Early predictors of acetabular growth after closed reduction in late detected developmental dysplasia of the hip

Abstract

This study evaluates improvement of the acetabular index (AI) in patients with developmental dysplasia of the hip at 4 years after closed reduction, and determines the association between the final AI and a set of factors. Sixty-two patients (74 hips) treated with closed reduction were categorized into three groups according to age: group A (0-12 months, 18 hips), group B (13-18 months, 24 hips), and group C (>18 months, 32 hips). There was no difference in AI among the three groups before reduction (P=0.293). In groups A and C, the AI decreased significantly over time until 3 years after reduction and no differences were observed between the time points of 3 and 4 years. At 4 years after reduction, the AI of group C was significantly higher than that of groups A (P<0.001) and B (P=0.012). The overall AI improvement rate was 28.63%. The AI improvement rate of group A was significantly higher than that of group C (P=0.005). Pearson correlation analysis indicated no correlation between center-head distance discrepancy and the final AI (P=0.811). Linear regression suggested that age and initial AI correlated significantly with the final AI (R=0.617, F=15.031, P<0.001). Other factors, such as sex, center-edge angle of Wiberg, bilaterally involved, and avascular necrosis of the femoral head, showed no correlations with the final AI (P>0.05). According to the coefficients, initial AI (β1=0.432, P<0.001) had greater effect than age (β2=0.197, P=0.023) on the final AI. In conclusion, the AI decreases in all patients after reduction and stabilizes at 3 years after reduction. The AI improvement rate is correlated negatively with age. Age and initial AI are early predictors of the progress of AI after closed reduction in developmental dysplasia of the hip patients.

Does Perfusion MRI After Closed Reduction of Developmental Dysplasia of the Hip Reduce the Incidence of Avascular Necrosis?

“…A concentric reduction of the hip is also crucial for continued acetabular growth and development [16]. Consistent with prior studies, both of our cohorts showed continued improvement of their dysplasia as measured by AI and International Hip Dysplasia Institute criteria for approximately 3 to 4 years after closed reduction [3,16,33,36]. We saw no differences between the groups in terms of initial or final acetabular dysplasia.…”

“…In their review of the literature, Cooper et al [8] found a wide range in reported AVN rates between 3% and 60%, which they attributed to variations in the definition of AVN and the length of followup. In a more recent sample [4,6,7,16,19,21,24,30,34], AVN rates varied more consistently between 7% and 36%, but again a wide variety of radiographic criteria was used to identify AVN. In this study, we used Salter criteria as did Tiderius et al [34].…”

“…Although many studies looking at both open and closed reduction have shown a protective response with respect to its presence [4,6,27], studies looking more specifically at closed reduction have shown no effect [7,18,30,35]. Some studies have linked older age at treatment to an increased risk of AVN [30,35] and an increased rate of residual dysplasia [16], whereas others have concluded younger age has either no influence [3,16,18,27] or a negative effect on AVN rates [15,25]. Furthermore, early reduction takes advantage of the acetabulum's increased remodeling potential at young ages [18,23,27] and may improve clinical outcomes [20] and reduce the need for future corrective surgeries [17].…”

Association between open or closed reduction and avascular necrosis in developmental dysplasia of the hip

“…Many studies have reported that age at the time of reduction had no effect on the incidence of AVN. [27,30,47–49] However, considering that our analysis included few studies, further research is needed to confirm whether age at the time of reduction is a risk factor for AVN.…”

Serum prolidase activity and oxidative–antioxidative status in patients with developmental dysplasia of the hip and its relationship with radiographic severity

“…10,18 DDH is one of the most common congenital disorders of the lower limbs that evolves over time. 19 At birth, the neonatal acetabulum is completely composed of cartilage, with a thin rim of fibrocartilage called the labrum. The ligamentum teres also elongates and thickens, and it may take up valuable space within the acetabulum.…”