Introducing a Novel Combined Acetabuloplasty and Chondroplasty Technique for the Treatment of Developmental Dysplasia of the Hip.

BACKGROUND: The aim of the treatment of developmental dysplasia of the hip (DDH) is to maintain a concentric reduction. We describe a novel approach to treat DDH that involves improvement of cartilaginous acetabular coverage, involves the preservation of the secondary ossification center of the acetabulum, and is adjunctive to early open reduction. METHODOLOGY: Thirty-nine children (40 hips) aged six to 18 months were included in the study. Open reduction with chondroplasty was performed during the same surgery. Patients were followed up for 15 years with both clinical and radiological assessments. At the final follow-up, all patients were graded as good or excellent according to Severin's classification. RESULTS: The mean age at reduction was 11.9 months (range: 8-16). The mean preoperative acetabular index (AI) was 43.43 (range: 40-48). After the operation, mean AI decreased to 16.97 (P < 0.0001, 95% confidence interval (CI) = 16.24-17.70). AI improved significantly during growth (mean AI changes 13.50, P < 0.0001, 95% CI = 12.65-14.34). The mean lateral center-edge (CE) angle at skeletal maturity was 32.94° (SD = 4.16°). Mild avascular necrosis (AVN) was observed in two hips with involvement of the epiphysis and was of Kalamchi grade 1. CONCLUSION: Chondroplasty in conjunction with open reduction can yield a concentric reduction with improved acetabular coverage that facilitates acetabular remodeling that is sustained until skeletal maturity. Prompt correction through this procedure may help to improve the development of the hip and lead to near normal function as demonstrated by improved mean AI and Severin scores at the last follow-up. With low complication and reoperation rates, this procedure could be considered as a surgical treatment option for DDH in patients between the age of six and 18 months

Consensus on definition and severity grading of lymphatic complications after kidney transplantation

Background: The incidence of lymphatic complications after kidney transplantation varies considerably in the literature. This is partly because a universally accepted definition has not been established. This study aimed to propose an acceptable definition and severity grading system for lymphatic complications based on their management strategy. Methods: Relevant literature published in MEDLINE and Web of Science was searched systematically. A consensus for definition and a severity grading was then sought between 20 high-volume transplant centres. Results: Lymphorrhoea/lymphocele was defined in 32 of 87 included studies. Sixty-three articles explained how lymphatic complications were managed, but none graded their severity. The proposed definition of lymphorrhoea was leakage of more than 50 ml fluid (not urine, blood or pus) per day from the drain, or the drain site after removal of the drain, for more than 1 week after kidney transplantation. The proposed definition of lymphocele was a fluid collection of any size near to the transplanted kidney, after urinoma, haematoma and abscess have been excluded. Grade A lymphatic complications have a minor and/or non-invasive impact on the clinical management of the patient; grade B complications require non-surgical intervention; and grade C complications require invasive surgical intervention. Conclusion: A clear definition and severity grading for lymphatic complications after kidney transplantation was agreed. The proposed definitions should allow better comparisons between studies