Tag Archive for: hip

Functional Outcome after Revision Surgery for Developmental Dysplasia of the Hip (DDH)

Volume 9 | Issue 2 | May-August 2023 | Page: 21-26 | Atul Bhaskar

DOI- https://doi.org/10.13107/ijpo.2023.v09.i02.167

Submitted: 24/02/2023; Reviewed: 18/03/2023; Accepted: 25/05/2023; Published: 10/08/2023

Authors: Atul Bhaskar MS Ortho, FRCS Ortho [1]

[1] Department of Orthopaedics, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India.

Address of Correspondence

Dr. Atul Bhaskar,
Paediatric Orthopaedic Surgeon, Department of Orthopaedics, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India.
E-mail: arb_25@yahoo.com

Abstract

Background: Failure after primary DDH surgery can occur early or immediate, delayed (within six months) and late due to poor remodelling. We report the short-term results after revision surgery in eighteen children including four early and 14 delayed failures.
Patient and Methods: Between 2002 and 2017, eighteen children (19 hips) underwent primary surgery at a mean age of 19 months (range: 9 months – 24 months). There were 12 girls and 6 boys in the study, with nine left and eight right sided dislocations. One child had bilateral dislocation. The mean age at revision surgery was 30 months (range: 22 months – 48 months).
Results: All cases were assessed with the modified Ponseti score to include squatting and cross-leg sitting. Eleven children (61%) were completely pain free, able to squat (Modified Ponseti score 1 and 2), three (17%) had mild limp and four (22%) had gross limitation of function. Avascular necrosis (AVN) was recorded according to Kalamchi and MacEwen criteria. Nine hips (50%) had mild AVN and six (33%) had coxa valga due to lateral physeal arrest.
The radiological outcome at final radiograph was based on Severin grade. Only 4 hips (22%) had a spherical head. Ten hips had moderate deformity (55%) and 5 hips (27%) had aspherical incongruency.
Conclusion: Early and delayed failures in DDH surgery are mainly due to inadequate initial exposure and poor hip stabilization techniques. About 50% of the revision cases had a satisfactory outcome on short term follow-up.
Keywords: Hip, Revision, Surgery, Function, Outcome

