabad, Gujarat, India.
E-mail: ganjwala@gmail.com

Life is a learning process and learning is a lifelong process. This is true for professionals in any field as knowledge expands rapidly and it is difficult to keep pace with it. Paediatric Orthopaedic Society of India (POSI) has hosted a variety of educational activities in the field of paediatric orthopaedics to support our one common aim: improving the quality of patient care. International Journal of Paediatric Orthopaedics (IJPO), the official journal of POSI is an important tool to serve this purpose. I wish that the knowledge circulated by IJPO will improve the quality of care offered to children not only in India but around the world. I congratulate Dr. Jayanth Sampath, the current editor of IJPO, for the hard work and untiring efforts to make this possible. I also thank the editorial board members for their dedication and devotion to bring out such an informative inaugural issue. It is a matter of pride that the contributors to this issue are from different countries across 3 continents. I wish IJPO every success in its mission to disseminate knowledge for better treatment to children suffering from musculoskeletal problems.

Dhiren Ganjwala
The President, POSI

How to Cite this Article: Ganjwala D | Foreword | International Journal of Paediatric Orthopaedics | May-August 2020; 6(2): 01.

(Abstract)      (Full Text HTML)      (Download PDF)

Current Concepts in The Management of Septic Hip Sequelae in Children

Volume 6 | Issue 2 | May-August 2020 | Page: 39-47 | Shobhit Gupta, Anil Agarwal

Authors: Shobhit Gupta [1], Anil Agarwal [1]

[1] Department of Orthopedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, India.

Address of Correspondence
Dr. Anil Agarwal,
Department of Pediatric Orthopedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, India, 110031
E-mail: anilrachna@gmail.com

Abstract

Septic arthritis of the hip can have a serious impact on long term function. From minor changes to severe destruction of proximal femoral anatomy, the spectrum varies. The consequence is altered biomechanics of hip joint leading to pain, limp, instability, stiffness and gait abnormalities. Management of these sequelae has evolved over the years. Less severe sequelae are relatively easy to manage and have reasonably predictable results. Severe sequelae of septic hip, on the other hand pose a significant surgical challenge. Correction of limb length discrepancy, providing stable hips, and elimination of Trendelenburg gait with preservation of hip range of motion should be the main aims in the management of sequelae of the septic hip. Needless to say, even in this era of powerful antibiotics and advanced surgical techniques, early recognition of septic arthritis and timely intervention are of paramount importance in ensuring good long-term hip function.
Keywords: Sepsis; Hip; Sequelae; Choi classification.

