Does Open Reduction of the Developmental Dislocated Hip Increase the Risk of Osteonecrosis?

Pospischill, Renata; Weninger, Julia; Rudolf, G.; Altenhuber, J; Grill, Franz

doi:10.1007/s11999-011-1929-4

Cited by 75 publications

(95 citation statements)

References 27 publications

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“…Since then, we have continued to use preliminary traction to decrease the risk of complications in case of closed reduction, as reported by others [24,51,57]. The effect of preoperative traction has been questioned for surgical treatment of DDH since all the anatomic obstacles to hip reduction are surgically eliminated [35,59,64,82].…”

Section: Discussionmentioning

confidence: 96%

Developmental Dislocation of the Hip Successfully Treated by Preoperative Traction and Medial Open Reduction: A 22-year Mean Followup

Farsetti

Caterini

Potenza

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background During the last 35 years, the medial approach has been reported more frequently than the anterior approach for open reduction of developmental dislocation of the hip (DDH), however, few studies have followed children treated by medial open reduction to adulthood. Questions/purposes The purposes of our study were: (1) to assess the development of 71 completely dislocated hips after medial open reduction, the incidence of additional surgery and avascular necrosis during the followup period, and the long-term radiographic and functional results; and (2) to compare our results with those obtained by others who performed open reduction either by the medial or anterior approach. Patients and Methods We retrospectively evaluated, after the end of growth, 71 hips in 52 patients who underwent open reduction by the medial approach. The mean age of the patients was 16 months (range, 3-36 months). After surgery, the hips were immobilized in 100°flexion, 60°a bduction, and neutral rotation for an average of 6 months. All patients had staged clinical and radiographic followups until skeletal maturity. The length of followup averaged 22 years (range, 13-32 years). Results In all the surgically treated hips, the acetabular index normalized by the end of growth, the incidence of avascular necrosis was 18%, and additional surgery was required in 15% of our cases. At the last followup, 93% of the hips were classified as Severin Classes I or II and 7% as Class III; 76% of the hips had an excellent result, 17% had a good result, and 7% had a fair result according to the McKay scale as modified by Barrett and colleagues. Conclusions Open reduction of DDH through a medial approach provided good long-term radiographic and functional results in patients 3 to 36 months old and it was the only surgery performed in 85% of our cases. Future comparative studies are needed to confirm our results, especially in older children. Level of evidence Level IV, therapeutic study.

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Section: Discussionmentioning

confidence: 96%

Developmental Dislocation of the Hip Successfully Treated by Preoperative Traction and Medial Open Reduction: A 22-year Mean Followup

Farsetti

Caterini

Potenza

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…The rates of necrosis of the femoral head are described in literature as ranging between 0 and 69 % [15,16]. In contrast to the medial approach, the rate of necrosis of the femoral head appears to be lower when an anterior approach is used.…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic reduction and acetabuloplasty for the treatment of dislocated hips in children of walking age: a preliminary report

Eberhardt

Wirth

Fernández

2014

Arch Orthop Trauma Surg

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We can conclude that the standardized arthroscopic surgical technique presented here can also be used to safely perform arthroscopic reduction in toddlers. The new arthroscopic method is an alternative to open reduction for selective hip dislocations. We believe this approach can be used to treat dislocated hips that are classified as grades 2 and 3 dislocations according Tönnis. Early results are promising. Medium-term results are needed to make a definitive statement on the rates of necrosis of the femoral head.

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“…Reports often pool results from a variety of different surgical approaches undertaken in ill-defined patient groups with broad age ranges and varying degrees of followup [25,27,35]. Given the complexities of the data reported, it is difficult to appraise the literature to appropriately advise parents on the effectiveness and potential harms associated with surgical intervention their child may face.…”

Section: Introductionmentioning

confidence: 99%

How Does Bony Surgery Affect Results of Anterior Open Reduction in Walking-age Children With Developmental Hip Dysplasia?

Kothari

Grammatopoulos

Hopewell

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Anterior open reduction is commonly used to treat hip subluxation or dislocation in developmental dysplasia of the hip (DDH) in walking-age children. Pelvic and/ or femoral osteotomy may be used in addition, but it is unclear how this affects avascular necrosis (AVN) risk and radiological and clinical results. Questions/purposes The purpose of this study was to review studies of walking-age patients treated either with an open reduction alone or combined with pelvic and/or femoral osteotomies and determine whether there is a difference between groups in the proportion of patients: (1) developing clinically relevant femoral head AVN (Kalamchi & MacEwen Types II to IV or equivalent); (2) achieving a satisfactory radiological result (Severin Grade I/II or equivalent); (3) achieving a satisfactory clinical result (McKay excellent or good rating or equivalent); and (4) requiring further nonsalvage surgery. Methods MEDLINE, Embase, the Cochrane Centre Register of Controlled Trials, and ClinicalTrials.gov were searched for studies of anterior open reduction for DDH in children aged 12 months to 6 years old. We assessed AVN, clinical and radiological results, and requirement for further procedures. The effect of failed conservative management, traction, age at operation, and followup duration was also assessed. Eighteen studies met the review eligibility criteria. Conclusions Open reduction with concomitant pelvic osteotomy is the most appropriate option to provide durable results with the lowest risk of AVN and best radiological and clinical results. There is no evidence that addition of a femoral osteotomy provides any additional benefit to the patient, although it may be necessary to achieve reduction. Level of Evidence Level III, therapeutic study.

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Does Open Reduction of the Developmental Dislocated Hip Increase the Risk of Osteonecrosis?

Abstract: We advocate early reduction of the dislocated hip in the first year of life to avoid the need for concomitant osteotomies combined with open reduction.

Cited by 75 publications

References 27 publications

Developmental Dislocation of the Hip Successfully Treated by Preoperative Traction and Medial Open Reduction: A 22-year Mean Followup

Developmental Dislocation of the Hip Successfully Treated by Preoperative Traction and Medial Open Reduction: A 22-year Mean Followup

Arthroscopic reduction and acetabuloplasty for the treatment of dislocated hips in children of walking age: a preliminary report

How Does Bony Surgery Affect Results of Anterior Open Reduction in Walking-age Children With Developmental Hip Dysplasia?

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