Abstract
BackgroundOpen reduction of the congenitally dislocated hip may not be possible without femoral shortening. The goal of this study is to develop a prognostic prediction model for the need of femoral shortening in children undergoing anterior open reduction for the treatment of developmental dysplasia of the hip (DDH). The secondary objective was to determine if femoral shortening influences the risk of adverse events.MethodsA cohort from February 1, 2008 thru July 31, 2017 was studied retrospectively at a single centre. Patients between the age of 1 and 8 years, having international hip dysplasia institute (IHDI) grade 3 and 4, undergoing primary anterior open reduction for DDH were included in the study. The outcome of interest was femoral shortening, and the potential predictors were age, sex, side, body mass index and IHDI grade. Logistic regression was employed to identify the independent predictors and was followed by internal validation using bootstrapping. In addition, complications encountered were recorded and analysed.ResultsA total of 548 hips in 435 patients were included. Median follow-up (interquartile range) was 27 (13–48.25) months. Femoral shortening was needed on 119 hips. Factors that increased the probability of femoral shortening in the reduced model were age, male gender, and IHDI grade 4. Adjusting for IHDI and the addition of pelvic osteotomy, the probability of recurrence was lower when femoral shortening is included and higher with increased patient age. There were more deep infections when femoral shortening is added. Femoral shortening did not affect the occurrence of avascular necrosis.ConclusionIn addition to age and superior displacement of the femoral head, male gender is considered to be an independent predictor for needing femoral shortening. Studying the probability of femoral shortening in DDH surgery may optimize family education, operating room preparation, and operative time utilization. Moreover, there appears to be less risk of recurrence when femoral shortening is performed at the cost of higher probability of deep surgical site infection.
Highlights
Open reduction of the congenitally dislocated hip may not be possible without femoral shortening
Femoral shortening is a fundamental component of the surgical treatment of developmental dysplasia of the hip (DDH) and usually considered on an individualized basis
Excessive tension across a reduced hip may increase the risk of avascular necrosis, redislocation and probably stiffness [1,2,3]
Summary
Open reduction of the congenitally dislocated hip may not be possible without femoral shortening. An alternative to skeletal traction is an external distractor, which Wojciechowski et al used to lower the femoral head before open reduction and acetabuloplasty [7]. This method, entails two-stage surgery and carries the additional risk of pin site infection. In an analysis of 39 hips, Schoenecker et al did not find an advantage for preoperative traction in patients older than 3 years of age, for the reduction of avascular necrosis rate [1]
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