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

Abstract

Long-term outcomes of surgical treatment for pediatric developmental dysplasia of the hip (DDH) are not well defined. The purpose of this study was to report long-term radiographic and clinical outcomes, survivorship free of total hip arthroplasty (THA), and predictors of subsequent THA following childhood treatment of DDH. This study was a single-institution retrospective review of hips treated for DDH with closed or open reduction at a minimum 10-year follow-up. 107 patients (119 hips) were included with a mean patient age of 3.3 years at childhood treatment. At mean 30.5 years follow-up, 24 hips had undergone THA (20%). Mean patient age at time of THA was 33.5 years. None of the hips treated with closed reduction alone required THA, whereas 8 hips treated with open reduction (25%) underwent THA. Hips with patient age > 4 years at the time of treatment had lower survivorship at 35 years follow-up (50% vs. 85%; p < 0.001). Additionally, femoral osteotomy (OR 2.0, p < 0.001), and previous treatment elsewhere (27% vs. 16%; p < 0.01) were associated with subsequent THA. Early referral and appropriate intervention may prove important, as age and prior treatment were predictive of subsequent THA.

Total hip arthroplasty in patients with common pediatric hip orthopedic pathology

“…Another study conducted at the Mayo Clinic, which followed patients for at least 10 years, concluded that closed reduction treatment for DDH hips did not necessitate THA. 12 However, patients who received treatment after the age of 4 years exhibited lower hip survivorship rates at the 35-year mark, with a 50% survival rate compared to 85% for those treated before 4 years of age. These findings suggest that early referral and treatment may be advantageous for the longevity of hip function.…”

“…Femoral osteotomy was found to be correlated with subsequent THA 11 , 12 ( Table 2 ). Table 2 also presents two studies that investigated THA outcomes for DDH patients under the ages of 20 and 30 years, respectively 13 , 14 ( Table 2 ).…”

“…Two studies revealed an increased risk of revision due to dislocation within the first 6 months after THA, 8,10 while the other two studies found no statistically significant differences in inpatient complications, discharge disposition, readmissions, or reoperations compared to THA for OA. 7,9 Femoral osteotomy was found to be correlated with subsequent THA 11,12 (Table 2). Table 2 also presents two studies that investigated THA outcomes for DDH patients under the ages of 20 and 30 years, respectively 13,14 (Table 2).…”

The incidence of late-detected developmental dysplasia of the hip and its functional outcomes: a 17-year cohort study using selective ultrasound screening

“…The later DDH is diagnosed and treatment initiated, the worse the prognosis for the hip [ 2 ]. A possible trend towards a worse prognosis has been suggested after 18 months [ 34 , 35 ].…”

“…However, a study in 2019 found no reduction in the incidence of late-detected DDH in England over the last 35 years [ 1 ]. Another study reported that 20% of the hips treated for late-detected DDH underwent a total hip arthroplasty with 30 years of follow-up [ 2 ].…”