Predicting acetabular growth in developmental dysplasia of the hip following open reduction after walking age

Takamasa Miyake, Tomonori Tetsunaga, Hirosuke Endo, Kazuki Yamada, Tomoaki Sanki, Kazuo Fujiwara, Eiji Nakata, Toshifumi Ozaki

Research output: Contribution to journalArticle

Abstract

Background: Acetabular dysplasia of the hip following open reduction can complicate the treatment of developmental dysplasia of the hip (DDH). The purposes of this retrospective study were to investigate the long-term results of open reduction performed via an extensive anterolateral approach for DDH after walking age and to predict acetabular development using postoperative radiographs and arthrograms. Methods: From 1973 to 2001, we performed open reduction for 131 hips in 119 pediatric patients with DDH after failed closed reduction. Of these, 85 hips of 73 patients who underwent arthrography at 5 years old were followed-up radiologically until skeletal maturity. Mean age at the time of surgery was 17 ± 4.6 months (range, 10–33 months), and mean age at final survey was 19 ± 5.7 years (range, 14–33 years). Mean follow-up time was 17.7 ± 5.8 years (range, 13–32 years). Groups with satisfactory outcomes (66 hips) and unsatisfactory outcomes (19 hips) according to the Severin classification were compared. Factors predicting acetabular development were identified using univariate and multiple logistic analyses. Results: Univariate analysis showed a significant between-group difference in acetabular index (AI) at 2 months postoperatively, and in center-edge (CE) angle, cartilaginous AI (CAI), and cartilaginous CE angle at 5 years old (p < 0.05 each). In multiple logistic regression analysis, CAI at 5 years old represented a predictor of acetabular development after open reduction for DDH (odds ratio, 1.81; 95% confidence interval (CI), 1.04–3.13; p < 0.05). Area under the receiver operating characteristic curve for CAI at 5 years old was 0.93 (95%CI, 0.85–1.0), and the optimal cut-off was 10° (81.8% sensitivity, 92% specificity). Conclusions: A CAI ≥10° on hip arthrograms at 5 years old may offer a useful indicator of the need for corrective surgery following open reduction after walking age.

Original languageEnglish
JournalJournal of Orthopaedic Science
DOIs
Publication statusAccepted/In press - Jan 1 2018

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Hip Dislocation
Walking
Hip
Growth
Confidence Intervals
Arthrography
ROC Curve
Retrospective Studies
Logistic Models
Odds Ratio
Regression Analysis
Pediatrics
Sensitivity and Specificity

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

@article{d7695d6500f040a9906ff1856b1977b7,
title = "Predicting acetabular growth in developmental dysplasia of the hip following open reduction after walking age",
abstract = "Background: Acetabular dysplasia of the hip following open reduction can complicate the treatment of developmental dysplasia of the hip (DDH). The purposes of this retrospective study were to investigate the long-term results of open reduction performed via an extensive anterolateral approach for DDH after walking age and to predict acetabular development using postoperative radiographs and arthrograms. Methods: From 1973 to 2001, we performed open reduction for 131 hips in 119 pediatric patients with DDH after failed closed reduction. Of these, 85 hips of 73 patients who underwent arthrography at 5 years old were followed-up radiologically until skeletal maturity. Mean age at the time of surgery was 17 ± 4.6 months (range, 10–33 months), and mean age at final survey was 19 ± 5.7 years (range, 14–33 years). Mean follow-up time was 17.7 ± 5.8 years (range, 13–32 years). Groups with satisfactory outcomes (66 hips) and unsatisfactory outcomes (19 hips) according to the Severin classification were compared. Factors predicting acetabular development were identified using univariate and multiple logistic analyses. Results: Univariate analysis showed a significant between-group difference in acetabular index (AI) at 2 months postoperatively, and in center-edge (CE) angle, cartilaginous AI (CAI), and cartilaginous CE angle at 5 years old (p < 0.05 each). In multiple logistic regression analysis, CAI at 5 years old represented a predictor of acetabular development after open reduction for DDH (odds ratio, 1.81; 95{\%} confidence interval (CI), 1.04–3.13; p < 0.05). Area under the receiver operating characteristic curve for CAI at 5 years old was 0.93 (95{\%}CI, 0.85–1.0), and the optimal cut-off was 10° (81.8{\%} sensitivity, 92{\%} specificity). Conclusions: A CAI ≥10° on hip arthrograms at 5 years old may offer a useful indicator of the need for corrective surgery following open reduction after walking age.",
author = "Takamasa Miyake and Tomonori Tetsunaga and Hirosuke Endo and Kazuki Yamada and Tomoaki Sanki and Kazuo Fujiwara and Eiji Nakata and Toshifumi Ozaki",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.jos.2018.09.015",
language = "English",
journal = "Journal of Orthopaedic Science",
issn = "0949-2658",
publisher = "Springer Japan",

