Long-term outcome of closed reduction in late-detected hip dislocation: 60 patients aged six to 36 months at diagnosis followed to a mean age of 58 years

Abstract

PurposeThe aims of this study on late-detected developmental dislocation of the hip (DDH) were to assess the outcome in patients aged 55 to 60 years and to define prognostic factors.MethodsThe study included 60 patients (74 hips). Primary treatment was skin traction to obtain closed reduction, followed by hip spica plaster cast. There were 52 girls and eight boys with a mean age at reduction of 19.6 months (8 to 37). Criteria for good long-term outcome were no osteoarthritis (OA) or total hip arthroplasty (THA) and modified Harris Hip Score ≥ 80 points.ResultsThe mean patient age at follow-up was 57.7 years (55 to 60). Good long-term clinical and radiographic outcome occurred in 39 of 73 hips (53%). In all, 24 hips (32%) had undergone THA at a mean patient age of 48.1 years (31 to 58). Survival analysis with conversion to THA as endpoint showed a reduction in survival from 100% at patient age 30 years to 62% at 58 years. Risk factors for poor outcome were age at reduction ≥ 1.5 years and residual dysplasia (Severin grades III/IV) at skeletal maturity.ConclusionWith a mean follow-up of patient age 58 years, the outcome of late-detected DDH, treated with traction and closed reduction, was satisfactory in more than half the hips. This indicates that the hip will probably last more than 50 years if risk factors like age at reduction ≥ 1.5 years, residual dysplasia and avascular necrosis are avoided.

Open reduction, Dega osteotomy and proximal femoral osteotomy in delayed diagnosis of developmental hip dislocation: Outcome at 40-year follow-up

“…Even excluding mild AVN cases (AVN grade 1), our study’s AVN rate is 63.2%, despite performing shortening PFO in 96% of treated joints to lower the acetabulum pressure on the femoral head. Terjesen 33 reported an AVN rate of 8.1% and Thomas et al 35 of 5.7%, while not performing shortening PFO. It might suggest that the natural history of untreated DDH is more responsible for AVN development than excessive femoral head pressure.…”

“…To our knowledge, only three studies [33][34][35] have assessed the treatment outcome of DDH patients with comparable follow-up length (Table 4). Our material hips survivorship is worse at 40-years than in Terjesen 33 or Thomas et al's 34 studies by 32% and 23%, respectively.…”

“…To our knowledge, only three studies [33][34][35] have assessed the treatment outcome of DDH patients with comparable follow-up length (Table 4). Our material hips survivorship is worse at 40-years than in Terjesen 33 or Thomas et al's 34 studies by 32% and 23%, respectively. Higher median patient age at operation in this study might drive this difference and influence much higher AVN rates than in other studies.…”

Management and effects of residual limbus inversion following closed reduction in developmental hip dysplasia: Protocol for a multicenter randomized controlled trial

“…Among these, RAD is the most common complication of DDH closed reduction treatment. A prospective multicenter study conducted by Sankar et al ( 2 ) found that even with stable closed reduction, approximately 11% of children still had residual dysplasia, and long-term follow-up results of a study by Terjesen ( 3 ) noted a higher statistic of up to 38%. RAD is the main cause of osteoarthritis (OA) in young adults ( 4 , 5 ) which often requires total hip replacement (THR).…”

Special symposium issue: Developmental dysplasia and dislocation of the hip

“…The longest follow-up in DDH seems to be the study on closed reduction from Norway. 11 In patients aged 1.5 to three years, skin traction to obtain gradual closed reduction resulted in 76% survival at patient age 50 years and 54% survival at 58 years. This indicates that gradual reduction by traction, although the method has largely been abandoned, has similar long-term outcome as open reduction combined with Salter osteotomy.…”