Modified Smith–Petersen approach with rectus-sparing reduces severe avascular necrosis for developmental dysplasia of the hip at walking age: minimum 5-year follow-up
Abstract Background Developmental dysplasia of the hip (DDH) is one of the most common orthopedic malformations in children. Open reduction for DDH at walking age remains a major concern. The goal of this study is to evaluate the mid-term effect of a modified Smith–Petersen approach which preserves...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-12-01
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| Series: | Journal of Orthopaedic Surgery and Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13018-022-03441-6 |
| _version_ | 1811198355567542272 |
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| author | Mingyuan Miao Sheng Jin Haiqing Cai Haoqi Cai Jingxia Bian Zhigang Wang |
| author_facet | Mingyuan Miao Sheng Jin Haiqing Cai Haoqi Cai Jingxia Bian Zhigang Wang |
| author_sort | Mingyuan Miao |
| collection | DOAJ |
| description | Abstract Background Developmental dysplasia of the hip (DDH) is one of the most common orthopedic malformations in children. Open reduction for DDH at walking age remains a major concern. The goal of this study is to evaluate the mid-term effect of a modified Smith–Petersen approach which preserves the rectus femoris on DDH at walking age, in particular avascular necrosis (AVN). Methods A retrospective review of DDH patients aged between 12 and 24 months was carried out between January 2010 and June 2016. Open reduction through the Smith–Petersen approach (Group A) and modified Smith–Petersen approach, which preserves the rectus femoris (Group B), were both used. Measurement of hip geometry included acetabular index, the International Hip Dysplasia Institute classification, and AVN degree. Clinical records included operation time, bleeding volume, and abduction angle. Results There were 101 children (119 hips) with DDH who met the inclusion criteria. There were 66 hips in Group A and 53 in Group B. The mean surgical age at open reduction was 17.0 ± 2.4 months, with a mean 104.9 ± 19.5 months at last follow-up. There was no statistical difference in surgical age between the two groups (17.2 vs. 16.4 months). There was no significant difference in the incidence of all types of clinically significant AVN between group A and group B (27.3 vs. 18.9%), but the incidence of severe AVN was lower in group B (19.7 vs. 5.7%, P = 0.026). In addition, the lower the age at the time of open reduction, the lower the severity of AVN (P = 0.002). Conclusions These mid-term data suggest that the modified Smith–Petersen approach with rectus-sparing could reduce severe AVN more than the classical Smith–Peterson approach in open reduction in DDH at walking age. In addition, early open reduction can reduce the postoperative degree of AVN. |
| first_indexed | 2024-04-12T01:30:11Z |
| format | Article |
| id | doaj.art-ed00901432f14e8b9790f989975ceb14 |
| institution | Directory Open Access Journal |
| issn | 1749-799X |
| language | English |
| last_indexed | 2024-04-12T01:30:11Z |
| publishDate | 2022-12-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj.art-ed00901432f14e8b9790f989975ceb142022-12-22T03:53:31ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2022-12-011711810.1186/s13018-022-03441-6Modified Smith–Petersen approach with rectus-sparing reduces severe avascular necrosis for developmental dysplasia of the hip at walking age: minimum 5-year follow-upMingyuan Miao0Sheng Jin1Haiqing Cai2Haoqi Cai3Jingxia Bian4Zhigang Wang5Department of Orthopedic Surgery, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong UniversityDepartment of Orthopedic Surgery, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong UniversityDepartment of Orthopedic Surgery, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong UniversityDepartment of Orthopedic Surgery, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong UniversityDepartment of Orthopedic Surgery, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong UniversityDepartment of Orthopedic Surgery, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong UniversityAbstract Background Developmental dysplasia of the hip (DDH) is one of the most common orthopedic malformations in children. Open reduction for DDH at walking age remains a major concern. The goal of this study is to evaluate the mid-term effect of a modified Smith–Petersen approach which preserves the rectus femoris on DDH at walking age, in particular avascular necrosis (AVN). Methods A retrospective review of DDH patients aged between 12 and 24 months was carried out between January 2010 and June 2016. Open reduction through the Smith–Petersen approach (Group A) and modified Smith–Petersen approach, which preserves the rectus femoris (Group B), were both used. Measurement of hip geometry included acetabular index, the International Hip Dysplasia Institute classification, and AVN degree. Clinical records included operation time, bleeding volume, and abduction angle. Results There were 101 children (119 hips) with DDH who met the inclusion criteria. There were 66 hips in Group A and 53 in Group B. The mean surgical age at open reduction was 17.0 ± 2.4 months, with a mean 104.9 ± 19.5 months at last follow-up. There was no statistical difference in surgical age between the two groups (17.2 vs. 16.4 months). There was no significant difference in the incidence of all types of clinically significant AVN between group A and group B (27.3 vs. 18.9%), but the incidence of severe AVN was lower in group B (19.7 vs. 5.7%, P = 0.026). In addition, the lower the age at the time of open reduction, the lower the severity of AVN (P = 0.002). Conclusions These mid-term data suggest that the modified Smith–Petersen approach with rectus-sparing could reduce severe AVN more than the classical Smith–Peterson approach in open reduction in DDH at walking age. In addition, early open reduction can reduce the postoperative degree of AVN.https://doi.org/10.1186/s13018-022-03441-6Developmental dysplasia of the hipWalking ageSmith–Petersen approachAvascular necrosis |
| spellingShingle | Mingyuan Miao Sheng Jin Haiqing Cai Haoqi Cai Jingxia Bian Zhigang Wang Modified Smith–Petersen approach with rectus-sparing reduces severe avascular necrosis for developmental dysplasia of the hip at walking age: minimum 5-year follow-up Journal of Orthopaedic Surgery and Research Developmental dysplasia of the hip Walking age Smith–Petersen approach Avascular necrosis |
| title | Modified Smith–Petersen approach with rectus-sparing reduces severe avascular necrosis for developmental dysplasia of the hip at walking age: minimum 5-year follow-up |
| title_full | Modified Smith–Petersen approach with rectus-sparing reduces severe avascular necrosis for developmental dysplasia of the hip at walking age: minimum 5-year follow-up |
| title_fullStr | Modified Smith–Petersen approach with rectus-sparing reduces severe avascular necrosis for developmental dysplasia of the hip at walking age: minimum 5-year follow-up |
| title_full_unstemmed | Modified Smith–Petersen approach with rectus-sparing reduces severe avascular necrosis for developmental dysplasia of the hip at walking age: minimum 5-year follow-up |
| title_short | Modified Smith–Petersen approach with rectus-sparing reduces severe avascular necrosis for developmental dysplasia of the hip at walking age: minimum 5-year follow-up |
| title_sort | modified smith petersen approach with rectus sparing reduces severe avascular necrosis for developmental dysplasia of the hip at walking age minimum 5 year follow up |
| topic | Developmental dysplasia of the hip Walking age Smith–Petersen approach Avascular necrosis |
| url | https://doi.org/10.1186/s13018-022-03441-6 |
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