Reliability of the computed tomography criteria after closed reduction of developmental dislocation of the hip

Abstract

BACKGROUND: Developmental dislocation of the hip includes femoral head subluxation or dislocation and/or acetabular dysplasia. Closed reduction of the hip should be performed under general anesthesia. Appropriate performance and interpretation of closed reduction are difficult and require experience. The role of computed tomography (CT) in different aspects of treatment of developmental hip dysplasia is well established. It was an accurate way to assess the adequacy of reduction of dislocated hips for patients in spica casts.

AIM: This study aimed to assess the role of CT in the evaluation of closed reduction of developmental hip dislocation in infants and children immobilized in spica casts.

MATERIALS AND METHODS: This study included 16 patients with 20 involved hips who presented with developmental hip dysplasia. The youngest patient was 12 months old, and the oldest was 24 months old, with a mean age of 19.62 ± 4.27 months. There were 15 girls (93.75%) and one boy (6.25%). There were four patients with bilateral hip involvement (25%), and the right side was involved in five hips (31.25%), whereas the left side was affected in 7 (43.75%) hips.

RESULTS: Closed reduction was performed in 20 hips, and according to the post-reduction CT evaluation, the final results were satisfactory in 16 (80%) hips and unsatisfactory in 4 (20%) hips. On the coronal CT cuts, the modified Shenton’s line gave a sensitivity of 75%, specificity of 81.25%, and accuracy of 80%. Second, the calculation of femoral head coverage on coronal CT cuts showed the highest sensitivity of 100%, specificity of 50%, and accuracy of 60%. Lastly, the posterior neck line identified on the axial CT cuts gave a sensitivity of 75%, specificity of 87%, and accuracy of 85%. On comparing and evaluating the three methods, the method that gave the best level of reliability for the adequacy of the reduction was the posterior neckline (82.23 %), followed by modified Shenton’s line (78.75%), and finally femoral head coverage (70%).

CONCLUSIONS: The posterior neck line is the preferred method to confirm the adequacy of hip relocation on multi-slice post-reduction axial CT.

Keywords

computed tomography / developmental hip dysplasia / closed reduction / posterior neckline

References

[1] Tarpada SP, Girdler SJ, Morris MT. Developmental dysplasia of the hip: a history of innovation. J Pediatr Orthop B. 2018;27(3):271−273. DOI: 10.1097/BPB.0000000000000463

[2] Tarpada S.P., Girdler S.J., Morris M.T. Developmental dysplasia of the hip: a history of innovation // J. Pediatr. Orthop. B. 2018. Vol. 27. No. 3. P. 271−273. DOI: 10.1097/BPB.0000000000000463

[3] Hefti F, Brunner R, Freuler F, et al. Developmental dysplasia and congenital dislocation of the hip. In: Hefti F, Brunner R, Freuler F, et al. (eds). Pediatric orthopedic in practice. 1st ed. New York: Springer; 2007. P. 177−200.

[4] Hefti F., Brunner R., Freuler F. et al. Developmental dysplasia and congenital dislocation of the hip. In: Pediatric orthopedic in practice. Ed. by F. Hefti, R. Brunner, F. Freuler et al. 1st ed. New York: Springer, 2007. P. 177−200.

[5] Beaty JH. Congenital and developmental dysplsia of the hip. In: Canale T, Beaty JH, Daugherty K, Jones L (eds). Cambell’s operative orthopedic. 11th ed. Philadelphia, Pennsylvania: Mosby Elsvier; 2007. P. 1180−1219.

[6] Beaty J.H. Congenital and developmental dysplsia of the hip. In: Cambell’s operative orthopedic. Ed by T. Canale, J.H. Beaty, K. Daugherty, L. Jones. 11th ed. Philadelphia, Pennsylvania: Mosby Elsvier, 2007. P. 1180−1219.

[7] Cai Z, Piao C, Zhang T, et al. Accuracy of CT for measuring femoral neck anteversion in children with developmental dislocation of the hip verified using 3D printing technology. J Orthop Surg Res. 2021;16(1):256−264. DOI: 10.1186/s13018-021-02400-x

[8] Cai Z., Piao C., Zhang T. et al. Accuracy of CT for measuring femoral neck anteversion in children with developmental dislocation of the hip verified using 3D printing technology // J. Orthop. Surg. Res. 2021. Vol. 16. No. 1. P. 256−264. DOI: 10.1186/s13018-021-02400-x

[9] Stanton RP, Capecci R. Computed tomography for early evaluation of developmental dysplasia of the hip. J Pediatr Orthop. 1992;12(6):727−730. DOI: 10.1097/01241398-199211000-00005

[10] Stanton R.P., Capecci R. Computed tomography for early evaluation of developmental dysplasia of the hip // J. Pediatr. Orthop. 1992. Vol. 12. No. 6. P. 727−730. DOI: 10.1097/01241398-199211000-00005

[11] Toby EB, Koman LA, Bechtold RE, Nicastro JN. Postoperative computed tomographic evaluation of congenital hip dislocation. J Pediatr Orthop. 1987;7(6):667−670.

