Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Symposium: The Hip From Childhood to Adolescence 11 articles

Articles

What Is the Impact of Center Variability in a Multicenter International Prospective Observational Study on Developmental Dysplasia of the Hip?

Kishore Mulpuri MBBS, MS(Ortho) MHSc(Epi), Emily K. Schaeffer PhD, Simon P. Kelley MBChB, FRCS (Tr and Ortho), Pablo Castañeda MD, Nicholas M. P. Clarke ChM, DM, FRCS, FRCS Ed, Jose A. Herrera-Soto MD, Vidyadhar Upasani MD, Unni G. Narayanan MBBS, MSc, FRCSC, Charles T. Price MD, FAAP

Little information exists concerning the variability of presentation and differences in treatment methods for developmental dysplasia of the hip (DDH) in children < 18 months. The inherent advantages of prospective multicenter studies are well documented, but data from different centers may differ in terms of important variables such as patient demographics, diagnoses, and treatment or management decisions. The purpose of this study was to determine whether there is a difference in baseline data among the nine centers in five countries affiliated with the International Hip Dysplasia Institute to establish the need to consider the center as a key variable in multicenter studies.

How Often Does Femoroacetabular Impingement Occur After an Innominate Osteotomy for Acetabular Dysplasia?

Pablo Castañeda MD, Carlos Vidal-Ruiz MD, Alfonso Méndez MD, Diego Pérez Salazar MD, Armando Torres MD, MSc, FACS

Femoroacetabular impingement is increasingly recognized as a cause of hip pain but its incidence after an innominate osteotomy for the correction of acetabular dysplasia has not been determined. This information would be essential for the orthopaedic surgeon because it has the potential to produce a poor outcome in the long term when trying to balance acetabular instability and overcorrection.

What Risk Factors and Characteristics Are Associated With Late-presenting Dislocations of the Hip in Infants?

Kishore Mulpuri MBBS, MS(Ortho), MHSc(Epi), Emily K. Schaeffer PhD, Janice Andrade BSW, Wudbhav N. Sankar MD, Nicole Williams BMedSc, FRACS(Ortho), Travis H. Matheney MD, MLA, Scott J. Mubarak MD, Peter J. Cundy MBBS, FRACS, Charles T. Price MD, FAAP

Most infants with developmental dysplasia of the hip (DDH) are diagnosed within the first 3 months of life. However, late-presenting DDH (defined as a diagnosis after 3 months of age) does occur and often results in more complex treatment and increased long-term complications. Specific risk factors involved in late-presenting DDH are poorly understood, and clearly defining an associated set of factors will aid in screening, detection, and prevention of this condition.

How Does Bony Surgery Affect Results of Anterior Open Reduction in Walking-age Children With Developmental Hip Dysplasia?

Alpesh Kothari MRCS, MSc, George Grammatopoulos FRCS (Tr & Orth), DPhil, Sally Hopewell DPhil, Tim Theologis MSc, PhD

Anterior open reduction is commonly used to treat hip subluxation or dislocation in developmental dysplasia of the hip (DDH) in walking-age children. Pelvic and/or femoral osteotomy may be used in addition, but it is unclear how this affects avascular necrosis (AVN) risk and radiological and clinical results.

Is Age or Surgical Approach Associated With Osteonecrosis in Patients With Developmental Dysplasia of the Hip? A Meta-analysis

Eduardo N. Novais MD, Mary K. Hill BA, Patrick M. Carry BA, Patricia C. Heyn MS, PhD

Osteonecrosis of the femoral head is a major complication that negatively impacts the clinical and radiographic long-term outcome after treatment of developmental hip dysplasia (DDH). There are conflicting results in the literature whether age at the time of closed or open reduction and a specific surgical approach are associated with osteonecrosis. Better understanding of the impact of age at reduction and surgical approach is important to reduce the risk of osteonecrosis in patients with DDH.

Acetabuloplasties at Open Reduction Prevent Acetabular Dysplasia in Intentionally Delayed Developmental Dysplasia of the Hip: A Case-control Study

M. Belen Carsi MD, PhD, BSc, FRCS, Nicholas M. P. Clarke ChM, DM, FRCS

Avascular necrosis (AVN) and residual acetabular dysplasia are the two main complications of developmental dysplasia of the hip (DDH) treatment. Although early reduction of the hip may decrease the incidence of residual dysplasia, it may increase the incidence of AVN and vice versa. However, we do not know if changes in surgical technique may lead to a modification in these outcomes.

Have Changes in Treatment of Late-detected Developmental Dysplasia of the Hip During the Last Decades Led to Better Radiographic Outcome?

Terje Terjesen MD, PhD, Joachim Horn MD, PhD

Despite considerable changes in the treatment of of late-detected congenital or developmental hip dislocation (DDH) during the last 50 years, it is unclear whether and to what degree these changes have led to better long-term outcome for the patients.

Success of Pavlik Harness Treatment Decreases in Patients ≥ 4 Months and in Ultrasonographically Dislocated Hips in Developmental Dysplasia of the Hip

Hakan Ömeroğlu MD, Nusret Köse MD, Anil Akceylan MD

Treatment of developmental dysplasia of the hip (DDH) using the Pavlik harness has been a widely used method in patients between 0 and 6 months of age for many years. However, the factors influencing the success rate of this treatment modality have still not exactly been determined as a result of the limited number of clinical studies with higher level of evidence.

Does Perfusion MRI After Closed Reduction of Developmental Dysplasia of the Hip Reduce the Incidence of Avascular Necrosis?

Alex L. Gornitzky BS, Andrew G. Georgiadis MD, Mark A. Seeley MD, B. David Horn MD, Wudbhav N. Sankar MD

Gadolinium-enhanced perfusion MRI (pMRI) after closed reduction/spica casting for developmental dysplasia of the hip (DDH) has been suggested as a potential means to identify and avoid avascular necrosis (AVN). To date, however, no study has evaluated the effectiveness of pMRI in clinical practice or compared it with other approaches (such as postreduction CT scan) to show a difference in the proportion of AVN.

What Is the Early/Mid-term Survivorship and Functional Outcome After Bernese Periacetabular Osteotomy in a Pediatric Surgeon Practice?

George Grammatopoulos FRCS (Tr & Orth), DPhil, Jeremy Wales MBBS, Alpesh Kothari MSc, MRCS, Harinderjit S. Gill BEng, DPhil, Andrew Wainwright FRCS (Orth), MSc, Tim Theologis MSc, PhD, FRCS

The Bernese periacetabular osteotomy (PAO) is a recognized joint-preserving procedure. Achieving joint stability without creating impingement is important, but the orientation target that best balances these sometimes competing goals has not yet been clearly defined. Moreover, the learning curve of this challenging procedure has not been described.