}

TY - JOUR

T1 - Predicting acetabular growth in developmental dysplasia of the hip following open reduction after walking age

AU - Miyake, Takamasa

AU - Tetsunaga, Tomonori

AU - Endo, Hirosuke

AU - Yamada, Kazuki

AU - Sanki, Tomoaki

AU - Fujiwara, Kazuo

AU - Nakata, Eiji

AU - Ozaki, Toshifumi

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Acetabular dysplasia of the hip following open reduction can complicate the treatment of developmental dysplasia of the hip (DDH). The purposes of this retrospective study were to investigate the long-term results of open reduction performed via an extensive anterolateral approach for DDH after walking age and to predict acetabular development using postoperative radiographs and arthrograms. Methods: From 1973 to 2001, we performed open reduction for 131 hips in 119 pediatric patients with DDH after failed closed reduction. Of these, 85 hips of 73 patients who underwent arthrography at 5 years old were followed-up radiologically until skeletal maturity. Mean age at the time of surgery was 17 ± 4.6 months (range, 10–33 months), and mean age at final survey was 19 ± 5.7 years (range, 14–33 years). Mean follow-up time was 17.7 ± 5.8 years (range, 13–32 years). Groups with satisfactory outcomes (66 hips) and unsatisfactory outcomes (19 hips) according to the Severin classification were compared. Factors predicting acetabular development were identified using univariate and multiple logistic analyses. Results: Univariate analysis showed a significant between-group difference in acetabular index (AI) at 2 months postoperatively, and in center-edge (CE) angle, cartilaginous AI (CAI), and cartilaginous CE angle at 5 years old (p < 0.05 each). In multiple logistic regression analysis, CAI at 5 years old represented a predictor of acetabular development after open reduction for DDH (odds ratio, 1.81; 95% confidence interval (CI), 1.04–3.13; p < 0.05). Area under the receiver operating characteristic curve for CAI at 5 years old was 0.93 (95%CI, 0.85–1.0), and the optimal cut-off was 10° (81.8% sensitivity, 92% specificity). Conclusions: A CAI ≥10° on hip arthrograms at 5 years old may offer a useful indicator of the need for corrective surgery following open reduction after walking age.

AB - Background: Acetabular dysplasia of the hip following open reduction can complicate the treatment of developmental dysplasia of the hip (DDH). The purposes of this retrospective study were to investigate the long-term results of open reduction performed via an extensive anterolateral approach for DDH after walking age and to predict acetabular development using postoperative radiographs and arthrograms. Methods: From 1973 to 2001, we performed open reduction for 131 hips in 119 pediatric patients with DDH after failed closed reduction. Of these, 85 hips of 73 patients who underwent arthrography at 5 years old were followed-up radiologically until skeletal maturity. Mean age at the time of surgery was 17 ± 4.6 months (range, 10–33 months), and mean age at final survey was 19 ± 5.7 years (range, 14–33 years). Mean follow-up time was 17.7 ± 5.8 years (range, 13–32 years). Groups with satisfactory outcomes (66 hips) and unsatisfactory outcomes (19 hips) according to the Severin classification were compared. Factors predicting acetabular development were identified using univariate and multiple logistic analyses. Results: Univariate analysis showed a significant between-group difference in acetabular index (AI) at 2 months postoperatively, and in center-edge (CE) angle, cartilaginous AI (CAI), and cartilaginous CE angle at 5 years old (p < 0.05 each). In multiple logistic regression analysis, CAI at 5 years old represented a predictor of acetabular development after open reduction for DDH (odds ratio, 1.81; 95% confidence interval (CI), 1.04–3.13; p < 0.05). Area under the receiver operating characteristic curve for CAI at 5 years old was 0.93 (95%CI, 0.85–1.0), and the optimal cut-off was 10° (81.8% sensitivity, 92% specificity). Conclusions: A CAI ≥10° on hip arthrograms at 5 years old may offer a useful indicator of the need for corrective surgery following open reduction after walking age.

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