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Variables influencing the pelvic radiological evaluation in children with developmental dysplasia of the hip managed by closed reduction: a multicentre investigation

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Abstract

Purpose

This study aims to evaluate (1) the probability to achieve normal pelvic radiographs in children with developmental dysplasia of the hip (DDH) treated by closed reduction and (2) the amount of time needed to achieve normal pelvic radiographs and to assess what factors influence both probability and time to achieve normal radiographic parameters following CR and spica cast immobilization for DDH.

Methods

We retrospectively reviewed 436 patients (393 girls, 43 boys; 507 hips) with DDH treated by closed reduction (CR). Tönnis grade, AVN, acetabular index (AI), centre-edge angle (CEA), and Severin radiographic grade were evaluated on plain radiographs. Criteria to rate pelvis radiographs as normal were established. Cox regression was used to evaluate the factors influencing the probability and the time to achieve normal radiographs.

Results

According to our criteria, 167 hips (32.9%) achieved normal radiographic parameters during follow-up. The overall amount of time to achieve normal pelvis radiographs was 36.1 ± 15.5 months. Patients older than 24 months of age at the time of CR needed longer time to achieve normal radiographic parameters (55.2 ± 28 months) compared with other age groups. Cox regression analysis suggested the overall cumulative probability of recovery increased by 46% at five years following CR, then it tended to plateau with an annual increase less than 5%. Age older than 24 months, bilateral dislocation, pre-operative AI greater than 40°, and AVN were risk factors for reduced probability of achieving normal radiographic parameters.

Conclusions

The cumulative probability of achieving normal pelvis radiographs increases linearly during the first five years following CR, then it tends to plateau. Age older than 24 months and Tönnis grade III and IV are associated with longer time to achieve normal radiographic parameters. Age older than 24 months, bilateral dislocation, pre-operative AI greater than 40°, and AVN are risk factors for reduced probability of achieving normal radiographic parameters in children with DDH treated by closed means.

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References

  1. Tomlinson J, O’Dowd D, Fernandes JA (2016) Managing developmental dysplasia of the hip. Indian J Pediatr 83(11):1275–1279. https://doi.org/10.1007/s12098-016-2160-9

    Article  PubMed  Google Scholar 

  2. Kotlarsky P, Haber R, Bialik V, Eidelman M (2015) Developmental dysplasia of the hip: what has changed in the last 20 years? World J Orthop 6(11):886–901. https://doi.org/10.5312/wjo.v6.i11.886

    Article  PubMed  PubMed Central  Google Scholar 

  3. Loder RT, Skopelja EN (2011) The epidemiology and demographics of hip dysplasia. ISRN Orthop 2011:238607. https://doi.org/10.5402/2011/238607

    Article  PubMed  PubMed Central  Google Scholar 

  4. Albinana J, Dolan LA, Spratt KF, Morcuende J, Meyer MD, Weinstein SL (2004) Acetabular dysplasia after treatment for developmental dysplasia of the hip. Implications for secondary procedures. J Bone Joint Surg (Br) 86(6):876–886

    Article  CAS  Google Scholar 

  5. Cooperman DR, Wallensten R, Stulberg SD (1983) Acetabular dysplasia in the adult. Clin Orthop Relat Res 175:79–85

    Google Scholar 

  6. Li Y, Guo Y, Li M, Zhou Q, Liu Y, Chen W, Li J, Canavese F, Xu H (2018) Acetabular index is the best predictor of late residual acetabular dysplasia after closed reduction in developmental dysplasia of the hip. Int Orthop 42(3):631–640. https://doi.org/10.1007/s00264-017-3726-5

    Article  PubMed  Google Scholar 

  7. Kitoh H, Kitakoji T, Katoh M, Ishiguro N (2006) Prediction of acetabular development after closed reduction by overhead traction in developmental dysplasia of the hip. J Orthop Sci 11(5):473–477. https://doi.org/10.1007/s00776-006-1049-2

