Adverse Outcomes in Infantile Bilateral Developmental Dysplasia of the Hip

BACKGROUND:It is believed that bilateral developmental dysplasia of the hip (DDH) has poorer outcomes with higher rates of avascular necrosis (AVN) and reintervention, compared with unilateral DDH. However, there is limited evidence in the literature, with few studies looking specifically at bilater...

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Published in:	Journal of pediatric orthopaedics Vol. 35; no. 5; pp. 490 - 495
Main Authors:	Morbi, Abigail H.M, Carsi, Belen, Gorianinov, Vitalli, Clarke, Nicholas M.P
Format:	Journal Article
Language:	English
Published:	United States Copyright Wolters Kluwer Health, Inc. All rights reserved 01-07-2015
Subjects:	Delayed Diagnosis - adverse effects Female Femur Head Necrosis - epidemiology Femur Head Necrosis - etiology Follow-Up Studies Hip Dislocation, Congenital - epidemiology Hip Dislocation, Congenital - surgery Hip Dislocation, Congenital - therapy Humans Incidence Infant Male Orthopedic Procedures - adverse effects Orthopedic Procedures - methods Orthotic Devices - adverse effects Outcome Assessment (Health Care) Physical Examination Retrospective Studies Risk Factors Time-to-Treatment United Kingdom
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Summary:	BACKGROUND:It is believed that bilateral developmental dysplasia of the hip (DDH) has poorer outcomes with higher rates of avascular necrosis (AVN) and reintervention, compared with unilateral DDH. However, there is limited evidence in the literature, with few studies looking specifically at bilateral cases. METHODS:A retrospective review of 36 patients (72 hips) with >4 years of follow-up. Patient population included surgically treated DDH including late presentations and failures of conservative treatment. The dislocated hips underwent either simultaneous closed or 1 open and 1 closed, or sequential open reduction. AVN and secondary procedures were used as endpoints for analysis as well as clinical and radiologic outcomes. RESULTS:At the last follow-up, 33% of hips had radiologic signs of AVN. Those hips that had no ossific nucleus (ON) at the time of surgery had an odds ratio of developing AVN of 3.05 and a statistically significant association between the 2 variables, whereas open/closed or simultaneous/sequential reduction did not increase the risk for AVN. In addition, 45.8% of those hips required further surgery. The estimated odds ratio of needing additional surgery after simultaneous reduction was 4.04. Clinically, 79.2% of the hips were graded as McKay I, whereas radiologically only 38.8% were Severin I. CONCLUSIONS:The AVN rate in bilateral DDH treated surgically is greater than the rate noted in unilateral cases from the same institution undergoing identical protocols. There was no difference in AVN rates between simultaneous and sequential or between the first and second hip to be sequentially reduced. Presence of ON decreases the risk for AVN, suggesting that in bilateral cases, awaiting the appearance of the ON is an important tool to reduce the incidence of AVN. LEVEL OF EVIDENCE:IV.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0271-6798 1539-2570
DOI:	10.1097/BPO.0000000000000310