Introducing a Novel Combined Acetabuloplasty and Chondroplasty Technique for the Treatment of Developmental Dysplasia of the Hip.
acetabular coverage
chondroplasty
developmental dysplasia of the hip
early open reduction
hip
Journal
Cureus
ISSN: 2168-8184
Titre abrégé: Cureus
Pays: United States
ID NLM: 101596737
Informations de publication
Date de publication:
Jan 2022
Jan 2022
Historique:
accepted:
29
01
2022
entrez:
7
3
2022
pubmed:
8
3
2022
medline:
8
3
2022
Statut:
epublish
Résumé
The aim of the treatment of developmental dysplasia of the hip (DDH) is to maintain a concentric reduction. We describe a novel approach to treat DDH that involves improvement of cartilaginous acetabular coverage, involves the preservation of the secondary ossification center of the acetabulum, and is adjunctive to early open reduction. Thirty-nine children (40 hips) aged six to 18 months were included in the study. Open reduction with chondroplasty was performed during the same surgery. Patients were followed up for 15 years with both clinical and radiological assessments. At the final follow-up, all patients were graded as good or excellent according to Severin's classification. The mean age at reduction was 11.9 months (range: 8-16). The mean preoperative acetabular index (AI) was 43.43 (range: 40-48). After the operation, mean AI decreased to 16.97 (P < 0.0001, 95% confidence interval (CI) = 16.24-17.70). AI improved significantly during growth (mean AI changes 13.50, P < 0.0001, 95% CI = 12.65-14.34). The mean lateral center-edge (CE) angle at skeletal maturity was 32.94° (SD = 4.16°). Mild avascular necrosis (AVN) was observed in two hips with involvement of the epiphysis and was of Kalamchi grade 1. Chondroplasty in conjunction with open reduction can yield a concentric reduction with improved acetabular coverage that facilitates acetabular remodeling that is sustained until skeletal maturity. Prompt correction through this procedure may help to improve the development of the hip and lead to near normal function as demonstrated by improved mean AI and Severin scores at the last follow-up. With low complication and reoperation rates, this procedure could be considered as a surgical treatment option for DDH in patients between the age of six and 18 months.
Sections du résumé
BACKGROUND
BACKGROUND
The aim of the treatment of developmental dysplasia of the hip (DDH) is to maintain a concentric reduction. We describe a novel approach to treat DDH that involves improvement of cartilaginous acetabular coverage, involves the preservation of the secondary ossification center of the acetabulum, and is adjunctive to early open reduction.
METHODOLOGY
METHODS
Thirty-nine children (40 hips) aged six to 18 months were included in the study. Open reduction with chondroplasty was performed during the same surgery. Patients were followed up for 15 years with both clinical and radiological assessments. At the final follow-up, all patients were graded as good or excellent according to Severin's classification.
RESULTS
RESULTS
The mean age at reduction was 11.9 months (range: 8-16). The mean preoperative acetabular index (AI) was 43.43 (range: 40-48). After the operation, mean AI decreased to 16.97 (P < 0.0001, 95% confidence interval (CI) = 16.24-17.70). AI improved significantly during growth (mean AI changes 13.50, P < 0.0001, 95% CI = 12.65-14.34). The mean lateral center-edge (CE) angle at skeletal maturity was 32.94° (SD = 4.16°). Mild avascular necrosis (AVN) was observed in two hips with involvement of the epiphysis and was of Kalamchi grade 1.
CONCLUSION
CONCLUSIONS
Chondroplasty in conjunction with open reduction can yield a concentric reduction with improved acetabular coverage that facilitates acetabular remodeling that is sustained until skeletal maturity. Prompt correction through this procedure may help to improve the development of the hip and lead to near normal function as demonstrated by improved mean AI and Severin scores at the last follow-up. With low complication and reoperation rates, this procedure could be considered as a surgical treatment option for DDH in patients between the age of six and 18 months.
Identifiants
pubmed: 35251857
doi: 10.7759/cureus.21787
pmc: PMC8890947
doi:
Types de publication
Journal Article
Langues
eng
Pagination
e21787Informations de copyright
Copyright © 2022, Yazdanshenas et al.
Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
Arthroscopy. 2013 Apr;29(4):666-74
pubmed: 23395250
J Bone Joint Surg Br. 1996 May;78(3):471-6
pubmed: 8636189
J Bone Joint Surg Br. 1996 Nov;78(6):924-9
pubmed: 8951008
World J Orthop. 2013 Apr 18;4(2):32-41
pubmed: 23610749
Cureus. 2021 Jan 22;13(1):e12864
pubmed: 33520559
J Bone Joint Surg Br. 2004 Apr;86(3):430-3
pubmed: 15125133
J Bone Joint Surg Am. 2003 Feb;85(2):239-43
pubmed: 12571300
J Clin Med. 2020 Apr 22;9(4):
pubmed: 32331338
J Bone Joint Surg Br. 2005 Mar;87(3):380-3
pubmed: 15773650
J Pediatr Orthop. 2006 May-Jun;26(3):307-9
pubmed: 16670540
J Pediatr Orthop. 1997 Mar-Apr;17(2):181-8
pubmed: 9075093
Int Orthop. 2009 Oct;33(5):1391-6
pubmed: 19449005
Acta Orthop. 2014 Feb;85(1):66-70
pubmed: 24460107
J Bone Joint Surg Am. 1986 Jul;68(6):829-46
pubmed: 3733773
J Bone Joint Surg Am. 2009 Nov;91(11):2622-36
pubmed: 19884437
J Bone Joint Surg Am. 1997 May;79(5):656-63
pubmed: 9160937
J Pediatr Orthop. 2011 Apr-May;31(3):227-31
pubmed: 21415679
J Bone Joint Surg Br. 2006 Aug;88(8):1076-81
pubmed: 16877609
Croat Med J. 2002 Jun;43(3):312-8
pubmed: 12035138
J Bone Joint Surg Br. 1990 Mar;72(2):175-80
pubmed: 2312552
J Bone Joint Surg Am. 1997 Jun;79(6):810-7
pubmed: 9199376
J Bone Joint Surg Br. 2012 Dec;94(12):1625-31
pubmed: 23188902
Arch Orthop Trauma Surg. 1991;110(3):169-72
pubmed: 2059544
Injury. 2011 Sep;42 Suppl 2:S3-15
pubmed: 21704997
Acta Orthop Scand. 2000 Jun;71(3):232-42
pubmed: 10919293
J Pediatr Orthop B. 2005 May;14(3):151-5
pubmed: 15812283
Chang Gung Med J. 2011 Jan-Feb;34(1):84-92
pubmed: 21392478
Int Orthop. 2011 Sep;35(9):1359-67
pubmed: 21553044
J Pediatr Orthop. 1995 Nov-Dec;15(6):768-79
pubmed: 8543606
J Pediatr Orthop. 1997 Mar-Apr;17(2):176-80
pubmed: 9075092
J Bone Joint Surg Br. 2008 Jul;90(7):858-63
pubmed: 18591592
J Child Orthop. 2010 Oct;4(5):429-38
pubmed: 21966307
Curr Rev Musculoskelet Med. 2021 Feb;14(1):60-66
pubmed: 33587261
J Pediatr Orthop. 2004 Sep-Oct;24(5):493-500
pubmed: 15308898
J Bone Joint Surg Am. 1980 Sep;62(6):876-88
pubmed: 7430175
J Pediatr Orthop. 2008 Sep;28(6):607-13
pubmed: 18724195
J Bone Joint Surg Am. 1966 Oct;48(7):1413-39
pubmed: 5921797
J Pediatr Orthop B. 1995;4(2):171-8
pubmed: 7670986
J Pediatr Orthop. 1990 May-Jun;10(3):335-40
pubmed: 2355075
J Pediatr Orthop. 2010 Oct-Nov;30(7):676-82
pubmed: 20864852
J Bone Joint Surg Br. 2004 Aug;86(6):876-86
pubmed: 15330030
Orthop Rev (Pavia). 2010 Sep 23;2(2):e19
pubmed: 21808709
J Pediatr Orthop B. 2005 Nov;14(6):415-21
pubmed: 16200016