References

1) Chmielewski J, Albiñana J. Failures of open reduction in developmental dislocation of the hip. J Pediatr Orthop. 2002;11:284–9.
2) McCluskey WP, Bassett GS, Mora-Garcia G, MacEwen GD. Treatment of failed open reduction for congenital dislocation of the hip. J Pediatr Orthop. 1989;9:633
3) 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.
4) Tonnis D. Berlin, Heidelberg: Springer-Verlag; 1987. Congenital Dysplasia and Dislocation of Hip in Children and Adults.
5) Ponseti IV Causes of failure in the treatment of congenital dislocation of the hip. J Bone Joint Surg 1944; 26:775–792.
6) Wedge JH, Kelley SP. Strategies to improve outcomes from operative childhood management of DDH. Orthop Clin North Am. 2012;43:291–9.
7) Bos CF, Slooff TJ. Treatment of failed open reduction for congenital dislocation of the hip. A 10-year followup of 14 patients. Acta Orthop Scand. 1984;55:531–5.
8) Abouelnas BA, Zaghloul K, Saied AM. Revision Surgery for developmental dysplasia of the hip (DDH). Egyptian Orth Jour. 2018-53:45-50
9) Hung, N.N. Revision of Outcomes and Complications Following Open Reduction, and Zigzag Osteotomy Combined with Fibular Allograft for Developmental Dysplasia of the Hip in Children. Open Journal of Orthopedics 2016:6, 184-200.
10) Chidambaram S, Abd Halim AR, Yeap JK, Ibrahim S. Revision surgery for the developmental dysplasia of the hip. Med J Malaysia 2005;60(C):91-98.
11) Sankar WN, Young CR, Lin AG, Crow SA, Baldwin KD, Moseley CF. Risk factors for failure after open reduction for DDH: A matched cohort analysis. J Pediatr Orthop. 2011;31:232–9.
12) Kamath SU, Bennet GC. Re-dislocation following open reduction for developmental dysplasia of the hip. Int Orthop 2005;29(3):191-194.
13) Brougham DI, Broughton NS, Cole WG, Menelaus MB. Avascular necrosis following closed reduction of congenital dislocation of the hip. Review of influencing factors and long term followup. J Bone Joint Surg Br. 1990;72:557–62. [PubMed] [Google Scholar]
14) Wenger DR, Congenital hip dislocation: Techniques for primary open reduction including femoral shortening. Instructional course lecture.1984;38:343-54.
15) Severin E. Contribution to knowledge of congenital dislocation of hip joint. Late results of closed reduction and arthrographic studies of recent cases. Acta Chir Scand. 1941;84(Suppl 63):1–142.
16) Kalamchi A, MacEwen GD. Avascular necrosis following treatment of the hip. J Bone Joint Surg Am 1980; 62:876–888.
17) Johari AN, Wadia FD. Revision Surgery for Developmental Dysplasia of the Hip. Indian J Orthop.2003;37:233-6
18) 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 Sep; 50(5): 479–485.
19) Harris NH. Acetabular growth potential in congenital dislocation of the hip and some factors upon which it may depend. Clin Orthop Relat Res. 1976;119:99–106.
20) Clarke NM, Jowett AJ, Parker L. The surgical treatment of established CDH: Result of surgery after planned delayed intervention following the appearance of capital femoral ossific nucleus. J Pediatr Orthop. 2005;25:434039
21) Castañeda P, Tejerina P, Nualart L, Cassis N. The safety and efficacy of a transarticular pin for maintaining reduction in patients with developmental dislocation of the hip undergoing an open reduction. J Pediatr Orthop. 2015 Jun;35(4):358-62. doi: 10.1097/BPO.0000000000000284. PMID: 25075885.
22) Castañeda P, Masrouha KZ, Ruiz CV, Moscona-Mishy L. Outcomes following open reduction for late-presenting developmental dysplasia of the hip. Journal of Children’s Orthopaedics. 2018;12(4):323-330. doi:10.1302/1863-2548.12.180078

How to Cite this Article:  Bhaskar | A Functional Outcome after Revision Surgery for Developmental Dysplasia of the Hip (DDH) | International Journal of Paediatric Orthopaedics | May-August 2023; 9(2): 21-26. https://doi.org/10.13107/ijpo.2023.v09.i02.167

(Article Text HTML)      (Full Text PDF)

Functionality Against Odds: Lower Extremity Functional Scale and Children Health Assessment Questionnaire in Children with Bilateral Septic Sequelae of Hip

Volume 9 | Issue 1 | January-April 2023 | Page: 21-25 | Abdus Sami, Anil Agarwal, Lokesh Sharma., Yogesh Patel, Varun Garg 

DOI- https://doi.org/10.13107/ijpo.2023.v09.i01.151

Authors: Abdus Sami [1]  MS Orth., Anil Agarwal [1] MS Orth., Lokesh Sharma [1] MS Orth., Yogesh Patel [1] MS Orth., Varun Garg [1] MS Orth.

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

Address of Correspondence

Dr. Anil Agarwal,
Specialist, Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, India.
E-mail: anilrachna@gmail.com

Abstract

Purpose: We assessed the functional and radiological outcomes of children with sequelae of bilateral septic hips. Additionally, we attempted to determine the impact of radiological unstable hips on clinical functionality of the child.
Material and methods: The retrospective case series included 9 children minimum 2 years post infection. The functional outcomes were assessed using Lower Extremity Function Score (LEFS) and Children Health Assessment Questionnaire (CHAQ). Follow up hip radiographs were classified according to the Choi’s classification. We labelled the patient as having instability if either hip had a Choi type >3A.
Results: The mean age at final follow-up was 7.6 years. Five patients had multiple joints affection. The mean LEFS score was 62.7 and CHAQ-DI 0.2. The mean LEFS values for radiological stable hips (n= 5 patients) was 66 ± 19.4 and 58.5 ± 15.3 for unstable hips (p=0.5487) while corresponding CHAQ-DI scores were 0.12 ± 0.13 and 0.27 ± 0.12 respectively (p=0.1098) indicating poor relatability between functional capabilities of the child and the radiological appearances of the hips. A strong negative correlation however existed between LEFS/ CHAQ-DI values (R= -0.897; p=0.001).
Conclusions: Septic hip sequelae in children leads to various degrees of functional limitations and patients with multiple joint involvement have worse outcomes. The hip radiological findings do not relate with the overall functional status of the child.
Keywords: Functional outcome, Disability, Hip, Sepsis, Child

