Closed vs open reduction in developmental dysplasia of the hip: The short-term effect on acetabular remodeling

Abousamra, Oussama; Deliberato, David; Singh, Satbir; Klingele, Kevin E.

doi:10.1016/j.jcot.2019.09.010

Cited by 14 publications

(11 citation statements)

References 17 publications

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“…Contrary to prior reports by Morris et al 7 and Abousamra et al, 11 we did not observe a significant effect of reduction type (open vs. closed) on residual dysplasia. This indicates the clinical effectiveness of both open and closed reduction in patients with DDH at our institution.…”

Section: Discussioncontrasting

confidence: 99%

“…A recent report by Morris et al 7 demonstrated a 41% rate of secondary surgery requirement in patients followed until 10 years of age after open or closed reduction, comparable to prior published rates by Bolland et al (35%) 8 and Luhmann et al (58%). 9 Several studies have attempted to identify risk factors for residual dysplasia in these patients with reports indicating that preoperative femoral head coverage on anteroposterior radiographs, 10 reduction technique (open vs. closed), 8,11 and age at time of reduction 7,12,13 all impact the future development of the hip. In addition, several reports exist regarding the influence of limbus morphology 14,15 and the labrochondral complex, 16 as assessed on postoperative magnetic resonance imaging (MRI), leading to higher rates of residual dysplasia in the short-term.…”

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confidence: 99%

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MRI Predictors of Residual Dysplasia in Developmental Dysplasia of the Hip Following Open and Closed Reduction

Johnson

Gohel²,

Nguyen

et al. 2022

Journal of Pediatric Orthopaedics

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Background: Following open or closed reduction for children with developmental dysplasia of the hip, there remains a significant risk of residual acetabular dysplasia which can compromise the long-term health of the hip joint. The purpose of this study was to use postoperative in-spica magnetic resonance imaging (MRI) data to determine factors predictive of residual acetabular dysplasia at short-term follow-up. Methods: We retrospectively reviewed 63 hips in 48 patients which underwent closed or open reduction and spica casting for developmental dysplasia of the hip. MRI performed in-spica at ∼3-week follow-up were used to assess 11 validated metrics and 2 subjective factors. Acetabular index (AI) was measured on anteroposterior pelvic radiographs at 2-year postoperative followup. Binary logistic regression was then used to identify variables predictive of residual dysplasia, defined as an AI greater than the 90th percentile for age based on historic normative data. Results: Average age at surgical reduction was 9.3 ± 3.2 months. 58.7% (37/63) of reductions were open. A total of 43 (68.3%) hips demonstrated residual acetabular dysplasia at 2 years postoperatively based on normative values. In those with persistent dysplasia, patients were on average older at the time of reduction (10.0 mo ± 3.2 vs. 8.0 mo ± 2.8, P = 0.010) and more likely female (88.4% vs. 60.0%, P = 0.010). Patients with residual dysplasia were more likely to have mild subluxation on postoperative MRI (40.0% vs. 10.5%, P = 0.022). Hips with a cartilaginous acetabular index (CAI) of > 23 degrees were 7.6 times more likely to develop residual dysplasia. Type of reduction (ie, closed vs. open) did not appear to influence the rate of residual dysplasia (P = 0.682). Conclusion:In this series, the rate of residual dysplasia after surgical reduction was higher than most previous reports, with no appreciable difference between closed and open reductions. Older age, female sex, and a higher CAI were associated with a greater risk of persistent radiographic dysplasia. In particular, hips with a CAI > 23 degrees were 7.6 times more likely to be dysplastic at 2-year follow-up.

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Section: Discussioncontrasting

confidence: 99%

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confidence: 99%

MRI Predictors of Residual Dysplasia in Developmental Dysplasia of the Hip Following Open and Closed Reduction

Johnson

Gohel²,

Nguyen

et al. 2022

Journal of Pediatric Orthopaedics

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“…In this study, those treated without a pelvic osteotomy at the time of index reduction had double the risk of developing RAD (78.0% at 2 years) as those treated with an osteotomy (39.0% at 1 year). These rates are much higher than previous reports, which more often have shown rates of RAD around 20% with a follow-up period of 1-2 years 20,31. However, these analyses did not use age-adjusted acetabular index values for defining RAD and often relied on rates of further corrective surgery, the indications for which are largely subjective.…”

Section: Discussionmentioning

confidence: 80%

“…These rates are higher than previous reports, which more often have shown rates of RAD around 20% with a follow-up period of 1-2 years. 20,31 However, these analyses did not use ageadjusted acetabular index values for defining RAD and often relied on rates of further corrective surgery, the indications for which are largely subjective. Notably, among patients without an osteotomy, the average age at open reduction did not differ between those who did and did not develop RAD.…”

Section: Discussionmentioning

confidence: 99%

A Prospective, Multicenter Study of Developmental Dysplasia of the Hip: What Can Patients Expect After Open Reduction?

