Outcomes following open reduction for late-presenting developmental dysplasia of the hip.

PURPOSE: Patients with late-presenting developmental dysplasia of the hip (DDH) are more likely to require an open reduction. Since many developing countries do not have mandated screening, there continues to be a relatively high incidence of late-presenting DDH. We report the clinical and radiographic outcomes of open reduction in a series of patients who presented late. PATIENTS AND METHODS: This was a retrospective review of 712 hips in 645 patients that underwent open reduction, alone or in combination with a pelvic osteotomy. In all, 91 hips had open reduction alone and 621 had open reduction and pelvic osteotomy. Femoral shortening was performed in 221 hips. The mean age at the time of surgery was 2.1 years (1 to 6.5) and the mean follow-up time was 9.3 years (6 to 14). We used the Children's Hospital Oakland Hip Evaluation Score (CHOHES) to determine functional outcomes and the Severin classification was used to evaluate radiographic outcomes. The rate of avascular necrosis (AVN) and the need for a reoperation were also recorded and analyzed. RESULTS: In all 80% (570 hips) had good radiographic outcomes (Severin type I or II) and 87% had a CHOHES score of > 90 at final follow up. There was a 14% rate of AVN and only a 2% rate of redislocation. Better radiographic outcomes and lower reoperation rates were seen with patients who underwent both an open reduction and pelvic osteotomy. A trend was observed towards worse outcomes in older patients. CONCLUSIONS: There was a high rate of good clinical and radiographic outcomes at a minimum six-year follow-up in patients with late-presenting DDH who underwent open reduction. Those who underwent open reduction in combination with a pelvic osteotomy had a higher rate of good radiographic outcomes and a lower rate of complications, particularly reoperation.

[The Seebauer classification for the staging of arthropathy due to rotator cuff massive tear: intra- and interobserver concordance analysis]. / Clasificación de Seebauer para la estadificación de la artropatía por desgarro masivo del manguito de los rotadores: Análisis de concordancia intra e inter-observador.

INTRODUCTION: L. Seebauer developed a radiologic classification of arthropathy due to massive rotator cuff tear, based on the medial and/or proximal displacement of the humeral head as a result of disease progression. The purpose of this paper is to conduct an evaluation of the concordance of such classification. METHODS: A group of 34 patients with massive rotator cuff lesion was created. Their X-rays were reviewed and classified by 5 independent observers. An inter- and intraobserver concordance analysis was carried out using the Kappa index, and the results were interpreted according to the Landis and Kock criteria. RESULTS: The intraobserver concordance determined for the 5 observers showed that the one with the greatest experience had an agreement close to 100%; the interobserver concordance found that only 2 of the 5 observers had moderate agreement and, finally, the interobserver concordance of the stages of classification 2A showed a substantial agreement, while a moderate agreement was found for IA and IB. DISCUSSION: An important variability was found in the intraobserver concordance, where the capacity to reproduce the same results depends on the observer's experience. The results of the interobserver concordance show that the criteria established by Seebauer are insufficient to be reproduced. Finally, in the concordance among the stages a moderate agreement was found in each of the stages. CONCLUSION: The results of this paper show that the Seebauer classification is experience-dependent, which hinders its routine use by orthopedists not sufficiently trained on shoulder surgery or by residents in training.