[12] Toby E.B., Koman L.A., Bechtold R.E., Nicastro J.N. Postoperative computed tomographic evaluation of congenital hip dislocation // J. Pediatr. Orthop. 1987. Vol. 7. No. 6. P. 667−670.

[13] Silva MS, Fernandes ARC, Cardoso FN, et al. Radiography, CT, and MRI of hip and lower limb disorders in children and adolescents. Radiographics. 2019;39(3):779−794. DOI: 10.1148/rg.2019180101

[14] Silva M.S., Fernandes A.R.C., Cardoso F.N. et al. Radiography, CT, and MRI of hip and lower limb disorders in children and adolescents // Radiographics. 2019. Vol. 39. No. 3. P. 779−794. DOI: 10.1148/rg.2019180101

[15] Edelson JG, Hirsch M, Weinberg H, et al. Congenital dislocation of the hip and computerised axial tomography. J Bone Joint Surg [Br]. 1984;66(4):472−478. DOI: 10.1302/0301-620X.66B4.6746676

[16] Edelson J.G., Hirsch M., Weinberg H. et al. Congenital dislocation of the hip and computerised axial tomography // J. Bone Joint Surg. [Br]. 1984. Vol. 66. No. 4. P. 472−478. DOI: 10.1302/0301-620X.66B4.6746676

[17] Morin C, Harcke HT, MacEwen GD. The infant hip: real-time US assessment of acetabular development. Radiology. 1985;157(3):673–677. DOI: 10.1148/radiology.157.3.3903854

[18] Morin C., Harcke H.T., MacEwen G.D. The infant hip: real-time US assessment of acetabular development // Radiology. 1985. Vol. 157. No. 3. P. 673–677. DOI: 10.1148/radiology.157.3.3903854

[19] Dezateux C, Rosendahl K. Developmental dysplasia of the hip. Lancet. 2007;369(9572):1541−1552. DOI: 10.1016/S0140-6736(07)60710-7

[20] Dezateux C., Rosendahl K. Developmental dysplasia of the hip // Lancet. 2007. Vol. 369. No. 9572. P. 1541−1552. DOI: 10.1016/S0140-6736(07)60710-7

[21] Sankar WN, Gornitzky AL, Clarke NMP, et al; International Hip Dysplasia Institute. Closed reduction for developmental dysplasia of the hip: Early-term results from a prospective, multicenter cohort. J Pediatr Orthop. 2019;39(3):111−118. DOI: 10.1097/BPO.0000000000000895

[22] Sankar W.N., Gornitzky A.L., Clarke N.M.P. et al; International Hip Dysplasia Institute. Closed reduction for developmental dysplasia of the hip: Early-term results from a prospective, multicenter cohort // J. Pediatr. Orthop. 2019. Vol. 39. No. 3. P. 111−118. DOI: 10.1097/BPO.0000000000000895

[23] Li Y, Lin X, Liu Y, et al. Effect of age on radiographic outcomes of patients aged 6-24 months with developmental dysplasia of the hip treated by closed reduction. J Pediatr Orthop B. 2020;29(5):431−437. DOI: 10.1097/BPB.0000000000000672

[24] Li Y., Lin X., Liu Y. et al. Effect of age on radiographic outcomes of patients aged 6-24 months with developmental dysplasia of the hip treated by closed reduction // J. Pediatr. Orthop. B. 2020. Vol. 29. No. 5. P. 431−437. DOI: 10.1097/BPB.0000000000000672

[25] Smith BG, Kasser JR, Hey LA, et al. Postreduction computed tomography in developmental dislocation of the hip: part I: analysis of measurement reliability. J Pediatr Orthop. 1997;17(5):626−630. DOI: 10.1097/00004694-199709000-00010

[26] Smith B.G., Kasser J.R., Hey L.A. et al. Postreduction computed tomography in developmental dislocation of the hip: part I: analysis of measurement reliability // J. Pediatr. Orthop. 1997. Vol. 17. No. 5. P. 626−630. DOI: 10.1097/00004694-199709000-00010

[27] Moraleda L, Albinana J, Salcedo M, Gonzalez-Moran G. Dysplasia in the development of the hip. Rev Esp Cir Ortop Traumatol. 2013;57(1):67−77.

[28] Moraleda L., Albinana J., Salcedo M., Gonzalez-Moran G. Dysplasia in the development of the hip // Rev. Esp. Cir. Ortop. Traumatol. 2013. Vol. 57. No. 1. P. 67−77.

