August 13, 2020Journal of Pediatric Orthopaedics BOpen Access

Acetabular depth, an early predictive factor of acetabular development: MRI in patients with developmental dysplasia of the hip after open reduction

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Developmental dysplasia of the hip (DDH) (n=37). Intervention: Labral acetabular roof depth (L-AR) on MRI at 5 years of age vs. Poor outcomes (Severin group III and IV). Primary outcome: Severin classification at final follow-up (good vs poor outcomes) (OR 0.27, 95% CI 0.077-0.910, p=0.035).

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Key result

Labral acetabular roof depth (OR 0.27) and labral hip center distance (OR 3.4) on MRI at 5 years of age were significant early predictors of acetabular development after open reduction for DDH.

Why the study?

Early prediction of future acetabular development is important to determine additional surgery for developmental dysplasia of the hip.

Population

37 pediatric patients with DDH who underwent open reduction after walking age

Comparison

Good outcomes vs poor outcomes according to Severin classification

Design

Retrospective study

Authors

YKYoshi KawamuraOkayama University TTTomonori TetsunagaOkayama University HAHirofumi AkazawaOkayama Medical Center

Discussion

Member takes

Implication

Early MRI metrics may aid risk stratification after DDH reduction; leaves open prospective validation before clinical use.

Study Design

Type

Cohort (n=37)

Multicenter

Structured PICO

Population

37 pediatric patients (40 dislocated hips) with developmental dysplasia of the hip who underwent open reduction after walking age, evaluated by MRI at 5 years of age and followed to a mean age of 19 years.

Exposure

MRI evaluation of cartilaginous acetabulum and labrum (specifically labral acetabular roof depth and labral hip center distance) at 5 years of age

Outcome

Acetabular development at final follow-up (mean age 19 years) assessed by Severin classification (good vs poor outcomes)surrogate

Main Result

Odds Ratio: 0.27 (95% CI 0.077–0.91)

p-value: p=0.035

Labral acetabular roof depth and labral hip center distance measured by MRI at 5 years of age can predict future acetabular development in pediatric patients with developmental dysplasia of the hip after open reduction.

Limitations

MRI at 5 years of age might be too late to determine the necessity for corrective surgery.
MRI performed in early infancy and childhood requires sedation.
Unaffected hips in patients with unilateral DDH were used as normal controls, which may contain primary acetabular dysplasia.
Some patients with poor results on the unaffected side were treated with a Pavlik harness and might be affected by avascular necrosis of the femoral head.
Waiting until 5 years of age for MRI might be too late for corrective surgery
MRI in early infancy and childhood requires sedation
Unaffected hip in unilateral DDH might not accurately reflect a normal control group
Some unaffected hips treated with Pavlik harness might be affected by avascular necrosis

Cite This Study

Kawamura et al. (2020) conducted a cohort in Developmental dysplasia of the hip (DDH) (n=37). Labral acetabular roof depth (L-AR) on MRI at 5 years of age vs. Poor outcomes (Severin group III and IV) was evaluated on Severin classification at final follow-up (good vs poor outcomes) (OR 0.27, 95% CI 0.077-0.910, p=0.035). Labral acetabular roof depth (OR 0.27) and labral hip center distance (OR 3.4) on MRI at 5 years of age were significant early predictors of acetabular development after open reduction for DDH.

synapsesocial.com/papers/6a771f397d04941475ae28f9 https://doi.org/10.1097/bpb.0000000000000799

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August 13, 2020Journal of Pediatric Orthopaedics BOpen Access

Acetabular depth, an early predictive factor of acetabular development: MRI in patients with developmental dysplasia of the hip after open reduction

View Full Paper

Ask AI

Bookmark

Key result

Labral acetabular roof depth (OR 0.27) and labral hip center distance (OR 3.4) on MRI at 5 years of age were significant early predictors of acetabular development after open reduction for DDH.

Why the study?

Early prediction of future acetabular development is important to determine additional surgery for developmental dysplasia of the hip.

Population

37 pediatric patients with DDH who underwent open reduction after walking age

Comparison

Good outcomes vs poor outcomes according to Severin classification

Design

Retrospective study

Authors

YKYoshi KawamuraOkayama University TTTomonori TetsunagaOkayama University HAHirofumi AkazawaOkayama Medical Center

Discussion

Member takes

Implication

Early MRI metrics may aid risk stratification after DDH reduction; leaves open prospective validation before clinical use.

Study Design

Type

Cohort (n=37)

Multicenter

Structured PICO

Population

Exposure

MRI evaluation of cartilaginous acetabulum and labrum (specifically labral acetabular roof depth and labral hip center distance) at 5 years of age

Outcome

Acetabular development at final follow-up (mean age 19 years) assessed by Severin classification (good vs poor outcomes)surrogate

Main Result

Odds Ratio: 0.27 (95% CI 0.077–0.91)

p-value: p=0.035

Limitations

MRI at 5 years of age might be too late to determine the necessity for corrective surgery.
MRI performed in early infancy and childhood requires sedation.
Unaffected hips in patients with unilateral DDH were used as normal controls, which may contain primary acetabular dysplasia.
Some patients with poor results on the unaffected side were treated with a Pavlik harness and might be affected by avascular necrosis of the femoral head.
Waiting until 5 years of age for MRI might be too late for corrective surgery
MRI in early infancy and childhood requires sedation
Unaffected hip in unilateral DDH might not accurately reflect a normal control group
Some unaffected hips treated with Pavlik harness might be affected by avascular necrosis

Cite This Study

synapsesocial.com/papers/6a771f397d04941475ae28f9 https://doi.org/10.1097/bpb.0000000000000799

Also Consider

Synapse has enriched 4 closely related papers on similar clinical questions. Consider them for comparative context:

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