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International Orthopaedics

Published in:

01-02-2019 | Original Paper

Duration of immobilization after developmental dysplasia of the hip and open reduction surgery

Authors: Khaled Emara, Mohamed Ahmed AL Kersh, Fahad Abdulazeez Hayyawi

Published in: International Orthopaedics | Issue 2/2019

Abstract

Background

There is no consensus about the duration of post-operative immobilization in the treatment of DDH (developmental dysplasia of hip). Our aim in this study is to compare between two post-operative immobilization protocols for patients undergoing open reduction.

Materials and methods

Thirty-eight hips in 32 patients assigned to group A were immobilized in hip spica for four weeks followed by abduction brace application which was gradually weaned through the periods of several months and 29 hips in 24 patients assigned to group B immobilized in hip spica for 12 weeks without further bracing. Both groups were surgically reduced using anterior approach between the ages of 12–24 months.

Results

There were non-significant statistical difference between both groups as regards clinical and radiological outcome but there is significant statistical difference as regards AVN (avascular necrosis) on follow-up between both groups. The rate of AVN cannot be related to the method of immobilization, as there are many factors can lead to AVN of the hip as immobilization in an extreme position and tight reduction.

Conclusion

Group A post-operative immobilization protocol is safer and associated with less complications and more comfortable to the patient and parents than that used in group B. Early removal of hip spica cast and application of hip abduction brace does not increase the rate of re-dislocation.

Level of Evidence

Level III Retrospective comparative study

Sewell MD, Eastwood DM (2011) Screening and treatment in developmental dysplasia of the hip—where do we go from here? Int Orthop. https://doi.org/10.1007/s00264-011-1257-z

Jing YJ, Lian YL, Li JZ, Qun Z, Xi JL (2012) Three dimensional-CT evaluation of femoral neck anteversion, acetabular anteversion and combined anteversion in unilateral DDH in an early walking age group. Int Orthop 36:119–124CrossRef

Murphy RF, Kim YJ (2016) Surgical management of pediatric developmental dysplasia of the hip. J Am Acad Orthop Surg 24(9):615–624CrossRefPubMed

Zionts LE, MacEwan GD (1986) Treatment of congenital dislocation of the hip in children between the ages of one and three years. J Bone Joint Surg 68-A:829–846CrossRef

Wenger DR, Bomar JD (2003) Human hip dysplasia: evolution of current treatment concepts. J Orthop Sci 8(2):264–271CrossRefPubMed

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):886–901CrossRefPubMedPubMedCentral

Gregosiewicz A, Wośko I (1988) Risk factors of avascular necrosis in the treatment of congenital dislocation of the hip. J Pediatr Orthop 8(1):17–19CrossRefPubMed

Albrektson J, Kay RM, Tolo VT, David L, Skaggs DL (2007) Abduction pillow immobilization following hip surgery: a welcome alternative for selected patients. J Child Orthop 1(5):299–305CrossRefPubMedPubMedCentral

Chen SH, Chen WS, Chuang JH (1992) Superior mesenteric artery syndrome as a complication in hip spica application for immobilization: report of a case. J Formos Med Assoc 91(7):731–733PubMed

10.

Weiss AP, Schenck RC Jr, Sponseller PD, Thompson JD (1992) Peroneal nerve palsy after early cast application for femoral fractures in children. J Pediatr Orthop 12(1):25–28CrossRefPubMed

11.

Stasikelis P, Leed D, Sullivan C (1999) Complications of osteotomies in severe cerebral palsy. J Pediatr Orthop 19:207–210CrossRefPubMed

12.

Yamada K, Mihara H, Fujii H, Hachiya M (2014) A long-term follow-up study of open reduction using Ludloff’s approach for congenital or developmental dislocation of the hip. Bone Joint Res 3(1):1–6CrossRefPubMedPubMedCentral

13.

Doudoulakis JK, Cavadias A (1993) Open reduction of CDH before one year of age :69 hips followed for 13 (1 0-1 9) years. Acta Orthop Scand 64(2):188–1 92CrossRefPubMed

14.

Ramani et al (2014) Outcome of surgical management for DDH in children between 18 and 24 months. Indian J Orthop 48:458–462CrossRefPubMedPubMedCentral

15.

Issen A, Oner A, Kockara N, Camurucu Y (2016) Comparison of open reduction alone and open reduction plus Dega osteotomy in developmental dysplasia of the hip. J Pediatr Orthop B 25(1):1–6CrossRef

16.

McKay DW (1974) A comparison of the innominate and the pericapsular osteotomy in the treatment of congenital dislocation of the hip. Clin Orthop Relat Res 98:124–132CrossRef

17.

Severin E (1941) Contribution to the knowledge of congenital dislocation of the hip joint: late results of closed reduction and arthrographic studies of recent cases. Acta Chir Scand 84(suppl 63):1–142

18.

Kalamchi A, MacEwen GD (1980) Avascular necrosis following treatment of congenital dislocation of the hip. J Bone Joint Surg Am 62(6):876–888CrossRefPubMed

19.

Akagi S, Tanabe T, Ogawa R (1998) Acetabular development after open reduction for developmental dislocation of the hip. 15-year follow-up of 22 hips without additional surgery. Acta Orthop Scand 69(1):17–20CrossRefPubMed

20.

Bulut M, Gürger M, Belhan O, Batur OC, Celik S, Karakurt L (2013) Management of developmental dysplasia of the hip in less than 24 months old children. Indian J Orthop 47(6):578–584CrossRefPubMedPubMedCentral

21.

Clarke NM, Jowett AJ, Parker L (2005) The surgical treatment of established congenital dislocation of the hip: results of surgery after planned delayed intervention following the appearance of the capital femoral ossific nucleus. J Pediatr Orthop 25(4):434–439CrossRefPubMed

22.

Matsushita T, Miyake Y, Akazawa H, Eguchi S, Takahashi Y (1999) Open reduction for congenital dislocation of the hip: comparison of the long-term results of the wide exposure method and Ludloff's method. J Orthop Sci 4(5):333–341CrossRefPubMed

23.

Szepesi K, Szücs G, Szeverényi C, Csernátony Z (2013) Long-term follow-up of DDH patients who underwent open reduction without a postoperative cast. J Pediatr Orthop B 22(2):85–90CrossRefPubMed

Title: Duration of immobilization after developmental dysplasia of the hip and open reduction surgery
Authors: Khaled Emara
Mohamed Ahmed AL Kersh
Fahad Abdulazeez Hayyawi
Publication date: 01-02-2019
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 2/2019
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-018-3962-3

At a glance: The STEP trials

Springer Medicine

Duration of immobilization after developmental dysplasia of the hip and open reduction surgery

Abstract

Background

Materials and methods

Results

Conclusion

Level of Evidence

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Materials and methods

Results

Conclusion

Level of Evidence

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