Tag Archive for: Developmental dysplasia of the hip; Walking age; Gradual reduction; Overhead traction; Salter innominate osteotomy.

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.

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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)