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. 2021 Feb 17;22(1):199.
doi: 10.1186/s12891-021-04065-3.

The path to minimizing instability in developmental dysplasia of the hip: is Capsulorrhaphy a necessity or a futile habit?

Ramin Zargarbashi  1 , Mohammadreza Bozorgmanesh  2 , Behnam Panjavi  1 , Fardis Vosoughi  3
Affiliations

The path to minimizing instability in developmental dysplasia of the hip: is Capsulorrhaphy a necessity or a futile habit?

Ramin Zargarbashi et al. BMC Musculoskelet Disord. .

Abstract

Background: To evaluate and quantify the intraoperative effect of capsulorrhaphy on the deep seating of femoral head within the acetabulum as measured by medial joint space, a surrogate measure of acetabular-head contact.

Methods: In order to determine the exact effect of capsulorrhaphy, we prospectively scrutinized a consecutive sample of 18 patients with unilateral dysplastic hips aging > 18 months and followed them for a period of at least 12 months. The procedure of open reduction is described in detail. Two pediatric orthopedists carried out the operations from August 2014 to January 2019 at a tertiary pediatric hospital. Intraoperatively, AP radiographs of the pelvis were obtained before and after capsulorrhaphy. The distance between the inferomedial edge of the proximal femoral metaphysis and the lateral edge of the obturator foramen was recorded. To determine if there were differences in medial joint space due to capsulorrhaphy, a generalized linear model was run on the study sample. All patients were followed for at least 12 months to determine the rate of re-dislocation.

Results: Mean age (±standard deviation) of the participants was 37.5 (±24.7) months. All cases underwent Salter osteotomy, 5 cases needed femoral shortening (27.8%) and none needed derotational osteotomy. Capsulorrhaphy lead to a statistically significant decrease in the mean medial joint space from 1.59 cm before (95% CI: 1.12-2.05) to 0.76 cm after (95% CI: 0.50-1.02) the capsulorrhaphy (P < 0.001). When we took the effect of age into account the corresponding figures were 1.47 (95% CI: 1.22-1.75) and 0.67 (95% CI: 0.39-0.94), respectively (P < 0.001). After follow up periods of 1 to 5.5 years, none of the patients experienced instability or re-dislocation.

Conclusions: Capsulorrhaphy, independently, of age was associated with a 1-cm decrease in the mean medial hip joint space and a more deeply seated femoral head. Furthermore, this study presents a successful experience with capsulorrhaphy to prevent hip instability.

Keywords: Capsulorrhaphy; DDH; Developmental hip dysplasia; Medial joint space.

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Conflict of interest statement

All authors declare that there were no competing interests for this study.

Figures

Fig. 1
Fig. 1
Schematic drawing of the medial hip joint space. [This illustration is the sole work of the corresponding author (F.V.), presented for the purpose of publication in the current study]
Fig. 2
Fig. 2
Medial joint space before (left) and after (right) capsulorrhaphy
Fig. 3
Fig. 3
Medial Joint space for each patient before (blue+ orange columns) and after (blue columns) capsulorrhaphy. The cases are sorted by increasing age and each patient’s age is shown on the X-axis. Patients who underwent femoral shortening are marked (*). The effect of capsulorrhaphy can be seen in patients with different ages
Fig. 4
Fig. 4
stem-and-leaf plot for mean pre-capsulorrhaphy and post-capsulorrhaphy medial joint space
See this image and copyright information in PMC

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References

    1. Lee MC, Eberson CP. Growth and development of the child's hip. Orthop Clin North Am. 2006;37(2):119–132. doi: 10.1016/j.ocl.2005.12.001. - DOI - PubMed
    1. Guille JT, Pizzutillo PD, MacEwen GD. Development dysplasia of the hip from birth to six months. J Am Acad Orthop Surg. 2000;8(4):232–242. doi: 10.5435/00124635-200007000-00004. - DOI - PubMed
    1. Schwend RM, Shaw BA, Segal LS. Evaluation and treatment of developmental hip dysplasia in the newborn and infant. Pediatr Clin N Am. 2014;61(6):1095–1107. doi: 10.1016/j.pcl.2014.08.008. - DOI - PubMed
    1. Alves C, Truong WH, Thompson MV, Suryavanshi JR, Penny CL, Do HT, et al. Diagnostic and treatment preferences for developmental dysplasia of the hip: a survey of EPOS and POSNA members. J Child Orthop. 2018;12(3):236–244. doi: 10.1302/1863-2548.12.180034. - DOI - PMC - PubMed
    1. Cashman J, Round J, Taylor G, Clarke N. The natural history of developmental dysplasia of the hip after early supervised treatment in the Pavlik harness: a prospective, longitudinal follow-up. J Bone Joint Surg Br. 2002;84(3):418–425. doi: 10.1302/0301-620X.84B3.0840418. - DOI - PubMed