Developmental Dysplasia of the Hip
Conditions
Brief summary
To determine the role of arthroscopy in treatment of the DDH.
Detailed description
* The term developmental dysplasia of the hip (DDH) is composed of a spectrum of pathologies from stable acetabular dysplasia (femoral head centered in acetabulum but acetabulum is shallow) to concentric hips that are unstable (femoral head can be moved in and out of the confines of the acetabulum) and frankly dislocated hips in which there is a complete loss of contact between the femoral head and acetabulum. * Open reduction , traditionally through a Smith - Peterson approach should be considered only if closed reduction cannot be performed. * Medial open surgical reduction is a choice for the management of patients younger than 18 months with DDH. The minimal incision and minimal blood loss are advantages of this approach. Limited exposure of the hip joint is a disadvantage. * The arthroscopic procedure was reported to represent a meaningful alternative to the open procedure due to a lower complication rate, a safe setting, a lower rate of residual dysplasia, no observed redislocation and low rate occurrence of osteonecrosis. * All the intra-articular structures (hypertrophic ligamentum teres, transverse acetabular ligament, and pulvinar tissue) in the acetabulum that impede the reduction of the femoral head could be eliminated by using the arthroscopic technique.
Interventions
PROCEDUREarthroscopically assisted
Arthroscopically-Assisted reduction through anterolateral portal for visualization and other accessory portals for instrumentation to achieve reduction and postoperative immobilization in a hip spica.
PROCEDUREopen surgical reduction
Open reduction through a bikini incision anterior approach and postoperative immobilization in a hip spica.
Sponsors
Assiut University
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
9 Months to 18 Months
Healthy volunteers
Yes
Inclusion criteria
* Inclusion Criteria: * Age: - from nine months to 18 months. * Irreducible Hip Dislocation. *
Exclusion criteria
* Patient age: below 9 months or above 18 months. * Teratologic hip dislocation
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Determination the success of reduction and incidence of redislocation rate | immediately postoperative | Documentation of concentric reduction of the hip in immediate postoperative MRI as an assessment tool for the success of the procedure. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Assessment of the cosmetic appearance . | 3 month follow up | Documentation the wound size after 3 months follow up in clinical examination as an assessment tool of cosmotic appearance |
| Assessment of the shortening | 1 year follow up | Assessment the incidence of leg length discrepancy and shortening that affect walking after one year follow up in clinical examination and x-ray as an assessment tool of shortening |
| Assessment the incidence stiffness and decrease range of motion of the affected hip | 1 year follow up | documentation the range of motion of the affected hip and incidence of stiffness after 6 months follow up in clinical examination as an assessment tool of stiffness. |
| Assessment the incidence of avascular necrosis in the affected hip | 1 year follow up | documentation the incidence of avascular necrosis of the affected head of hip after one year follow up in clinical examination and x-ray |
Contacts
Primary Contactmohamed ebrahim, resident
Backup Contactmohamed Abd El- Radi, dr
Outcome results
None listed