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BMC Pediatrics
Published in: BMC Pediatrics 1/2021

Open Access 01-12-2021 | Magnetic Resonance Imaging | Research Article

Magnetic resonance imaging follow-up can screen for soft tissue changes and evaluate the short-term prognosis of patients with developmental dysplasia of the hip after closed reduction

Authors: Xianghong Meng, Jianping Yang, Zhi Wang

Published in: BMC Pediatrics | Issue 1/2021

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Abstract

Background

Magnetic resonance imaging (MRI) can show the architecture of the hip joint clearly and has been increasingly used in developmental dysplasia of the hip (DDH) confirmation and follow-up. In this study, MRI was used to observe changes in the hip joints before and after closed reduction (CR) and to explore risk factors of residual acetabular dysplasia (RAD).

Methods

This is a prospective analysis of unilateral DDH patients with CR and spica cast in our hospital from October 2012 to July 2018. MRI and pelvic plain radiography were performed before and after CR. The labro-chondral complex (LCC) of the hip was divided into four types on MRI images. The variation in the thickening rate of the ligamentum teres, transverse ligaments, and pulvinar during MRI follow-up was analyzed, and the difference in cartilaginous acetabular head index was evaluated. The “complete relocation” rate of the femoral head was analyzed when the cast was changed for the last time, and the necrotic rate of the femoral head was evaluated after 18 months or more after CR. Lastly, the risk factors of RAD were analyzed.

Results

A total of 63 patients with DDH and CR were included. The LCC was everted before CR and inverted after CR, and the ligamentum teres, transverse ligaments, and pulvinar were hypertrophic before and after CR, and then gradually returned to normal shape. The cartilaginous acetabular head index gradually increased to normal values. Complete relocation was observed in 58.7% of femoral heads, while 8.6% had necrosis. The abnormalities in LCC was related to RAD (OR: 4.35, P = 0.03), and the rate of type 3 LCC in the RAD group was higher. However, the IHDI classification (P = 0.09); the “complete relocation” of femoral heads (P = 0.61); and hypertrophy of the ligamentum teres (P = 1.00), transverse ligaments (P = 1.00), and pulvinar (P = 1.00) were not related to RAD.

