Intraoperative 3D Fluoroscopy During Open Reduction for DDH: An Effective Alternative to Postoperative CT/MRI.

Background: Computed tomography CT or magnetic resonance imaging (MRI) has been the most used imaging modality to assess hip reduction in developmental dysplasia of the hip (DDH) after open reduction (OR). In 2015, intraoperative 3D fluoroscopy (3D) was introduced at our center as an alternative to CT/MRI. 3D offers the advantage that if hip reduction is insufficient, it can be addressed at the time of surgery.

A comprehensive nonoperative treatment protocol for developmental dysplasia of the hip in infants.

Aims: Brace treatment is the cornerstone of managing developmental dysplasia of the hip (DDH), yet there is a lack of evidence-based treatment protocols, which results in wide variations in practice. To resolve this, we have developed a comprehensive nonoperative treatment protocol conforming to published consensus principles, with well-defined a priori criteria for inclusion and successful treatment.

Methods: This was a single-centre, prospective, longitudinal cohort study of a consecutive series of infants with ultrasound-confirmed DDH who underwent a comprehensive nonoperative brace management protocol in a unified multidisciplinary clinic between January 2012 and December 2016 with five-year follow-up radiographs.

Interobserver and Intraobserver Reliability in the Salter Classification of Avascular Necrosis of the Femoral Head in Developmental Dysplasia of the Hip.

Background: Avascular necrosis (AVN) of the femoral head is a concerning complication that can result from treatments for developmental dysplasia of the hip (DDH). AVN can lead to degenerative osteoarthritis, persistent acetabular dysplasia, reduced function, and continuing hip pain. The incidence of AVN reported in the DDH literature is widely varied (0% to 73%).

Predicting developmental dysplasia of the hip in at-risk newborns.

Background: The development of developmental dysplasia of the hip can be attributed to several risk factors and often in combination with each other. When predicting the likelihood of developing this condition, clinicians tend to over and underestimate its likelihood of occurring. Therefore, the study aim is to determine among at-risk newborns how to best predict developmental dysplasia of the hip (DDH) within 8 weeks post-partum.

Avascular necrosis following closed reduction for treatment of developmental dysplasia of the hip: a systematic review.

Background: Avascular necrosis (AVN) is a significant and potentially devastating complication following the treatment of developmental dysplasia of the hip (DDH). The reported rate of AVN following closed reduction for DDH ranges from 4 to 60%, and the resultant influence on hip development remains unclear.

Purpose: A systematic review of the literature was undertaken to evaluate the frequency of AVN after more than 5 years of follow-up in children that underwent closed reduction at younger than 2-years of age for DDH.

Evaluation of Brace Treatment for Infant Hip Dislocation in a Prospective Cohort: Defining the Success Rate and Variables Associated with Failure.

Background: The use of a brace has been shown to be an effective treatment for hip dislocation in infants; however, previous studies of such treatment have been single-center or retrospective. The purpose of the current study was to evaluate the success rate for brace use in the treatment of infant hip dislocation in an international, multicenter, prospective cohort, and to identify the variables associated with brace failure.

Methods: All dislocations were verified with use of ultrasound or radiography prior to the initiation of treatment, and patients were followed prospectively for a minimum of 18 months.

Education of parents in Pavlik harness application for developmental dysplasia of the hip using a validated simulated learning module.

Background: The Pavlik harness is the most common initial treatment for developmental dysplasia of the hip worldwide. During treatment, parents are required to re-apply the harness at home. Teaching parents how to apply the harness is therefore paramount to success.

Skill Acquisition and Retention Following Simulation-Based Training in Pavlik Harness Application.

Background: Simulation-based learning is increasingly prevalent in many surgical training programs, as medical education moves toward competency-based curricula. In orthopaedic surgery, developmental dysplasia of the hip is a commonly treated condition, where the standard of care for patients less than six months of age is an orthotic device such as the Pavlik harness. However, despite widespread use of the Pavlik harness and the potential complications that may arise from inappropriate application, we know of no previously described formal training curriculum for Pavlik harness application.

A Reliable and Valid Objective Structured Assessment of Technical Skill for the Application of a Pavlik Harness Based on International Expert Consensus.

Background: The use of competency-based training is increasing in medical education as it offers individualized learning opportunities to master required skills. Inherent to this method of teaching is the need for standardized and objective assessments of skill mastery. In orthopaedic surgery, educational programs have focused on surgical skills with lesser emphasis on nonoperative techniques.

How are dysplastic hips different? A three-dimensional CT study.

Background: Surgical correction of acetabular dysplasia can postpone or prevent joint degeneration. The specific abnormalities that make up the dysplastic hip are controversial.

Questions/purposes: (1) What are the relative size, shape, and orientations of the typical nondysplastic hip? (2) How do these variables differ in the developmentally dysplastic hip? (3) Are there version differences between the acetabuli of dysplastic and nondysplastic hips? (4) Are there pairs of variables in which the change in one is always accompanied by a change in the other for both nondysplastic and dysplastic acetabuli?

Methods: Of 117 consecutive three-dimensional (3-D) CT scans performed for hip dysplasia between March 1988 and October 1995, 48 met criteria of developmentally dysplastic hips by plain radiography.

Management of hip instability in trisomy 21.

The unstable hip in Trisomy 21 presents with a spectrum of hip instability with different problems at different ages. What links this multiphase problem, in many patients, is the final common pathway of untreated instability, that of a stiff, dislocated, and often-painful hip, leading to significant functional disability. Historically, the results of treating hip instability in Trisomy 21 were variable with a notable frequency of poor results.

