A special surgical technique and consideration is necessary in the total hip arthroplasty for dysplastic osteoarthritis after
Aims. To determine the likelihood of achieving a successful closed reduction (CR) of a dislocated hip in developmental dysplasia of the hip (DDH) after failed Pavlik harness treatment We report the rate of avascular necrosis (AVN) and the need for further surgical procedures. Methods. Data was obtained from the Northern Ireland DDH database. All children who underwent an attempted closed reduction between 2011 and 2016 were identified. Children with a dislocated hip that failed Pavlik harness treatment were included in the study. Successful closed reduction was defined as a hip that reduced in theatre and remained reduced. Most recent imaging was assessed for the presence of AVN using the
Introduction and Aims: To review the existing classifications in characterising the pathologic morphology of congenital lower limb deficiencies (CLLLD) and their usefulness in planning limb reconstruction. Method: Ninety-five patients undergoing limb reconstruction were classified using existing classifications. Predominantly femoral deficiencies were classified using Aitken, Amstutz, Hamanishi, Gillespie and Torode, Fixsen and Lloyd-Roberts,
Objective: To review the existing classifications in characterizing the pathological morphology of congenital lower limb deficiencies and their usefulness in planning limb reconstruction. Methods: Ninety-five patients undergoing limb reconstruction were classified using existing classifications. Predominantly femoral deficiencies were classified using Aitken,Amstutz,Hamanishi,Gillespie andTorode,Fixsen and Lloyd-Roberts,
The treatment of developmental dysplasia of the hip (DDH) in children remains controversial, we describe the clinical and radiological outcomes of 47 hips in 43 children treated with open surgery by one surgeon between 2004 and 2008 for DDH. The mean age at operation was 25 months (5 to 113) with a mean follow up of 89 months (22 to 169). 46 hips had an anterior open reduction, 1 had a medial approach performed and 16 had anterior open reductions only. 5 of the primary operations also had a pelvic osteotomy, 7 had a femoral osteotomy and 18 had a combined femoral and pelvic osteotomy. 7 (15%) of the hips required a second operation for dislocation, subluxation or dysplasia. At the latest follow up 40 of the 45 hips where Severin grades were recordable (89%) were graded as excellent or good, Severin class I or II. Clinically significant AVN (grade II to III according to the
The long term results of closed reduction of the hip for DDH were reviewed to determine if the presence of the ossific nucleus had an effect on outcome. The clinical and radiological outcome of a single-surgeon series of closed reduction for DDH was assessed in a strictly defined group of 48 hips in 42 patients with an average of 11.1 years follow up. In 50% of cases, the ossific nucleus was absent. 100% of patients had an excellent or good result (Severin classification) at final follow-up. 8.3% (4 hips) demonstrated evidence of avascular necrosis. Three were
The authors evaluate the incidence, patterns and causative factors of avascular necrosis (AVN) in patients with developmental dysplasia of the hip (DDH) and to follow up these patients to determine what their long term functional and radiological outcome is. All patients treated for DDH by the same consultant with the subsequent development of AVN were assessed. Outcome was assessed by grading the AVN using the
Purpose. To compare the early medial open approach (MO) with the anterior approach (AO) performed after the appearance of the ossific nucleus for DDH that has failed closed reduction or presented late. Methods. We present the experience of 2 UK surgeons with prospectively gathered data for MO (26 hips) compared with that of a third surgeon in the same unit for the AO (21 hips) in 41 children under 24 months of age at index surgery. Femoral head osteonecrosis (FHO) risk was predicted using the height-to-width index of Bruce et al, measured at 12–18 months post reduction, and graded with the
The management of developmental dysplasia of the hip (DDH) requiring open reduction between 12 and 18 months of age is controversial. We compare the outcome of medial approach open reduction (MAOR) versus delayed anterior open reduction with Salter osteotomy in such patients. 17 consecutive patients who underwent MAOR aged 12–20 months were reviewed (mean follow-up of 40 months, range 6–74). This group was compared to 15 controls who underwent anterior reduction and Salter osteotomy aged 18–23 months (mean follow-up of 44 months, range 14–134). 13 of the 17 (76%) MAOR patients required subsequent Salter osteotomy at a mean of 22 months post-reduction, with a further 2 patients under follow-up being likely to require one. Acetabular index improved from 42 (32–50, SD − 5.5) to 16 (7–24, SD − 4.5) in the MOAR group after Salter osteotomy compared to an improvement of 40 (30–53, SD − 6) to 13 (4–24, SD − 5) in the control group (p>0.05). Acetabular index at last follow-up was within normal limits in 15 of 17 (88%) MAOR patients. All patients in the control group had acetabular indices (or centre-edge angles of Wiberg) within the normal range. There was 1 subluxation (7%) in the control group. There were 6 cases (33%) of post-operative avascular necrosis (5
Ischemic necrosis of the femoral head occurring after the treatment of congenital dysplasia of the hip can negatively affect the long-term prognosis of the involved hip. The purpose of the study was to evaluate a number of clinical and radiological risk factors for AVN after non-operative treatment of DDH. Clinical data and radiographs of 77 patients with103 abnormal hips treated because of developmental dysplasia of the hip by closed reduction followed by cast immobilization were reviewed retrospectively. The average age of patients at the time of reduction was 16 months (ranged, 4 to 28) and the average final follow up was 22,4 years (ranged from 13 to 47 years).
