Dataset Information

Cartilaginous predictors of residual acetabular dysplasia (RAD) in developmental dysplasia of the hip following closed or open reduction: A systematic review and meta-analysis.

ABSTRACT:

Object

This study was designed to analyze the cartilaginous predictors of residual acetabular dysplasia (RAD) after early treatment of developmental dysplasia of the hip and their diagnostic accuracy.

Study design

Databases such as PubMed, Embase, Cochrane, and Web of science were searched to screen the literature. The quality of the literature was assessed by the QUADAS-2 tool. Qualitative and quantitative synthesis of literature were performed based on extracted data. For quantitative synthesis studies, the sensitivity, specificity, diagnostic odds ratio (DOR), and summary receiver operating characteristic (SROC) curve with corresponding confidence intervals were calculated.

Results

For the cartilaginous acetabular index (CAI) group, the combined values of sensitivity, specificity, and DOR were 0.80 (95% CI = 0.54-0.93), 0.73 (95% CI = 0.57-0.84), and 10.62 (95% CI = 3.96-28.53), respectively. The corresponding values in the cartilaginous center-edge angle (CCE) group were 0.71 (95% CI = 0.57-0.82), 0.78 (95% CI = 0.66-0.87), and 8.64 (95% CI = 3.08-24.25), respectively. The area under the curve (AUC) of SROC was 0.82 (95% CI = 0.78-0.85) and 0.80 (95% CI = 0.76-0.83) for the CAI and CCE groups. The CAI group had higher sensitivity, DOR, and AUC than the CCE group.

Conclusion

Both of these two groups have good diagnostic accuracy, and CAI/L-AI has a little edge over CCE/L-CEA. However, there is still more research needed to determine whether they can be used as independent indications for secondary orthopedic surgery.Systematic review registration: [https://www.crd.york.ac.uk/PROSPERO/], identifier: [CRD42022338332].

SUBMITTER: Yang S

PROVIDER: S-EPMC10090413 | biostudies-literature | 2023

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Cartilaginous predictors of residual acetabular dysplasia (RAD) in developmental dysplasia of the hip following closed or open reduction: A systematic review and meta-analysis.

Yang Shuai S Su Fei F Jia Hao-Ruo HR Liu Chen-Xin CX Lu Qing-Da QD Yang Ya-Ting YT Liu Yong Y Wang Jia-Ju JJ Jie Qiang Q

Frontiers in pediatrics 20230329

<h4>Object</h4>This study was designed to analyze the cartilaginous predictors of residual acetabular dysplasia (RAD) after early treatment of developmental dysplasia of the hip and their diagnostic accuracy.<h4>Study design</h4>Databases such as PubMed, Embase, Cochrane, and Web of science were searched to screen the literature. The quality of the literature was assessed by the QUADAS-2 tool. Qualitative and quantitative synthesis of literature were performed based on extracted data. For quanti ...[more]

PMID: 37063659

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Project description:BackgroundThe diagnostic and prediction criteria of residual hip dysplasia (RHD) remains controversial. There were no studies that focused on the risk factors of RHD after closed reduction (CR) in children with developmental dislocation of the hips (DDH) over 12 months of age. In this study, we assessed the percentage of RHD in DDH patients aged 12 to 18 months vs. that in DDH patients aged over 18 months after CR and determine the predictors of RHD. Meanwhile, we tested the reliability of our RHD criteria compared with Harcke standard.MethodsPatients over 12 months of age who underwent successful CR from October 2011 to November 2017 and followed up for at least 2 years were enrolled. Gender, affected side, age at CR and follow-up time were recorded. Acetabular index (AI), horizontal acetabular width (AWh), center-to-edge angle (CEA), and femoral head coverage (FHC) were measured. The cases were divided into two groups according to whether older than 18 months. RHD was determined according to our criteria.ResultsA total of 82 patients (107 hips) were included, including 69 females (84.1%), 13 males (15.9%), 25 patients (30.5%) with bilateral DDH, 33 patients (40.2%) with left side, 24 patients (29.3%) with right side, 40 patients (49 hips) with age 12-18 months, and 42 patients (58 hips) with age >18 months. At a mean follow-up of 47.8 [24-92] months, the percentage of RHD was higher in patients >18 months of age (58.6%) than patients 12-18 months of age (40.8%), but the difference was not statistically significant. Binary logistic regression analysis showed that pre-AI, pre-AWh, and improvement in AI and AWh (P=0.025, 0.016, 0.001, 0.003, respectively) had significant difference. The sensitivity and specialty of our RHD criteria were 81.82% and 82.69%, respectively.ConclusionsFor patients with DDH over 18 months, CR is still a choice. We documented four predictors of RHD, suggesting that we should focus on the developmental potential of an individual's acetabulum. Our RHD criteria may be one of the reliable and useful tools in clinical practice to help determine whether to perform continuous observation or surgery, but further research is needed due to limited sample size and follow-up time.