References

1. Arkader A, Brusalis C, Warner WC Jr, Conway JH, Noonan K. Update in pediatric musculoskeletal infections: when it is, when it isn’t, and what to do. J Am Acad Orthop Surg.2016;24:e112-21.
2. Howard JB, Highgenboten CL, Nelson JD. Residual effects of septic arthritis in infancy and childhood. JAMA.1976;236:932-5.
3. Samora JB, Klingele K. Septic arthritis of the neonatal hip: acute management and late reconstruction. J Am Acad Orthop Surg.2013;21:632-41.
4. Mue D, Salihu M, Awonusi F, Yongu W, Kortor J, Elachi I. The epidemiology and outcome of acute septic arthritis: a hospital based study. J West Afr Coll Surg.2013;3:40-52.
5. Nunn TR, Cheung WY, and Rollinson PD. A prospective study of pyogenic sepsis of the hip in childhood. J Bone Joint Surg Br.2007;89:100-6.
6. Kini AR, Shetty V, Kumar AM, Shetty SM, Shetty A. Community-associated, methicillin-susceptible, and methicillin-resistant Staphylococcus aureus bone and joint infections in children: experience from India. J Pediatr Orthop B.2013;22:158-66.
7. Narang A, Mukhopadhyay K, Kumar P, Bhakoo ON. Bone and joint infection in neonates. Indian J Pediatr.1998;65:461-4.
8. 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;72:1150-65.
9. 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;28:524-8.
10. Agarwal A, Rastogi P. Septic sequelae of hip in children: long-term clinicoradiological outcome study. J Pediatr Orthop B.2021;30:563-71.
11. Binkley JM, Stratford PW, Lott SA, Riddle DL. The Lower Extremity Functional Scale (LEFS): scale development, measurement properties, and clinical application. North American Orthopaedic Rehabilitation Research Network. Phys Ther.1999;79:371-83.
12. Singh G, Athreya BH, Fries JF, Goldsmith DP. Measurement of health status in children with juvenile rheumatoid arthritis. Arthritis Rheum.1994;37:1761-9.
13. Agarwal A, Kumar Kh V. Suppurative arthritis of hip in a walking child: Effect of patient’s age, delay in surgical drainage, and organism virulence. J Orthop Surg (Hong Kong).2020;28:2309499020910974.
14. Dingemans SA, Kleipool SC, Mulders MAM, et al. Normative data for the lower extremity functional scale (LEFS). Acta Orthop.2017;88:422-6.
15. Sontichai W, Vilaiyuk S. The correlation between the Childhood Health Assessment Questionnaire and disease activity in juvenile idiopathic arthritis. Musculoskeletal Care.2018;16:339-344.

 

How to Cite this Article: Sami A, Agarwal A, Sharma L, Patel Y, Garg V | Functionality Against Odds: Lower Extremity Functional Scale and Children Health Assessment Questionnaire in Children with Bilateral Septic Sequelae of Hip | International Journal of Paediatric Orthopaedics| January-April 2023; 9(1): 21-25 | https://doi.org/10.13107/ijpo.2023.v09.i01.151

(Article Text HTML)      (Full Text PDF)

Bilateral Septic Hip Epiphyseal Detachment in Children: A Case Report and Review of the Literature

Volume 7 | Issue 2 | May-August 2021 | Page: 20-23 | Ferdinand Nyankoue Mebouinz, Serge Etoundi Bekoé, Rose Bengono, Bertine Manuela Ndjeunga, Cathy Bebey Engome, Fabrice Arroye Betou