References 

1. Fabry G, Meire E. Septic arthritis of the hip in children: poor results after late and inadequate treatment. J Pediatr Orthop. 1983;3:461-466.
2. Vidigal Júnior EC, Vidigal EC, Fernandes JL. Avascular necrosis as a complication of septic arthritis of the hip in children. Int Orthop. 1997;21:389-392.
3. Johari AN, Hampannavar A, Johari RA, Dhawale AA. Coxa vara in post septic arthritis of the hip in children. J Pediatr Orthop B. 2017;26:313-319.
4. Nunn TR, Cheung WY, Rollinson PD. A prospective study of pyogenic sepsis of the hip in childhood. J Bone Joint Surg Br. 2007;89:100-106.
5. Betz RR, Cooperman DR, Wopperer JM, Sutherland RD, White JJ Jr, Schaaf HW, Aschliman MR, Choi IH, Bowen JR, Gillespie R. Late sequelae of septic arthritis of the hip in infancy and childhood. J Pediatr Orthop. 1990;10:365-372.
6. Choi IH, Pizzutillo PD, Bowen JR, Dragann R, Malhis T. Sequelae and reconstruction after septic arthritis of the hip in infants. J Bone Joint Surg Am. 1990;72:1150-1650.
7. Hunka L, Said SE, MacKenzie DA, Rogala EJ, Cruess RL. Classification and surgical management of severe sequelae of septic hips in children. Clin Orthop Relat Res. 1982;171:30-36.
8. Forlin E, Milani C. Sequelae of septic arthritis of the hip in children: a new classification and a review of 41 hips. J Pediatr Orthop. 2008;28:524-528.
9. Wada A, Fujii T, Takamura K, Yanagida H, Urano N, Surijamorn P. Operative reconstruction of the sever sequelae of infantile septic arthritis of the hip. J Pediatr Orthop. 2007;27:910-914.
10. Manzotti A, Rovetta L, Pullen C, Catagni MA. Treatment of the late sequelae of septic arthritis of the hip. Clin Orthop Relat Res. 2003;410:203-212.
11. Choi IH, Shin YW, Chung CY, Cho TJ, Yoo WJ, Lee DY. Surgical treatment of the severe sequelae of infantile septic arthritis of the hip. Clin Orthop Relat Res. 2005;434:102-109.
12. Li XD, Chen B, Fan J, Zheng CY, Liu DX, Wang H, Xia X, Ji SJ, Du SX. Evaluation of the modified Albee arthroplasty for femoral head loss secondary to septic arthritis in young children. J Bone Joint Surg Am. 2010;92:1370-1380.
13. Johari AN, Dhawale AA, Johari RA. Management of post septic hip dislocations when the capital femoral epiphysis is present. J Pediatr Orthop B. 2011;20:413-421.
14. Kanojia RK, Gupta S, Kumar A, Reddy BK. Closed reduction, osteotomy, and fibular graft are effective in treating pediatric femoral neck pseudarthrosis after infection. Clin Orthop Relat Res. 2018;476:1479-1490.
15. Agarwal A, Aggarwal AN. Sequelae of septic hip and it’s reconstruction. In: Agarwal A, Aggarwal AN, editors. Pediatric osteoarticular infections. Delhi: Jaypee; 2014. p. 75-92.
16. Choi IH, Yoo WJ, Cho TJ, Chung CY. Operative reconstruction for septic arthritis of the hip. Orthop Clin North Am. 2006;37:173-83.
17. Rastogi P, Agarwal A. Management of post septic sequelae of hips with dislocation in children. Int Orthop. 2020. doi: 10.1007/s00264-020-04743-2.
18. Albee FH. Arthroplasty of the hip and preservation of its stability. Ann Surg. 1935;102:108-114.
19. L’Episcopo JB. Stabilization of pathological dislocation of the hip in children. J Bone Joint Surg. 1936;18:737-742.
20. Harmon PH. Surgical treatment of residual deformity from suppurative arthritis of hip occurring in young children. J Bone Joint Surg Am. 1942;24:576-585.
21. Colonna PC. A new type of reconstruction operation for old ununited fractures of the neck of the femur. J Bone Joint Surg. 1935;17:110-122.
22. Cheng JC, Aguilar J, Leung PC. Hip reconstruction for femoral head loss from septic arthritis in children. A preliminary report. Clin Orthop Relat Res. 1995;314:214-224.
23. Freeland AE, Sullivan DJ, Westin GW. Greater trochanteric hip arthroplasty in children with loss of the femoral head. J Bone Joint Surg Am. 1980;62:1351-1361.
24. Pafilas D, Nayagam S. The pelvic support osteotomy: indications and preoperative planning. Strategies Trauma Limb Reconstr. 2008;3:83-92.
25 Lunseth PA, Heiple KG. Prognosis in septic arthritis of the hip in children. Clin Orthop Relat Res. 1979;139:81-85.
26. Lee SC, Shim JS, Seo SW, Lee SS. Prognostic factors of septic arthritis of hip in infants and neonates: minimum 5-year follow-up. Clin Orthop Surg. 2015;7:110-119.

How to Cite this Article: Gupta S, Agarwal A | Current Concepts in The Management of Septic Hip Sequelae in Children| International Journal of Paediatric Orthopaedics | May-August 2020; 6(2): 39-47.

