Residual Acetabular Dysplasia in the Reduced Hip.
Developmental dysplasia of the hip
Osteoarthritis
Pediatric hip
Pediatrics
Pelvic osteotomy
Residual acetabular dysplasia
Journal
Indian journal of orthopaedics
ISSN: 0019-5413
Titre abrégé: Indian J Orthop
Pays: Switzerland
ID NLM: 0137736
Informations de publication
Date de publication:
Dec 2021
Dec 2021
Historique:
received:
19
07
2021
accepted:
04
09
2021
entrez:
10
1
2022
pubmed:
11
1
2022
medline:
11
1
2022
Statut:
epublish
Résumé
Residual acetabular dysplasia occurs in up to a third of patients treated successfully for developmental dysplasia of the hip (DDH) and has been found to be a significant risk factor for early hip osteoarthritis (OA). Age at the time of initial reduction and the initial severity of DDH have been linked to residual acetabular dysplasia. An anteroposterior pelvic radiograph is the main diagnostic modality, but MRI also provides valuable information, particularly in equivocal cases. The literature supports intervening when significant residual acetabular dysplasia persists at 4-5 years of age, and common surgical indications include acetabular index (AI) > 25°-30°, lateral center-edge angle (LCEA) < 8°-10°, and a broken Shenton's line on radiographs; and a cartilaginous acetabular angle (CAI) > 18°, cartilaginous center-edge angle (CCE) < 13°, and/or the presence of high-signal intensity areas on MRI. Surgical options include redirectional pelvic osteotomies and reshaping acetabuloplasties, which provide comparable radiographic and clinical results. RAD is common after treatment of DDH and requires regular follow-up for diagnosis and appropriate management to decrease the long-term risk of OA. Long-term outcomes of patients treated with pelvic osteotomies are generally favorable, and the risk of OA can be decreased, although the risk of total hip replacement in the long-term remains.
Sections du résumé
BACKGROUND
BACKGROUND
Residual acetabular dysplasia occurs in up to a third of patients treated successfully for developmental dysplasia of the hip (DDH) and has been found to be a significant risk factor for early hip osteoarthritis (OA).
DISCUSSION
CONCLUSIONS
Age at the time of initial reduction and the initial severity of DDH have been linked to residual acetabular dysplasia. An anteroposterior pelvic radiograph is the main diagnostic modality, but MRI also provides valuable information, particularly in equivocal cases. The literature supports intervening when significant residual acetabular dysplasia persists at 4-5 years of age, and common surgical indications include acetabular index (AI) > 25°-30°, lateral center-edge angle (LCEA) < 8°-10°, and a broken Shenton's line on radiographs; and a cartilaginous acetabular angle (CAI) > 18°, cartilaginous center-edge angle (CCE) < 13°, and/or the presence of high-signal intensity areas on MRI. Surgical options include redirectional pelvic osteotomies and reshaping acetabuloplasties, which provide comparable radiographic and clinical results.
CONCLUSION
CONCLUSIONS
RAD is common after treatment of DDH and requires regular follow-up for diagnosis and appropriate management to decrease the long-term risk of OA. Long-term outcomes of patients treated with pelvic osteotomies are generally favorable, and the risk of OA can be decreased, although the risk of total hip replacement in the long-term remains.
Identifiants
pubmed: 35003538
doi: 10.1007/s43465-021-00515-1
pii: 515
pmc: PMC8688620
doi:
Types de publication
Journal Article
Review
Langues
eng
Pagination
1480-1489Informations de copyright
© Indian Orthopaedics Association 2021.
Déclaration de conflit d'intérêts
Conflict of InterestThe authors declare that they have no conflict of interest.
