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osteotomy, known as San Diego acetabuloplasty, was designed initially for hip dysplasia secondary to neuromuscular disease, where the deficiency is predominantly posterosuperior or direct lateral compared to the anterolateral deficiency seen in DDH ( 11
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typically located superiorly. 87 Fig. 6 (A) Schematic drawing, (B) direct MR arthrography with traction at 3T of a 17-year-old woman with hip dysplasia who underwent (B) surgical hip dislocation and subsequent periacetabular osteotomy. (A–C) Static
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index; LCE, lateral centre edge; AI, acetabular index. Bernese periacetabular osteotomy (PAO) The PAO is an accepted surgical technique for treatment of both hip dysplasia 78 and pincer-type FAI due to acetabular retroversion. 79
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recent study has indicated that the risk of OA is significantly reduced following PAO. 23 Conclusions PAO is an effective treatment for symptomatic hip dysplasia. The risk of complication is relatively low if experienced surgeons perform the
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Background and purpose
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Diagnostics and treatment of developmental dysplasia of the hip (DDH) are highly variable in clinical practice. To obtain more uniform and evidence-based treatment pathways, we developed the ‘Dutch guideline for DDH in children < 1 year’. This study describes recommendations for unstable and decentered hips.
Materials and methods
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The Appraisal of Guidelines for Research and Evaluation criteria (AGREE II) were applied. A systematic literature review was performed for six predefined guideline questions. Recommendations were developed, based on literature findings, as well as harms/benefits, patient/parent preferences, and costs (GRADE).
Results
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The systematic literature search resulted in 843 articles and 11 were included. Final guideline recommendations are (i) Pavlik harness is the preferred first step in the treatment of (sub) luxated hips; (ii) follow-up with ultrasound at 3–4 and 6–8 weeks; (iii) if no centered and stable hip after 6–8 weeks is present, closed reduction is indicated; (iv) if reduction is restricted by limited hip abduction, adductor tenotomy is indicated; (v) in case of open reduction, the anterior, anterolateral, or medial approach is advised, with the choice based on surgical preference and experience; (vi) after reduction (closed/open), a spica cast is advised for 12 weeks, followed by an abduction device in case of residual dysplasia.
Interpretation
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This study presents recommendations on the treatment of decentered DDH, based on the available literature and expert consensus, as Part 2 of the first official and national evidence-based ‘Guideline for DDH in children < 1 year’. Part 1 describes the guideline sections on centered DDH in a separate article.
Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC-Institut de Biomécanique Humaine Georges Charpak, HESAM Université, Paris, France
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Introduction Hip dysplasia may have different etiologies, including congenital, neuromuscular, teratological, and genetic. Untreated, it can cause pain and deterioration of function, such as loss of locomotion, precarious sitting position. The
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deficient anterior acetabular wall. 3 Fig. 1 A 21-year-old female patient with right hip dysplasia. She had had a previous subtrochanteric femoral valgus support osteotomy at the age of 14 years. Dysplasia is never confined to the hip joint alone
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posterior dislocation commonly return to sport at three months. Atraumatic instability is usually associated with hip dysplasia and connective tissue disorders, such as Marfan’s or Ehlers-Danlos syndromes. Idiopathic instability is commonly described
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. Health condition of interest Intervention I (#1) II (#2) (#3) Cerebral palsy Hip dysplasia Reconstruction Hip subluxation Osteotomy Hip luxation Surgery Hip dislocation Hip displacement
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. Prevalence of combined abnormalities of tibial and femoral torsion in patients with symptomatic hip dysplasia and femoroacetabular impingement . Bone and Joint Journal 2020 102–B 1636 – 1645 . ( https://doi.org/10.1302/0301-620X.102B12.BJJ-2020-0460.R1 ) 6
