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Arthroscopic reduction of the dislocated hip in infants
O Eberhardt1, F F Fernandez, T Wirth
1Olgahospital Stuttgart, Orthopaedic Department, Bismarckstrasse 8, Stuttgart 70176, Germany. o.eberhardt@klinikum-stuttgart.de
Insights
Arthroscopic hip reduction is a viable treatment for infants with developmental dysplasia of the hip (DDH) when closed reduction fails. This minimally invasive technique successfully reduced dislocated hips in young children, with stable outcomes observed post-procedure.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Minimally Invasive Surgery
Background:
- Developmental dysplasia of the hip (DDH) is a common condition in infants.
- Closed reduction is the standard treatment for dislocated hips in DDH.
- Failed closed reduction necessitates alternative treatment strategies.
Purpose of the Study:
- To evaluate the feasibility and early outcomes of arthroscopic reduction for dislocated hips in infants with DDH.
- To assess the safety and efficacy of a two-portal arthroscopic technique for hip reduction.
- To identify intra-articular structures and obstacles during arthroscopic reduction.
Main Methods:
- A two-portal arthroscopic technique was employed in five infants (mean age 5.8 months) with eight dislocated hips.
- Procedures involved evaluation of intra-articular structures, resection of hypertrophic ligamentum teres and acetabular pulvinar, and capsular release.
- Reduction was confirmed arthroscopically and via MRI, with a mean follow-up of 13.2 months.
Main Results:
- All eight dislocated hips were successfully reduced in a single arthroscopic procedure.
- The primary obstacle to reduction was capsular constriction.
- At follow-up, all hips remained stable, with three cases of avascular necrosis and a significant decrease in the mean acetabular index.
Conclusions:
- Arthroscopic reduction using a standardized two-portal technique is feasible for treating dislocated hips in infants with DDH after failed closed reduction.
- The technique allows for evaluation and management of intra-articular pathology.
- Longer-term studies are required to ascertain functional outcomes and the full impact of avascular necrosis.
Abstract:
We present our early experience of arthroscopic reduction of the dislocated hip in very young infants with developmental dysplasia of the hip (DDH). Eight dislocated hips, which had failed attempts at closed reduction, were treated by arthroscopy of the hip in five children with a mean age of 5.8 months (4 to 7). A two-portal technique was used, with a medial sub-adductor portal for a 2.7 mm cannulated system with a 70° arthroscope and an anterolateral portal for the instruments. Following evaluation of the key intra-articular structures, the hypertrophic ligamentum teres and acetabular pulvinar were resected, and a limited release of the capsule was performed prior to reduction of the hip. All hips were reduced by a single arthroscopic procedure, the reduction being confirmed on MRI scan. None of the hips had an inverted labrum. The greatest obstacle to reduction was a constriction of the capsule. At a mean follow-up of 13.2 months (9 to 24), all eight hips remained stable. Three developed avascular necrosis. The mean acetabular index decreased from 35.5° (30° to 40°) pre-operatively to 23.3° (17° to 28°). This study demonstrates that arthroscopic reduction is feasible using two standardised portals. Longer follow-up studies are necessary to evaluate the functional results.
