Developmental Dislocation of the Hip Successfully Treated by Preoperative Traction and Medial Open Reduction: A 22-year Mean Followup

• Published in: Clinical orthopaedics and related research Vol. 473; no. 8; pp. 2658 - 2669
• Main Authors: Farsetti, P., Caterini, R., Potenza, V., Ippolito, E.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-08-2015; Lippincott Williams & Wilkins Ovid Technologies
• Subjects: Adolescent; Adult; Biomechanical Phenomena; Child; Child, Preschool; Clinical Research; Combined Modality Therapy; Conservative Orthopedics; Female; Hip Dislocation, Congenital - diagnosis; Hip Dislocation, Congenital - physiopathology; Hip Dislocation, Congenital - surgery; Hip Joint - abnormalities; Hip Joint - diagnostic imaging; Hip Joint - physiopathology; Hip Joint - surgery; Humans; Infant; Male; Medicine; Medicine & Public Health; Orthopedic Procedures - adverse effects; Orthopedic Procedures - methods; Orthopedics; Pediatrics; Radiography; Range of Motion, Articular; Recovery of Function; Reoperation; Retrospective Studies; Sports Medicine; Surgery; Surgical Orthopedics; Time Factors; Traction - adverse effects; Treatment Outcome; Young Adult; Open Reduction; Medial Approach; Anterior Approach; Femoral Head; Acetabular Index
• ISSN: 0009-921X; 1528-1132
• DOI: 10.1007/s11999-015-4264-3

Background
During the last 35 years, the medial approach has been reported more frequently than the anterior approach for open reduction of developmental dislocation of the hip (DDH), however, few studies have followed children treated by medial open reduction to adulthood.
Questions/purposes
The purposes of our study were: (1) to assess the development of 71 completely dislocated hips after medial open reduction, the incidence of additional surgery and avascular necrosis during the followup period, and the long-term radiographic and functional results; and (2) to compare our results with those obtained by others who performed open reduction either by the medial or anterior approach.
Patients and Methods
We retrospectively evaluated, after the end of growth, 71 hips in 52 patients who underwent open reduction by the medial approach. The mean age of the patients was 16 months (range, 3–36 months). After surgery, the hips were immobilized in 100° flexion, 60° abduction, and neutral rotation for an average of 6 months. All patients had staged clinical and radiographic followups until skeletal maturity. The length of followup averaged 22 years (range, 13–32 years).
Results
In all the surgically treated hips, the acetabular index normalized by the end of growth, the incidence of avascular necrosis was 18%, and additional surgery was required in 15% of our cases. At the last followup, 93% of the hips were classified as Severin Classes I or II and 7% as Class III; 76% of the hips had an excellent result, 17% had a good result, and 7% had a fair result according to the McKay scale as modified by Barrett and colleagues.
Conclusions
Open reduction of DDH through a medial approach provided good long-term radiographic and functional results in patients 3 to 36 months old and it was the only surgery performed in 85% of our cases. Future comparative studies are needed to confirm our results, especially in older children.
Level of evidence
Level IV, therapeutic study.