Correction of the acetabular index is more crucial than the type of acetabuloplasty in developmental dysplasia
Tóm tắt
Acetabular remodeling may not be predictable after open reduction in developmental dysplasia of the hip (DDH) in older children. Several acetabuloplasties have been developed, and all are aimed at correcting the dysplastic acetabulum. The goal of this study is to evaluate if the type of pelvic acetabuloplasty and the corrected (postoperative) acetabular index (AI) affect early follow-up femoral head coverage. A retrospective review of single-surgeon consecutive acetabuloplasties (Dega or Pemberton) from December 2012 to December 2015 was conducted. The inclusion criteria were a diagnosis of DDH, undergoing simultaneous primary open reduction, and follow-up of at least 18 months. Univariable analysis was based on the type of acetabuloplasty. The correlation between AI and final center edge angle (CEA) was tested. Multiple regression was performed. Of the total 58 hips in 39 patients included, 41 underwent Dega acetabuloplasty, and 17 had Pemberton acetabuloplasty. The median follow-up was 40.50 months (interquartile range 27.25–57). Pemberton acetabuloplasty produced a lower corrected AI, but the difference was not significant in follow-up measurements. Corrected AI was significantly correlated with final CEA (R = − 0.31, P = 0.018). In the multiple regression, only corrected AI was independently associated with final CEA (B = − 0.29, SE = 0.15, P = 0.06), whereas the type of acetabuloplasty, age, and preoperative severity of the dislocation were not. The correction obtained during acetabuloplasty affects early follow-up femoral head coverage. Ensuring proper sizing and placement of the grafted bone is probably more important than the type of acetabuloplasty chosen. Level III.
Tài liệu tham khảo
Pemberton PA (1965) Pericapsular osteotomy of the ilium for treatment of congenital subluxation and dislocation of the hip. J Bone Joint Surg Am 47(1):65–86
Dega W (1969) Selection of surgical methods in the treatment of congenital dislocation of the hip in children. Chir Narzadow Ruchu Ortop Pol 34(4):357–366
Mubarak SJ, Valencia FG, Wenger DR (1992) One-stage correction of the spastic dislocated hip: use of pericapsular acetabuloplasty to improve coverage. J Bone Joint Surg Am 74(9):1347–1357
Salter RB (1961) Innominate osteotomy in the treatment of congenital dislocation and subluxation of the hip. J Bone Joint Surg Br 43–B(3):518–539
Sarikaya B, Sipahioglu S, Sarikaya ZB, Bozkurt C, Altay MA, Isikan UE (2018) The early radiological effects of Dega and Pemberton osteotomies on hip development in children aged 4–8 years with developmental dysplasia of the hip. J Pediatr Orthop B 27(3):250–256
Badrinath R, Bomar JD, Wenger DR, Mubarak SJ, Upasani VV (2019) Comparing the Pemberton osteotomy and modified San Diego acetabuloplasty in developmental dysplasia of the hip. J Child Orthop 13(2):172–179
Narayanan U, Mulpuri K, Sankar WN, Clarke NMP, Hosalkar H, Price CT (2015) Reliability of a new radiographic classification for developmental dysplasia of the hip. J Pediatr Orthop 35(5):478–484
Gaspoz F, Monnin P, Petter D, Ple J, Ding S (2015) Precision and accuracy of measurements on CT scout view. J Med Imaging Radiat Sci 46(3):309–316. https://doi.org/10.1016/j.jmir.2015.06.006
Salter RB, Kostuik J, Dallas S (1969) 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 12(1):44–61
Alassaf N, Abuhaimed J, Almahmoud N, Binkhulaif R (2017) The added value of postoperative axial imaging in developmental dysplasia of the hip. Open Orthop J 11(1):567–576
Alassaf N (2018) Single-leg spica provides adequate stability after open reduction in developmental dysplasia of the hip. Arch Orthop Trauma Surg 138(2):173–178
Ertürk C, Altay MA, Isikan UE (2013) A radiological comparison of Salter and Pemberton osteotomies to improve acetabular deformations in developmental dysplasia of the hip. J Pediatric Orthop B 22:527–532
Wu K-W, Wang T-M, Huang S-C et al (2010) Analysis of osteonecrosis following Pemberton acetabuloplasty in developmental dysplasia of the hip. J Bone Joint Surg Am 92(11):2083–2094
Akiyama M, Nakashima Y, Oishi M, Kuo KN, Chen CW (2014) Risk factors for acetabular retroversion in developmental dysplasia of the hip: does the Pemberton osteotomy contribute? J Orthop Sci 19(1):90–96
Rampal V, Klein C, Arellano E, Boubakeur Y, Seringe R, Glorion C, Wicart P (2014) Outcomes of modified Dega acetabuloplasty in acetabular dysplasia related to developmental dislocation of the hip. Orthop Traumatol Surg Res 100(2):207–211