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Arthrography in the evaluation of congenital dislocation of the hip
D S Drummond1, J O'Donnell, A Breed
1Division of Orthopedic Surgery, Children's Hospital of Philadelphia, PA 19104.
Insights
Intraoperative hip arthrography accurately identifies reduction depth and soft tissue obstructions in pediatric hip dysplasia. This imaging technique is more reliable than standard X-rays for assessing hip anatomy and guiding treatment in young children.
Area of Science:
- Pediatric Orthopedics
- Diagnostic Imaging
- Skeletal Dysplasias
Background:
- Congenital dysplasia of the hip (CDH) is a common condition in infants.
- Accurate assessment of hip anatomy is crucial for successful treatment, especially during open reduction procedures.
- Intraoperative imaging can aid in evaluating reduction quality and identifying obstacles.
Purpose of the Study:
- To evaluate the diagnostic value of intraoperative hip arthrography in children with CDH.
- To compare arthrographic findings with plain radiography and surgical observations.
- To determine the reliability of arthrography in assessing key anatomical features relevant to hip reduction.
Main Methods:
- Retrospective review of 48 preoperative hip arthrograms from 35 children under 18 months with CDH.
- Comparison of arthrographic findings with plain roentgenograms and intraoperative findings at open reduction.
- Assessment of the frequency of common arthrographic observations and their correlation with surgical outcomes.
Main Results:
- Arthrography demonstrated high reliability in identifying reduction depth (100%), osteocartilaginous configuration (96%), and soft tissue obstructions like the limbus (98%) and ligamentum teres (78%).
- It was less effective in detecting psoas contracture (36%), which was consistently present at surgery.
- Arthrography provided more accurate calculation of the Wiberg center edge (CE) angle compared to plain roentgenograms due to eccentric femoral head ossification.
Conclusions:
- Intraoperative hip arthrography is a valuable tool for assessing hip anatomy and reduction quality in pediatric CDH.
- It reliably identifies key structures that may impede closed reduction, such as the inverted limbus.
- Arthrography offers superior accuracy in measuring the CE angle compared to conventional radiography in this patient population.
Abstract:
To assess the value of intraoperative arthrography, 48 preoperative hip arthrograms of 35 children under 18 months of age treated for congenital dysplasia of the hip were reviewed. The frequency of the common arthrographic observations was assessed and was compared with the findings observed from the plain roentgenograms, and with the pathoanatomy seen at the time of open reduction. Arthrography proved reliable in identifying the depth of reduction (medial dye column, 100%), the configuration of the osteocartilaginous structures (96%), and the presence of potentially obstructing soft tissue (limbus, 98%, and ligamentum teres, 78%). Arthrography was less reliable in discerning psoas contracture (36%), despite its presence at all open reductions. Arthrography proved reliable in outlining the inverted limbus that can obstruct closed reduction. Because ossification of the femoral head was frequently eccentric, the center edge (CE) angle of Wiberg was calculated from arthrography more accurately than from roentgenograms.