Long-term outcome following medial open reduction in developmental dysplasia of the hip: A retrospective cohort study

Abstract

IntroductionAvascular necrosis (AVN) is a serious complication of treatment for developmental dysplasia of the hip. There is ongoing controversy regarding AVN and its influence on hip development following medial open reduction (MOR).PurposeThe aim of our study was to (1) determine the long-term prevalence of AVN following MOR, (2) evaluate hip development after MOR, and (3) identify predictors of AVN and radiographic outcome at skeletal maturity after MOR.MethodsA retrospective cohort analysis of 60 patients (70 hips) who underwent MOR with a mean follow-up of 10.83 years (5.23–16.74) was conducted. AVN was recorded according to Bucholz and Ogden classification and radiographic outcome based on Severin grading. AVN and hip morphology related to length of follow-up were evaluated. Chi-squared and t-tests were used to identify relationships between AVN and other variables. Logistic regression was used to assess predictors of AVN and Severin outcome.ResultsThe rate of clinically significant AVN (types 2–4) following MOR was 32.9 % with type 2 accounting for 82.6 % of these cases. While early acetabular development was satisfactory, long-term outcome was unsatisfactory in 26 % of cases with AVN (vs 8.7 % of cases without AVN). A higher rate of AVN was identified when hips were immobilized in ≥60° of abduction postoperatively. A higher rate of poor Severin outcome was identified in hips with AVN.ConclusionsOur findings suggest that there is a high rate of AVN and unsatisfactory long-term outcome following MOR. AVN remains a significant concern following MOR surgery for developmental dysplasia of the hip that may not be apparent until long-term evaluation.

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

“…In the literature osteonecrosis is reported in 6% to 48%. 5,[17][18][19][20] Better results for arthroscopic reduction are also confirmed by some authors 10,12 who assume that a reduction in osteonecrosis can be achieved by a more gentle, arthroscopic approach (Fig. 2).…”

Redislocation After Posteromedial Open Reduction in Developmental Dysplasia of the Hip: Analyzing the Risk Factors and Determining the Optimal Treatment Method

“…With a reported frequency between 1% and 11%, redislocation is an important complication in the treatment of DDH. [15][16][17] Although several etiological factors effective in the development of redislocation have been identified, the associated risk factors have not been revealed. 5 No matter what the cause is, early diagnosis and rapid intervention are crucial in the treatment of redislocation.…”

Low rate of clinically important avascular necrosis of the femoral head after Ludloff’s procedure

“…Gardner et al (14) stated, in a recently published retrospective cohort study, that they have abandoned the use of medial open reduction (MOR) for developmental dysplasia of the hip at their department due to a high rate of clinically relevant AVN (type 2-4 according to the Bucholz and Ogden classification) and unsatisfactory long-term outcome following MOR. The overall rate was 32.9% with 82.6% being type 2.…”