Results of medial open reduction of developmental dysplasia of the hip with regard to walking age

Abstract

This study aimed to evaluate the outcome of medial open reduction for developmental dysplasia of the hip (DDH) in patients before and after walking age. A minimum 5-year radiographic and clinical follow-up compared 29 patients (group 1) before walking age with 38 patients (group 2) after walking age for DDH. The correction ratio of acetabular index was similar in both groups postoperatively (41.8% for group 1 and 44.9% for group 2), and it was statistically not significant (P>0.05). The Kalamchi-MacEwen classification showed no correlation between operative age and the rate of avascular necrosis (P>0.05). This report presents similar complication rates as that of the Severin criteria for medial open reduction of the hip and challenges the conventional belief that a medial open reduction for the treatment of DDH in a walking-age child at short-term to mid-term follow-up has comparable results.

Is Age or Surgical Approach Associated With Osteonecrosis in Patients With Developmental Dysplasia of the Hip? A Meta-analysis

“…Thirty-nine studies [1, 4, 6-8, 11, 13, 14, 16, 18-20, 23, 27, 29, 30, 34, 38, 40, 41, 45, 53, 54, 56, 61, 64, 67, 69, 72, 74, 77, 79, 81, 83-85, 89, 94, 96] [54], older than 6 months [5], between 6 and 18 months old [95], younger than 18 months [43], and younger than 24 months [87]; an anterior approach for patients 12 months or older [57,69]; and no operative treatment at all before 9 months of age [7].…”

“…Sixteen studies [1,4,5,11,14,27,49,53,56,61,62,65,69,88,94,95] statistically analyzed the relationship between age at reduction and the occurrence of osteonecrosis. The analyses of five studies [56,62,69,94,95] were based partly on data that did not reflect our definition of index reduction.…”

“…Additionally, one study [62] found osteonecrosis occurrence increased with age in a comparison of subjects operatively treated 12 months old or younger, 13 to 24 months old, and older than 24 months old. When analyzing only Grade II or greater osteonecrosis, three studies [5,14,53] found no statistically significant relationship between age at reduction and osteonecrosis incidence, whereas one study [65] found average age at medial open reduction to be significantly older for patients who had osteonecrosis develop than for those who did not. None of the 66 reviewed studies statistically analyzed the relationship between operative approach (medial versus anterior) and osteonecrosis occurrence.…”

“…The same is true for DDH treatment by open reduction. Although a correlation between increased age at reduction and osteonecrosis has been reported [49,55,56,62,65], others have found no such association [4,5,11,27,95].…”

Single-stage medial open reduction and Pemberton acetabuloplasty in developmental dysplasia of the hip

“…Avascular necrosis is one of the most feared complications of the treatment for developmental dysplasia of the hip. Reported rates of the incidence of avascular necrosis after medial open reduction vary from 0 to 67% 2 , 3 , 11 – 15 . Extensive capsular dissection, T-shaped capsular incision and ligation of femoral circumflex vessels during the operation were considered responsible for increasing the incidence of avascular necrosis 11 .…”