Closed Vs. Open Reduction/Salter Innominate Osteotomy for Developmental Hip Dislocation After Age 18 Months

Abstract

Background: Despite widespread use of single-stage open reduction and pelvic osteotomy for treatment of developmental dysplasia of the hip (DDH) after walking age, this aggressive strategy remains controversial. We directly compared dislocated hips treated with closed reduction (CR) to those treated with open reduction and Salter innominate osteotomy (OR/IO) to estimate the relative hazard of total hip arthroplasty (THA) and the THA-free survival time. Methods: In a series of patients 18 to 60 months of age, 45 patients (58 hips) underwent CR and 58 patients (78 hips) were treated with OR/IO and followed to a minimum 40 years post-reduction. Observations in the survival analysis were censored if no THA had occurred by 48 years. Multivariate Cox regression analysis was used to estimate the hazard of THA given treatment, age, and bilaterality. Complications and additional procedures were noted. Results: At 48 years of follow-up, 29 (50%) of the hips survived after CR compared with 54 (69%) after OR/IO. At 45 years, the survival probability after OR/IO was 0.63 (95% confidence interval [CI] = 0.50 to 0.78) compared with 0.55 (95% CI = 0.43 to 0.72) after CR. The hazard ratio (HR) of THA was modeled as a function of treatment, age at reduction, and bilaterality. The effect of age and treatment on the outcome of hips in patients with unilateral involvement was minimal. However, age did significantly alter the relationship between treatment and outcome in bilateral cases. In the bilateral group, the predicted HR of THA was lower after CR in hips that were reduced at the age of 18 months (HR = 0.16, 95% CI = 0.04 to 0.64) but higher in those that were reduced at 36 months (HR = 4.23, 95% CI = 2.00 to 8.95). Additional procedures were indicated for 17% and 22% of hips after CR and OR/IO, respectively. Conclusions: Osteoarthritis and THA was more likely after CR than OR/IO, but the data do not indicate a difference in unadjusted hip-survival time. In patients with bilateral disease, an older age at reduction was associated with an increased hazard of THA after CR than after OR/IO. Both treatments provided substantial benefit relative to the natural history of DDH, but THA is the expected outcome in middle adulthood. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Predictors of Total Hip Arthroplasty Following Pediatric Surgical Treatment of Developmental Hip Dysplasia at 20-Year Follow-Up

“…There are only three long-term studies on the Salter osteotomy in the literature. Bohm et al reported outcomes at a mean 30 years after pelvic osteotomy, Thomas et al reported Dr. Salter’s original cohort at mean 43 years following surgery, and Scott et al reported outcomes at a mean of 45 years after either closed reduction or open reduction with Salter innominate osteotomy [ 7 , 28 , 29 ]. All studies showed between 77 and 100% survivorship at 30 and 40 years.…”

Increased Loading Rates During Gait Correlate With Morphology of Unaffected Hip in Juveniles With Treated Developmental Hip Dysplasia

“…For more definite causative conclusions, further longitudinal studies will be needed. Furthermore, since different surgical methods and the surgical age may have different effects on the post-operative condition and subsequent development of the morphology and mechanics of the hip ( Wang et al, 2016 ; Scott et al, 2020 ) further affecting the loading conditions of the lower extremities, future studies on such effects will also be needed. On the other hand, the current study was limited to level walking.…”

The incidence of avascular necrosis following a cohort of treated developmental dysplasia of the hip in a single tertiary centre

“…However, perhaps this will need to be redefined or looked at from a broader perspective. 13,14 Patients who presented at 12 weeks or less were classified as an early presentation; post-12 weeks patients were classified as late. This was similar to the criteria used by Senaran et al 15 Infants below the age of six months were defined as having DDH according to the sonographic method described by Graf.…”