Dynamic long leg casting fixation for treating 12- to 18-month-old infants with developmental dysplasia of the hip

BMC Musculoskelet Disord

et al. 2020

Background It remains controversial whether the older age to perform closed reduction (CR) procedure for developmental dysplasia of the hip (DDH), the higher incidence of complications. The aim of this study is to evaluate the midterm outcome of CR for DDH among different age groups, and to analyze and identify risk factors for the failure of this procedure. Methods Clinical data of 107 DDH patients, who received CR, were retrospectively reviewed. Data were divided into three groups according to initial treatment age (Group I: younger than 12 months; Group II: 12 months to less or equal to18 months; Group III: older than 18 months). The presence of avascular necrosis (AVN), residual acetabular dysplasia (RAD), re-dislocation, and further surgeries (FS) were observed. The risk factors were identified for those outcomes aforementioned using univariable logistic regression models. For identified risk factor age, pre-op acetabular index (AI) and post-op AI, their prediction of CR failure were evaluated by receiver operating characteristics curve (ROC). Results A total of 107 patients (156 hips) undergoing CR procedure were evaluated with a median age at initial reduction of 13.0 ± 5.4 months (range, 4 to 28 mo). Mean follow-up time in this study was 6.7 ± 0.8 years (range, 3–8 years). The incidence of AVN, RAD and re-dislocation was 15.4% (24/156), 17.3% (27/156) and 14.7% (23/156) respectively. For AVN, RAD and re-dislocation, the significant risk factors are pre-op IHDI IV (p = 0.033), age ≥ 18 months (p = 0.012), and pre-op IHDI IV (p = 0.004) and walking (p = 0.011), respectively. The areas under the ROC curve of each type of failures were 0.841 (post-op AI), 0.688 (pre-op AI) and 0.650 (age). Conclusions Severe DDH patients older than 18 months with CR procedure may result in a high risk of RAD complication. Re-dislocation is significantly associated with pre-op IHDI IV and walking. Patients, who are older than 12.5 months or have a pre-op AI of 38.7° or a post-op AI of 26.4°, are also more likely to fail of CR procedure.

Section: Discussionsupporting

confidence: 90%

Timing for closed reduction procedure for developmental dysplasia of the hip and its failure analysis

BMC Musculoskelet Disord

et al. 2020

“…Except from IHDI IV, the walking experience was also a risk factor about re-dislocation (OR: 2.524, p = 0.033). As the time went on, especially after independent walking, a series of pathological changes of the affected hip would make CR more di cult, which, certainly, lowered the e ciency of CR [28,29]. This is consistent with results in our present study, namely, walking ability should be an important evaluation at the time of treatment.…”

Section: Discussionsupporting

confidence: 90%

Timing For Closed Reduction of Developmental Dysplasia of the Hip and Failure Analysis

et al. 2020

Preprint

BackgroundIt remains controversial whether the older age at closed reduction (CR) of developmental dysplasia of the hip (DDH), the higher incidence of complications.The aim of this study is to evaluate theMid-term outcome of CR for DDHamongdifference age groups, and to analyze and identify risk factors for the failure of this procedure. Methods Clinical data of DDH patients, who received CR, were retrospectively reviewed. Hips were divided into three groups according to initial age (Group I: <12 months; Group II: 12 months to ≤18 months; Group III: >18 months). The presence of avascular necrosis (AVN),residual acetabular dysplasia (RAD), re-dislocation, further surgeries (FS)and failure of CR were observed. The risk factors were identified for those outcomes abovementioned. Receiver operating characteristics (ROC) curve analysis based on age, pre-op AI and post-op AI for failure was conducted.ResultsA total of 107 patients (156 hips) undergoing CR wereevaluated with a median age at initial reduction of 13.0 months(range, 4 to 28 mo). The incidence of AVN, RADand re-dislocationwas 15.4% (24/156), 17.3% (27/156) and 14.7% (23/156). For AVN, RAD and re-dislocation, the risk factors were pre-op IHDI IV(p=0.033), age≥18 months (p=0.012), and pre-op IHDI IV and walking (p=0.004 and p=0.011), respectively. The areas under the ROC curve of failure were 0.841 (post-op AI), 0.688 (pre-op AI)and 0.650 (age).ConclusionsRAD is a complication that must be carefully considered for severepatients older than 18 months before CR. Re-dislocation is associated with pre-op IHDI IV and walking.Patients, who are older than 12.5 months or have a pre-op AI of 38.7° or a post-op AI of 26.4°, are more likely fail of CR.

“…Except from IHDI IV, the walking experience is also a risk factor for re-dislocation (OR: 2.524, p=0.033). As the time proceeds, especially after the patient is capable of independent walk, a series of pathological changes of the affected hip will make CR more di cult, which, certainly, lowers the e ciency of CR [30,31]. This is consistent with results in our study, namely, walking ability should be an important factor to evaluate at the time of treatment.…”

Section: Discussionsupporting

confidence: 89%

Timing for Closed Reduction Procedure for Developmental Dysplasia of the Hip and its Failure Analysis

et al. 2020

Preprint

Background It remains controversial whether the older age to perform closed reduction (CR) procedure for developmental dysplasia of the hip (DDH), the higher incidence of complications. The aim of this study is to evaluate the midterm outcome of CR for DDH among difference age groups, and to analyze and identify risk factors for the failure of this procedure. Methods Clinical data of 107 DDH patients, who received CR, were retrospectively reviewed. Data were divided into three groups according to initial treatment age (Group I: younger than 12 months; Group II: 12 months to less or equal to18 months; Group III: older than 18 months). The presence of avascular necrosis (AVN), residual acetabular dysplasia (RAD), re-dislocation, and further surgeries (FS) were observed. The risk factors were identified for those outcomes aforementioned using univariable logistic regression models. For identified risk factor age, pre-op acetabular index (AI) and post-op AI, their prediction of CR failure were evaluated by receiver operating characteristics curve (ROC).Results A total of 107 patients (156 hips) undergoing CR procedure were evaluated with a median age at initial reduction of 13.0±5.4 months (range, 4 to 28 mo). Mean follow-up time in this study was 6.7±0.8 years (range, 3-8 years). The incidence of AVN, RAD and re-dislocation was 15.4% (24/156), 17.3% (27/156) and 14.7% (23/156) respectively. For AVN, RAD and re-dislocation, the significant risk factors are pre-op IHDI IV (p=0.033), age≥18 months (p=0.012), and pre-op IHDI IV (p=0.004) and walking (p=0.011), respectively. The areas under the ROC curve of each type of failures were 0.841 (post-op AI), 0.688 (pre-op AI) and 0.650 (age).Conclusions Severe DDH patients older than 18 months with CR procedure may result in a high risk of RAD complication. Re-dislocation is significantly associated with pre-op IHDI IV and walking. Patients, who are older than 12.5 months or have a pre-op AI of 38.7° or a post-op AI of 26.4°, are also more likely to fail of CR procedure.