Clinical and radiological outcomes of open reduction alone versus open reduction with pelvic osteotomy for developmental dysplasia of the hip in children over 1.5 years of age.

Abstract

Developmental dysplasia of the hip (DDH) is commonly addressed through surgical intervention, usually performed in a specialized tertiary care facility. The purpose of this study was to evaluate the surgical outcomes in patients with DDH who had open reduction alone or in conjunction with bone surgery at our facility. We retrospectively reviewed the medical records of patients with DDH, categorizing them into two groups: Group OR underwent open reduction (OR) alone, and group ORBO underwent OR in conjunction with femoral or pelvic osteotomies. The modified McKay classification was used to evaluate clinical outcomes, and the Severin classification was used to evaluate radiological outcomes. Avascular necrosis and other postoperative issues were observed. Our cohort consisted of 66 patients (76 hips), with a mean age at surgery of 1.8±2.6 and a follow-up period ranging from one to three years. Clinically, 48 out of 66 patients achieved satisfactory outcomes, and radiologically, 47 patients were classified as satisfactory. Although there was no statistically significant difference in the radiological outcome (P=0.85), more patients in the OR group than in the ORBO group (P=0.05) had better outcomes. Avascular necrosis (AVN) was observed in 23 hips (34.8%), with Grade I AVN being the most prevalent in 19 hips that underwent OR with bone surgery (63.2%). The occurrence of AVN was associated with poorer clinical and radiological outcomes (P=0.05). Overall, the DDH operation at our center had positive outcomes. The OR group showed better clinical outcomes despite similar radiological findings and AVN rates compared to the OR with bone surgery group. The presence of AVN was linked to poor clinical and radiological outcomes.