Risk factors for early redislocation after primary treatment of developmental dysplasia of the hip

Abstract

Background:Re-dislocation after primary treatment of developmental dysplasia of the hip is a serious complication. We analyzed the various risk factors that contribute to re-dislocation, and whether the bony ossific nucleus (ON) confers increased stability against re-dislocation.Materials and Methods:Fifty-five children (60 hips) were classified into three treatment groups: Closed reduction (CR) in 15 children (17 hips), open reduction (OR) in 26 children (28 hips), and OR with bony surgery (ORB) in 14 children (15 hips). The mean age at initial treatment was 16 months (range 6–36 months). Fifty-one hips and 9 hips were Tonnis Grade 4 and 3, respectively. The mean preoperative acetabular index (AI) was 44.82° (range 32°–56°) for the study group. At initial treatment, bony ON was absent in 8 hips and present in 52 hips.Results:No hip developed stiffness and pain after primary treatment. Although the AI index, Tonnis grade, and absence of ossific nucleus were higher in the re-dislocated groups, this was not statistically significant. Excluding the re-dislocations, four children had a fair outcome, 11 had good outcome, and 36 had excellent outcome as per McKay's criteria. In the CR group (17 hips), two children (2 hips) with absent ON had re-dislocation. In the OR group (28 hips), three re-dislocations were seen (three children) at 3, 5, and 7 months, respectively. Two of these had an absent bony ON. In the ORB group (15 hips), one late sub-luxation occurred in a child with absent ON. The mean preoperative AI for the re-dislocated and located group was 44.66° (range 42°–48°) and 44.53° (range 39°–56°), respectively. The postoperative AI was 34.53.Conclusion:The experience of the treating surgeon and technical factors play an overwhelming role in preventing early dislocation. The absence of ON should perhaps alert the surgeon for enhanced spica care, postoperative splinting, and meticulous intra-operative management.

Short versus Long-Leg Hip Spica After Closed Reduction in Developmental Dysplasia of the Hip: A Retrospective Comparative Study

“…The success rate for CR of the hip in the literature varies and changes according to the Tonnis stage, age at time of procedure, previous treatment by other methods, and surgeon experience. 12–14 In general, our results showed overall success rate similar to previous reports in the literature. 4 , 5 , 15 , 16…”

Narrative Review of Complications Following DDH Treatment

“…Some controversy exists regarding very early (prior to presence of the ossific nucleus) reduction as well. Some authors have postulated that delaying reduction until after the presence of an ossific nucleus may be protective against the development of osteonecrosis [56][57][58][59][60][61][62][63][64]. Segal et al evaluated the rate of AVN in the presence or absence of the ossific nucleus, either on ultrasound or radiographs [62].…”

Diferencias entre las técnicas quirúrgicas utilizadas sobre el aductor mediano en pacientes entre 18 y 36 meses de edad con displasia del desarrollo de cadera

“…Lo que nos produce una tasa de 8-20% de reluxación en caderas tratadas por primera vez, la falla en la técnica quirúrgica al tratar de obtener una cabeza concéntrica y estable es de las principales causas del fallo del tratamiento. 17,20,21 El objetivo de este estudio fue definir si existen diferencias entre los procedimientos quirúrgicos sobre el aductor mediano que influyan en la recidiva de la luxación de cadera en pacientes mayores de 18 meses.…”