Native hip dislocation at acetabular fracture predicts poor long-term outcome

IntroductionOnly a handful of studies report outcomes after open reduction for developmental hip dislocation beyond skeletal maturity. For successfully reduced hips it is the outcome into late adulthood on which the results of this intervention should be judged. These studies indicate clearly the importance of preservation of the acetabular growth centres during surgery. The acetabulum must also be addressed when insufficient growth remains reliably to remodel residual dysplasia even after stable, concentric reduction.SummaryComparing the longest-term outcome studies for open reduction to less invasive, but mainly historical, techniques of gradual traction reduction it is unsettling to note that the latter protocols are associated with the best results. Whereas open reduction and innominate osteotomy are practised as originally described by Salter, gradual traction reduction has largely been abandoned.ConclusionsThere are probably aspects of the more time-consuming methods of gradual reduction that do not violate the hip joint capsule that expose the femoral head to a lower risk of femoral head osteonecrosis leading to better long-term outcomes.

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Long-Term Outcome of Secondary Joint Replacement after Acetabular Fracture

European Journal of Trauma ◽

10.1007/s00068-001-1157-9 ◽

2001 ◽

Vol 27 (6) ◽

pp. 301-308 ◽

Cited By ~ 6

Author(s):

Michael R. Sarkar ◽

Emanuel Billharz ◽

Nikolaus Wachter ◽

Lothar Kinzl ◽

Mark Bischoff

Keyword(s):

Joint Replacement ◽

Acetabular Fracture ◽

Term Outcome ◽

Long Term Outcome

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Long-term outcome of closed reduction in late-detected hip dislocation: 60 patients aged six to 36 months at diagnosis followed to a mean age of 58 years

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.12.180024 ◽

2018 ◽

Vol 12 (4) ◽

pp. 369-374 ◽

Cited By ~ 4

Author(s):

T. Terjesen

Keyword(s):

Risk Factors ◽

Closed Reduction ◽

Hip Dislocation ◽

Harris Hip Score ◽

Patient Age ◽

Term Outcome ◽

Long Term Outcome ◽

Patient Âgé

PurposeThe aims of this study on late-detected developmental dislocation of the hip (DDH) were to assess the outcome in patients aged 55 to 60 years and to define prognostic factors.MethodsThe study included 60 patients (74 hips). Primary treatment was skin traction to obtain closed reduction, followed by hip spica plaster cast. There were 52 girls and eight boys with a mean age at reduction of 19.6 months (8 to 37). Criteria for good long-term outcome were no osteoarthritis (OA) or total hip arthroplasty (THA) and modified Harris Hip Score ≥ 80 points.ResultsThe mean patient age at follow-up was 57.7 years (55 to 60). Good long-term clinical and radiographic outcome occurred in 39 of 73 hips (53%). In all, 24 hips (32%) had undergone THA at a mean patient age of 48.1 years (31 to 58). Survival analysis with conversion to THA as endpoint showed a reduction in survival from 100% at patient age 30 years to 62% at 58 years. Risk factors for poor outcome were age at reduction ≥ 1.5 years and residual dysplasia (Severin grades III/IV) at skeletal maturity.ConclusionWith a mean follow-up of patient age 58 years, the outcome of late-detected DDH, treated with traction and closed reduction, was satisfactory in more than half the hips. This indicates that the hip will probably last more than 50 years if risk factors like age at reduction ≥ 1.5 years, residual dysplasia and avascular necrosis are avoided.

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