Please use this identifier to cite or link to this item: http://hdl.handle.net/2440/114539
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Type: Journal article
Title: Obstacles to reduction in infantile developmental dysplasia of the hip
Author: Studer, K.
Williams, N.
Studer, P.
Baker, M.
Glynn, A.
Foster, B.
Cundy, P.
Citation: Journal of Children's Orthopaedics, 2017; 11(5):358-366
Publisher: British Editorial Society of Bone and Joint Surgery
Issue Date: 2017
ISSN: 1863-2521
1863-2548
Statement of
Responsibility: 
K. Studer, N. Williams, P. Studer, M. Baker, A. Glynn, B. K. Foster, P. J. Cundy
Abstract: Purpose: Identification of anatomical structures that block ­reduction in developmental dysplasia of the hip (DDH) is ­important for the management of this challenging condition. Obstacles to reduction seen on arthrogram are well-known. However, despite the increasing use of MRI in the assessment of adequacy of reduction in DDH, the interpretation of MRI patho-anatomy is ill-defined with a lack of relevant literature to guide clinicians. Method: This is a retrospective analysis of the MRI of patients with DDH treated by closed reduction over a five-year period (between 2009 and 2014). Neuromuscular and genetic disorders were excluded. Each MRI was analysed by two orthopaedic surgeons and a paediatric musculoskeletal radiologist to identify the ligamentum teres, pulvinar, transverse acetabular ligament (TAL), capsule, labrum and acetabular roof cartilage hypertrophy. Inter- and intraobserver reliability was calculated. The minimum follow-up was 12 months. Results: A total of 29 patients (38 hips) underwent closed reduction for treatment of DDH. Eight hips showed persistent subluxation on post-operative MRI. Only three of these eight hips showed an abnormality on arthrogram. The pulvinar was frequently interpreted as ‘abnormal’ on MRI. The main obstacles identified on MRI were the ligamentum teres (15.8%), labrum (13.1%) and acetabular roof cartilage hypertrophy (13.2%). The inter-rater reliability was good for TAL, capsule and pulvinar; moderate for ligamentum teres and labrum; and poor for hypertrophied cartilage. Conclusion: The labrum, ligamentum teres and acetabular roof cartilage hypertrophy are the most important structures seen on MRI preventing complete reduction of DDH. Focused interpretation of these structures may assist in the management of DDH.
Keywords: MRI; infantile dysplasia of the hip; obstacles to reduction; closed reduction; arthrogram
Rights: This article is distributed under the terms of the Creative Commons Attribution-Non Commercial 4.0 International (CC BY-NC 4.0) licence (https://creativecommons. org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed.
RMID: 0030077115
DOI: 10.1302/1863-2548.11.170031
Appears in Collections:Orthopaedics and Trauma publications

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