CONGENITAL HIP DYSPLASIA HIGHLIGHTS OF AVASCULAR NECROSIS INCIDENCE AFTER OPEN REDUCTION FOR DEVELOPMENTAL DYSPLASIA OF THE HIP IN NAJAF (IRAQ)

Abstract

Developmental dysplasia of the hip (DDH) is a one of the most common congenital abnormalities. It presents with the wide spectrum of anatomical features due to the mild or incomplete formation of the acetabulum leading to laxity of the joint capsule, secondary deformity of the proximal femur head and irreducible hip dislocation. It present with an estimated incidence ranging from 1.4 to 35.0 per 1000 newborns with higher prevalence in Asian, Mediterranean, Caucasian, and American populations with a sex-ratio of girls to boys as 4-10:1. The risk of complications after treatment is associated with the type of reduction and also depends of previous treatment and immobilization, degree of dislocation, patient’s age at surgery. This study is a cross-sectional study with DDH patients born between January 2018 and December 2019, in the city of Al Najaf, Iraq. Ethnicity, gender, fetal presentation, time of diagnosis, affected side of the hip, family history and avascular necrosis of the femoral head (AVN) complications were considered. Post-operative clinical and radiological evaluation was preformed depending on McKay’s criteria and Severin’s classification. A total of 49 DDH patients were identified with female:male ratio of 7,2:1. Among girls, the time of diagnosis was 2,68 ±1,14 years, in the group of boys this indicator was 3,4 ±1,02 years, р=0,231. In both gender group the bilateral process was most common (66,7% in male group and 58,9% in female group). In 30% patient the family history was positive. Normal vaginal delivery was in 69,4% cases (67,4 and 83,3% girls and boys). Breech presentation was observed exclusively in female group. In 14% cases a combination of DDH with other malformations was revealed, in most cases it was joint laxity, less common minor congenital malformations. In 30% patients the closed bilateral reduction was performed. 46 patients were undergoing open reduction. Complications of DDH were detected in 29% cases. Most common was avascular necrosis in varying degrees (35%), 14% patients had early osteoarthritis, 21% local infections. The post-operative clinical McKay’s criteria showed prevalence of excellent and good results. Findings of the post-operative radiographic assessment (Severins grade method) were excellent in 21 hips, good in 14 hips. Сonsequently, late diagnosis of DDH leads worth outcomes, requires surgical interventions and causes increasing frequency of complications.