Reliability of Bucholz and Ogden classification for osteonecrosis secondary to developmental dysplasia of the hip.

Background: Osteonecrosis is perhaps the most important serious complication after treatment of developmental dysplasia of the hip (DDH). The classification by Bucholz and Ogden has been used most frequently for grading osteonecrosis in this context, but its reliability is not established and unreliability could affect the validity of studies reporting the outcome of treatment.

Questions/purpose: We established the interrater and intrarater reliabilities of this classification and analyzed the frequency and nature of disagreements.

Strategies to improve outcomes from operative childhood management of DDH.

The operative management of DDH is technically challenging. To achieve excellent results, surgeons need to select the most appropriate operative treatment, minimize the risk of complications, and be aggressive in the management of serious complications, such as redislocation and AVN, when they occur. We have described specific steps and strategies to assist in each of these key steps.

Functional outcomes in children with osteonecrosis secondary to treatment of developmental dysplasia of the hip.

Background: Osteonecrosis of the femoral head is a major potential complication following the treatment of developmental dysplasia of the hip. It remains unclear if the radiographic changes associated with osteonecrosis are clinically relevant.

Methods: In the present cross-sectional study, we determined the relationship between morphological changes on radiographs (classified with use of the Bucholz-Ogden system) and health-related quality of life (assessed with the Health Utilities Index Mark 3 [HUI3]; maximum score, 1), physical function (assessed with the Activities Scale for Kids [ASK]; maximum score, 100), and hip function (assessed with the Children's Hospital Oakland Hip Evaluation Scale [CHOHES]; maximum score, 100).

Standardized diagnostic criteria for developmental dysplasia of the hip in early infancy.

Background: Clinicians use various criteria to diagnose developmental dysplasia of the hip (DDH) in early infancy, but the importance of these various criteria for a definite diagnosis is controversial. The lack of uniform, widely agreed-on diagnostic criteria for DDH in patients in this age group may result in a delay in diagnosis of some patients.

Questions/purposes: Our purpose was to establish a consensus among pediatric orthopaedic surgeons worldwide regarding the most relevant criteria for diagnosis of DDH in infants younger than 9 weeks.

Femoral varus derotation osteotomy for the treatment of habitual subluxation and dislocation of the pediatric hip in trisomy 21: a 10-year experience.

Background: Habitual hip subluxation and dislocation are potentially disabling features of the trisomy 21 syndrome. We describe outcomes after a femoral varus derotation osteotomy to achieve and maintain hip stability and community ambulation.

Methods: All individuals with trisomy 21, who underwent hip surgery at our institution between 1998 and 2008, were searched using the hospital databases.

The presence of an ossific nucleus does not protect against osteonecrosis after treatment of developmental dysplasia of the hip.

Background: Osteonecrosis (ON) is a major complication after treatment of developmental dysplasia of the hip (DDH). Several studies have explored the absence of the femoral head ossific nucleus at the time of hip reduction as a risk factor for the development of ON, but findings have been inconsistent.

Questions/purposes: We therefore determined the incidence of ON in children who underwent reduction of a dislocated hip in the presence or absence of the ossific nucleus.

The health and quality of life outcomes among youth and young adults with cerebral palsy.

Unlabelled: Young NL, Rochon TG, McCormick A, Law M, Wedge JH, Fehlings D. The health and quality of life outcomes among youth and young adults with cerebral palsy.

Objectives: To describe the health and quality of life (QoL) of youth and young adults who have cerebral palsy (CP), and to assess the impact of 3 key factors (severity, age, and sex) on these outcomes.

Effect of innominate and femoral varus derotation osteotomy on acetabular development in developmental dysplasia of the hip.

Background: Open reduction for the treatment of hip dislocation due to developmental dysplasia of the hip in children of walking age is frequently combined with either a femoral varus derotation osteotomy or an innominate osteotomy; however, it remains unclear which of these procedures is preferable in terms of subsequent hip development. The purpose of the present study was to compare acetabular development in patients managed for dislocation of the hip with open reduction combined with one of the two osteotomies.

Methods: Patients between fifteen months and four years of age with hip dislocations that were treated at two different centers were compared.

Radiographic results of combined Salter innominate and femoral osteotomy in Legg-Calvé-Perthes disease in older children.

Purpose: Treatment of Legg-Calvé-Perthes disease in older children with greater involvement of the femoral head remains uncertain. Innominate, femoral or combined innominate and femoral osteotomies are generally performed to better contain and provide more coverage of the femoral head by the acetabulum with the objective of achieving a more spherical head and a congruent joint. The purpose of the study was to evaluate the radiographic outcomes of simultaneous femoral and pelvic osteotomies.

Outcome at forty-five years after open reduction and innominate osteotomy for late-presenting developmental dislocation of the hip. Surgical technique.

Background: A consecutive series of seventy-six patients (101 hips) underwent primary open reduction, capsulorrhaphy, and innominate osteotomy for late-presenting developmental dislocation of the hip. They were between 1.5 and five years old at the time of surgery, which was done between 1958 and 1965.

Outcome at forty-five years after open reduction and innominate osteotomy for late-presenting developmental dislocation of the hip.

Background: A consecutive series of seventy-six patients (101 hips) underwent primary open reduction, capsulorrhaphy, and innominate osteotomy for late-presenting developmental dislocation of the hip. They were between 1.5 and five years old at the time of surgery, which was done between 1958 and 1965.