Efficacy of closed reduction for developmental dysplasia of the hip: midterm outcomes and risk factors associated with treatment failure and avascular necrosis

Ge Zhang,Yujiang Cao,Cong Luo,Xiangyang Qu,Yuan Zhang,Xing Liu,Ming Li

doi:10.1186/s13018-020-02098-3

Abstract

BackgroundThe purpose of this study was to evaluate the efficacy of closed reduction (CR) in the treatment of developmental dysplasia of the hip (DDH) and to investigate risk factors associated with CR failure and avascular necrosis (AVN) occurrence in follow-ups.MethodsThe study retrospectively included 110 patients and 138 hips with DDH diagnosis that underwent closed reduction between February 2012 and November 2015 in our single tertiary medical institution. The failure rate of CR and the underlying risk factors were evaluated. Meanwhile, the incidence of AVN and the related risk factors among the successful CR cases were assessed.ResultsThe overall failure rate of DDH treated by CR in the present study was 31.16% (43/138). Risk factors for the CR failure were older age at the time of CR (≥ 18.35 month), large medical interval before CR (≥ 35.35 mm), and severer dislocation of the affected hip (IDHI grades III and IV). The incidence of AVN was 8.33% (6/72) in patients with successful CR at the last follow-up. No significant risk factors had been established in the present study that associated with the AVN occurrence.ConclusionsFor the treatment of DDH with CR, patients with younger age might achieve better outcomes; early diagnosis and early treatment might be the key point in the DDH treatment.

Highlights

The purpose of this study was to evaluate the efficacy of closed reduction (CR) in the treatment of developmental dysplasia of the hip (DDH) and to investigate risk factors associated with CR failure and avascular necrosis (AVN) occurrence in follow-ups
The DDH encompasses a spectrum of disorders according to the relationship between the acetabulum and the femoral head which is ranged from mild acetabular dysplasia to hip subluxation and eventually dislocation
Our inclusion criteria were (1) patients with late-presenting DDH of more than 6 months at diagnosis and patients who failed to the prior treatment including Pavlik harness or Ilfeld abduction orthoses, (2) DDH patients with hip subluxation and dislocation (IHDI ≥ grade II), (3) patients who received CR following the bilateral long leg hip spica cast immobilization, and (4) patients and their radiographic data who were followed for at least 24 months

Summary

Introduction

The purpose of this study was to evaluate the efficacy of closed reduction (CR) in the treatment of developmental dysplasia of the hip (DDH) and to investigate risk factors associated with CR failure and avascular necrosis (AVN) occurrence in follow-ups. Developmental dysplasia of the hip (DDH) is a common hip deformity among infants which affects 1 to 3% of newborns [1]. The DDH encompasses a spectrum of disorders according to the relationship between the acetabulum and the femoral head which is ranged from mild acetabular dysplasia to hip subluxation and eventually dislocation. The primary goal of the treatment is to achieve a stable, concentric reduction to enable normal femoral head development and continued acetabular growth and remodeling [6]. A successful initial treatment of DDH with the Pavlik harness appears to restore the natural development of the hip to normal [7]. Many patients, especially those in developing countries, miss this early treatment window [8]

Objectives

Methods

Results

Conclusion