|
Year |
2002 |
|---|---|
|
Question Number |
263(2) |
|
Category |
Pediatric Orthopaedics |
Question
An asymptomatic 12-year-old girl with developmental dysplasia of the hip underwent open reduction at age 2 years. The current radiograph shown in Figure 73 reveals
1- a normal hip
2- slipped capital femoral epiphysis
3- Legg-Calve-Perthes disease
4- dysplasia secondary to partial lateral growth arrest
5- early osteoarthritis
Figures
Answer (click for answer)
Preferred answer: 4
Growth disturbance of the capital femoral epiphysis is the most common complication in the treatment of developmental dysplasia of the hip (DDH). Its sequelae can include femoral head deformity, acetabular dysplasia, and early degenerative joint disease. The most common type of growth disturbance is lateral growth arrest, responsible for about 25% of all cases. It is characterized by decreased growth at the lateral aspect of the physis or premature lateral fusion which results in valgus deformity of the femoral head on the neck. The radiographic hallmark of this type of arrest is lateral tilting of the capital femoral epiphysis. Both lateral tilting of the epiphysis and valgus deformity are demonstrated in the supplied figure, making 4 the correct answer. There is no head collapse suggestive of Perthes (incorrect answer 3), no degenerative changes (incorrect answer 5), and no displacement of the epiphysis as seen with SCFE (incorrect answer 2). However, the hip is definitely not normal for the reasons described above (incorrect answer 1).
Lateral growth arrest has been associated with acetabular dysplasia and poor femoral head coverage. This, coupled with valgus deformity of the head, can lead to secondary subluxation and predispose the patient to degenerative joint disease. The study by Kim demonstrated acetabular dysplasia in 41% of 58 hips with identified lateral growth arrest. The authors also noted that evidence of this dysplasia could be seen radiographically prior to the identification of the lateral arrest on X-ray, which is often not apparent until the patient has progressed further toward skeletal maturity (average age 10 years). Therefore, they stressed the importance of monitoring acetabular development in children with DDH rather than looking for evidence of physeal arrest which shows up later in the most common scenario.
Reference: Kim HW, Morcuende JA, Dolan LA, Weinstein SL: Acetabular development in developmental dysplasia of the hip complicated by lateral growth disturbance of the capital femoral epiphysis. J Bone Joint Surg Am 2000;82:1692-1700
Weinstein SL: Developmental hip dysplasia and dislocation, in Morrissy RT, Weinstein SL (eds): Lovell and Winter’s Pediatric Orthopaedics, ed 5. Philadelphia, PA, Lippencott Williams and Wilkins, 2001, pp 905-956.
Herring JA: Developmental dysplasia of the hip, in Herring JA (ed): Tachdjian’s Pediatric Orthopaedics, ed 3, Philadelphia, PA, WB Saunders, 2002, pp 513-654.
Keret D, MacEwen GD: Growth disturbance of the proximal part of the femur after treatment for congenital dislocation of the hip. J Bone Joint Surg AM 1991;73:410-423.
Campbell P, Tarlow SD: Lateral tethering of the proximal femoral physis complicating the treatment of congenital hip dysplasia. J Pediatr Orthop 1990;10:6-8.