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Published in: International Orthopaedics 6/2024

13-03-2024 | Wound Debridement | Original Paper

Arthroscopic debridement and reduction is an effective procedure for failed closed reduction in young children with developmental dislocation of the hip

Authors: Yuan Zhang, Liuqi Weng, Ge Zhang, Hai Zhou, Xing Liu, Yujiang Cao

Published in: International Orthopaedics | Issue 6/2024

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Abstract

Purpose

To assess the efficacy of arthroscopic debridement and reduction through two medial portals for the treatment of developmental dislocation of the hip (DDH) with failure of initial closed reduction and to explore key pathological structures obstructing reduction.

Methods

Forty-eight children with 58 irreducible dislocated hips treated by arthroscopic reduction between January 2017 and December 2020 were retrospectively evaluated. Arthroscopic reduction was performed via two medial portals located in the superior and inferior adductor longus. All intra-articular obstacles were eliminated via arthroscopy, followed by manual reduction and spica cast immobilization. The surgical duration, extent of improvement in the safe zone, and extent of secondary surgical treatment were noted. All the children were followed up for > 24 months. Hip function and radiographic outcomes were evaluated.

Results

All 58 hips showed safe zone improvement and concentric reduction after arthroscopic debridement. Hypertrophic ligamentum teres and thickened pulvinars were detected and resected in all hips. Constrictive capsules preventing reduction were observed in 15 hips, which needed to be further released. No inverted labrum was observed. Secondary surgery was performed in four hips with redislocation and seven hips with subluxation during follow-up. The remaining 47 hips (81.03%) maintained their reduction at the last follow-up. Excellent and good clinical outcomes were achieved in 95.74% of patients according to McKay’s criteria. Two hips, three hips, and one hip were diagnosed with grade I, II, and III osteonecrosis of the femoral head, respectively.

Conclusion

This study demonstrated that arthroscopic debridement and reduction is a safe and feasible choice for treating irreducible DDH.
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Literature
Metadata
Title
Arthroscopic debridement and reduction is an effective procedure for failed closed reduction in young children with developmental dislocation of the hip
Authors
Yuan Zhang
Liuqi Weng
Ge Zhang
Hai Zhou
Xing Liu
Yujiang Cao
Publication date
13-03-2024
Publisher
Springer Berlin Heidelberg
Published in
International Orthopaedics / Issue 6/2024
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-024-06140-5

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