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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

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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

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Surgical Treatment of Pathological Developmental Dysplasia of the Hip: A 12-Year Study

Volume 7 | Issue 2 | May-August 2021 | Page: 02-06 | Qaisar Choudry, Robin W. Paton

Authors: Qaisar Choudry [1], Robin W. Paton [1]

[1] Department of Orthopaedics, East Lancashire Hospitals NHS Trust, England.

Address of Correspondence
Dr. Qaisar Choudry
Department of Orthopaedics, East Lancashire Hospitals NHS Trust, England.
E-mail: qaisar.choudry@elht.nhs.uk

Abstract

Aim: We aimed to assess outcomes of a 12-year longitudinal observational study of developmental dysplasia of the hip (DDH) requiring surgical intervention.

Method: We conducted a prospective study from 2004 to 2015 of all cases of DDH undergoing surgical intervention. In addition to clinical examination, Tönnis acetabular index (AI) method and International Hip Dysplasia Institute (IHDI) grading used.  Avascular necrosis of the femoral head (AVN) was assessed by the Kalamchi method.

Results & Discussion: There were 81 hips in 72 patients (12 male, 60 female).  Mean age of the first operative procedure was 16.4 months (95% CI, 13.66 to 19.14). Mean follow up was 47.6 months (95% CI, 41.8 to 53.4). 31 children underwent closed reductions, 48 required open reduction; 17 femoral and 39 pelvic osteotomies were performed during the course of the study. Overall, post-surgery 96.3 % were noted to have an acceptable AI (< 2 SD of the mean).  Five hips were considered to have poor results due to residual subluxation/ dislocation (6.2%).  Evidence of avascular necrosis was present in 16 of the 81 hips (19.8%).

Higher grades of hip pathology were generally associated with a later age of diagnosis and likely to require more extensive surgical interventions.

Conclusion: Operative intervention for DDH results in acceptable clinical and radiographic outcomes in the vast majority of children.

Keywords: DDH, Developmental Dysplasia of the hip, Surgery.

References 

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How to Cite this Article:  Choudry Q, Paton RW | Surgical Treatment  of Pathological Developmental Dysplasia of the Hip: A 12-Year Study | International Journal of Paediatric Orthopaedics | May-August 2021; 7(2): 02-06.

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Osteochondroma Arising from the Head of the Fibula: A Rare Cause of Drop Foot in Pediatric Age

Volume 3 | Issue 1 | Jan-Jun 2017 | Page 2-5 | Pérez-Ortiz Sergio, Blas-Dobón JA, Peralta-Nieto J, Gómez-Barbero P

Authors : Pérez-Ortiz Sergio [1], Blas-Dobón JA [1], Peralta-Nieto J [1], Gómez-Barbero P [1].

[1] Hospital Universitario Doctor Peset, Valencia, Spain

Address of Correspondence
Dr. Sergio Perez  Ortiz

Hospital Universitario Doctor Peset, Valencia, Spain.

Email: serperort@gmail.com

Abstract

Background: The common peroneal nerve (CPN) or external popliteal nerve is the most frequently involved nerve in entrapment syndromes in the lower extremities. Its proximity to the head of the fibula makes it particularly susceptible to damage by different injury mechanisms. Osteochondromas arising from the proximal fibula are a rare cause of common peroneal nerve injury.
Methods: We report a case of a 13-year-old Caucasian male patient referred to our hospital with drop foot and palpable mass in the head of the right fibula. Physical examination revealed a severe paresis, grade 2 objectified by the scale of the Medical Research Council (MRC) in the extensor hallucislongus, extensor digitorumlongus and tibialis anterior muscles and hypoesthesia in the dorsal surface of foot and portions of the anterior, lower-lateral leg. In magnetic resonance imaging (MRI) a tumor in the head of the fibula compressing the CPN is observed. Electromyographic studies confirmed the presence of severe partial axonotmesis of the right peroneal nerve.
The patient underwent surgery for decompression of the peroneal nerve and resection of the proximal fibula osteocartilaginousexostosis. The histopathological analysis confirmed the diagnosis of osteochondroma.
Results: At the 12-month postoperative follow-up the patient recovered sensitivity and presented, according to the MRC scale, muscle strength of 4 out of 5 in thepreviouslynamed muscles, being able to walk without orthotic devices. In the electromyography, subacuteaxonotmesis with important signs of active reinnervation observed
Conclusions : Osteochondroma in the head of the fibula is a rare cause of CPN injury, that can go easily unnoticed and has to be considered in the differential diagnosis of the drop foot in pediatric ages. Diagnosis and treatment should not be delayed to get a good neurological recovery because, otherwise, it could be irreversible.
Keywords: Drop foot, peroneal palsy, osteochondroma, tumor, nerve injury, surgery, nerve decompression, tumor of the fibula, pediatrics.

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How to Cite this Article: Sergio PO, Blas-Dobón JA, Peralta-Nieto J, Gómez-Barbero POsteochondroma Arising from the Head of the Fibula: A Rare Cause of Drop Foot in Pediatric Age. International Journal of Paediatric Orthopaedics Jan-June 2017;3(1):20-23.

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