Authors: Ferdinand Nyankoue Mebouinz [1], Serge Etoundi Bekoé [1], Rose Bengono [1], Bertine Manuela Ndjeunga [2], Cathy Bebey Engome [3], Fabrice Arroye Betou [4]

[1] Department of Orthopaedic Trauma Surgery, Aristide Le Dantec Hospital, Cheikh Anta Diop University, Dakar, Senegal.
[2] Obstetrics Gynecology Clinic, Aristide Le Dantec Hospital, Cheikh Anta Diop University, Dakar, Senegal.
[3] Albert Royer Children’s Hospital University teaching Hospital of Fann, Cheikh Anta Diop University, Dakar,Senegal.
[4] Department of Cardiovascular and Thoracic Surgery, University teaching Hospital of Fann, Cheikh Anta Diop University, Dakar, Senegal.

Address of Correspondence
Dr Ferdinand Nyankoue Mebouinz,
Estrada do Forte do Alto Duque, 1449-005, Lisbon.
E-mail: ferdinandmebouinz@gmail.com

Abstract

Background: Diagnosed and treated fairly early, children’s septic arthritis of the hip has few or no complications. Septic epiphyseal detachment of the hip in children is a rare complication due to delayed treatment. Unilateral forms have been reported, but bilateral involvement has never been described in the literature.
Case presentation: We report the case of an 8-year-old girl who presented with hip pain associated fever and diminished lower limb movements, approximately 4 months after the onset of symptoms. The diagnosis of bilateral septic epiphyseal detachment of the hips was made and computerized tomography (CT) scan revealed osteonecrosis of both femoral heads. The necrotic epiphyses required removal in order to control the infection.
Conclusion: This report highlights the importance of early diagnosis of septic arthritis of the hip in the neonatal period. Any delay in presentation, diagnosis or management can result in irrecoverable sequelae for the developing hip and seriously impact long-term function.
Keywords: Septic arthritis, Bilateral, Epiphysis detachment, Hip, Ablation.

