The effectiveness of preliminary traction in the treatment of congenital dislocation of the hip

Abstract

Background Historical papers on the treatment of congenital dislocation of the hip suggest the use of preliminary traction to facilitate closed reduction or to decrease the risk of avascular necrosis (AVN) of the femoral head. In the 1980s, some authors questioned the role of preliminary traction and suspended its use, yielding satisfactory results. Since then, several studies called into question this method, and some authors have continued to recommend preliminary traction while other authors have discouraged its use. Materials and methods We reanalysed the full set of radiographs of 71 hips (52 patients) surgically treated by a medial approach after 4 weeks of preoperative longitudinal traction. The mean age at operation was 16 months. Before and after traction, the height of the dislocation was graded according to the Gage and Winter method. The hips were divided into two groups: group 1, in which the traction was effective, and group 2, in which the traction was not effective. These two groups were statistically analysed regarding the severity of the dislocation, the age of the patient at surgery and the incidence of AVN. Results Preliminary traction was effective in 48 hips (68%, group 1), while it was not effective in the remaining 23 (32%, group 2). The effectiveness of preliminary traction was statistically related to the height of the dislocation and to the age of the patient at surgery, with traction being less effective in more severe dislocations and in older children. The incidence of AVN was statistically lower in group 1 than in group 2. Conclusions In our study population, despite not having a control group, preliminary traction—when effective—seemed to reduce the incidence of AVN in patients surgically treated for congenital dislocation of the hip. The effectiveness of the traction was influenced by the severity of the dislocation and the age of the patient; it worked better for less severe dislocations and in younger children. To reduce hospital costs, traction should be applied at home. Level of evidence 3.

The Optimal Age for Surgical Management of DDH Differs by Treatment Method

“…Earlier surgery was also associated with a greater improvement in radiographic measures of dysplasia in all groups, as compared with later age at index surgery (Table 8). This association has been well-supported in the literature previously, as this provides a greater opportunity for acetabular remodeling 4,6,7,9,11,16–19 …”

“…Age at treatment, unilateral or bilateral DDH, preoperative traction, the presence of an ossific nucleus, Tönnis grade of dislocation, surgical approach, and concurrent bony osteotomy have been studied previously to understand their effects on the need for FCS, acetabular or femoral remodeling, and outcomes. 4,6,7,9,11,[16][17][18][19] We identified age-specific cutoffs for patients treated for a dislocated hip with CR, OR, and ORP within each treatment group that minimized the risk of FCS before skeletal maturity.…”

Risk factors for postoperative avascular necrosis of the femoral head in children with developmental dysplasia of the hip

“…Preliminary traction may lower the risk of ANFH by reducing the tightness of the hip musculature. Similarly, effective preliminary traction was shown to reduce the incidence of ANFH in patients surgically treated for congenital dislocation of the hip, and the age of patients affected the effectiveness of traction ( 20 ).…”

The Effect of Traction before Closed Reduction in Patients with Developmental Dysplasia of the Hip

“…When the hip has a limited range of motion, or when the femoral head has migrated proximally, traction treatment prior to CR can be used to improve the success rate and to reduce the incidence of AVN [ 6 , 8 , 9 , 10 , 11 ]. During this treatment, the hips are gradually reduced via traction and abduction.…”