of congenital hip dislocation 3month Progress Report December 2 2021 Gyula Domos About the lecturer Gyula Domos PhD Student Department Department of ID: 911496
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Slide1
Revaluating the treatment of congenital hip dislocation
3-month Progress ReportDecember 2, 2021
Gyula
Domos
Slide2About the lecturer
Gyula Domos
PhD
Student
Department:
Department of
Orthopaedics, Semmelweis UniversitySupervisor(s): György SzőkeScientific methodology supervisor: Szilárd VáncsaStatistician: Gergely AgócsVision: - to ensure the highest quality treatment for pediatric patients - to build one of the best pediatric orthopaedic centers in EuropeMission: - to introduce the best available treatment methods in every field of pediatric orthopaedics, to work out new treatment protocols Contact: domosgy@gmail.com
Slide3Specific goals
PROJECT LIST
1. Identifying the risk factors of failure in the treatment of
congenital hip dislocation
a
systematic review and meta-analysis Project started: September 20212. The results of primary complex surgical treatment in congenital hip dislocation retrospective cohort analysis Project started:
October
2021
Slide4Identifying the risk factors of failure in the treatment of congenital hip dislocation
Project started:September 2021Planned submission
date
:
May 2022
Systematic review and meta-analysis
Co-investigator
:
Csaba Varga
Expert
:
Csenge
Szeverényi
Project students: Anna Perge
1
Slide5Background
Open reduction
Failed
conservative
treatment
Congenital hip dislocationOpen reduction + femoral +/- pelvic osteotomyClosed reduction
Children over 6
months
of
age
AIMS:
OVERALL RATE OF FAILURE?
RISK FACTORS?
10% of
all
dysplasia
Biedermann
2018
Tennant
2016,
Talahti
2020,
Bradley
2016
Tennant
2016,
Presch
2019, Gardner 2014
15-43% failure
10%
avascular necrosis
11-29% failure
20%
avascular necrosis
Slide6Background
Open reduction
Conservative
treatment
Congenital
hip dislocationOpen reduction + femoral +/- pelvic osteotomyClosed reduction
AIMS:
OVERALL RATE OF FAILURE?
RISK FACTORS?
10% of
all
dysplasia
Biedermann
2018
Risk factors?
Risk factors?
Risk factors?
HIP DISLOCATION
Tennant
2016,
Talahti
2020,
Bradley
2016
Tennant
2016,
Presch
2019, Gardner 2014
15-43% failure
10%
avascular necrosis
11-29% failure
20%
avascular necrosis
Slide7QuestionsP1
children with hip dislocation treated with CONSERVATIVE therapyP2 children treated with CLOSED reduction
P3
children treated with
OPEN
reductionI the presence of risk factors (age, the severity of the dislocation, previously failed treatment, etc.) C the absence of risk factorsO1 rate of failure (unsuccessful reduction, redislocation)O2 rate of avascular necrosis and secondary surgeriesHypothesis: Certain risk factors increase the rate of failure in the treatment of congenital hip
dislocation
What
are
the risk factors and the overall rate of failure in the
treatment
of
congenital
hip
dislocation
?
Clinical
implication
:
decrease
the rate of
unnecessary
interventions
and
complications
Slide8Systematic search
Databases: Medline (5.867), Embase (5.812), Central (417)
Date
of
search
:
October 20, 2021Searchkey: hip AND (dislocation OR luxation OR dislocated OR dysplasia OR displacement OR DDH) AND (reduce OR reduction OR reposition)
Slide9Flowchart of selection
Cohen’s Kappa: 0.69
Slide10The results of primary
complex surgical treatment in congenital hip dislocation
Project started:
October
2021
Planned submission date:July 2022Retrospective cohort analysisExpert: Csenge SzeverényiProject students: Anna Perge2
Slide11Background
The failure rate in closed and open reduction in the treatment of congenital hip dislocation is 11-43% (Tennant
2016,
Presch
2019,
Talahti
2020)The rate of iatrogenic avascular necrosis of the femoral head is 10% in closed and 20% in open reduction (Bradley 2016, Gardner 2014)Semmelweis University: primary complex surgical treatment (open reduction + femoral osteotomy) – no forced reduction ~0% redislocation
~0%
avascular
necrosis
Aim:
rate of complications and late results
Slide12Eligibility criteria
Place
:
Semmelweis University
Department
of Orthopaedics Period: 2008-2019 (12 years
)
Follow
up
:
min. 2 years Patients: children (‹18 years) with congenital hip dislocation - after failed conservative treatment - in case of
late presentation - in case of syndromesTreatment
:
open reduction and
femoral
osteotomy
Inclusion
criteria
Exclusion
criteria
Patients:
-
with
secondary
surgery
- with
cerebral
palsy
or
other
secondary
hip
dislocation
Slide13Preliminary results
62%
38%
n=116
86%
14%
41%
Slide14Specific goals
AIMS
1. Identifying the risk factors of failure in the treatment of congenital hip dislocation
:
a
systematic
review and meta-analysis Planned submission date: May 20222. The results of primary complex surgical treatment in congenital hip dislocation: retrospective study analysis Planned submission date:
July
2022
Slide15Thank you for your attention!
The highest quality is our
moral
duty
.(István Szepsy)