Retrospective Comparison of Outcomes Between Closed and Open Reduction for Developmental Dysplasia of the Hip in Children Aged 6–24 Months

Abstract

Background: This study aimed to compare the early outcomes between closed reduction (CR) and open reduction (OR) in children aged 6-24 months with developmental dysplasia of the hip (DDH) who could be reduced safely and stably by the closed method.Methods: We retrospectively reviewed the medical records of 77 patients who underwent CR or OR treatment for DDH from August 2012 to October 2017. Fifty-one patients (56 hips) underwent CR, while 26 (29 hips) underwent OR. The demographic data, International Hip Dysplasia Institute classi cation, and acetabular index (AI) before reduction were analysed. The centre-edge angle (CEA), AI, Alsberg angle (AA), Reimer's migration index (RMI), and height-to-width index (HWI) of the epiphysis were compared between the CR and OR groups at the nal follow-up. The percentages of avascular necrosis (AVN), residual acetabular dysplasia (RAD), HWI < 0.357, RMI > 33%, AA > 81˚, and coxa magna > 15% of the normal side were calculated.Results: At the nal follow up, the mean AA in the CR and OR groups were 77.66˚ (60˚-89˚) and 81.97( 73˚-91˚) (p=0.001), respectively, and there were 32.14% and 58.62% of the hips with an AA > 81( p=0.019). The frequency of coxa magna > 15% of the normal side was higher in the OR group (60.9%) than in the CR group (6.5%) (p<0.001). There was no difference in the improvement of AI, CEA, HWI, and RMI at the nal follow-up. The percentages of RAD, HWI < 0.357, RMI > 33%, and AVN were not statistically different. Conclusion:In children aged 6-24 months with DDH, if a stable and safe CR can be obtained but with a widening joint space, an OR may not bene t acetabular remodelling more than a CR procedure, and thus, CR should be attempted.

Follow-up Value of Hip Medial Ultrasound in Infants and Children With Developmental Dysplasia of the Hip Treated With Reduction and Spica Casting

“…Spica casting can be used for several months and subsequently changed under general anesthesia to keep the casting clean and not too tight. 2,3 In the evolution of the hip in children with DDH after reduction, the most important clinical concern is the position of the femoral head and its docking relation to the acetabulum, which is required for the normal development of the hip. 4 Several methods, including radiography, 5 computed tomography (CT), 6,7 and magnetic resonance imaging (MRI), 8 have been used to determine the position of the femoral head during spica casting.…”

“…The duration of postreduction cast immobilization varies and should be individually adjusted. Spica casting can be used for several months and subsequently changed under general anesthesia to keep the casting clean and not too tight 2,3 …”