The Added Value of Postoperative Axial Imaging in Developmental Dysplasia of the Hip
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Nabil Alassaf1, Joud Abuhaimed2, Nouf Almahmoud2
1Department of surgical specialties, King Fahad Medical City, P.O. BOX 59046, Riyadh 11525, Kingdom of Saudi Arabia.
Insights
Axial imaging, such as computed tomography (CT), is more effective than conventional radiography in detecting hip redislocation after developmental dysplasia of the hip (DDH) surgery. Early detection with CT aids prompt treatment, preventing delayed complications.
Area of Science:
- Pediatric Orthopedics
- Radiology
- Skeletal Dysplasia
Background:
- Redislocation is a significant complication following surgical reduction for developmental dysplasia of the hip (DDH) in children.
- Early detection of redislocation is crucial for timely reoperation and better outcomes.
- Current recommendations suggest axial imaging postoperatively, despite limited evidence.
Purpose of the Study:
- To compare the effectiveness of conventional pelvic radiography versus axial imaging in detecting hip redislocation after DDH surgery.
- To evaluate the impact of imaging modality on the timeliness of redislocation detection and management.
Main Methods:
- Retrospective analysis of patients undergoing operative reduction for DDH between 2012 and 2016.
- Comparison of hips imaged with routine low-dose computed tomography (CT) versus those with anteroposterior pelvic radiography alone.
- Level III diagnostic study.
Main Results:
- Computed tomography (CT) detected redislocations more effectively than radiography, with 2/2 redislocations addressed before discharge compared to 3/9 with radiography.
- No significant delay in hospital discharge was observed when CT was utilized.
- The study included 241 patients (339 hips), with 192 in the CT group and 147 in the radiography group.
Conclusions:
- Conventional pelvic radiography is less effective than axial imaging for detecting hip redislocation post-DDH surgery.
- Axial imaging facilitates earlier identification and management of redislocations, improving patient care.
Background:
Redislocation is a dreaded complication after reduction of developmental dysplasia of the hip (DDH) in young children. While early detection facilitates urgent reoperation, delayed revisions are more complicated. Despite the weak evidence, an axial postoperative imaging tool is recommended. This study's goal is to compare the effectiveness of conventional pelvic radiography alone and axial imaging.
Methods:
Data were collected retrospectively between 2012 and 2016. One study group comprised consecutive patients who had operative reduction followed by routine low-dose computed tomography (CT). Hips that had anteroposterior pelvic radiographs as the only confirmatory tool were used as a reference group.
Results:
We identified 241 patients (339 hips). The mean age and follow up were 19.6 months ± 9.3, and 15.5 months ± 11.1, respectively. There were 147 hips in the radiography group and 192 in the CT group. Radiography detected only three out of nine redislocations during the same admission; in contrast, 2/2 redislocations in the routine CT group were addressed before hospital discharge (p<0.01). There was no significant delay in hospital discharge when CT was used (p= 0.28).
Conclusion:
Conventional radiography is not as effective as axial imaging in preventing late detection of redislocation.
Level Of Evidence:
level III, Diagnostic Study.
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