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

Abstract

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.

Anteroposterior pelvic radiograph is not sufficient to confirm hip reduction after conservative treatment of developmental dysplasia of the hip

“…The study subjects were children diagnosed with DDH who were treated at our hospital from June 2018 to June 2020. The inclusion criteria were (1) a diagnosis of completely dislocated DDH (ultrasonic examination of children less than 6 months of age showed Graft type IV or anteroposterior pelvic radiographs of children aged 6-12 months showed International Hip Dysplasia Institute type III or IV DDH); (2) a positive Ortolani sign (reduction of the femoral head to the acetabulum and detection of the bouncing sound of reduction); (3) children aged ≤12 months; (4) treatment with the Pavlik harness or manual reduction and plaster fixation (for children less than 6 months of age, the Pavlik harness was adopted; for children aged 6-12 months or those in whom the Pavlik harness failed, manual reduction and plaster fixation were performed); (5) anteroposterior pelvic radiographs and MRI of the hip joint were performed after 3 weeks of treatment with the Pavlik harness or 1 day after manual reduction and plaster fixation, and the quality of images met the requirements of the study; (6) complete data.…”

Short-term outcomes of treatment in children presenting with DDH in walking age - An analysis of 84 hips

“…3,4,10e15 Most of the studies define failure of CR as the need for a subsequent OR following a re-dislocation. 16 Zhang et al, in their series of 138 hips treated by CR, reported a failure rate of 31% and concluded that age more than 18.35 months and IHDI Grade III & IV are more likely to fail with CR. 4 Schoenecker et al reported a successful CR in 68% of 38 hips, all of which were >18 months of age.…”

Narrative Review of Complications Following DDH Treatment

“…Older age at reduction has been implicated in several studies as a cause of worse outcomes. Zhang et al specifically evaluated the impact of age following closed reduction [ 44 ]. They conducted a retrospective review of 107 patients with DDH, split into three groups based on age at reduction: < 12 months, 12–18 months and > 18 months.…”