Redislocation After Posteromedial Open Reduction in Developmental Dysplasia of the Hip: Analyzing the Risk Factors and Determining the Optimal Treatment Method

Abstract

Background: Redislocation, which is one of the most serious problems in developmental dysplasia of the hip (DDH), might occur because of several reasons. Regardless of the treatment, redislocations are reported to be associated with high complication rates in the literature. Our objective was to identify the risk factors for redislocation in the patients treated for DDH and to determine the optimal treatment method for redislocations. Methods: Patients with DDH who were treated with the limited posteromedial approach in our clinic between 1993 and 2021 and followed up prospectively were examined in this single-centered study. The participants were assigned into 2 groups: a study group consisting of 25 hips of 17 patients with redislocation and a control group consisting of 502 hips of 390 patients without redislocation. To determine the risk factors for redislocation, demographic data, known risk factors for DDH, preoperative Tönnis stage, and whether the capsule was opened or not were evaluated. To determine the optimal treatment method, a subgroup analysis based on applied treatment (closed reduction and cast replacement vs. repeating open reduction) was conducted, and recurrent redislocation, complication, and secondary surgery rates were evaluated. Results: Bilaterality and high-grade hip dislocations were found to be associated with higher odds ratio (OR) for redislocation [P = 0.007, OR = 3.64, 95% confidence interval (CI), 1.3 to 8.8; and P = 0.006, OR = 4.52, 95% CI, 1.37 to 14.91, respectively].Recurrent redislocation and complication rates were found to be significantly higher in redislocations treated with closed reduction and cast replacement (P = 0.007 and P = 0.015, respectively). Conclusions: Bilaterality and higher preoperative Tönnis stage are critical risk factors for redislocation after open reduction in DDH. It should be kept in mind that closed reduction and cast replacement is associated with higher rates of recurrent redislocation and complications, and redislocation cases should be treated by repeating open reduction.

Bilateral Involvement in Developmental Dislocation of the Hip: Analysis of 561 Patients Operated on Using the Limited Posteromedial Approach

“…In 2016, a study in Jordan reported a bilateral involvement rate of 60.5% in Jordanian men [24]. Studies conducted in our country report bilateral involvement rates ranging from 22 to 29% in DDH cases [7,8,21]. Regional differences in the incidence of bilateral involvement in patients with developmental dysplasia of the hip imply that racial and genetic factors may contribute to this parameter.…”

“…There were several studies in the literature that supported our hypothesis. A 2022 study explored the development of redislocation in patients with DDH who underwent surgery via the limited posteromedial approach and reported that bilateral involvement emerged as a critical risk factor for redislocation [7]. Similarly, in 2011, an analysis indicated that bilateral involvement is a risk factor for redislocation after open reduction [28].…”

“…For patients with redislocation, the routine treatment protocol in our clinic is to change the hip-spica cast under general anesthesia. If adequate stability cannot be achieved perioperatively or in recurrent redislocation cases, open reduction is repeated, and in a few cases where stability cannot be achieved and redislocation persists, osteotomy procedures are performed, as suggested and discussed in the literature [7].…”

“…Redislocation, residual acetabular dysplasia (RAD), and avascular necrosis of the femoral head (AVN) are among the most prevalent complications following developmental dysplasia of the hip (DDH). By identifying the factors that contribute to these complications and adopting preventative measures, one can mitigate the morbidity and disability associated with DDH [6][7][8][9]. In a recent study performed, it was determined that bilateral involvement is an important risk factor for redislocation [7].…”

“…By identifying the factors that contribute to these complications and adopting preventative measures, one can mitigate the morbidity and disability associated with DDH [6][7][8][9]. In a recent study performed, it was determined that bilateral involvement is an important risk factor for redislocation [7]. Over the years, researchers have found that bilateral involvement is associated with redislocation, residual acetabular dysplasia, and avascular necrosis.…”