Clinical trial NCT06408987: Arthroscopically Assisted Versus Open Surgical Reduction of the Hip in Patients With Irreducible DDH Before the Walking Age
Official title: Arthroscopically Assisted Versus Open Surgical Reduction of the Hip in Patients With Irreducible DDH Before the Walking Age
Study type: INTERVENTIONAL
Overall status: NOT_YET_RECRUITING
Phase: NA
Conditions: Developmental Dysplasia of the Hip
Lead sponsor: Assiut University
Sponsor class: OTHER
First posted: 2024-05-10
Enrollment: 32
Sex: ALL
Minimum age (years): 9
Maximum age (years): 18
Standard ages: CHILD
Accepts healthy volunteers: yes
Allocation: NON_RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

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.

Eligibility criteria: * Inclusion Criteria:
* Age: - from nine months to 18 months.
* Irreducible Hip Dislocation.
* Exclusion Criteria:
* Patient age: below 9 months or above 18 months.
* Teratologic hip dislocation

Primary outcomes:
measure: Determination the success of reduction and incidence of redislocation rate
timeFrame: immediately postoperative
Secondary outcomes:
measure: Assessment of the cosmetic appearance .
timeFrame: 3 month follow up
measure: Assessment of the shortening
timeFrame: 1 year follow up
measure: Assessment the incidence stiffness and decrease range of motion of the affected hip
timeFrame: 1 year follow up
measure: Assessment the incidence of avascular necrosis in the affected hip
timeFrame: 1 year follow up
Other outcomes:
Locations:
Study officials:
affiliation: Orthopedic and Trauma surgery at assiut university hospital
name: Nariman aboloyoun, Ass.Prof
role: STUDY_DIRECTOR
affiliation: Orthopedic and Trauma surgery at assiut university hospital
name: Hatem Galal El-Din Zaki, prof
role: STUDY_DIRECTOR
References:
citation: Roof AC, Jinguji TM, White KK. Musculoskeletal screening: developmental dysplasia of the hip. Pediatr Ann. 2013 Nov;42(11):229-35. doi: 10.3928/00904481-20131022-10.
citation: Jenner EA, Chauhan GS, Burahee A, Choudri J, Gardner A, Bache CE. Comparison of clinical and radiological outcomes for the anterior and medial approaches to open reduction in the treatment of bilateral developmental dysplasia of the hip: a systematic review protocol. Syst Rev. 2024 Feb 23;13(1):72. doi: 10.1186/s13643-023-02444-6.
citation: Duman S, Camurcu Y, Sofu H, Ucpunar H, Akbulut D, Yildirim T. Arthroscopic versus open, medial approach, surgical reduction for developmental dysplasia of the hip in patients under 18 months of age. Acta Orthop. 2019 Jun;90(3):292-296. doi: 10.1080/17453674.2019.1599775. Epub 2019 Apr 2.
citation: Presch C, Eberhardt O, Wirth T, Fernandez FF. Comparison of arthroscopic and open reduction of conservatively irreducible dislocated hips of children. J Child Orthop. 2019 Aug 1;13(4):377-384. doi: 10.1302/1863-2548.13.190057.
citation: Bulut O, Ozturk H, Tezeren G, Bulut S. Arthroscopic-assisted surgical treatment for developmental dislocation of the hip. Arthroscopy. 2005 May;21(5):574-9. doi: 10.1016/j.arthro.2005.01.004.