Outcomes of Open Reduction in Children With Developmental Hip Dislocation: A Multicenter Experience Over a Decade

Abstract

Background: Open reduction of the hip is commonly performed in children with severe developmental dysplasia of the hip, or in cases that are refractory to nonoperative forms of treatment. The open reduction has been associated with numerous complications including avascular necrosis (AVN) of the femoral head, the need for reoperation, and residual radiographic dysplasia. This study seeks to determine the effects of preoperative severity of dysplasia, associated procedures (femoral and acetabular osteotomies), age on AVN, and the need for reoperation. Methods: Children with developmental dysplasia of the hip and a minimum of 2 years of follow-up who underwent open reduction were identified. The following data points were recorded: sex, laterality of hip involvement, simultaneous procedures, surgical approach used, age, acetabular index, and International Hip Dysplasia Institute grade. We analyzed the effects of preoperative International Hip Dysplasia Institute, age, surgical approach (anterior/medial), bilateral reduction, and simultaneous femoral shortening or pelvic osteotomy on the outcomes of AVN and reoperation. Results: One hundred eighty-five hips in 149 patients were included in this study with an average follow-up of 4 years (range: 2 to 5 y). The average age at index surgery was 23 months (range: 1 to 121 mo). Overall, 60 hips (32.4%) required secondary surgical procedures at an average age of 58.5 months. High-grade AVN was noted in 24 hips (13.0%) and was found to be associated with the severity of the hip dislocation (P = 0.02). A higher rate of reoperation was found in children over 18 months at the time of open reduction who did not receive an acetabular osteotomy (P = 0.012). Conclusion: Approximately 1/3 of patients require another operative intervention within the first 4 years after open reduction of the hip. We found the severity of hip dislocation to be associated with a higher risk of AVN development. These findings support performing an acetabular osteotomy in children over 18 months of age at the time of open reduction to decrease the likelihood of requiring future reoperation during the first 4 years after the index procedure. Level of Evidence: Level III.

Children’s orthopaedics

“…In a multicentre study of six tertiary centres, led by authors from St Louis (Missouri, USA) , the participating children were identified with developmental hip dislocation who had undergone open reduction and had a minimum follow-up of two years. 1 Data were collected over ten years, and key data were recorded including the patient’s age, sex, concurrent procedures, surgical approach, acetabular index, and International Hip Dysplasia Institute grade. The study team then went on to analyze how the severity of hip dysplasia, age, surgical approach, and the use of additional procedures such as femoral or acetabular osteotomies influenced the occurrence of AVN of the femoral head and the need for reoperation.…”

What’s New in Pediatric Orthopaedics

“…In a prospective, multicenter study of infantile developmental dysplasia of the hip, open reduction was associated with a 7% risk of redislocation, a 44% risk of proximal femoral growth disturbance, and a 55% risk of residual acetabular dysplasia, but a concomitant pelvic osteotomy yielded about one-half the rate of residual dysplasia at the 2-year follow-up 34 . Another multicenter study of children who had an open reduction for developmental dysplasia of the hip found that 63 (33.7%) of 187 hips required secondary surgical procedures at a mean age of 58.5 months 35 . A high rate of reoperation was noted in children >18 months of age at the time of open reduction who did not receive an acetabular osteotomy.…”