Outcomes of Open Reduction for Developmental Dysplasia of the Hip: Does Bilateral Dysplasia Have a Poorer Outcome?

Abstract

Our data confirmed that the clinical outcome of bilateral developmental dysplasia of the hip was worse primarily because of asymmetrical outcomes. Age and Tönnis grade played an important role in the risk of occurrence of osteonecrosis. The radiographic outcome according to the Severin classification did not differ significantly between the groups.

Developmental Dislocation of the Hip Successfully Treated by Preoperative Traction and Medial Open Reduction: A 22-year Mean Followup

“…The effect of preoperative traction has been questioned for surgical treatment of DDH since all the anatomic obstacles to hip reduction are surgically eliminated [35,59,64,82]. Although the percentage of our excellent and good long-term radiographic results, according to the Severin classification, is higher than in other series in which traction was not used [18,30,33,39,50,71,[78][79][80], it is difficult to determine whether preoperative traction served to decrease the complication rate. Inpatient traction is costly [35,59,82]; however, more than 1/2 of our patients successfully completed home traction before surgery.…”

“…Although we were aware of this general trend in favor of anterior open reduction that provides capsulorrhaphy and avoids medial circumflex vessels, the good preliminary results we obtained in children older than 24 months encouraged us to increase the upper age limit for medial open reduction to 36 months. Moreover, according to the literature, even open reduction by the anterior approach may provide unsatisfactory results in children older than 24 months [17,18,25,30,33,47,58,73,79,80]. Schoenecker and Strecker [64] reported two series of patients older than 24 months who had open reduction by the anterior approach.…”

“…During the last 36 years, the anterior approach has been reported less frequently [1,10,17,18,20,23,25,30,31,47,58,70,71,73,79,80] than the medial approach [4, 6, 7, 11, 16, 21, 22, 33, 36, 37, 39, 40, 46, 48-50, 52-54, 60, 69, 77, 78, 85, 88], especially in younger children.…”

“…It is known that the final result of DDH after open reduction can be evaluated only when musculoskeletal growth is completed [81], but to our knowledge, there is a paucity of studies including skeletally mature patients [5,18,30,33,39,52,71,[78][79][80].…”

Developmental dysplasia of the hip: What has changed in the last 20 years?

“…A tipping point is reached, probably around the age of eight years, after which complications from treatment may lead to an outcome no better than the untreated clinical course [23,27,28] . The clinical outcome of bilateral DDH treated surgically is worse compared to unilateral cases mainly due to asymmetrical outcome [29] . Avascular necrosis (AVN) of the femoral head is the most feared complication in children with DDH.…”