Hip arthrography plays an integral role in the decision between closed and open reduction in patients with developmental dysplasia of the hip. Arthrography is a dynamic test to assess the stability and quality of hip reduction. Įvaluation of the pediatric hip with arthrography demonstrates the cartilaginous anatomy of the acetabulum and femoral head. Arthrography is paramount for evaluating and managing pathology in the pediatric hip because it allows for visualization of the femoral head, acetabulum, and any soft tissue blocks to adequate hip reduction. Hip arthrography is safe, minimally invasive, quick, and inexpensive when performed correctly. Hip arthrography aids the pediatric orthopedic surgeon in establishing a diagnosis and treatment for developmental hip dysplasia. Hip arthrography can be used to visualize these cartilaginous structures. Pediatric hip structures that are cartilaginous are not easily identified on plain radiographs. The hip radiograph in a pediatric patient cannot yield all the information desired to diagnose or treat developmental dysplasia of the hip. While the patient is under general anesthesia, arthrography provides diagnostic information that directly impacts decision-making. Arthrography remains a helpful resource in the operating room. More recently, CT and MRI have replaced arthrography for diagnostic purposes. Originally, arthrography was primarily used as an adjunct to radiography for diagnostic joint evaluation. Arthrography is useful for the evaluation of the pediatric hip joint, specifically as it pertains to developmental dysplasia of the hip. Improved visualization of a given structure is integral to patient care, as this may impact surgical management for a given condition. Periarticular structures in pediatric patients can be difficult to identify and assess secondary to the cartilaginous nature. This activity describes the examination and highlights the role of the interprofessional team in evaluating pediatric patients who undergo hip arthrography.Īrthrography is a useful resource, especially for pediatric orthopedic surgery. Soft tissue barriers to successful closed reduction include an inverted labrum, inverted limbus, ligamentum teres hypertrophy, pulvinar, transverse acetabular ligament hypertrophy, and iliopsoas tendon constriction on the hip joint capsule. Pediatric hip arthrograms are performed in developmental dysplasia of the hip to identify any possible blocks to reduction and confirm adequate closed reduction under anesthesia. Arthrography aids in evaluating the congruency of the hip joint, joint stability, femoral head sphericity, and reducibility of the femoral head. Evaluation of the pediatric hip with arthrography demonstrates the cartilaginous anatomy of the acetabulum and femoral head. Abnormal hip development results in acetabular dysplasia, subluxation of the femoral head, and hip dislocation. doi:10.Developmental dysplasia of the hip involves a spectrum of disorders resulting from abnormal hip development. (2021) British journal of sports medicine. Primary cam morphology bump, burden or bog-standard? A concept analysis. Dijkstra HP, Ardern CL, Serner A, Mosler AB, Weir A, Roberts NW, Mc Auliffe S, Oke JL, Khan KM, Clarke M, Glyn-Jones S. (2002) The Journal of Bone and Joint Surgery. The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement. (2012) American Journal of Roentgenology. Femoroacetabular Impingement: Can the Alpha Angle Be Estimated?. (2016) Journal of hip preservation surgery. Is there a pathological alpha angle for hip impingement? A diagnostic test study. Barrientos C, Barahona M, Diaz J, Brañes J, Chaparro F, Hinzpeter J. Potential for Change in US Diagnosis of Hip Dysplasia Solely Caused by Changes in Probe Orientation: Patterns of Alpha-angle Variation Revealed by Using Three-dimensional US. Swami, Lucy Jamieson, Kelvin Chow, Richard B. 2021) a value of ≥60° has been proposed as definitional of cam morphology 5. Initially, in 2002, an alpha angle of ≥50° was proposed as pathological 4, subsequently, a value of ≥57° was proposed in symptomatic patients 2, and more recently (c. There is no one value that can define cam morphology 5. a line from the center of the femoral head to a point where the distance from the bone to the center of the head is greater than the radius of the cartilage-covered femoral head.a line from the center of the femoral head to the center of the femoral neck at its narrowest point.Measured on oblique axial images as the angle between 4: Measured on obliquely oriented radiographs. The term alpha angle is also used in a separate and unrelated context in the evaluation of developmental dysplasia of the hip (DDH) in children.
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