Although the use of ultrasound in the diagnosis and early treatment of developmental dysplasia of the hip (DDH) has reduced the number of patients diagnosed late and decreased the number of operative procedures, surgical treatment is still needed in some patients. Late cases continue to occur as a result of missing the screening examination, being normal at initial screening and missing followup. Dysplasia may persist despite appropriate nonoperative or operative treatment. Many of these patients subsequently undergo closed or open reduction and femoral or acetabular reconstruction. Ultrasound of the hips is generally used up to 6 or 8 months of age, during which time the hips are largely cartilaginous, and radiographs after that time when bony development is more complete. Options to supplement ultrasound and radiography include arthrography, computed tomography, and magnetic resonance imaging. Several advances have been made in the imaging of DDH and its complications including acetabular labral pathology and of femoroacetabular impingement (FAI). We review imaging techniques other than ultrasound used in the management of DDH.

/pdf/imaging-in-the-surgical-management-of-developmental-47fcq6xnj8.pdf

Imaging in the Surgical Management of Developmental Dislocation of the Hip

Purpose
At present, the indications for femoral derotational osteotomy remain controversial due to the inconsistent findings in femoral neck anteversion in developmental dysplasia of the hip (DDH). Moreover, combined anteversion is not assessed in unilateral DDH using three dimensional-CT. Therefore, the purposes of our study were to observe whether the femoral neck anteversion (FA), acetabular anteversion (AA) and combined anteversion (CA) on the dislocated hips were universally presented in unilateral DDH according to the classification system of Tonnis.

Three dimensional-CT evaluation of femoral neck anteversion, acetabular anteversion and combined anteversion in unilateral DDH in an early walking age group

BACKGROUND The purpose of this paper was to compare the use of computed tomography (CT) versus magnetic resonance imaging (MRI) to evaluate hip reduction in patients with dysplasia of the hip. METHODS A retrospective review of postoperative pelvic CT and MRI in patients <13 months of age with hip dysplasia was performed. Scanner time, anesthesia requirement, cost, and radiation dosage were recorded. Hips were classified as dislocated, subluxated, or reduced. Sensitivity and specificity of CT and MRI were calculated. The outcomes of the subluxated hips were followed. RESULTS Thirty-two CT scans and 33 MRI scans in 39 patients were evaluated. CT scanner time was 2.8 minutes, which was significantly less than the 8.9 minutes required for MRI (P=0.0001). Postoperative anesthesia was only required for 1 CT case. Average cost of CT examination was $788 and $1104 for MRI. Average radiation dose with CT examinations was 1 mSv. Of the postoperative nonsubluxated hips (n=30 for CT and n=37 for MRI), CT demonstrated a sensitivity of 100% and a specificity of 96%, whereas MRI exhibited a sensitivity of 100% and a specificity of 100%. Of the postoperative subluxated hips, 66.7% spontaneously reduced, 22.2% remained subluxated, and 11.1% redislocated. CONCLUSIONS This is the first study to compare these imaging modalities in the evaluation of hip reduction in DDH. This study affirms MRI as an alternative to CT scan. The sensitivity and specificity of both modalities appears excellent. Similar to other studies, a large percentage of subluxated hips in both groups reduce without additional surgical intervention. LEVEL OF EVIDENCE Diagnostic level II.

Comparison of hip reduction using magnetic resonance imaging or computed tomography in hip dysplasia.

Background:When closed reduction of a developmental dislocation of the hip fails, some form of open reduction is required. In recent years, the many advantages of the medial approach open reduction have been emphasized. However, there have been suggestions that the rate of growth disturbance in the

Ligamentum Teres Tenodesis in Medial Approach Open Reduction for Developmental Dislocation of the Hip

Developmental dysplasia of the hip is a spectrum disorder of hip development that ranges in severity from abnormal acetabular morphology to complete hip dislocation. While treatment with a Pavlik harness is highly effective in infants younger than 6 months, older infants and children and those with orthotic failure often warrant surgical reduction and placement of a spica cast, which limits subsequent imaging evaluation. Magnetic resonance (MR) imaging has been described in the evaluation of the adequacy of hip reduction for more than 2 decades, but the practice is still not widespread and is performed routinely at relatively few centers. MR imaging is a robust tool for outcome assessment after hip reduction and placement of a spica cast, facilitating multiplanar confirmation of concentric reduction independent of an ossific nucleus or orthopedic hardware. Excellent image contrast of soft tissues allows identification of obstacles to concentric reduction, which may be extra-articular or intra-articular. Extra-articular obstacles include tightening of the adductor muscles and tightening of the iliopsoas tendon with constriction of the joint capsule. Intra-articular obstacles include limbus formation, labral inversion, an enlarged pulvinar, and hypertrophy of the ligamentum teres and/or the transverse acetabular ligament. Intravenous contrast material administration may demonstrate altered epiphyseal blood flow and help identify patients at risk for early ischemia. Imaging technique and image interpretation can be optimized to facilitate the performance of postreduction MR imaging studies where they may be of benefit. (©)RSNA, 2016.

https://pubs.rsna.org/doi/pdf/10.1148/rg.2016150159

MR Imaging in Postreduction Assessment of Developmental Dysplasia of the Hip: Goals and Obstacles.

Magnetic resonance imaging (MRI) was performed on 73 hips in 59 children aged 3 to 16 months after surgical reduction of developmental dislocation of the hip. Twenty-seven hips in 22 children had repeat MRI 6 weeks after reduction, and 20 hips in 16 patients had further MRI at least 1 year later. Only 38% of hips appeared concentrically reduced on the initial MRI scan, but this increased to 90% by 1 year later, without intervention. The authors measured coronal plane acetabular index and transverse plane anterior, posterior, and axial acetabular indices, as well as acetabular version and anteversion. Persistent difference could be shown in the coronal plane acetabular index between the dysplastic and normal sides for the cartilaginous anlage and the bony model of the acetabulum in scans performed at least 1 year after reduction. However, 40% of cartilaginous coronal plane acetabular indices fell within the "normal" range at 1 year. No other parameters could be shown to be persistently different.

Magnetic resonance imaging evaluation of surgical management in developmental dysplasia of the hip in childhood.

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Magnetic resonance imaging evaluation of surgical management in developmental dysplasia of the hip in childhood.