Project description:BackgroundClosed reduction (CR) is a common treatment for infantile developmental dysplasia of the hip. The purpose of this observational, prospective, multicenter study was to determine the early outcomes following CR.MethodsProspectively collected data from an international multicenter study group was analyzed for patients treated from 2010 to 2014. Baseline demographics, clinical exam, radiographic/ultrasonographic data, and history of previous orthotic treatment were assessed. At minimum 1-year follow-up, failure was defined as an IHDI grade 3 or 4 hip and/or need for open reduction. The incidence of avascular necrosis (AVN), residual dysplasia, and need for further surgery was assessed.ResultsA total of 78 patients undergoing CR for 87 hips were evaluated with a median age at initial reduction of 8 months (range, 1 to 20 mo). Of these, 8 hips (9%) were unable to be closed reduced initially. At most recent follow-up (median 22 mo; range, 12 to 36 mo), 72/79 initially successful CRs (91%) remained stable. The likelihood of failure was unaffected by initial clinical reducibility of the hip (P=0.434), age at initial CR (P=0.897), or previous treatment in brace (P=0.222). Excluding those hips that failed initial CR, 18/72 hips (25%) developed AVN, and the risk of osteonecrosis was unaffected by prereduction reducibility of the hip (P=0.586), age at CR (P=0.745), presence of an ossific nucleus (P=0.496), or previous treatment in brace (P=0.662). Mean acetabular index on most recent radiographs was 25 degrees (±6 degrees), and was also unaffected by any of the above variables. During the follow-up period, 8/72 successfully closed reduced hips (11%) underwent acetabular and/or femoral osteotomy for residual dysplasia.ConclusionsFollowing an initially successful CR, 9% of hips failed reduction and 25% developed radiographic AVN at early-term follow-up. History of femoral head reducibility, previous orthotic bracing, and age at CR did not correlate with success or chances of developing AVN. Further follow-up of this prospective, multicenter cohort will be necessary to establish definitive success and complication rates following CR for infantile developmental dysplasia of the hip.Level of evidenceLevel II-prospective observational cohort.

Project description:IntroductionIt has been reported that the cartilaginous roof of the acetabulum is thicker in infants with developmental dysplasia of the hip (DDH) than in those with healthy hips. However, there is limited research on the changes in the thickness of acetabular cartilage after follow-up or treatment of DDH. This study aims to report the thickness of acetabular cartilage before and after treatment of DDH.Materials and methodsIn this prospective study, infants with clinical suspicion of DDH were enrolled in the pediatric outpatient service in our hospital from January 2022 to August 2023. The thickness of acetabular cartilage was measured in the standard coronal plane. Borderline hips (Graf IIa type) were monitored with monthly ultrasound examination until they were classified as normal hips (Graf I type), while dysplastic hips (Graf IIb type or worse) were treated with the Pavlik harness until they were also classified as normal hips in the final ultrasound examination.ResultsA total of 592 children [median age, 96 days (interquartile range, 70-142 days); 197 boys] were enrolled in the study. The thickness of acetabular cartilage in dysplastic hips (4.3 ± 1.6 mm) was greater than that in normal hips (3.0 ± .39 mm, P < 0.001) and borderline hips (3.1 ± .57 mm, P < 0.001). In borderline hips, the thickness of acetabular cartilage decreased from 3.1 ± .57 mm in the initial evaluation to 2.9 ± .53 mm in the final follow-up scan (P = 0.01). In dysplastic hips, the thickness of acetabular cartilage decreased from 4.3 ± 1.6 mm in the initial evaluation to 3.5 ± .51 mm after treatment (P = 0.003). The thickness of acetabular cartilage in dysplastic hips after treatment remained greater than that in normal hips (P < 0.0001).ConclusionThe thickness of acetabular cartilage decreased after follow-up or treatment of DDH. Further research is required to determine whether cartilage that remain thicker in dysplastic hips than that in normal hips after treatment should be considered an early indicator of residual acetabular dysplasia.

Dataset Information

Cartilaginous predictors of residual acetabular dysplasia (RAD) in developmental dysplasia of the hip following closed or open reduction: A systematic review and meta-analysis.

Object

Study design

Results

Conclusion

Publications

Cartilaginous predictors of residual acetabular dysplasia (RAD) in developmental dysplasia of the hip following closed or open reduction: A systematic review and meta-analysis.

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