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Hip joint instability after the neonatal period. Diagnosis and treatment of 20 consecutive cases
Insights
Idiopathic hip joint instability in children can be successfully treated with closed reduction and plaster immobilization. Most children achieve stable hips and normal walking, though some may experience complications.
Area of Science:
- Pediatric Orthopedics
- Developmental Dysplasia of the Hip
Background:
- Idiopathic hip joint instability diagnosed after the neonatal period presents a clinical challenge.
- Early diagnosis and intervention are crucial for optimal outcomes in pediatric hip conditions.
Purpose of the Study:
- To evaluate the efficacy of closed reduction and plaster treatment for idiopathic hip joint instability in young children.
- To assess long-term clinical and radiological outcomes, including complications and prognosis.
Main Methods:
- A series of 20 children (21 hips) diagnosed with idiopathic hip joint instability after the neonatal period were included.
- Diagnosis was confirmed via hip joint arthrography. Treatment involved closed reduction and subsequent plaster immobilization, with or without prior adductor tenotomy.
- Clinical and radiological evaluations, including repeat arthrography, were performed at 1-4.5 years post-diagnosis.
Main Results:
- Closed reduction was successful in all cases. Rapid stability was achieved during plaster treatment.
- At follow-up, all children had clinically stable hips and normal gait. 81% (17/21 hips) had a good prognosis.
- Complications included avascular necrosis of the femoral head in two hips and delayed skeletal development in three hips.
Conclusions:
- Closed reduction and plaster treatment represent an effective management strategy for idiopathic hip joint instability in children diagnosed post-neonatally.
- While generally successful, potential complications like avascular necrosis and developmental delay warrant careful monitoring and consideration of treatment duration based on age.
Abstract:
A consecutive series of 20 children (21 hips) with idiopathic hip joint instability, diagnosed after the neonatal period, is presented. The diagnosis was confirmed by hip joint arthrography. In all the children, 1.5-21 months old at the time of diagnosis, closed reduction could be achieved. They were treated in plaster directly or after treatment of contractures in the adductor muscles of the hip joint. Stability was rapidly attained during plaster treatment. The results of the treatment in plaster were checked by a second arthrography in two thirds of the cases, and all cases have been clinically and radiologically evaluated 1-4.5 years after diagnosis. All of the children developed clinically stable hips and they walk normally. In two hips signs of avascular necrosis of the femoral head were found and in three hips (two children) the skeletal development was markedly delayed. In 81 per cent (17/21 hips) the prognosis was considered good; it is uncertain in the remaining four hips. The appropriate period of fixation in plaster related to the age of the child is discussed.
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