To review the results of limb lengthening and deformity correction in fibular hemimelia, fifty-five patients with fibular hemimelia underwent limb reconstruction at Sheffield Children’s Hospital. According to Achter-man and
The results of the Ferguson medial open reduction of the hip for DDH were reviewed to determine the complications, re-operation rate, clinical and radiological outcome. Notes were reviewed for 75 cases, of which 5 were bilateral. X-rays were available for 69 hips and were analysed for Acetabular index (AI) and Centre Edge (CE) angles of the operated and unaffected hips. The hips were assessed for avascular necrosis by the method of
Aims: To review the results of limb lengthening and deformity correction in fibular hemimelia. Methods: Fifty-five patients with fibular hemimelia underwent limb reconstruction at Sheffield Children’s Hospital. According to Achterman and
Aims: Evaluation of the clinical and radiological results after primary surgical treatment of CDH in children with late discovered CDH. Methods: We have studied 64 hips of 58 patients (51 female and 7 male), who were between 18 months-8 years old with late discovered CDH. The study was made between 1991–2000. Teratological and neuromuscular cases were excluded. None of the patients have had previous treatment before admission in hospital. Preoperative radiographic evaluation of the cases was made based on the Tšnnis classiþcation system (12-gr.I, 26-gr.II, 19-gr.III, 7-gr.IV). Preliminary traction was used in 5 hips (4 patients). 8 of them were treated by open reduction, 18 by open reduction and pericapsular osteotomy of the ilium described by Pemberton, 38 by combined pelvic osteotomy (29 Pem-berton osteotomy, 9 Chiari osteotomy) and femoral derotation and/or varus osteotomy (with femoral shortening in 8 cases). Postoperatively, a plaster cast was applied for 6 weeks. Average follow-up period was 6.8 years. Results: The radiological results are based on Severin Classiþcation. We obtained in 77.5% of the cases excellent, good and satisfactory results. Using the clinical rating system of Fergusson and Howard, the results were good and satisfactory in 78.8 of the cases. Avascular necrosis occurred in 6 cases, being rated as group II and III according to the
Aim: The aim of the study was to evaluate the outcome of open surgery for DDH in a tertiary centre. Method: Primary and tertiary referrals between 1983 and 1996 were followed up for 8.2 years (4.1 to 16.8 years). 60 hips in 47 patients had open reduction for DDH. 39 patients were females. 13 hips had bilateral involvement. Age at operation was 2.1 years (0.1 to 5.5 years). 32 patients were referred from elsewhere for surgery after closed or open primary treatment. Results: Clinical and radiological assessment was done on all the patients. The outcome was evaluated using the McKay system and Severin grade for subluxation. 12 hips had Type II, III or IV or unclassifiable AVN according to the
When the present study was initiated, we changed the treatment for late-detected developmental dislocation of the hip (DDH) from several weeks of skin traction to markedly shorter traction time. The aim of this prospective study was to evaluate this change, with special emphasis on the rate of stable closed reduction according to patient age, the development of the acetabulum, and the outcome at skeletal maturity. From 1996 to 2005, 49 children (52 hips) were treated for late-detected DDH. Their mean age was 13.3 months (3 to 33) at reduction. Prereduction skin traction was used for a mean of 11 days (0 to 27). Gentle closed reduction under general anaesthesia was attempted in all the hips. Concurrent pelvic osteotomy was not performed. The hips were evaluated at one, three and five years after reduction, at age eight to ten years, and at skeletal maturity. Mean age at the last follow-up was 15.7 years (13 to 21).Aims
Methods
There are several reports clarifying successful results following
open reduction using Ludloff’s medial approach for congenital (CDH)
or developmental dislocation of the hip (DDH). This study aimed
to reveal the long-term post-operative course until the period of
hip-joint maturity after the conventional surgical treatments. A long-term follow-up beyond the age of hip-joint maturity was
performed for 115 hips in 103 patients who underwent open reduction
using Ludloff’s medial approach in our hospital. The mean age at
surgery was 8.5 months (2 to 26) and the mean follow-up was 20.3
years (15 to 28). The radiological condition at full growth of the hip
joint was evaluated by Severin’s classification.Objectives
Methods