Closed Reduction for Developmental Dysplasia of the Hip: Early-term Results From a Prospective, Multicenter Cohort

Sankar, Wudbhav N.; Gornitzky, Alex L.; Clarke, Nicholas; Herrera-Soto, José A.; Kelley, Simon P.; Matheney, Travis; Mulpuri, Kishore; Schaeffer, Emily K.; Upasani, Vidyadhar V.; Williams, Nicole; Price, Charles T.

doi:10.1097/bpo.0000000000000895

Cited by 83 publications

(68 citation statements)

References 37 publications

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“… 9 , 12 , 27 , 28 The rate of stable closed reduction decreases with increasing patient age. In children under 18 months of age, closed reduction was obtained in 76% of the present hips and in 83% of the hips reported by Sankar et al 11 In children aged 18 to 36 months, the rate of closed reduction was 50% of the present hips and 61% in a previous study. 10 Another study confirms this trend, 28 although the rates of closed reduction were somewhat lower (58% under 12 months and 36% at age 12 to 36 months).…”

Section: Discussionmentioning

confidence: 48%

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Management of late-detected DDH in children under three years of age

Terjesen

Horn

2020

Bone & Joint Open

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Aims When the present study was initiated, we changed the treatment for late-detected developmental dislocation of the hip (DDH) from several weeks of skin traction to markedly shorter traction time. The aim of this prospective study was to evaluate this change, with special emphasis on the rate of stable closed reduction according to patient age, the development of the acetabulum, and the outcome at skeletal maturity. Methods From 1996 to 2005, 49 children (52 hips) were treated for late-detected DDH. Their mean age was 13.3 months (3 to 33) at reduction. Prereduction skin traction was used for a mean of 11 days (0 to 27). Gentle closed reduction under general anaesthesia was attempted in all the hips. Concurrent pelvic osteotomy was not performed. The hips were evaluated at one, three and five years after reduction, at age eight to ten years, and at skeletal maturity. Mean age at the last follow-up was 15.7 years (13 to 21). Results Stable closed reduction was obtained in 36 hips (69%). Open reduction was more often necessary in patients ≥ 18 months of age at reduction (50%) compared with those under 18 months (24%). Residual hip dysplasia/subluxation occurred in 12 hips and was significantly associated with avascular necrosis (AVN) and with high acetabular index and low femoral head coverage the first years after reduction. Further surgery, mostly pelvic and femoral osteotomies to correct subluxation, was performed in eight hips (15%). The radiological outcome at skeletal maturity was satisfactory (Severin grades 1 or 2) in 43 hips (83%). Conclusions Gentle closed reduction can be attempted in children up to three years of age, but is likely to be less successful in children aged over 18 months. There is a marked trend to spontaneous improvement of the acetabulum after reduction, even in patients aged over 18 months and therefore simultaneous pelvic osteotomy is not always necessary.

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Section: Discussionmentioning

confidence: 48%

“…Although open reduction is more often needed in older patients, there are little objective data on the success of closed reduction according to patient age. 9 - 11 …”

Section: Introductionmentioning

confidence: 99%

Management of late-detected DDH in children under three years of age

Terjesen

Horn

2020

Bone & Joint Open

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“…In early-presenting infants, a Pavlik harness may solve the problem [1,2]. For those who failed the treatment or the early diagnosis, closed reduction (CR) or open reduction (OR) might be necessary within 24 months of age [3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Anterior approach with mini-bikini incision in open reduction in infants with developmental dysplasia of the hip