[29] Barkatali BM, Imalingat H, Childs J, et al. MRI versus computed tomography as an imaging modality for postreduction assessment of irreducible hips in developmental dysplasia of the hip: an interobserver and intraobserver reliability study. J Pediatr Orthop B. 2016;25(6):489−492. DOI: 10.1097/BPB.0000000000000326

[30] Barkatali B.M., Imalingat H., Childs J. et al. MRI versus computed tomography as an imaging modality for postreduction assessment of irreducible hips in developmental dysplasia of the hip: an interobserver and intraobserver reliability study // J. Pediatr. Orthop. B. 2016. Vol. 25. No. 6. P. 489−492. DOI: 10.1097/BPB.0000000000000326

[31] Samora J, Quinn RH, Murray J, et al. Management of developmental dysplasia of the hip in infants up to six months of age: Intended for use by orthopaedic specialists. J Am Acad Orthop Surg. 2019;27(8):e360−363. DOI: 10.5435/JAAOS-D-18-00522

[32] Samora J., Quinn R.H., Murray J. et al. Management of developmental dysplasia of the hip in infants up to six months of age: Intended for use by orthopaedic specialists // J. Am. Acad. Orthop. Surg. 2019. Vol. 27. No. 8. P. e360−363. DOI: 10.5435/JAAOS-D-18-00522

[33] Cooper A, Evans O, Ali F, Flowers M. A novel method for assessing postoperative femoral head reduction in developmental dysplasia of the hip. J Child Orthop. 2014;8(4):319−324. DOI: 10.1007/s11832-014-0600-5

[34] Cooper A., Evans O., Ali F., Flowers M. A novel method for assessing postoperative femoral head reduction in developmental dysplasia of the hip // J. Child. Orthop. 2014. Vol. 8. No. 4. P. 319−324. DOI: 10.1007/s11832-014-0600-5

[35] Li L, Jia J, Zhao Q, et al. Evaluation of femoral head coverage following Chiari pelvic osteotomy in adolescents by three-dimensional computed tomography and conventional radiography. Arch Orthop Trauma Surg. 2012;132(5):599−605. DOI: 10.1007/s00402-012-1464-0

[36] Li L., Jia J., Zhao Q. et al. Evaluation of femoral head coverage following Chiari pelvic osteotomy in adolescents by three-dimensional computed tomography and conventional radiography // Arch. Orthop. Trauma Surg. 2012. Vol. 132. No. 5. P. 599−605. DOI: 10.1007/s00402-012-1464-0

[37] Renshaw TS. Inadequate reduction of congenital dislocation of the hip. J Bone Joint Sur (Am). 1981;63-A:1114−1121.

[38] Renshaw T.S. Inadequate reduction of congenital dislocation of the hip // J. Bone Joint Surg. (Am). 1981. Vol. 63-A. P. 1114−1121.

[39] Liu JS, Kuo KN, Lubicky JP, et al. Hip arthrography in the assessment of children with developmental dysplasia of the hip and Perthes’ disease. J Pediatr Orthop B. 2008;17(3):114−119. DOI: 10.1097/BPB.0b013e3280103684

[40] Liu J.S., Kuo K.N., Lubicky J.P. et al. Hip arthrography in the assessment of children with developmental dysplasia of the hip and Perthes’ disease // J. Pediatr. Orthop. B. 2008. Vol. 17. No. 3. P. 114−119. DOI: 10.1097/BPB.0b013e3280103684

[41] Ahmed AA, Fadel M. Role of intraoperative arthrogram in decision making of closed versus medial open reduction of developmental hip dysplasia. Int J Res Orthop. 2019;5:1037−1043.

[42] Ahmed A.A., Fadel M. Role of intraoperative arthrogram in decision making of closed versus medial open reduction of developmental hip dysplasia // Int. J. Res. Orthop. 2019. Vol. 5. P. 1037−1043.

[43] Zhang Z, Zhe F Yang J, et al. Intraoperative arthrogram predicts residual dysplasia after successful closed reduction of DDH. Orthopaedic Surg. 2016;8(3):338−344. DOI: 10.1111/os.12273

[44] Zhang Z., Zhe F., Yang J. et al. Intraoperative arthrogram predicts residual dysplasia after successful closed reduction of DDH // Orthopaedic. Surg. 2016. Vol. 8. No. 3. P. 338−344. DOI: 10.1111/os.12273

[45] Smith BG, Millis MB, Hey LA, et al. Postreduction computed tomography in developmental dislocation of the hip: part II: predictive value for outcome. J Pediatr Orthop. 1997;17(5):631−636. DOI: 10.1097/00004694-199709000-00011

[46] Smith B.G., Millis M.B., Hey L.A. et al. Postreduction computed tomography in developmental dislocation of the hip: part II: predictive value for outcome // J. Pediatr. Orthop. 1997. Vol. 17. No. 5. P. 631−636. DOI: 10.1097/00004694-199709000-00011

RIGHTS & PERMISSIONS

Khaled L.E., Hesham T.K., Amin A.R., Mohamed A.