(Abstract)      (Full Text HTML)      (Download PDF)

 

 

 

 

 

 

 

 

Gradual Reduction Using Overhead Traction for Developmental Dysplasia of The Hip After Walking Age: A 30-year Retrospective Study

Volume 6 | Issue 2 | May-August 2020 | Page: 12-17 | Hiroshi Kaneko, Hiroshi Kitoh, Koji Iwata, Kenichi Mishima, Masaki Matsushita, Naoki Ishiguro, Tadashi Hattori

Authors : Hiroshi Kaneko [1], Hiroshi Kitoh [1], Koji Iwata [1], Kenichi Mishima [2], Masaki Matsushita [2], Naoki Ishiguro [2], Tadashi Hattori [1]

[1] Department of Orthopaedic Surgery, Aichi Children’s Health and Medical Center, Obu, Aichi, Japan.
[2] Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.

Address of Correspondence
Dr. Hiroshi Kitoh,
Department of Orthopaedic Surgery, Aichi Children’s Health
and Medical Center, 7-426 Moriokacho, Obu, Aichi, 474-8710, Japan.
E-mail: hiroshi_kitou@sk00106.achmc.pref.aichi.jp

Abstract

Background: The optimal management for untreated developmental dysplasia of the hip (DDH) after walking age remains controversial.
Methods: We retrospectively reviewed 80 DDH patients (85 hips) diagnosed at one through 3 years of age who underwent gradual reduction (GR) using overhead traction (OHT) with a mean follow-up of 8.2 years. We investigated radiological severity of DDH, successful reduction, avascular necrosis (AVN) of the femoral head, residual dysplasia, secondary procedures, and Severin classification. The data were compared between patients under (42 hips) and over (43 hips) 18 months of age at diagnosis.
Results: Eighty-three hips (98%) were successfully reduced by OHT. Three hips (4%) re-dislocated later and needed closed reduction or open reduction with Salter osteotomy. No AVN occurred during follow-up. Sixty-eight hips were observed without further treatment beyond 5 years of age, of which 52 (76%) remained acetabular dysplasia and 47 (69%) underwent Salter osteotomy with or without femoral osteotomy. We could finally evaluate 69 hips using Severin classification, and 52 (75%) were classified in Group I, 10 (14%) in Group II, and seven (10%) in Group III. Radiological severity of DDH at diagnosis was the only significant variable between the groups: High hip dislocation was more frequently observed in the older age group (p = 0.0131).
Conclusions: GR using OHT is a beneficial initial treatment with a high reduction rate and a low incidence of complications for DDH after walking age, from 1 to 3 years of age. Salter osteotomy performed during preschool ages can provide a satisfactory mid-term outcome for hips with residual acetabular dysplasia after OHT.
Level of Evidence: Therapeutic studies, level IV (case series).
Keywords: Developmental dysplasia of the hip; Walking age; Gradual reduction; Overhead traction; Salter innominate osteotomy.