References

1. Barthes X, Safar A, Seringe R. Treatment of septic arthritis in children. Arch Pediatr. 1 mai 1997;4(5):460‑3.
2. Badgley CE, Yglesias L, Perham WS, Snyder CH. STUDY OF THE END RESULTS IN 113 CASES OF SEPTIC HIPS. JBJS. Oct 1936; 18(4):1047.
3. Siffert RS. The Effect of Juxta-epiphyseal Pyogenic Infection on Epiphyseal Growth. Clin Orthop Relat Res. Oct 1957; 10:131.
4. Teklali Y, Ettayebi F, Benhammou M, El Alami ZF, El Madhi T, Gourinda H, et al.
Septic arthritis in infants and children about 554 cases. J Pediatrics and Childcare. 2002;15(3):137‑41. https://doi.org/10.1016/S0987-7983(02)83036-5
5. Coulibaly Y, Diakite AA, Keita M, Diakite I, Dembele M, Diallo G. Epidemiology and therapy of osteoarthritis in children. Mali Med. 2009; 24(3):7–10.
6. Aroojis AJ, Johari AN. Epiphyseal Separations After Neonatal Osteomyelitis and Septic Arthritis, Journal of Pediatric Orthopaedics. July 2000; 20(4):544.
7. Wyers MR, Samet JD, Mithal LB. Physeal separation in pediatric osteomyelitis. Pediatr Radiol. 2019;49:1229-33. https://doi.org/10.1007/s00247-019-04410-8.
8. Gajdobranski D, Petković L, Komarcević A, Tatić M, Marić D, Pajić M. [Septic arthritis in neonates and infants]. Med Pregl. June 2003; 56(5‑6):269‑75.
9. Mue DD, Salihu MN, Yongu WT, Ochoga M, Kortor JN, Elachi IC. Paediatric Septic Arthritis in a Nigerian Tertiary Hospital: A 5-Year Clinical Review. West Afr J Med. Aug 2018; 35(2):70‑4.
10. Atarraf K, Arroud M, Chater L, Afifi MA. Post-infectious femoral epiphysis detachment, about two cases. Pan Afr Med J. Aug 2014; 18:319. https://doi: 10.11604/pamj.2014.18.319.2242.
11. Schiavon R, Borgo A, Micaglio A. Septic physeal separation of proximal femur in a newborn. J Orthop Traumatol. Jun 2009; 10(2):105‑10.
12. Singh D, Krishna LG, Siddalingaswamy MK, Gupta V. Extra capsular extrusion of femoral capital epiphysis – an unusual presentation of sequelae of septic arthritis of hip. J Pediatr Orthop Part B. Nov 2011; 20(6):428‑31.
13. Goergens ED, McEvoy A, Watson M, Barrett IR. Acute osteomyelitis and septic arthritis in children. J Paediatr Child Health. 2005;41(1‑2):59‑62.https://doi.org/10.1111/j.1440-1754.2005.00538.x
14. RAMSEYER P, CAHUZAC JP. Acute osteo-articular infection of limbs in children. Rev Prat. 2001; 9:337‑45.
15. Rasigade J-P, Trouillet-Assant S, Laurent F. Staphylococcal bone and joint infections.Rev Francoph Lab. 2016;2016(480):33‑40. http://doi.org/10.1016/S1773-035X(16)30085-5
16. Sferopoulos NK, Papavasiliou VA. [Proximal epiphyseal separation of the femur in the newborn: early ultrasonic diagnosis]. Revue de Chirurgie Orthopedique et Reparatrice de L’appareil Moteur. 1994 ;80(4):338-341.
17. Laine JC, Denning JR, Riccio AI, Jo C, Joglar JM, Wimberly RL. The use of ultrasound in the management of septic arthritis of the hip. J Pediatr Orthop Part B. 2015;24(2):95‑8.
18. Le Saux N. Diagnosis and management of acute osteoarticular infections in children. Paediatr Child Health. 18 jul 2018;23(5):344‑52.
19. Akakpo-Numado GK, Gnassingbe K, Songne B, Amadou A, Tekou H. [Hip septic arthritis in young children with sickle-cell disease]. Revue de Chirurgie Orthopedique et Reparatrice de L’appareil Moteur. Feb 2008; 94(1):58‑63. http://doi.org/10.1016/j.rco.2007.09.004
20. Fernandez FF, Langendörfer M, Wirth T, Eberhardt O. Treatment of septic arthritis of the hip in children and adolescents. Orthopeadic Trauma Surgery. Dec 2013; 151 (6):596‑602.
21. Seivert V, Milin L, Coudane H, Delagoutte J-P, Martrille L. Medical conditions and arthroscopy Osteoarthritis, osteochondromatosis, synovitis septic and rheumatologic arthritis. In: Hulet C, Flurin P-H, editors. Arthroscopic Technics of Upper Limb. Paris: Elsevier Masson; 2013 p. 153‑63.
22. Daffe M, Sarr L, Gueye AB, Dembele B, Diouf AB, Sane A, et al. Hip Septic Arthritis: A Rare Complication. Int J Paediatr Orthop. 2019; 5(1):25‑6.
23. Choi IH, Pizzutillo PD, Bowen JR, Dragann R, Malhis T. Sequelae and reconstruction after septic arthritis of the hip in infants. JBJS. 1990; 72(8):1150‑65.
24. Hunka L, Said SE, MacKenzie DA, Rogala EJ, Cruess RL. Classification and surgical management of the severe sequelae of septic hips in children. Clin Orthop Relat Res. 1982;171:30‑6.
25. Choi IH, Shin YW, Chung CY, Cho T-J, Yoo WJ, Lee DY. Surgical treatment of the severe sequelae of infantile septic arthritis of the hip. Clin Orthop. 2005; (434):102‑9.

How to Cite this Article:  Mebouinz FN, Bekoé SE, Bengono R, Ndjeunga BM, Engome CB, Betou FA | Bilateral Septic Hip Epiphyseal Detachment in Children: A Case Report and Review of the Literature |
International Journal of Paediatric Orthopaedics | May-August 2021; 7(2): 20-23.

(Article Text HTML)      (Download PDF)