Timing for Closed Reduction Procedure for Developmental Dysplasia of the Hip and Its Failure Analysis

Overview

Journal BMC Musculoskelet Disord

Publisher Biomed Central

Specialties Orthopedics
Physiology

Date 2020 Sep 15

PMID 32928170

Citations 7

Authors

Zhiqiang Zhang

Hao Li

Hai Li

Ziming Zhang

Affiliations

Soon will be listed here.

Abstract

Background: It remains controversial whether the older age to perform closed reduction (CR) procedure for developmental dysplasia of the hip (DDH), the higher incidence of complications. The aim of this study is to evaluate the midterm outcome of CR for DDH among different age groups, and to analyze and identify risk factors for the failure of this procedure.

Methods: Clinical data of 107 DDH patients, who received CR, were retrospectively reviewed. Data were divided into three groups according to initial treatment age (Group I: younger than 12 months; Group II: 12 months to less or equal to18 months; Group III: older than 18 months). The presence of avascular necrosis (AVN), residual acetabular dysplasia (RAD), re-dislocation, and further surgeries (FS) were observed. The risk factors were identified for those outcomes aforementioned using univariable logistic regression models. For identified risk factor age, pre-op acetabular index (AI) and post-op AI, their prediction of CR failure were evaluated by receiver operating characteristics curve (ROC).

Results: A total of 107 patients (156 hips) undergoing CR procedure were evaluated with a median age at initial reduction of 13.0 ± 5.4 months (range, 4 to 28 mo). Mean follow-up time in this study was 6.7 ± 0.8 years (range, 3-8 years). The incidence of AVN, RAD and re-dislocation was 15.4% (24/156), 17.3% (27/156) and 14.7% (23/156) respectively. For AVN, RAD and re-dislocation, the significant risk factors are pre-op IHDI IV (p = 0.033), age ≥ 18 months (p = 0.012), and pre-op IHDI IV (p = 0.004) and walking (p = 0.011), respectively. The areas under the ROC curve of each type of failures were 0.841 (post-op AI), 0.688 (pre-op AI) and 0.650 (age).

Conclusions: Severe DDH patients older than 18 months with CR procedure may result in a high risk of RAD complication. Re-dislocation is significantly associated with pre-op IHDI IV and walking. Patients, who are older than 12.5 months or have a pre-op AI of 38.7° or a post-op AI of 26.4°, are also more likely to fail of CR procedure.

Citing Articles

Rates and risk factors for failure of reduction in closed reduction in developmental dysplasia of the hip: a systematic review and meta-analysis.

Domos G, Vancsa S, Szeverenyi C, Agocs G, Hegyi P, Perge A EFORT Open Rev. 2024; 9(9):908-922.

PMID: 39222331 PMC: 11457818. DOI: 10.1530/EOR-24-0007.

Protective effect of modified lange "second position" for developing avascular necrosis following closed reduction for developmental dysplasia of the hip.

Arenas-Diaz A, Guzman-Martin C, Ordaz-Robles T, Barron-Torres E, Haces-Garcia F, Dabaghi-Richerand A Arch Orthop Trauma Surg. 2024; 144(8):3337-3342.

PMID: 39105840 DOI: 10.1007/s00402-024-05488-y.

The impact of the introduction of selective screening in the UK on the epidemiology, presentation, and treatment outcomes of developmental dysplasia of the hip.

Poacher A, Hathaway I, Crook D, Froud J, Scourfield L, James C Bone Jt Open. 2023; 4(8):635-642.

PMID: 37607720 PMC: 10444535. DOI: 10.1302/2633-1462.48.BJO-2022-0158.R1.

Impact of Failed Pavlik Harness Treatment on the Outcomes Following Closed or Open Reduction in Developmental Dysplasia of the Hip.

Liu Y, Kan L, Sun J, Zhang Y Indian J Orthop. 2022; 56(9):1634-1639.

PMID: 36052383 PMC: 9385939. DOI: 10.1007/s43465-022-00680-x.

Narrative Review of Complications Following DDH Treatment.

Badrinath R, Orner C, Bomar J, Upasani V Indian J Orthop. 2022; 55(6):1490-1502.

PMID: 34987725 PMC: 8688677. DOI: 10.1007/s43465-021-00550-y.

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