SINGLE-EVENT VERSUS STAGED OPEN REDUCTION IN BILATERAL DEVELOPMENTAL DYSPLASIA OF THE HIP: DOES RATE OF EARLY DISLOCATION VARY?
Notice bibliographique
Résumé
There are currently no guidelines on surgical timing for bilateral developmental dysplasia of the hip (DDH) pathologies. The decision to perform single-event or staged open reduction (OR) is often dictated by surgeon or centre preference. Consequently, the influence of staged OR on treatment outcomes is poorly understood. This study aimed to investigate early re-dislocation rates following single-event and staged bilateral ORs in a prospective cohort of patients with DDH. A global multi-center, prospective database of patients diagnosed with DDH was queried for patients who underwent bilateral OR. Patients with syndromic-associated hip dislocations/dysplasia were excluded. Included patients were divided into two groups depending on whether both hips underwent OR in a single event (Group 1), or as a staged procedure (Group 2). Patient demographics, risk factors, and diagnostic details were assessed pre-operatively. Post-operative outcomes included reduction status (IHDI grade) and re-dislocation rate in the early-mid post-operative period. The presence of avascular necrosis (AVN), residual dysplasia, and re-operation rate will be examined in longer-term analyses. In total, 72 patients (144 hips) identified from 12 centres globally underwent bilateral OR: 42 patients (84 hips) in Group 1 (single event) and 30 patients (60 hips) in Group 2 (staged). The study population included 55 females, 20 breech born and nine with positive family history. Patients were diagnosed at an average of 26.9 months (95% CI [21.4, 32.4]). Group 2 was significantly older at time of first surgery than Group 1 (42.1 months vs. 20,3 months). In Group 2, ORs were staged a median of 49 days apart (range 14-362). Group 2 hips more often underwent concomitant acetabular osteotomy and/or femoral osteotomy (80% compared to 25%); only 6/30 patients (12/60 hips) did not undergo an additional procedure. On the other hand, 31/42 patients did not undergo any additional procedure in Group 1. Reduction status and re-dislocation rate was evaluated at a mean follow-up of 6.8 months [6.4,7.2] postoperatively to capture early re-dislocations. Loss of reduction was seen in 23 hips (in 16 patients) total: 18 hips (12 patients) in Group 1 and five hips (four patients) in Group 2 (p=0.034). In Group 2, the interval between the two surgeries in 2/4 who underwent staged OR was less than eight weeks. Of the 23 hips that had a loss of reduction, 21 (91%) were IHDI Grade 2. In this cohort, loss of reduction occurred more frequently after single-event bilateral OR; however, complete re-dislocation (IHDI Grade 4) occurred in only two hips. Longer follow-up will be required to examine reduction status, rates of AVN and re-operation. The staged group was significantly older at time of diagnosis and first surgery, and more frequently underwent concomitant femoral/pelvic osteotomy, suggesting the influence of surgical decision-making on the decision to stage or perform single-event. A larger sample size and long-term follow-up will be required to formulate a management protocol to instill best treatment practices in order to optimize patient outcomes.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».