Conclusions

In this study, MRI can observe the variations of the abnormal soft tissue structures of the diseased hips after CR and spica casting, and can evaluate which hips will have RAD after CR. Therefore, we can utilize MRI in DDH patients appropriately.
Literature
1.
El-Sayed MM, Hegazy M, Abdelatif NM, ElGebeily MA, ElSobky T, Nader S. Dega osteotomy for the management of developmental dysplasia of the hip in children aged 2-8 years: results of 58 consecutive osteotomies after 13-25 years of follow-up. J Child Orthop. 2015;9:191–8.PubMedPubMedCentralCrossRef
2.
Walter SG, Bornemann R, Koob S, Ossendorff R, Placzek R. Closed reduction as therapeutic gold standard for treatment of congenital hip dislocation. Z Orthop Unfall. 2020;158:475–80.PubMedCrossRef
3.
Li YQ, Li M, Guo YM, Shen XT, Mei HB, Chen SY, et al. 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. 2019;28:436–41.PubMedCrossRef
4.
Gans I, Sankar WN. The medial dye pool revisited: correlation between arthrography and MRI in closed reductions for DDH. J Pediatr orthop. 2014;34:787–90.PubMedCrossRef
5.
Zhang ZL, Fu Z, Yang JP, Wang K, Xie LW, Deng SZ, et al. Intraoperative arthrogram predicts residual dysplasia after successful closed reduction of DDH. Orthop Surg. 2016;8:338–44.PubMedPubMedCentralCrossRef
6.
Yong BC, Li YQ, Li JC, Andreacchio A, Pavone V, Pereria B, et al. Post-operative radiograph assessment of children undergoing closed reduction and Spica cast immobilization for developmental dysplasia of the hip: does experience matter? Int Orthop. 2018;42:2725–31.PubMedCrossRef
7.
Fukuda A, Fukiage K, Futami T, Miyati T. 1.0 s ultrafast MRI in non-sedated infants after reduction with Spica casting for developmental dysplasia of the hip: a feasibility study. J Child Orthop. 2016;10:193–9.PubMedPubMedCentralCrossRef
8.
Dibello D, Odoni L, Pederiva F, Di Carlo V. MRI in Postreduction Evaluation of Developmental Dysplasia of the Hip: Our Experience. J Pediatr orthop. 2019;39:449–52.PubMedCrossRef
9.
Jadhav SP, More SR, Shenava V, Zhang W, Kan JH. Utility of immediate postoperative hip MRI in developmental hip dysplasia: closed vs. open reduction. Pediatr Radiol. 2018;48:1096–100.PubMedCrossRef
10.
Renshaw TS. Inadequate reduction of congenital dislocation of the hip. J Bone Joint Surg Am. 1981;63:1114–21.PubMedCrossRef
11.
Druschel C, Placzek R, Selka L, Seidl T, Funk J. MRI evaluation of hip containment and congruency after closed reduction in congenital hip dislocation. Hip int. 2013;23:552–9.PubMed
12.
Severin E. Congenital dislocation of the hip: development of the joint after closed reduction. J Bone Joint Surg Am. 1950;32–A:507–18.PubMedCrossRef
13.
Chen C, Doyle S, Green D, Blanco J, Scher D, Sink E, et al. Presence of the ossific nucleus and risk of osteonecrosis in the treatment of developmental dysplasia of the hip: a meta-analysis of cohort and case-control studies. J Bone Joint Surg Am. 2017;99:760–7.PubMedCrossRef
14.
15.
Mansour E, Eid R, Romanos E, Ghanem I. The management of residual acetabular dysplasia: updates and controversies. J Pediatr Orthop B. 2017;26:344–9.PubMedCrossRef
16.
Narayanan U, Mulpuri K, Sankar WN, Clarke NM, Hosalkar H, Price CT, et al. Reliability of a new radiographic classification for developmental dysplasia of the hip. J Pediatr Orthop. 2015;35:478–84.PubMedPubMedCentralCrossRef
17.
Takeuchi R, Kamada H, Mishima H, Mukai N, Miyakawa S, Ochiai N. Evaluation of the cartilaginous acetabulum by magnetic resonance imaging in developmental dysplasia of the hip. J Pediatr Orthop B. 2014;23:237–43.PubMedCrossRef
18.
Talathi NS, Chauvin NA, Sankar WN. Docking of the femoral head following closed reduction for DDH: does it really occur? J Pediatr Orthop. 2018;38:e440–5.PubMedCrossRef
19.
Salter RB, Kostuik J, Dallas S. 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. 1969;12:44–61.PubMed
20.
Li Y, Guo Y, Li M, Zhou Q, Liu Y, Chen W, et al. Acetabular index is the best predictor of late residual acetabular dysplasia after closed reduction in developmental dysplasia of the hip. Int Orthop. 2018;42:631–40.PubMedCrossRef
21.
22.
Studer K, Williams N, Studer P, Baker M, Glynn A, Foster BK, et al. Obstacles to reduction in infantile developmental dysplasia of the hip. J Child Orthop. 2017;11:358–66.PubMedPubMedCentralCrossRef
23.
24.
Hattori T, Ono Y, Kitakoji T, Takashi S, Iwata H. Soft-tissue interposition after closed reduction in developmental dysplasia of the hip. The long-term effect on acetabular development and avascular necrosis. J Bone Joint Surg Br. 1999;81:385–91.PubMedCrossRef
25.
Rosenbaum DG, Servaes S, Bogner EA, Jaramillo D, Mintz DN. MR imaging in postreduction assessment of developmental dysplasia of the hip: goals and obstacles. RadioGraphics. 2016;36:840–54.PubMedCrossRef
26.
Kim HT, Lee TH, Ahn TY, Jang JH. The fate of DDH hips showing cartilaginous or fibrous tissue-filled joint spaces following primary reduction. J Pediatr Orthop. 2017;37:184–91.PubMedCrossRef
27.
Yuan Z, Li Y, Hong K, Wu J, Canavese F, Xu H. Poor delineation of labrum and acetabular surface on arthrogram is a predictor of early failure of closed reduction in children aged six to 24 months with developmental dysplasia of the hip. J Child Orthop. 2020;14:372–8.PubMedPubMedCentralCrossRef
28.
Aoki K, Mitani S, Asaumi K, Akazawa H, Inoue H. Utility of MRI in detecting obstacles to reduction in developmental dysplasia of the hip: comparison with two-directional arthrography and correlation with intraoperative findings. J Orthop Sci. 1999;4:255–63.PubMedCrossRef
29.
Walter SG, Endler CH, Remig AC, Luetkens JA, Bornemann R, Placzek R. Risk factors for failed closed reduction in dislocated developmental dysplastic hips. Int Orthop. 2020;44:2343–8.PubMedCrossRef
30.
Lü XM, Feng C, Dong YF, Fu G, Guo Y. Study on the impact of labro-chondral complex on development of the acetabulum after close reduction in developmental dysplasia of the hip. Natl Med J China. 2016;96:2983–7.
31.
Novais EN, Hill MK, Carry PM, Heyn PC. Is age or surgical approach associated with osteonecrosis in patients with developmental dysplasia of the hip? A meta-analysis. Clin Orthop Relat Res. 2016;474:1166–77.PubMedCrossRef
32.
Douira-Khomsi W, Smida M, Louati H, Hassine LB, Bouchoucha S, Saied W, et al. Magnetic resonance evaluation of acetabular residual dysplasia in developmental dysplasia of the hip: a preliminary study of 27 patients. J Pediatr Orthop. 2010;30:37–43.PubMedCrossRef
33.
Meng XH, Wang Z, Yang JP, Zhang ZL, Guo L, Zhang XN. The effect of libmus on hip cartilage of patients with hip developmental dysplasia: evaluation using T2 mapping and CUBE. Int J Med Radiol. 2018;41:396–400.
Metadata
Title
Magnetic resonance imaging follow-up can screen for soft tissue changes and evaluate the short-term prognosis of patients with developmental dysplasia of the hip after closed reduction
Authors
Xianghong Meng
Jianping Yang
Zhi Wang
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Pediatrics / Issue 1/2021
Electronic ISSN: 1471-2431
DOI
https://doi.org/10.1186/s12887-021-02587-2

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