Abstract
Background
What makes treatment choice for developmental dysplasia of the hips diagnosed after walking age difficult is the poor understanding of prereduction conditions that obstruct the reduction in spatial terms. To evaluate these problems, we employed subtraction three-dimensional imaging to search for the factors involved in intraarticular obstruction. On the basis of the findings of preoperative subtraction threedimensional imaging from computed tomography, we developed a new method, a minimum invasive arthroscopic reduction with limboplasty, for reduction of developmental dysplasia of the hips after walking age. The purposes of this report were to: (1) describe the technique of the arthroscopic procedure, and (2) evaluate our new method using radiographic parameters.
Methods
Ten patients with ten hips with developmental dysplasia after walking age treated by arthroscopic reduction with limboplasty were included in this study. The mean age of the patients at reduction was 22.6 months (range, 18.6–29.7 months); mean age at follow up was 7.2 years (range, 3.9–10.9 years); and mean follow up was 5.4 years (range, 1.7–9.0 years). These ten hips were evaluated using radiographic measurements.
Results
Moderate or severe avascular necrosis of the femoral head was not observed. Two hips that had a spherical-shaped head with minimal residual height loss or coxa magna were classified as Kalamchi and MacEwen grade 1. Additional surgery had been performed for two hips classified as Severin group 4 during the course of follow up. These two hips were classified as Severin group 1 at final examination. One more hip was classified as Severin group 4 at final examination, and additional surgery was recommended. The remaining seven hips (70%) therefore obtained good evaluations by arthroscopic reduction with limboplasty alone.
Conclusions
We developed a new reduction method by using an arthroscopic procedure for the reduction of developmental dysplasia of the hips after walking age when this dysplasia failed to be reduced with nonoperative methods. The result of our new method is acceptable because good evaluations were obtained in 70% of hips 5.4 years after reduction by our new method alone.
Similar content being viewed by others
References
Agus H, Omeroglu H, Ucar H, Bicimoglu A. Evaluation of the risk factors of AVN in DDH in infants younger than 18 months of age. J Pediatr Orthop B 2002;11:41–46.
Huang SC, Wang JH. A comparative study of nonoperative versus operative treatment of DDH in patients of walking age. J Pediatr Orthop 1997;17:181–188.
Matsushita T, Miyake Y, Akazawa H, Eguchi S, Takahashi Y. Open reduction for CDH: comparison of the long-term results of the wide exposure method and Ludloff’s method. J Orthop Sci 1999;4:333–341.
Vitale MG, Skaggs DL. DDH from 6 months to 4 years of age. J Am Acad Orthop Surg 2001;9:401–411.
Zadeh HG, Catterall A, Hashemi-Nejad A, Perry RE. Test of stability as an aid to decide the need for osteotomy in association with open reduction in developmental dysplasia of the hip. J Bone Joint Surg Br 2000;82:17–27.
Danielsson L. Late-diagnosed DDH. Acta Orthop Scand 2000;71:232–242.
Kitano T, Komatsu T, Sakai T, Imai Y, Yamano Y. Arthroscopic reduction with labroplasty for developmental dysplasia of the hip. Nihon Shoni Seikeigeka Gakkiashi (J Jpn Paed Orthop Assoc) 2003;12:32–36 (in Japanese).
Landa J, Benke M, Feldman DS. The limbus and the neolimbus in developmental dysplasia of the hip. Clin Orthop Relat Res 2008;466:776–781.
Severin E. Congenital dislocation of the hip: development of the joint after closed reduction. J Bone Joint Surg Am 1950;32:507–518.
Chen IH, Kuo KN, Lubicky JP. Prognosticating factors in acetabular development following reduction of developemental dysplasia of the hip. J Pediatr Orthop 1994;14:3–8.
Kalamchi A, MacEwen GD. Avascular necrosis following treatment of congenital dislocation of the hip. J Bone Joint Surg Am 1980;62:876–888.
Katz JF. Conservative treatment of Legg-Calvé-Perthes disease. J Bone Joint Surg Am 1967;49:1043–1051.
Mose K. Method of measuring in Legg-Calvé-Perthes disease with special regard to the prognosis. Clin Orthop Relat Res 1980;150:103–109.
Meyer J. Treatment of Legg-Calvé-Perthes disease: radiological results of treatment and their late clinical consequence. Acta Orthop Scand Suppl 1977;167:8–111.
Edgren W. Coxa plana VII. The pathogenesis of coxa plana. Acta Orthop Scand Suppl 1965;84:93–129.
Zionts LE, MacEwen GD. Treatment of congenital dislocation of the hip in children between the ages of 1 and 3 years. J Bone Joint Surg Am 1986;68:829–846.
Thomas SR, Wedge JH, Salter RB. Outcome at 45 years after open reduction and innominate osteotomy for late-presenting developmental dislocation of the hip. J Bone Joint Surg Am 2007;89:2341–2350.
Mitchell N, Shepard N. The deleterious effects of drying on articular cartilage. J Bone Joint Surg Am 1989;71:89–95.
Speer KP, Callaghan JJ, Seaber AV, Tucker JA. The effects of exposure of articular cartilage to air. J Bone Joint Surg Am 1990;72:1442–1450.
Khanduja V, Villar RN. Arthroscopic surgery of the hip: current concepts and recent advances. J Bone Joint Surg Br 2006;88:1557–1566.
Bulut O, Öztürk H, Tezeren G, Bulut S. Arthroscopic-assisted surgical treatment for developmental dislocation of the hip. Arthroscopy 2005;21:574–579.
Author information
Authors and Affiliations
About this article
Cite this article
Kitano, T., Imai, Y., Morita, M. et al. New treatment method for developmental dysplasia of the hips after walking age: arthroscopic reduction with limboplasty based on the findings of preoperative imaging. J Orthop Sci 15, 443–451 (2010). https://doi.org/10.1007/s00776-010-1497-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00776-010-1497-6