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Acetabular development in congenital dislocation on the hip
J A Molina Guerrero1, L Munuera Martinez, B Esteban Mugica
1Department of orthopedic surgery, Hospital La pay, Madrid, Spain.
Insights
Open reduction improves acetabular development in children with congenital dislocation of the hip (CDH). Early treatment is crucial, as avascular necrosis (AN) negatively impacts hip remodeling and acetabular index (AI) improvement.
Area of Science:
- Orthopedics
- Pediatric Orthopedics
- Developmental Orthopedics
Background:
- Acetabular dysplasia is a frequent complication following treatment for congenital dislocation of the hip (CDH).
- Delayed diagnosis of CDH can impact acetabular development and treatment outcomes.
- Understanding factors influencing acetabular remodeling is crucial for long-term hip health.
Purpose of the Study:
- To analyze acetabular development in children with CDH and delayed diagnosis.
- To compare acetabular development based on the type of hip reduction (closed vs. open).
- To investigate the relationship between acetabular dysplasia, avascular necrosis (AN), and acetabular index (AI) post-treatment.
Main Methods:
- Retrospective analysis of 47 children (55 CDH cases) with delayed diagnosis.
- Classification of cases based on reduction type: closed (Group 1) and open (Group 2).
- Assessment of acetabular development using the acetabular index (AI), with >25 degrees indicating dysplasia after two years.
Main Results:
- Open reduction resulted in better acetabular development compared to closed reduction in CDH.
- Acetabular remodeling was less favorable in hips with avascular necrosis (AN) post-reduction.
- The acetabular index (AI) showed progressive improvement during CDH treatment, most notably in the first year post-reduction.
Conclusions:
- Open reduction is associated with superior acetabular development in CDH treatment.
- Avascular necrosis (AN) hinders acetabular remodeling following hip reduction.
- Early and effective management of CDH promotes favorable acetabular development and improves the acetabular index (AI).
Abstract:
Acetabular dysplasia is one of the most common complications in the treatment of congenital dislocation of the hip (CDH). Acetabular development is analyzed in a series of 47 children with 55 CDH with delayed diagnosis. Cases were studied on an overall basis and according to the type of reduction realized: closed (group 1) or open (group 2). The incidence of acetabular dysplasia in relation with the development of avascular necrosis (AN) of the hip during treatment was studied. Cases with an acetabular index (AI) of greater than 25 degrees two or more years after reduction were considered suggestive of dysplasia. Acetabular development was better in CDH treated by open reduction. Acetabular remodeling in dislocated hips treated by reduction and affected by AN was less than in reduced CDH free of AN. AI improves progressively during treatment of CDH, more markedly in the first post-reduction year.