Références
J Bone Joint Surg Am. 1997 May;79(5):656-63
pubmed: 9160937
J Bone Joint Surg Br. 2012 Dec;94(12):1625-31
pubmed: 23188902
J Bone Joint Surg Br. 1975 Feb;57(1):46-52
pubmed: 1117022
J Pediatr Orthop. 2018 Nov/Dec;38(10):498-502
pubmed: 27662383
J Pediatr Orthop B. 2020 Sep;29(5):431-437
pubmed: 31464797
Acta Orthop Belg. 2015 Sep;81(3):375-83
pubmed: 26435230
Semin Musculoskelet Radiol. 2014 Jul;18(3):219-27
pubmed: 24896739
J Pediatr Orthop. 2011 Jun;31(4):381-7
pubmed: 21572275
Iowa Orthop J. 2011;31:52-8
pubmed: 22096420
J Pediatr Orthop B. 2017 Jul;26(4):344-349
pubmed: 27379671
Bone Jt Open. 2020 Oct 27;1(4):55-63
pubmed: 33215108
J Pediatr Orthop B. 2013 Nov;22(6):527-32
pubmed: 23799355
Clin Orthop Relat Res. 1981 Oct;(160):14-29
pubmed: 7285414
Bone Joint J. 2013 Feb;95-B(2):279-85
pubmed: 23365042
J Child Orthop. 2011 Aug;5(4):251-60
pubmed: 22852031
J Bone Joint Surg Am. 2016 Jul 20;98(14):1215-21
pubmed: 27440570
J Bone Joint Surg Am. 2020 Aug 5;102(15):1351-1357
pubmed: 32769602
Skeletal Radiol. 2012 Sep;41(10):1273-8
pubmed: 22584462
Int Orthop. 2018 Mar;42(3):631-640
pubmed: 29285666
J Bone Joint Surg Am. 1978 Jul;60(5):575-85
pubmed: 681376
Clin Orthop Relat Res. 2014 Mar;472(3):1001-9
pubmed: 24096458
Clin Orthop Relat Res. 2017 Feb;475(2):336-350
pubmed: 27071391
J Bone Joint Surg Am. 2008 Oct;90(10):2267-81
pubmed: 18829926
Clin Orthop Relat Res. 1989 May;(242):98-103
pubmed: 2706864
Bone Joint J. 2014 Oct;96-B(10):1419-23
pubmed: 25274931
Curr Rev Musculoskelet Med. 2016 Dec;9(4):427-434
pubmed: 27613709
J Pediatr Orthop. 2018 Mar;38(3):163-169
pubmed: 27261963
Clin Orthop Relat Res. 2000 Sep;(378):174-82
pubmed: 10986992
Clin Orthop Relat Res. 1976 Sep;(119):39-47
pubmed: 954321
J Pediatr Orthop. 2006 Jan-Feb;26(1):16-23
pubmed: 16439895
Clin Orthop Relat Res. 1991 Apr;(265):207-17
pubmed: 2009660
J Child Orthop. 2012 Dec;6(6):471-7
pubmed: 24294309
J Bone Joint Surg Br. 2002 Apr;84(3):418-25
pubmed: 12002504
Orthop Surg. 2014 Aug;6(3):210-6
pubmed: 25179355
Clin Orthop Relat Res. 2016 May;474(5):1209-15
pubmed: 26822844
Skeletal Radiol. 2002 Jan;31(1):25-9
pubmed: 11807589
J Pediatr Orthop. 2021 Feb 1;41(2):e125-e129
pubmed: 33165268
Instr Course Lect. 2004;53:523-30
pubmed: 15116641
J Orthop. 2014 Jan 22;12(2):81-5
pubmed: 25972698
J Pediatr Orthop B. 2014 May;23(3):237-43
pubmed: 24394595
J Pediatr Orthop. 2010 Jan-Feb;30(1):37-43
pubmed: 20032740
J Child Orthop. 2019 Apr 01;13(2):172-179
pubmed: 30996742
Clin Orthop Relat Res. 1988 Nov;(236):199-204
pubmed: 3180571
J Pediatr Orthop. 2019 Mar;39(3):111-118
pubmed: 30730414
Ann Rheum Dis. 1991 May;50(5):308-10
pubmed: 2042985
J Child Orthop. 2011 Dec;5(6):425-31
pubmed: 23205144
J Bone Joint Surg Br. 2007 Feb;89(2):230-5
pubmed: 17322441
J Bone Joint Surg Am. 2002 Feb;84(2):178-86
pubmed: 11861722
J Bone Joint Surg Am. 1966 Oct;48(7):1413-39
pubmed: 5921797
Clin Orthop Relat Res. 1987 Dec;(225):62-76
pubmed: 3315382
J Bone Joint Surg Br. 2004 Aug;86(6):876-86
pubmed: 15330030
J Pediatr Orthop. 2013 Oct-Nov;33(7):714-8
pubmed: 23812157