DDH

BACKGROUND AND PURPOSE: As much as one-third of all total hip arthroplasties in patients younger than 60 years may be a consequence of developmental dysplasia of the hip (DDH). Screening and early treatment of neonatal instability of the hip (NIH) reduces the incidence of DDH. We examined the radiographic outcome at 1 year in children undergoing early treatment for NIH. SUBJECTS AND METHODS: All children born in Malmö undergo neonatal screening for NIH, and any child with suspicion of instability is referred to our clinic...

BACKGROUND: Ultrasound screening for developmental hip dysplasia and early conservative treatment might prevent later hip operations. A national hip ultrasound-screening programme, undertaken during the first 6 weeks of life, was introduced across Germany in 1996 and was continued for 5 years. We assessed the rate of first operation on the hip during this programme. METHODS: A national active surveillance programme of initial operations for developmental hip dysplasia was started in 1997 and continued for 5 years...

OBJECTIVE: Screening for hip dysplasia is controversial. A previous randomized controlled trial revealed that adding universal or selective ultrasound to routine clinical examination gave a nonsignificant reduction in rates of late presenting cases, but with higher treatment rates. This study assesses differences in outcome at skeletal maturity for the 3 newborn screening strategies in terms of radiographic markers of acetabular dysplasia and early degenerative change and avascular necrosis (AVN) secondary to neonatal treatment...

Revision surgery following failed open reduction for developmental dysplasia of the hip (DDH) is technically demanding. We reviewed 12 patients in our institution that required a revision surgery between January 1994 and December 2003. The aims of this study are to identify the causes of redislocation after the primary open reduction and to determine the clinical and radiological outcome after the revision surgery. The mean age at presentation for DDH was 31 months (range 1-84) and the mean age at primary open reduction surgery was 38 months (range 15-84) and the mean age at revision surgery was 69 months (range 21-180)...

Fourteen patients with 15 congenital dislocated hips with unsuccessful open reduction were referred for a secondary open reduction. All primary open reductions were incomplete due to an inadequate exposure and insufficient release of muscles and ligaments. The secondary open reduction was technically difficult. The patients were followed for 6-17 years. Six patients had no functional symptoms. Only three hips showed no radiographic deformity. In ten hips, femoral head necrosis was noted and two patients were left with shortening of 4 and 7 cm...

We have reviewed 17 patients (18 hips) who required repeat open reduction for recurrent or persistent dislocation after a previous attempt at open reduction for developmental dysplasia of the hip (DDH). The mean follow-up was 5.5 (3-15) years. At the review, five patients were limping and had limited hip motion but no pain. Six hips were classified as Severin class III or more, and avascular necrosis was evident in 11. We suggest that technical failure is usually the cause for re-dislocation in unilateral cases, as we discovered at repeat open reduction in five of six patients with unilateral dislocation...

We retrospectively reviewed our results of treatment of two groups of children with developmental dysplasia of the hip (DDH) aged between 13 and 17 months. The nonoperative group consisted of 16 patients (17 hips) who were treated by closed reduction and casting with or without skin traction. There were four hips with mild degrees of avascular necrosis, and one hip with a failed reduction. Before further treatment, there were one hip in Severin class I, nine in class III, six in class IV, and one in class VI...

I have prospectively studied 71 consecutive patients (75 hips) with late-diagnosed DDH (developmental dysplasia of the hip) treated uniformly with special reference to the development of the femoral head and the acetabulum. The age at the start of treatment was 10 (2-64) months. The follow-up time was 11 (6-18) years. After tenotomy and traction, closed reduction failed in 7 hips. These cases were treated by open reduction with or without Salter innominate osteotomy-in 2 hips femoral osteotomy was also done (shortening, varus and derotation)...

INTRODUCTION: The aim of this study was to define the clinical indications and demographic characteristics of patients under-going open reduction for developmental dysplasia of the hip (DDH), and determine the proportion due to preventable failures of contemporary clinical screening and early management. METHODS: Case notes were reviewed of consecutive primary open reductions performed for non-teratologic hip dislocation at the Great Ormond Street Hospital for Children over a five-year period...

It is difficult to obtain a good result by secondary open reduction if a primary open reduction for developmental dysplasia of the hip (DDH) fails. Complications such as avascular necrosis of the femoral head and subluxation of the hip are common. In this study, we retrospectively reviewed the causes of failure of primary open reduction and the final clinical and radiographic outcomes of 32 patients (34 hips) with DDH who underwent repeat open reduction and other procedures from January 1982 to December 1995...

BACKGROUND: Despite early recognition and appropriate treatment of congenital dislocation of the hip, there are a number of cases that subsequently require further surgery to prevent progressive dysplasia, instability, and eventual early osteoarthritis. This study aimed (1) to determine the incidence of pelvic osteotomy (PO) after late open (OR) or closed (CR) reduction for failed initial conservative treatment or late presentation; (2) study potential radiologic predictors of those that will require a secondary procedure; (3) and to evaluate the effect of potential confounding variables including age of reduction, Pavlik harness treatment, and surgical experience on PO rate...

OBJECTIVE: Cases of developmental dislocation of the hip (DDH) still occur after walking age because of late or missed diagnosis and failed conservative treatment. The choice of treatment for DDH after walking age continues to be controversial, and one of the options is open reduction combined with innominate osteotomy. METHODS: Twenty patients with 26 surgically treated hips with DDH, were evaluated from 2005 to 2008, using innominate osteotomy by Salter's technique after open reduction and capsulorraphy...

Twenty-three patients with 25 involved hips underwent repeat open reduction after previous unsuccessful attempts at open reduction for congenital dislocation of the hip (CDH). All hips ultimately were reduced at a mean age of 2 years 10 months (range 10 months to 7 years 3 months). On review, we noted that 15 of the hips were never concentrically reduced at the first procedure, and seven of these hips had undergone simultaneous Salter osteotomy. The most common cause of failure was improper exposure and release of the tight inferior capsule and transverse acetabular ligament, which blocked complete reduction...

We report a review of 33 hips (32 patients) which had required repeat open reduction for congenital dislocation of the hip. They were followed up for a mean of 76 months (36 to 132). Factors predisposing to failure of the initial open reduction were simultaneous femoral or pelvic osteotomy, inadequate inferior capsular release, and inadequate capsulorrhaphy. Avascular necrosis had developed in more than half the hips, usually before the final open reduction. At review, 11 of the hips (one-third) were in Severin grade 3 or worse; five had significant symptoms and only ten were asymptomatic and radiographically normal...

INTRODUCTION: Few studies have evaluated the reliability and reproducibility of the femoral neck-shaft angle (NSA), center-edge angle (CEA), and acetabular index (AI) in young children with developmental dysplasia of the hip (DDH). We wanted to determine whether these parameters could be used reliably by practitioners. METHODS: Fifty radiographs from 21 children with DDH were reviewed. Analysis was performed by three observers, at two time periods. The intra- and inter-observer reliability for each measure was assessed...

BACKGROUND: No controlled data exists regarding the risk factors for redislocation after a technically proficient open reduction for developmental dysplasia of the hip (DDH). The purposes of this study were to examine predictors of redislocation and to evaluate the long-term outcomes after revision surgery. METHODS: We performed a retrospective match-controlled study comparing 22 patients who had successful open reduction for DDH with 22 who required revision open reduction...