Kiani

Gornitzky

Matheney

et al. 2023

Journal of Pediatric Orthopaedics

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Background: Although there are several predominantly single-center case series in the literature, relatively little prospectively collected data exist regarding the outcomes of open hip reduction (OR) for infantile developmental dysplasia of the hip (DDH). The purpose of this prospective, multi-center study was to determine the outcomes after OR in a diverse patient population. Methods: The prospectively collected database of an international multicenter study group was queried for all patients treated with OR for DDH. Minimum follow-up was 1 year. Proximal femoral growth disturbance (PFGD) was defined by consensus review using Salter’s criteria. Persistent acetabular dysplasia was defined as an acetabular index >90th percentile for age. Statistical analyses were performed to compare preoperative and operative characteristics that predicted re-dislocation, PFGD, and residual acetabular dysplasia. Results: A cohort of 232 hips (195 patients) was identified; median age at OR was 19 months (interquartile range 13 to 28) and median follow-up length was 21 months (interquartile range 16 to 32). Re-dislocation occurred in 7% of hips (n=16/228). The majority (81%; n=13/16) occurred in the first year after initial OR. Excluding patients with repeat dislocation, 94.5% of hips were IHDI 1 at most recent follow-up. On the basis of strict radiographic review, some degree of PFGD was present in 44% of hips (n=101/230) at most recent follow-up. Seventy-eight hips (55%) demonstrated residual dysplasia compared with established normative data. Hips that had a pelvic osteotomy at index surgery had about half the rate of residual dysplasia (39%; n=32/82) versus those without a pelvic osteotomy with at least 2 years follow-up (78%; n=46/59). Conclusions: In the largest prospective, multicenter study to date, OR for infantile DDH was associated with a 7% risk of re-dislocation, 44% risk of PFGD, and 55% risk of residual acetabular dysplasia at short term follow-up. The incidence of these adverse outcomes is higher than previous reports. Patients treated with concomitant pelvic osteotomy had lower rates of residual dysplasia. These prospectively collected, multicenter data provide better generalizable information to improve family education and appropriately set expectations. Level of Evidence: Level II, prospective comparative study.

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“…This is due to the dearth of reliable evidence-based research that compares CR and OR and the lack of homogeneity among patients in previous cohorts. [13,14] Within the author's clinical unit, some physicians accept CR that is safe (hip abduction < 65˚ that can maintain reduction) and stable (safe zone > 30˚) [15], whereas others only accept complete concentric reduction whose MDP is less than 2mm [11,12] on the intraoperative radiography for children aged 6-24 months with DDH. Therefore, some patients with DDH who underwent safe and stable CR required subsequent OR due to widening of the joint space.…”

Section: Introductionmentioning

confidence: 99%

Retrospective Comparison of Outcomes Between Closed and Open Reduction for Developmental Dysplasia of the Hip in Children Aged 6–24 Months

Zhou²,

Li³

et al. 2022

JOIO

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Background: This study aimed to compare the early outcomes between closed reduction (CR) and open reduction (OR) in children aged 6-24 months with developmental dysplasia of the hip (DDH) who could be reduced safely and stably by the closed method.Methods: We retrospectively reviewed the medical records of 77 patients who underwent CR or OR treatment for DDH from August 2012 to October 2017. Fifty-one patients (56 hips) underwent CR, while 26 (29 hips) underwent OR. The demographic data, International Hip Dysplasia Institute classi cation, and acetabular index (AI) before reduction were analysed. The centre-edge angle (CEA), AI, Alsberg angle (AA), Reimer's migration index (RMI), and height-to-width index (HWI) of the epiphysis were compared between the CR and OR groups at the nal follow-up. The percentages of avascular necrosis (AVN), residual acetabular dysplasia (RAD), HWI < 0.357, RMI > 33%, AA > 81˚, and coxa magna > 15% of the normal side were calculated.Results: At the nal follow up, the mean AA in the CR and OR groups were 77.66˚ (60˚-89˚) and 81.97( 73˚-91˚) (p=0.001), respectively, and there were 32.14% and 58.62% of the hips with an AA > 81( p=0.019). The frequency of coxa magna > 15% of the normal side was higher in the OR group (60.9%) than in the CR group (6.5%) (p<0.001). There was no difference in the improvement of AI, CEA, HWI, and RMI at the nal follow-up. The percentages of RAD, HWI < 0.357, RMI > 33%, and AVN were not statistically different. Conclusion:In children aged 6-24 months with DDH, if a stable and safe CR can be obtained but with a widening joint space, an OR may not bene t acetabular remodelling more than a CR procedure, and thus, CR should be attempted.

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Closed vs open reduction in developmental dysplasia of the hip: The short-term effect on acetabular remodeling

Cited by 14 publications

References 17 publications

MRI Predictors of Residual Dysplasia in Developmental Dysplasia of the Hip Following Open and Closed Reduction

MRI Predictors of Residual Dysplasia in Developmental Dysplasia of the Hip Following Open and Closed Reduction

A Prospective, Multicenter Study of Developmental Dysplasia of the Hip: What Can Patients Expect After Open Reduction?

Retrospective Comparison of Outcomes Between Closed and Open Reduction for Developmental Dysplasia of the Hip in Children Aged 6–24 Months

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