Treatment of Developmental Dysplasia of the Hip After Walking Age With Open Reduction, Femoral Shortening, and Acetabular Osteotomy

Purpose Patients with late-presenting developmental dysplasia of the hip (DDH) are more likely to require an open reduction. Since many developing countries do not have mandated screening, there continues to be a relatively high incidence of late-presenting DDH. We report the clinical and radiographic outcomes of open reduction in a series of patients who presented late. Patients and methods This was a retrospective review of 712 hips in 645 patients that underwent open reduction, alone or in combination with a pelvic osteotomy. In all, 91 hips had open reduction alone and 621 had open reduction and pelvic osteotomy. Femoral shortening was performed in 221 hips. The mean age at the time of surgery was 2.1 years (1 to 6.5) and the mean follow-up time was 9.3 years (6 to 14). We used the Children’s Hospital Oakland Hip Evaluation Score (CHOHES) to determine functional outcomes and the Severin classification was used to evaluate radiographic outcomes. The rate of avascular necrosis (AVN) and the need for a reoperation were also recorded and analyzed. Results In all 80% (570 hips) had good radiographic outcomes (Severin type I or II) and 87% had a CHOHES score of > 90 at final follow up. There was a 14% rate of AVN and only a 2% rate of redislocation. Better radiographic outcomes and lower reoperation rates were seen with patients who underwent both an open reduction and pelvic osteotomy. A trend was observed towards worse outcomes in older patients. Conclusions There was a high rate of good clinical and radiographic outcomes at a minimum six-year follow-up in patients with late-presenting DDH who underwent open reduction. Those who underwent open reduction in combination with a pelvic osteotomy had a higher rate of good radiographic outcomes and a lower rate of complications, particularly reoperation.

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Predicting acetabular growth in developmental dysplasia of the hip following open reduction after walking age

Journal of Orthopaedic Science ◽

10.1016/j.jos.2018.09.015 ◽

2019 ◽

Vol 24 (2) ◽

pp. 326-331 ◽

Cited By ~ 3

Author(s):

Takamasa Miyake ◽

Tomonori Tetsunaga ◽

Hirosuke Endo ◽

Kazuki Yamada ◽

Tomoaki Sanki ◽

...

Keyword(s):

Open Reduction ◽

Developmental Dysplasia ◽

Walking Age ◽

Dysplasia Of The Hip

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An Unusual Complication Seen in a Six-Year-Old Girl Treated with Open Reduction and Pemberton Osteotomy for Neglected Developmental Dysplasia of the Hip: A Femoral Neck Fracture Sustained during Passive Motion under General Anesthesia

Case Reports in Orthopedics ◽

10.1155/2014/804098 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4

Author(s):

Vedat Uruc ◽

Samet Karabulut

Keyword(s):

Femoral Neck ◽

General Anesthesia ◽

Open Reduction ◽

Joint Stiffness ◽

Developmental Dysplasia ◽

Unusual Complication ◽

Passive Motion ◽

Femoral Shortening ◽

Neck Fracture ◽

Dysplasia Of The Hip

Despite the screening programs for newborn children with hip ultrasonography, neglected developmental dysplasia of the hip (DDH) is still continuing to be a problem in the east and southeast parts of our country. The main complications are redislocation, avascular necrosis, and joint stiffness. We present an unusual complication, femoral neck fracture during passive motion under general anesthesia, of a six-year-old girl with neglected DDH treated by open reduction and Pemberton osteotomy without femoral shortening. The fracture was treated by open reduction and internal fixation combined with proximal femoral shortening. After 5 years the patient had excellent clinical results, no avascular necrosis was seen, and the radiologic appearance was type IA according to modified Severin classification. In conclusion older children with neglected DDH are more likely to have joint stiffness after open reduction. If there is even a little doubt about joint stiffness after open reduction, one should not refrain from femoral shortening. Also passive motion under general anesthesia should be applied very carefully with fluoroscopic control.

