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Outcome after early mobilization following hip reconstruction in children with developmental hip dysplasia and luxation

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Abstract

Background

Most orthopedic surgeons prefer spica cast immobilization in children for 4 to 12 weeks after surgical hip reconstruction in children with developmental hip dysplasia. This challenging treatment may be associated with complications. Studies are lacking that focus on early mobilization without casting for postoperative care after hip reconstruction.

Methods

Twenty-seven children (3.4±2.0 years), including 33 hips with developmental hip dysplasia (DDH) and dislocation of the hip (Tönnis grade 1 to 4), who underwent hip reconstruction (Dega acetabuloplasty, varisation-derotation osteotomy and facultative open reduction) were retrospectively included in this study. Postoperatively the patients were placed in an individual foam shell with 30 degrees of hip abduction, hip extension, and neutral rotation. Early mobilization physiotherapy was performed within the first few days after the surgery under epidural anaesthesia. Full weight bearing was allowed after 3–4 weeks. All children received a clinical examination and radiographic evaluation before and after surgical intervention. The follow-up period was 12.3±2.9 months.

Results

On average, the postoperative acetabular index decreased significantly from 36.9 to 21.7 degrees and the center-edge angle increased from 9.9 to 28.6 degrees. All hips had reached Tönnis grade 1 at the time of the last follow-up. No complications such as dislocation of the bone wedge, avascular necrosis of the acetabulum or femur, lack of non-union, or nerve injury, were reported.

Conclusions

In this cohort study, hip reconstruction was successful according to clinical and radiographic outcome parameters after early mobilization without cast therapy. Early mobilization may be used as an alternative treatment option after hip reconstruction in DDH.

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References

  1. Ziegler J, Thielemann F, Mayer-Athenstaedt C, Günther KP. The natural history of developmental dysplasia of the hip. A meta-analysis of the published literature. Orthopade. 2008;37:515–6, 518–24 (in German).

    Google Scholar 

  2. Weinstein SL. Natural history and treatment outcomes of childhood hip disorders. Clin Orthop Relat Res. 1997;344:227–42.

    Article  Google Scholar 

  3. Wedge JH, Wasylenko MJ. The natural history of congenital disease of the hip. J Bone Jt Surg Br. 1979;61-B:334–8.

    Article  CAS  Google Scholar 

  4. Pavone V, Testa G, Riccioli M, Evola FR, Avondo S, Sessa G. Treatment of developmental dysplasia of hip with Tubingen hip flexion splint. J Pediatr Orthop. 2015;35:485–9.

    Article  PubMed  Google Scholar 

  5. Tschauner C, Klapsch W, Baumgartner A, Graf R. Maturation curve of the ultrasonographic alpha angle according to Graf’s untreated hip joint in the first year of life. Z Orthop Ihre Grenzgeb. 1994;132:502–4 (in German).

    Article  CAS  PubMed  Google Scholar 

  6. Novacheck TF. Developmental dysplasia of the hip. Pediatr Clin N Am. 1996;43:829–48.

    Article  CAS  Google Scholar 

  7. Grudziak JS, Ward WT. Dega osteotomy for the treatment of congenital dysplasia of the hip. J Bone Jt Surg Am. 2001;83-A:845–54.

    Article  CAS  Google Scholar 

  8. Ganz R, Klaue K, Vinh TS, Mast JW. A new periacetabular osteotomy for the treatment of hip dysplasias. Technique and preliminary results. Clin Orthop Relat Res. 1988;232:26–36.

    Google Scholar 

  9. Chiari K. Results of pelvic osteotomy as of the shelf method acetabular roof plastic. Z Orthop Ihre Grenzgeb. 1955;87:14–26 (in German).

    CAS  PubMed  Google Scholar 

  10. Pemberton PA. Pericapsular osteotomy of the ilium for treatment of congenital subluxation and dislocation of the hip. J Bone Jt Surg Am. 1965;47:65–86.

    Article  CAS  Google Scholar 

  11. Tönnis D, Behrens K, Tscharani F. A new technique of triple osteotomy for turning dysplastic acetabula in adolescents and adults (author’s transl). Z Orthop Ihre Grenzgeb. 1981;119:253–65 (in German).

    Article  PubMed  Google Scholar 

  12. Salter RB. Innominate osteotomy in the treatment of congenital dislocation and subluxation of the hip. J Bone Jt Surg. 1961;43:518–39.

