Role of intraoperative arthrogram in decision making of closed versus medial open reduction of developmental hip dysplasia
Keywords:Developmental hip dysplasia, Arthrogram, Closed reduction, Medial approach
Background: Hip arthrography in developmental dysplasia of the hip (DDH) has the advantages of viewing the shape and size of the cartilaginous part of both the femoral head and acetabulum, besides the soft tissue obstacles. The aim of the work was to assess the role of arthrogram in evaluation of closed reduction of developmental dysplasia of the hip.
Methods: This prospective study included 30 patients with 36 involved hips who presented with DDH. This study included 7 males (23.3%) and 23 females (76.7%). There were 6 patients with bilateral hip involvement (20.0%) and 24 patients with unilateral involvement (80.0%). In this study we used 3 ml Urografin 76% diluted in 7 ml saline and 3 to 5 ml of diluted Urografin was injected into the hip joint.
Results: Out of the 36 hips, closed reduction was successful in 33 hips (91.7%) and failed in 3 (8.3%). After the interpretation of the arthrogram we considered the reduction of 7 (21.2%) reduced hips nonconcentric because of the soft tissue obstacles. In the 7 hips with nonconcentric reduction besides the 3 hips with failed closed reduction, we proceeded to open reduction of the hip through medial approach. At the end of follow up, all hips (100%) showed concentric reduction without re-dislocation in any case.
Conclusions: Hip arthrogram is a very reliable method in diagnosing hip concentricity and the presence of soft tissue obstacles in management of DDH by closed reduction. Arthrogram helps the operator to decide open reduction in such cases achieving excellent results in all cases.
Beaty H. Congenital and developmental dysplasia of the hip. In: Canale T, ed. Cambell’s Operative Orthopaedics. 9th ed. St Louis, Boston, Chicago, London, Toronto, Baltimore: CV Mosby Company; 1998: 1079-1117.
Hadlow V. Neonatal screening for congenital dislocation of the hip. A prospective 21-year survey. J Bone Joint Surg (Br). 1988;70(5):740-3.
Jaglan SS, Crawford AH, Dias LS, Roy DR, Tachdjian MO. Closed versus open reduction of congenital dislocation of the hip in children between six and twenty-four months of age. Orthop Trans. 1991;15:736-41.
Race C, Herring JA. Congenital dislocation of the hip. An evaluation of closed reduction. J Pediatr Orthop. 1983;3:166-72.
Ali B, Haluk A, Hakan O. The effect of arthrographically detected femoral head lateralization and soft tissue interposition during closed reduction of developmental dislocation of the hip on mid-term results. Acta Orthop Traumatol Turc. 2004;38(1):1-7.
Wenstien SL, Morrissy RT. Natural history of congenital hip dislocation and hip dysplasia. 4th ed. Lovell and Winter's Pediatric Orthopedics. 2000: 984-1013.
Renshaw TS. Inadequate reduction of congenital dislocation of the hip. J Bone Joint Sur (Am). 1981;63:1114-21.
Ishii, Weinstien SL, Ponseti IV. Correlation between arthrogram and operative finding in congenital dislocation of the hip. Clin Orthop. 1980;153:138-45.
Severin E. Arthrography in congenital dislocation of the hip. J Bone Joint Surg (Am). 1939;21(2):304-13.
Leveuf J. Primary congenital subluxation of the hip. J Bone Joint Surg (Am). 1947;29:149-62.
Alan MS, Michael JG. Hip arthrography in children. Skeletal Radiol. 1978;3:155-60.
Dennis SD, Johno D, Alanb R, Albert MJ, Robertsonm WW. Arthroraphy in the evaluation of congenital dislocation of the hip. Clin Ortho. 1989;243:148-56.
Khoshhal KI, Kremli MK, Zamzam MM, Akod OM. The role of arthrography guided closed reduction in minimizing the incidence of avascular necrosis in developmental dysplasia of the hip. J Pediatr Orthp. 2005;14(4):256-61.
Lonnerholm T. Arthography of the hip in children. Acta Radiol Diag (Stockh). 1980;21(2):279-92.
Forlin E, Choi IH, Guille JT, Bowen JR, Glutting J. Prognostic factors in congenital dislocation of the hip treated with closed reduction. The importance of arthrographic evaluation. J Bone Joint Surg (Am). 1992;74:1140-52.
Bar E, Meyer S, Harari G, Port S. Ultrasonography of the hip in developmental hip dysplasia. J Bone Joint Surg (Br). 1998;80(2):321-4.
Hernandez RJ. Concentric reduction of the dislocated hip: Computed-tomographic evaluation. Radiol. 1984;150:266.
Laor T, Dennis R, Charles T, Mehlman DO. Limited magnetic resonance imaging examination after surgical reduction of developmental dysplasia of the hip. J Pediatr Orthop. 2000;20:572-4.
Suzuki S, Kashiwagi N, Seto Y, Muki S. Location of the femoral head in developmental dysplasia of the hip: three-dimensional evaluation by means of magnetic resonance image. J Pediatr Orthop. 1999;19:88-91.
Studer K, Williams N, Studer P, Baker M, Glynn A, Foster BK, et al. Obstacles to reduction in in¬fantile developmental dysplasia of the hip. J Child Orthop. 2017;11:358-66.
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.
Kotnis R, Spiteri V, Little C, Theologis T, Wainwright A, Benson MK. Hip arthrography in the assessment of children with developmental dysplasia of the hip and Perthes' disease. J Pediatr Orthop B. 2008;17(3):114-9.
Zhang Z, Zhe Fu, Yang J, Wang K, Xie L, Deng S, et al. Intraoperative arthrogram predicts residual dysplasia after successful closed reduction of DDH. Orthopaedic Surg. 2016;8(3):338-44.