References 

1. Dezateux C, Rosendahl K. Developmental dysplasia of the hip. Lancet 2007;369:1541-52.
2. Morin C, Wicart P, French Society of Pediatric Orthopaedics. Congenital dislocation of the hip, with late diagnosis after 1 year of age: Update and management. Orthop Traumatol Surg Res 2012;98:S154-8.
3. Rampal V, Sabourin M, Erdeneshoo E, Koureas G, Seringe R, Wicart P. Closed reduction with traction for developmental dysplasia of the hip in children aged between one and five years. J Bone Joint Surg Br 2008;90:858-63.
4. Schoenecker PL, Dollard PA, Sheridan JJ, Strecker WB. Closed reduction of developmental dislocation of the hip in children older than 18 months. J Pediatr Orthop 1995;15:763-7.
5. Vitale MG, Skaggs DL. Developmental dysplasia of the hip from six months to four years of age. J Am Acad Orthop Surg 2001;9:401-11.
6. Zionts LE, MacEwen GD. Treatment of congenital dislocation of the hip in children between the ages of one and three years. J Bone Joint Surg Am 1986;68:829-46.
7. Berkeley ME, Dickson JH, Cain TE, Donovan MM. Surgical therapy for congenital dislocation of the hip in patients who are twelve to thirty-six months old. J Bone Joint Surg Am 1984;66:412-20.
8. Galpin RD, Roach JW, Wenger DR, Herring JA, Birch JG. One-stage treatment of congenital dislocation of the hip in older children, including femoral shortening. J Bone Joint Surg Am 1989;71:734-41.
9. Ning B, Yuan Y, Yao J, Zhang S, Sun J. Analyses of outcomes of one-stage operation for treatment of late-diagnosed developmental dislocation of the hip: 864 hips followed for 3.2 to 8.9 years. BMC Musculoskelet Disord 2014;15:401.
10. Huang SC, Wang JH. A comparative study of nonoperative versus operative treatment of developmental dysplasia of the hip in patients of walking age. J Pediatr Orthop 1997;17:181-8.
11. Kaneko H, Kitoh H, Mishima K, Matsushita M, Ishiguro N. Long-term outcome of gradual reduction using overhead traction for developmental dysplasia of the hip over 6 months of age. J Pediatr Orthop 2013;33:628-34.
12. Hattori T, Ono Y, Kitakoji T, Takashi S, Iwata H. Soft-tissue interposition after closed reduction in developmental dysplasia of the hip. The long-term effect on acetabular development and avascular necrosis. J Bone Joint Surg Br 1999;81:385-91.
13. Kitoh H, Kawasumi M, Ishiguro N. Predictive factors for unsuccessful treatment of developmental dysplasia of the hip by the Pavlik harness. J Pediatr Orthop 2009;29:552-7.
14. Salter RB, Kostuik J, Dallas S. Avascular necrosis of the femoral head as a complication of treatment for congenital dislocation of the hip in young children: A clinical and experimental investigation. Can J Surg 1969;12:44-61.
15. Kalamchi A, MacEwen GD. Avascular necrosis following treatment of congenital dislocation of the hip. J Bone Joint Surg Am 1980;62:876-88.
16.Wiberg G. Studies on dysplastic acetabula and congenital subluxation of the hip joint. With special reference to the complication of osteo-arthritis. Acta Chir Scand 1939;83:1-135.
17. Kaneko H, Kitoh H, Mishima K, Matsushita M, Kadono I, Ishiguro N, et al. Factors associated with an unfavourable outcome after Salter innominate osteotomy in patients with unilateral developmental dysplasia of the hip: Does occult dysplasia of the contralateral hip affect the outcome? Bone Joint J 2014;96:1419-23.
18. Severin E. Contribution to the knowledge of congenital dislocation of the hip joint. Late results of closed reduction and arthrographic studies of recent cases. Acta Chir Scand 1941;84:1-142.the hip joint. Late results of closed reduction and arthrographic studies of recent cases. Acta Chir Scand 1941;84:1-142.
19. Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis 1957;16:494-502.
20. Salter RB, Dubos JP. The first fifteen year’s personal experience with innominate osteotomy in the treatment of congenital dislocation and subluxation of the hip. Clin Orthop Relat Res 1974;98:72-103.
21. Lindstrom JR, Ponseti IV, Wenger DR. Acetabular development after reduction in congenital dislocation of the hip. J Bone Joint Surg Am 1979;61:112-8.
22. Roposch A, Ridout D, Protopapa E, Nicolaou N, Gelfer Y. Osteonecrosis complicating developmental dysplasia of the hip compromises subsequent acetabular remodeling. Clin Orthop Relat Res 2013;471:2318-26.
23. Pun SY, Teng MS, Kim HT. Periodic rewetting enhances the viability of chondrocytes in human articular cartilage exposed to air. J Bone Joint Surg Br 2006;88:1528-32.
24. Gibson PH, Benson MK. Congenital dislocation of the hip. Review at maturity of 147 hips treated by excision of the limbus and derotation osteotomy. J Bone Joint Surg Br 1982;64:169-75.
25. Böhm P, Brzuske A. Salter innominate osteotomy for the treatment of developmental dysplasia of the hip in children: Results of seventy-three consecutive osteotomies after twenty-six to thirty-five years of follow-up. J Bone Joint Surg Am 2002;84:178-86.
26. Ito H, Ooura H, Kobayashi M, Matsuno T. Middle-term results of Salter innominate osteotomy. Clin Orthop Relat Res 2001;387:156-64.