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The effect of femoral shortening in the treatment of developmental dysplasia of the hip after walking age

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.13.190029 ◽

2019 ◽

Vol 13 (4) ◽

pp. 371-376

Author(s):

P. Castañeda ◽

L. Moscona ◽

K. Masrouha

Keyword(s):

Femoral Head ◽

Developmental Dysplasia ◽

Level Of Evidence ◽

High Tension ◽

Femoral Shortening ◽

Data Collection Instrument ◽

Hip Reduction ◽

Walking Age ◽

The Mean ◽

Dysplasia Of The Hip

Purpose The optimal treatment for late-presenting developmental dysplasia of the hip (DDH) is controversial. High tension forces after hip reduction increase the pressure on the femoral head, potentially causing avascular necrosis. Femoral shortening (FS) is commonly used as a means to decrease the pressure on the femoral head. We examined the effect of FS on the outcomes of patients with late-presenting DDH. Methods A total of 645 hips of a late-presenting DDH cohort treated with open reduction and iliac osteotomies were retrospectively reviewed; 328 hips had a FS performed (FS+) and 317 (FS-) had not. The mean age was 3.9 years (sd 1.55). We classified the hips with the Tönnis and International Hip Dysplasia Institute (IHDI) methods; and the Pediatric Outcomes Data Collection Instrument (PODCI), Iowa Hip Score (IHS) and Severin classification as outcome measurements. Results The FS- group had higher scores in PODCI (median 95 points; interquartile range (IQR) 78 to 91) and IHS (median 91 points; IQR 64 to 88) than the FS+ group (PODCI: median 94 points; IQR 69 to 89 points; IHS: median 89 points; IQR 62 to 87). The mean Severin scores were similar (FS- 2.65; FS+ 2.5; p = 0.93) but the FS– group had higher rates of good and excellent outcomes (FS- 56%; FS+ 41%; p < 0.00001) and lesser dislocation rates (FS- 6%; FS+ 14%; p = 0.16). Conclusion Although FS should be used when a hip cannot be reduced without undue tension, our results indicate that this procedure is not necessarily related to a better outcome. Level of evidence: Therapeutic, Level III.

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Prediction of the requirement of open reduction for developmental dysplasia of the hip

Journal of International Medical Research ◽

10.1177/0300060517717357 ◽

2017 ◽

Vol 46 (1) ◽

pp. 54-61 ◽

Cited By ~ 8

Author(s):

Nabil Alassaf

Keyword(s):

Open Reduction ◽

Area Under The Curve ◽

Internal Validity ◽

Developmental Dysplasia ◽

Estimation Model ◽

Cross Sectional ◽

Noninvasive Treatment ◽

Dysplasia Of The Hip ◽

Logistic Regression Equation ◽

Objective Tool

Objective Closed reduction (CR) is a noninvasive treatment for developmental dysplasia of the hip (DDH), and this treatment is confirmed intraoperatively. This study aimed to develop a preoperative estimation model of the probability of requiring open reduction (OR) for DDH. Methods The study design was cross-sectional by screening all patients younger than 2 years who had attempted CR between October 2012 and July 2016 by a single surgeon. Potential diagnostic determinants were sex, age, side, bilaterality, International Hip Dysplasia Institute (IHDI) grade, and acetabular index (AI). An intraoperative arthrogram was the reference standard. A logistic regression equation was built from a reduced model. Bootstrapping was performed for internal validity. Results A total of 164 hips in 104 patients who met the inclusion criteria were analysed. The prevalence of CR was 72.2%. Independent factors for OR were older age, higher IHDI grade, and lower AI. The probability of OR = 1/[1 + exp − (−2.753 + 0.112 × age (months) + 1.965 × IHDI grade III (0 or 1) + 3.515 × IHDI grade IV (0 or 1) − 0.058 × AI (degrees)]. The area under the curve was 0.79. Conclusion This equation is an objective tool that can be used to estimate the requirement for OR.

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