Wang

Lian

et al. 2020

J Orthop Surg Res

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Purpose: The anterior and medial approaches in open reduction for developmental dysplasia of the hip (DDH) had been widely used. The former could not directly approach the intra-articular interposition, while the latter had been associated with injury to blood vessel and avascular necrosis (AVN) of the femoral head. Meanwhile, the bikini incision had also been mentioned in some studies. The purpose of this study was to introduce a modified anterior approach through a mini-bikini incision and report its short-term outcomes. Methods: Data of DDH patients younger than 2 years at the time of surgery who had received this mini-bikini incision between June 2013 and December 2018 were collected. The surgical technique, operation duration, intraoperative blood loss, and length of incision were recorded in detail. In the latest follow up, the objective measurement of the scar and the subjective feeling towards the scar were collected. X-ray and magnetic resonance imaging (MRI) were performed at the last follow-up, and the incidence of residual dysplasia, redislocation, and femoral head AVN was analyzed. Results: Forty-three cases (49 hips) were included with an averaged follow-up of 43 months. The operation duration was 22 min, and the blood loss was 9.8 ml on average. The length of the scar averaged 2.6 cm. The mean University of North Carolina "4P" scar scale (UNC4P) for the scar was 0.92, and no patients complained numbness. Overall, all the parents were satisfied with the cosmetic appearance. The mean acetabular index (AI) was 27.42°± 6.41°in dislocated hip in the last follow-up. One hip redislocated soon after the operation and was reduced in a closed manner right away. MRI showed improved coverage but still some residual dysplasia that was in accordance with the post-operative recovery nature. Four hips (8%) had signs of AVN in X-ray. Conclusion: Open reduction through the anterior approach with the mini-bikini incision was a safe procedure with comparable outcomes to classical approaches. It would be a complementary approach for DDH patients younger than 2 years old who need an open reduction.

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“…Failure of reduction is a relatively common complication in children with DDH managed by CR with a reported rate ranging from 0% to 25%; 1 , 4 - 10 moreover, failed CR has been reported to be associated with increased avascular necrosis AVN and poor radiographic outcome. 6 , 9 Despite the fact that several predictors for failed CR in children with DDH have been investigated, including the patient’s age at reduction, 11 the severity of the dislocation 1 and the presence of an ossific nucleus at the time of reduction, 12 controversy still exists. Thus, it is meaningful to investigate which factors can be associated with failed CR.…”

Section: Introductionmentioning

confidence: 99%

Poor delineation of labrum and acetabular surface on arthrogram is a predictor of early failure of closed reduction in children aged six to 24 months with developmental dysplasia of the hip

Yuan

Hong

et al. 2020

Journal of Children's Orthopaedics

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Purpose The objective of this study was to explore the predictors for failed reduction in children with developmental dysplasia of the hip (DDH) managed by arthrogram, closed reduction (CR) and spica cast immobilization. Methods We retrospectively reviewed the clinical data of patients with DDH treated by CR and cast immobilization (2015-2020), including age, sex, affected side, presence/absence of an ossific nucleus, International Hip Dysplasia Institute classification, the delineation of labrum and acetabular surface on arthrogram, inverted labrum, acetabular index (AI), hip abduction angle and medial dye pool (MDP) distance. Predictors that potentially predicted failure of CR were evaluated by logistic regression analysis, simple t-test, Fisher’s Exact Test and chi-square test. Results In total, 16 out of 187 hips failed to achieve initial CR (8.6%). Gender, age, preoperative AI and poor delineation of arthrogram were candidate predictors for failed CR in children aged six to 24 months with DDH; on the other hand, logistic regression analysis confirmed age and poor delineation of arthrogram significantly predicted failure of CR. Receive operating characteristic curve (ROC) showed MDP less than 6 mm and age higher than 14.5 months significantly increased the failure rate of CR in children aged six to 24 months with DDH. Conclusion Age and poor delineation of labrum and acetabular surface during arthrogram predicted failure of CR in children with DDH. In particular, age > 14.5 months and MDP distance ≥ 6 mm significantly increased the risk of CR failure. Level of evidence III

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Closed Reduction for Developmental Dysplasia of the Hip: Early-term Results From a Prospective, Multicenter Cohort

Cited by 83 publications

References 37 publications

Management of late-detected DDH in children under three years of age

Management of late-detected DDH in children under three years of age

Anterior approach with mini-bikini incision in open reduction in infants with developmental dysplasia of the hip

Poor delineation of labrum and acetabular surface on arthrogram is a predictor of early failure of closed reduction in children aged six to 24 months with developmental dysplasia of the hip

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