Re-dislocation following open reduction for developmental dysplasia of the hip

Abstract

We have reviewed 17 patients (18 hips) who required repeat open reduction for recurrent or persistent dislocation after a previous attempt at open reduction for developmental dysplasia of the hip (DDH). The mean follow-up was 5.5 (3-15) years. At the review, five patients were limping and had limited hip motion but no pain. Six hips were classified as Severin class III or more, and avascular necrosis was evident in 11. We suggest that technical failure is usually the cause for re-dislocation in unilateral cases, as we discovered at repeat open reduction in five of six patients with unilateral dislocation. The biological behaviour of bilateral dislocations may in someway be different since in nine of 11 patients with bilateral dislocations, no obvious cause could be attributed. The outcome is usually poor.Résumé Nous avons examiné 17 malades (18 hanches) qui ont nécessité une réduction ouverte répétitive de la hanche pour une luxation récidivante ou persistante après une première réduction ouverte pour dysplasie congénitale (DDH). Le suivi moyen était de 5,5 ans (3-15). À la ré-vision cinq malades boitaient et avaient une limitation des amplitudes articulaires mais aucune douleur. Six hanches ont été classées comme Severin classe III ou plus et une nécrose avasculaire était présente dans 11 hanches. Nous suggérons que l'échec technique est la cause des luxations récidivantes dans les cas unilatéraux, comme nous l'avons constaté lors de la nouvelle réduction chez 5 des 6 malades avec luxation unilatérale. Le comportement des luxations bilatérales est différent puisque chez 9 des 11 malades avec luxation bilatérale aucune cause évidente ne pouvait être attribuée. Le résultat est habituellement mauvais.

Outcomes following open reduction for late-presenting developmental dysplasia of the hip

“…The incidence following open reduction is up to 8%, however, the rate is lower following open reduction combined with a pelvic osteotomy. 22,26,27 In the present cohort, the redislocation rate was 2%, however, the rate was 5.5% in the patients who underwent open reduction alone. The addition of a pelvic osteotomy in our cohort was based on the discretion of the senior surgeon, this was done routinely in patients over 18 months and only once in a patient younger than 18 months (16 months at the time of surgery).…”

Risk Factors for Failure After Open Reduction for DDH

“…1,2 These failures remain a challenging clinical problem as revision surgery has been associated with high rates of stiffness, residual dysplasia, and avascular necrosis (AVN). [2][3][4] Earlier studies have attempted to explain the reasons for redislocation of the hip after open reduction but have been limited by their small size and their uncontrolled nature. In most cases, the cause of failure has been attributed to technical shortcomings such as inadequate release of the psoas tendon, transverse acetabular ligament, or inferomedial capsule.…”

Sutura simples e âncora em quadris de coelhos

“…17 A relatively frequent complication in the treatment of DDH is the recurrence of dislocation, with loss of the reduction obtained previously. 18 The stability of the open reduction depends on several factors, including mechanical resistance of the articular capsule.…”