How to Cite this Article: Kaneko H, HKitoh H, Iwata K, Mishima K, Matsushita M, Ishiguro N, Hattori T | Gradual Reduction Using Overhead Traction for Developmental Dysplasia of The Hip After Walking Age: A 30-year Retrospective Study | International Journal of Paediatric Orthopaedics | May-August 2020; 6(1): 12-16.

(Abstract)      (Full Text HTML)      (Download PDF)

 

 

 

 

 

 

 

 

Teratologic Hip Dislocations : Controversies and Consensus

Volume 6 | Issue 2 | May-August 2020 | Page: 33-38 | Sukalyan Dey, Prerana Gogoi, Rupjyoti Gogoi, Tofile Ahmed, Roopak Patel, Diganta Phukan

Authors: Sukalyan Dey [1], Prerana Gogoi [2], Rupjyoti Gogoi [3], Tofile Ahmed [4], Roopak Patel [4], Diganta Phukan [4]

[1] Department of Orthopaedics, Fakhruddin Ali Ahmed Medical College, Barpeta, Assam, India.
[2] Resident Medical Officer, Pratiksha Hospital, Guwahati
[3] Consultant Orthopedic Surgeon, Gauhati Neurological Research Center, Six Mile, Guwahati
[4] Department of Orthopaedics, CORAS Pratiksha Hospital, Guwahati.

Address of Correspondence
Dr. Sukalyan Dey,
Department of Orthopaedics, Fakhruddin Ali Ahmed Medical College,
Barpeta, Assam, India.
E-mail: sukalyan.gmch@gmail.com

Abstract

Background: The optimal management for untreated developmental dysplasia of the hip (DDH) after walking age remains controversial.
Methods: We retrospectively reviewed 80 DDH patients (85 hips) diagnosed at one through 3 years of age who underwent gradual reduction (GR) using overhead traction (OHT) with a mean follow-up of 8.2 years. We investigated radiological severity of DDH, successful reduction, avascular necrosis (AVN) of the femoral head, residual dysplasia, secondary procedures, and Severin classification. The data were compared between patients under (42 hips) and over (43 hips) 18 months of age at diagnosis.
Results: Eighty-three hips (98%) were successfully reduced by OHT. Three hips (4%) re-dislocated later and needed closed reduction or open reduction with Salter osteotomy. No AVN occurred during follow-up. Sixty-eight hips were observed without further treatment beyond 5 years of age, of which 52 (76%) remained acetabular dysplasia and 47 (69%) underwent Salter osteotomy with or without femoral osteotomy. We could finally evaluate 69 hips using Severin classification, and 52 (75%) were classified in Group I, 10 (14%) in Group II, and seven (10%) in Group III. Radiological severity of DDH at diagnosis was the only significant variable between the groups: High hip dislocation was more frequently observed in the older age group (p = 0.0131).
Conclusions: GR using OHT is a beneficial initial treatment with a high reduction rate and a low incidence of complications for DDH after walking age, from 1 to 3 years of age. Salter osteotomy performed during preschool ages can provide a satisfactory mid-term outcome for hips with residual acetabular dysplasia after OHT.
Level of Evidence: Therapeutic studies, level IV (case series).
Keywords: Developmental dysplasia of the hip; Walking age; Gradual reduction; Overhead traction; Salter innominate osteotomy.

