Abstract
BackgroundIt 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.MethodsClinical 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).ResultsA 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).ConclusionsSevere 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.
Highlights
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
This procedure generally achieves satisfactory outcomes, CR procedure may lead to a number of adverse complications, including iatrogenic avascular necrosis (AVN), re-dislocation and residual acetabular dysplasia (RAD), which might need further surgeries (FS) to address the problem
The aim of this present study was to evaluate the effect of CR among different age groups, to identify the risk factors of complications of CR and to identify the ones significantly associated with CR failures
Summary
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. Closed reduction (CR) of the hip is performed on patients who failed to achieve stable reduction with Pavlik harness, or as the primary treatment option for patients with late diagnosis [3, 4] This procedure generally achieves satisfactory outcomes, CR procedure may lead to a number of adverse complications, including iatrogenic avascular necrosis (AVN), re-dislocation and residual acetabular dysplasia (RAD), which might need further surgeries (FS) to address the problem. Previous studies reported that increased age at the time of CR predicted a higher rate of complications or further corrective surgeries [5,6,7], while others not [8, 9] It still remains controversial whether CR or open reduction (OR) should be adopted for children approaching or older than 18 months at the time of first diagnosis, especially for the severe dislocated cases. The aim of this present study was to evaluate the effect of CR among different age groups, to identify the risk factors of complications of CR and to identify the ones significantly associated with CR failures
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