Arthroscopically Assisted Versus Open Surgical Reduction of the Hip in Patients With Irreducible DDH Before the Walking Age
- Conditions
- Developmental Dysplasia of the Hip
- Interventions
- Procedure: open surgical reductionProcedure: arthroscopically assisted
- Registration Number
- NCT06408987
- Lead Sponsor
- Assiut University
- Brief Summary
To determine the role of arthroscopy in treatment of the DDH.
- Detailed Description
* The term developmental dysplasia of the hip (DDH) is composed of a spectrum of pathologies from stable acetabular dysplasia (femoral head centered in acetabulum but acetabulum is shallow) to concentric hips that are unstable (femoral head can be moved in and out of the confines of the acetabulum) and frankly dislocated hips in which there is a complete loss of contact between the femoral head and acetabulum.
* Open reduction , traditionally through a Smith - Peterson approach should be considered only if closed reduction cannot be performed.
* Medial open surgical reduction is a choice for the management of patients younger than 18 months with DDH. The minimal incision and minimal blood loss are advantages of this approach. Limited exposure of the hip joint is a disadvantage.
* The arthroscopic procedure was reported to represent a meaningful alternative to the open procedure due to a lower complication rate, a safe setting, a lower rate of residual dysplasia, no observed redislocation and low rate occurrence of osteonecrosis.
* All the intra-articular structures (hypertrophic ligamentum teres, transverse acetabular ligament, and pulvinar tissue) in the acetabulum that impede the reduction of the femoral head could be eliminated by using the arthroscopic technique.
Recruitment & Eligibility
- Status
- NOT_YET_RECRUITING
- Sex
- All
- Target Recruitment
- 32
- Age: - from nine months to 18 months.
- Irreducible Hip Dislocation.
- Patient age: below 9 months or above 18 months.
- Teratologic hip dislocation
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description 2.open surgical reduction arm 2 open surgical reduction open surgical reduction of the hip in patients with irreducible DDH before the walking age arm 2 1 .Arthroscopically assisted arthroscopically assisted Arthroscopically assisted in surgical reduction of the hip in patients with irreducible DDH before the walking age arm 1
- Primary Outcome Measures
Name Time Method Determination the success of reduction and incidence of redislocation rate immediately postoperative Documentation of concentric reduction of the hip in immediate postoperative MRI as an assessment tool for the success of the procedure.
- Secondary Outcome Measures
Name Time Method Assessment the incidence of avascular necrosis in the affected hip 1 year follow up documentation the incidence of avascular necrosis of the affected head of hip after one year follow up in clinical examination and x-ray
Assessment of the cosmetic appearance . 3 month follow up Documentation the wound size after 3 months follow up in clinical examination as an assessment tool of cosmotic appearance
Assessment the incidence stiffness and decrease range of motion of the affected hip 1 year follow up documentation the range of motion of the affected hip and incidence of stiffness after 6 months follow up in clinical examination as an assessment tool of stiffness.
Assessment of the shortening 1 year follow up Assessment the incidence of leg length discrepancy and shortening that affect walking after one year follow up in clinical examination and x-ray as an assessment tool of shortening