    Article  PubMed  Google Scholar 

  8. Li Y, Zhou Q, Liu Y, Chen W, Li J, Canavese F, Xu H (2019) Closed reduction and dynamic cast immobilization in patients with developmental dysplasia of the hip between 6 and 24 months of age. Eur J Orthop Surg Traumatol 29(1):51–57. https://doi.org/10.1007/s00590-018-2289-5

    Article  PubMed  Google Scholar 

  9. Rampal V, Sabourin M, Erdeneshoo E, Koureas G, Seringe R, Wicart P (2008) Closed reduction with traction for developmental dysplasia of the hip in children aged between one and five years. J Bone Joint Surg (Br) 90(7):858–863. https://doi.org/10.1302/0301-620x.90b7.20041

    Article  CAS  Google Scholar 

  10. Kaneko H, Kitoh H, Mishima K, Matsushita M, Ishiguro N (2013) Long-term outcome of gradual reduction using overhead traction for developmental dysplasia of the hip over 6 months of age. J Pediatr Orthop 33(6):628–634. https://doi.org/10.1097/BPO.0b013e31829b2d8b

    Article  PubMed  Google Scholar 

  11. Tönnis D (1987) Congenital dysplasia and dislocation of the hip in children and adults. Springer Verlag, Berlin

    Book  Google Scholar 

  12. Salter RB, Kostuik J, Dallas S (1969) Avascular necrosis of the femoral head as a complication of treatment for congenital dislocation of the hip in young children: a clinical and experimental investigation. Can J Surg 12(1):44–61

    CAS  PubMed  Google Scholar 

  13. Bucholz RW, Ogden JA (1978) Patterns of ischemic necrosis of the proximal femur in nonoperatively treated congenital hip disease. Paper presented at the proceodings of the Sixth Open Scientific Meeting of the Hip Society, St Louis,

  14. Severin E (1941) Contribution to the knowledge of congenital dislocation of the hip joint. Acta Chir Scand 84(Suppl 63):1–142

    Google Scholar 

  15. Gage JR, Winter RB (1972) Avascular necrosis of the capital femoral epiphysis as a complication of closed reduction of congenital dislocation of the hip. A critical review of twenty years’ experience at Gillette Children’s hospital. J Bone Joint Surg Am 54(2):373–388

    Article  CAS  Google Scholar 

  16. Shi YY, Liu TJ, Zhao Q, Zhang LJ, Ji SJ, Wang EB (2010) The normal centre-edge angle of Wiberg in the Chinese population: a population-based cross-sectional study. J Bone Joint Surg (Br) 92(8):1144–1147. https://doi.org/10.1302/0301-620x.92b8.23993

    Article  CAS  Google Scholar 

  17. Shi YY, Liu TJ, Zhao Q, Zhang LJ, Ji SJ (2010) The measurements of normal acetabular index and sharp acetabular angle in Chinese hips (中国人髋关节髋臼指数和Sharp角正常值的测量). Chinese Journal of Orthopedics 30(8):748–753

    Google Scholar 

  18. Smith JT, Matan A, Coleman SS, Stevens PM, Scott SM (1997) The predictive value of the development of the acetabular teardrop figure in developmental dysplasia of the hip. J Pediatr Orthop 17(2):165–169

    Article  CAS  Google Scholar 

  19. Ward WT, Vogt M, Grudziak JS, Tumer Y, Cook PC, Fitch RD (1997) Severin classification system for evaluation of the results of operative treatment of congenital dislocation of the hip. A study of intraobserver and interobserver reliability. J Bone Joint Surg Am 79(5):656–663. https://doi.org/10.2106/00004623-199705000-00004

    Article  CAS  PubMed  Google Scholar 

  20. Ali AM, Angliss R, Fujii G, Smith DM, Benson MK (2001) Reliability of the Severin classification in the assessment of developmental dysplasia of the hip. J Pediatr Orthop B 10(4):293–297

