Comparison of arthroscopic and open reduction of conservatively irreducible dislocated hips of children

Abstract

Purpose Children with sonographic grade IV hip dysplasia according to Graf and with failed conservative treatment usually need surgical reduction afterwards. Surgical reduction of the hip can lead to severe complications, the occurrence of residual acetabular dysplasia, osteonecrosis, redislocation and other postoperative complications. This paper investigates whether arthroscopic reduction is a promising alternative to open reduction. Methods We retrospectively examined 66 patients (78 hips) who were not older than two years at the first time of surgery. Arthroscopic reduction was performed on 17 children (19 hips) and open reduction on 49 children (59 hips). Patient records were used to determine redislocation, postoperative complication and residual dysplasia. Radiographs were used to determine Tönnis classification for osteonecrosis and pathological acetabular (AC) angle for residual dysplasia. We considered data up to a two-year follow-up. Statistical evaluation was performed with binary logistic regression. Results After arthroscopic reduction, 6% showed osteonecrosis, compared with 20% with open reduction (p = 0.334). Redislocation was not observed after arthroscopic reduction but for 29% after open reduction (p = 0.005). An improvement of femoral head coverage was achieved with residual dysplasia of 23.5% after arthroscopic reduction, compared with 62% after open reduction (p = 0.002). Conclusion The arthroscopic procedure represents a meaningful alternative to the open procedure due to a lower complication rate, a safe setting, a lower rate of residual dysplasia, no observed redislocation and occurrence of osteonecrosis only once in the arthroscopic group of developmental dysplasia of the hip. The arthroscopic procedure should be tested in further studies and in other clinics in order to broaden the empirical base. Level of Evidence: Level III (retrospective cohort study)

Anterior approach with mini-bikini incision in open reduction in infants with developmental dysplasia of the hip

“…Besides, for cases that needed further treatment like pelvic osteotomy, this scar would be on the track of the new incision and therefore would not add any cosmetic concern. This approach yielded comparable short-term outcomes with similar reports [11,13]. None of the patients had any limited hip motion, and the gait of the patients was largely normal.…”

“…Since the potential for spontaneous resolution could still expected, simple followups were recommended to all the patients [27]. The AVN rate was 8%, which was significantly lower than previously reported [10][11][12][13][23][24][25], but the follow-up time was too short to draw any definite conclusion. All of the four AVN patients were IHDI type IV, and three were male, indicating a possible association between severe dislocation as well as male gender and the incidence of AVN.…”

“…Since the incision was along the grease fold, it was almost invisible and left minor cosmetic concerns. Previous reports showed that the success rate and incidence of complications were comparable with traditional anterior or medial approaches [11,13,[23][24][25]. This approach had also been used in total hip arthroplasty, also resulting in comparable outcomes but less scarring [9].…”

“…OR can be achieved via an anterior or a medial approach [7][8][9][10][11][12][13]. The anterior approach directly approaches the contracted hip capsule and intra-articular obstacles but may leave cosmetic concerns and the risk of lateral femoral cutaneous nerve dysesthesia [7][8][9].…”

“…The anterior approach directly approaches the contracted hip capsule and intra-articular obstacles but may leave cosmetic concerns and the risk of lateral femoral cutaneous nerve dysesthesia [7][8][9]. The medial approach, while facilitating the removal of the interposition, has been reported to increase the incidence of AVN and not facilitate capsulorrhaphy [10][11][12][13]. In order to address these concerns, some surgeons adopted the bikini incision and performed the Smith-Peterson (SP) approach underneath [14,15].…”