    Article  Google Scholar 

  13. El-Sayed M, Ahmed T, Fathy S, Zyton H. The effect of Dega acetabuloplasty and Salter innominate osteotomy on acetabular remodeling monitored by the acetabular index in walking DDH patients between 2 and 6 years of age: short- to middle-term follow-up. J Child Orthop. 2012;6:471–7.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Sadeghpour A, Rouhani A, Mohseni MA, Aghdam OA, Goldust M. Evaluation of surgical treatment of developmental dysplasia of hip for avascular necrosis of femoral head in children. Pak J Biol Sci. 2012;15:391–4.

    Article  CAS  PubMed  Google Scholar 

  15. Balioğlu MB, Öner A, Aykut ÜS, Kaygusuz MA. Mid term results of Pemberton pericapsular osteotomy. Indian J Orthop. 2015;49:418–24.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Neto AK, Ferraz A, Foresti FB, Hoffmann RB. Bilateral developmental dysplasia of the hip treated with open reduction and Salter osteotomy: analysis on the radiographic results. Rev Bras Ortop. 2014;49:350–8.

    Article  Google Scholar 

  17. Reichel H, Hein W. Dega acetabuloplasty combined with intertrochanteric osteotomies. Clin Orthop Relat Res. 1996;323:234–42.

    Article  Google Scholar 

  18. 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.

    Article  PubMed  PubMed Central  Google Scholar 

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

    Article  PubMed  Google Scholar 

  20. Tönnis D, et al. Developmental hip luxation and avascular necrosis of the femur. A statistics of hip dysplasia study group, Vol. 21. Stuttgart, Germany: Orthopaedic Library; 1978.

  21. Rampal V, Klein C, Arellano E, Boubakeur Y, Seringe R, Glorion C, et al. Outcomes of modified Dega acetabuloplasty in acetabular dysplasia related to developmental dislocation of the hip. Orthop Traumatol Surg Res. 2014;100:203–7.

    Article  CAS  PubMed  Google Scholar 

  22. Ward WT, Vogt M, Grudziak JS, Tümer Y, Cook PC, Fitch RD. Severin classification system for evaluation of the results of operative treatment of congenital dislocation of the hip. A study of intraobserver and interobserver reliability. J Bone Jt Surg Am. 1997;79:656–63.

    Article  CAS  Google Scholar 

  23. Carroll KL, Murray KA, MacLeod LM, Hennessey TA, Woiczik MR, Roach JW. Measurement of the center edge angle and determination of the Severin classification using digital radiography, computer-assisted measurement tools, and a Severin algorithm: intraobserver and interobserver reliability revisited. J Pediatr Orthop. 2011;31:e30–5.

    Article  PubMed  Google Scholar 

  24. Aksoy C, Yilgor C, Demirkiran G, Caglar O. Evaluation of acetabular development after Dega acetabuloplasty in developmental dysplasia of the hip. J Pediatr Orthop B. 2013;22:91–5.

    Article  PubMed  Google Scholar 

  25. Bulut M, Gürger M, Belhan O, Batur OC, Celik S, Karakurt L. Management of developmental dysplasia of the hip in less than 24 months old children. Indian J Orthop. 2013;47:578–84.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Gulman B, Tuncay IC, Dabak N, Karaismailoglu N. Salter’s innominate osteotomy in the treatment of congenital hip dislocation: a long-term review. J Pediatr Orthop. 1994;14:662–6.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Center of Orthopaedic and Trauma Surgery/Spinal Cord Injury Center, Heidelberg University Hospital, Schlierbacher Landstr. 200a, 69118, Heidelberg, Germany

    Katharina Susanne Gather, Eva von Stillfried, Sebastien Hagmann, Sebastian Müller & Thomas Dreher

Authors
  1. Katharina Susanne Gather
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  2. Eva von Stillfried
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  3. Sebastien Hagmann
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  4. Sebastian Müller
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  5. Thomas Dreher
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Contributions

Gather KS collected the data and wrote the manuscript. von Stillfried E collected the data. Hagmann S contributed to data evaluation. Müller S collected the data. Dreher T contributed to data evaluation and manuscript correction. All authors approved the final version of the manuscript.

Corresponding author

Correspondence to Katharina Susanne Gather.

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Ethical approval

This study was approved by the Ethical Committee of Heidelberg University Hospital.

Conflict of interest

The authors declare that they have no competing interest.

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Gather, K.S., von Stillfried, E., Hagmann, S. et al. Outcome after early mobilization following hip reconstruction in children with developmental hip dysplasia and luxation. World J Pediatr 14, 176–183 (2018). https://doi.org/10.1007/s12519-017-0105-7

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  • DOI: https://doi.org/10.1007/s12519-017-0105-7

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