    CAS  PubMed  Google Scholar 

  21. Tönnis D (1976) Normal values of the hip joint for the evaluation of X-rays in children and adults. Clin Orthop Relat Res 119:39–47

    Google Scholar 

  22. Li LY, Zhang LJ, Li QW, Zhao Q, Jia JY, Huang T (2012) Development of the osseous and cartilaginous acetabular index in normal children and those with developmental dysplasia of the hip: a cross-sectional study using MRI. J Bone Joint Surg (Br) 94(12):1625–1631. https://doi.org/10.1302/0301-620x.94b12.29958

    Article  CAS  Google Scholar 

  23. Huber H, Mainard-Simard L, Lascombes P, Renaud F, Jean-Baptiste M, Journeau P (2014) Normal values of bony, cartilaginous, and labral coverage of the infant hip in MR imaging. J Pediatr Orthop 34(7):674–678. https://doi.org/10.1097/bpo.0000000000000174

    Article  PubMed  Google Scholar 

  24. Li Y, Xu H, Li J, Yu L, Liu Y, Southern E, Liu H (2015) Early predictors of acetabular growth after closed reduction in late detected developmental dysplasia of the hip. J Pediatr Orthop B 24(1):35–39. https://doi.org/10.1097/bpb.0000000000000111

    Article  PubMed  Google Scholar 

  25. Fu Z, Yang JP, Zeng P, Zhang ZL (2014) Surgical implications for residual subluxation after closed reduction for developmental dislocation of the hip: a long-term follow-up. Orthop Surg 6(3):210–216. https://doi.org/10.1111/os.12113

    Article  PubMed  PubMed Central  Google Scholar 

  26. Eamsobhana P, Kamwong S, Sisuchinthara T, Jittivilai T, Keawpornsawan K (2015) The factor causing poor results in late developmental dysplasia of the hip (DDH). J Med Assoc Thail 98(Suppl 8):S32–S37

    Google Scholar 

  27. Terjesen T, Horn J, Gunderson RB (2014) Fifty-year follow-up of late-detected hip dislocation: clinical and radiographic outcomes for seventy-one patients treated with traction to obtain gradual closed reduction. J Bone Joint Surg Am 96(4):e28. https://doi.org/10.2106/jbjs.m.00397

    Article  PubMed  Google Scholar 

  28. Chaker M, Picault C, Kohler R (2001) Long term results in treatment of residual hip dysplasia by Salter osteotomy (study of 31 cases). Acta Orthop Belg 67(1):6–18

    CAS  PubMed  Google Scholar 

  29. Li Y, Guo Y, Shen X, Liu H, Mei H, Xu H, Canavese F (2019) Radiographic outcome of children older than twenty-four months with developmental dysplasia of the hip treated by closed reduction and spica cast immobilization in human position: a review of fifty-one hips. Int Orthop 43(6):1405–1411. https://doi.org/10.1007/s00264-019-04315-z

    Article  PubMed  Google Scholar 

  30. Li YQ, Li M, Guo YM, Shen XT, Mei HB, Chen SY, Shao JF, Tang SP, Canavese F, Xu HW (2018) Traction does not decrease failure of reduction and femoral head avascular necrosis in patients aged 6-24 months with developmental dysplasia of the hip treated by closed reduction: a review of 385 patients and meta-analysis. J Pediatr Orthop B. https://doi.org/10.1097/bpb.0000000000000586

    Article  Google Scholar 

  31. Terjesen T (2018) Long-term outcome of closed reduction in late-detected hip dislocation: 60 patients aged six to 36 months at diagnosis followed to a mean age of 58 years. J Child Orthop 12(4):369–374. https://doi.org/10.1302/1863-2548.12.180024

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Sankar WN, Gornitzky AL, Clarke NM, Herrera-Soto JA, Kelley SP, Matheney T, Mulpuri K, Schaeffer EK, Upasani VV, Williams N, Price CT (2019) Closed reduction for developmental dysplasia of the hip: early-term results from a prospective, multicenter cohort. J Pediatr Orthop 39(3):111–118. https://doi.org/10.1097/bpo.0000000000000895