References 

1. Katz JF. Teratological hip dislocation. Isr J Med Sci 1980;16:238-44.
2. LeBel ME, Gallien R. The surgical treatment of teratologic dislocation of the hip. J Pediatr Orthop B 2005;14:331-6.
3. Aaro S, Gottfries B, Kraepelien T, Troell S. Teratologic congenital dislocation of the hip. Report of two cases. Acta Orthop Scand 1983;54:178-81.
4. Bamshad M, Jorde LB, Carey JC. A revised and extended classification of the distal arthrogryposes. Am J Med Genet 1996;65:277-81.
5. Hall JG. Arthrogryposis multiplex congenita: Etiology, genetics, classification, diagnostic approach, and general aspects. J Pediatr Orthop B 1997;6:159-66.
6. Stilli S, Antonioli D, Lampasi M, Donzelli O. Management of hip contractures and dislocations in arthrogryposis. Musculoskelet Surg 2012;96:17-21.
7. Gruel CR, Birch JG, Roach JW, Herring JA. Teratologic dislocation of the hip. J Pediatr Orthop 1986;6:693-702.
8. Hass J. Congenital Dislocation of the Hip. Illinois: Charles C Thomas Publisher; 1951.
9. Akazawa H, Oda K, Mitani S, Yoshitaka T, Asaumi K, Inoue H. Surgical management of hip dislocation in children with arthrogryposis multiplex congenita. J Bone Joint Surg Br 1998;80:636-40.
10. Horton WA, Rimoin DL, Lachman RS, Skovby F, Hollister DW, Spranger J, et al. The phenotypic variability of diastrophic dysplasia. J Pediatr 1978;93:609-13.
11. Coleman SS. Teratologic congenital dislocation. In: Congenital Dysplasia and Dislocation of the Hip. St. Louis, MO: CV Mosby; 1978. p. 249-56.
12. Friedlander HL, Westin GW, Wood WL Jr. Arthrogryposis multiplex congenita: A review of forty-five cases. J Bone Joint Surg Am 1968;50:89-112.
13. Gibson DA, Urs ND. Arthrogryposis multiplex congenita. J Bone Joint Surg Br 1970;52:483-93.
14. Drummond DS, Mackenzie DA. Scoliosis in arthrogryposis multiplex congenita. Spine (Phila Pa 1976) 1978;3:146-51.
15. Bernstein RM. Arthrogryposis and amyoplasia. J Am Acad Orthop Surg 2002;10:417-24.
16. Lloyd-Roberts GC, Lettin AW. Arthrogryposis multiplex congenita. J Bone Joint Surg Br 1970;52:494-508.
17. Staheli LT, Chew DE, Elliott JS, Mosca VS. Management of hip dislocations in children with arthrogryposis. J Pediatr Orthop 1987;7:681-5.
18. St Clair HS, Zimbler S. A plan of management and treatment results in the arthrogrypotic hip. Clin Orthop Relat Res 1985;194:74-80.
19. Huurman WW, Jacobsen ST. The hip in arthrogryposis multiplex congenita. Clin Orthop Relat Res 1985;194:81-6.
20. Williams P. The management of arthrogryposis. Orthop Clin North Am 1978;9:67-88.
21. Martin S, Tobias JD. Perioperative care of the child with arthrogryposis. Paediatr Anaesth 2006;16:31-7.
22. Bevan WP, Hall JG, Bamshad M, Staheli LT, Jaffe KM, Song K. Arthrogryposis multiplex congenita (amyoplasia): An orthopaedic perspective. J Pediatr Orthop 2007;27:594-600.

How to Cite this Article: Dey S, Gogoi P, Gogoi R, Ahmed T, Patel R, Phukan D | Teratologic Hip Dislocations: Controversies and Consensus | International Journal of Paediatric Orthopaedics | May-August 2020; 6(2): 33-38.

(Abstract)      (Full Text HTML)      (Download PDF)