    Article  PubMed  Google Scholar 

  33. Al Shehri HM, Mahmoud AA, Ateeq SA, Alamrani AH (2018) Acetabular remodeling after closed reduction of developmental dysplasia of the hip. Saudi J Med Med Sci 6(1):23–26. https://doi.org/10.4103/sjmms.sjmms_139_16

    Article  PubMed  Google Scholar 

  34. Vrdoljak J, Gogolja D (1999) Development of acetabulum after closed reduction in developmental hip dysplasia. Coll Antropol 23(2):745–749

    CAS  PubMed  Google Scholar 

  35. Aksoy MC, Ozkoc G, Alanay A, Yazici M, Ozdemir N, Surat A (2002) Treatment of developmental dysplasia of the hip before walking: results of closed reduction and immobilization in hip spica cast. Turk J Pediatr 44(2):122–127

    PubMed  Google Scholar 

  36. Gotoh E, Tsuji M, Matsuno T, Ando M (2000) Acetabular development after reduction in developmental dislocation of the hip. Clin Orthop Relat Res 378:174–182. https://doi.org/10.1097/00003086-200009000-00027

    Article  Google Scholar 

  37. Vandergugten S, Traore SY, Docquier PL (2016) Risk factors for additional surgery after closed reduction of hip developmental dislocation. Acta Orthop Belg 82(4):787–796

    CAS  PubMed  Google Scholar 

  38. Terjesen T, Halvorsen V (2007) Long-term results after closed reduction of latedetected hip dislocation: 60 patients followed up to skeletal maturity. Acta Orthop 78(2):236–246. https://doi.org/10.1080/17453670710013744

    Article  PubMed  Google Scholar 

  39. Sibinski M, Synder M, Domzalski M, Grzegorzewski A (2004) Risk factors for avascular necrosis after closed hip reduction in developmental dysplasia of the hip. Ortop Traumatol Rehabil 6(1):60–66

    PubMed  Google Scholar 

  40. Thomas SR (2015) A review of long-term outcomes for late presenting developmental hip dysplasia. Bone Joint J 97-b (6):729-733. doi:https://doi.org/10.1302/0301-620x.97b6.35395

    Article  CAS  Google Scholar 

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Author information

Author notes

  1. YiQiang Li, Hang Liu, YueMing Guo and HongWen Xu contributed equally to this work.

Authors and Affiliations

  1. Department of Pediatric Orthopaedics, GuangZhou Women and Children’s Medical Center, GuangZhou Medical University, 9th JinSui Road, GuangZhou, 510623, China

    YiQiang Li, HongWen Xu, FuXing Xun, YanHan Liu, Zhe Yuan, JingChun Li & Federico Canavese

  2. Children’s Hospital of Chongqing Medical University, Chongqing, China

    Hang Liu

  3. Foshan Hospital of TCM, Foshan, China

    YueMing Guo

  4. DRCI, University Hospital of Clermont Ferrand, Clermont Ferrand, France

    Bruno Pereira

  5. Department of Pediatric Surgery, University Hospital Estaing, Clermont Ferrand, France

    Federico Canavese

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  1. YiQiang Li
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Chinese Multicenter Pediatric Orthopaedic Study Group (CMPOS)

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Correspondence to Federico Canavese.

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All procedures were performed in studies involving human participants and were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This is a retrospective study of patients’ data, and an IRB approval was obtained (GZWCMC 2015020904).

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Li, Y., Liu, H., Guo, Y. et al. Variables influencing the pelvic radiological evaluation in children with developmental dysplasia of the hip managed by closed reduction: a multicentre investigation. International Orthopaedics (SICOT) 44, 511–518 (2020). https://doi.org/10.1007/s00264-020-04479-z

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