Closed Reduction for Developmental Dysplasia of the Hip: Early-term Results From a Prospective, Multicenter Cohort

• Published in: Journal of pediatric orthopaedics Vol. 39; no. 3; pp. 111 - 118
• Main Authors: Sankar, Wudbhav N, Gornitzky, Alex L, Clarke, Nicholas M P, Herrera-Soto, José A, Kelley, Simon P, Matheney, Travis, Mulpuri, Kishore, Schaeffer, Emily K, Upasani, Vidyadhar V, Williams, Nicole, Price, Charles T
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 01-03-2019
• Subjects: Aftercare - methods; Aftercare - statistics & numerical data; Female; Femur - abnormalities; Femur - diagnostic imaging; Femur - surgery; Femur Head Necrosis - epidemiology; Femur Head Necrosis - etiology; Hip; Hip Dislocation, Congenital - diagnostic imaging; Hip Dislocation, Congenital - surgery; Humans; Incidence; Infant; Male; Orthopedic Procedures - adverse effects; Orthopedic Procedures - instrumentation; Orthopedic Procedures - methods; Orthopedic Procedures - statistics & numerical data; Osteotomy - methods; Osteotomy - statistics & numerical data; Prospective Studies; Radiography - methods; Reoperation - methods; Reoperation - statistics & numerical data; Treatment Outcome
• ISSN: 0271-6798; 1539-2570
• DOI: 10.1097/BPO.0000000000000895

Closed reduction (CR) is a common treatment for infantile developmental dysplasia of the hip. The purpose of this observational, prospective, multicenter study was to determine the early outcomes following CR.
Prospectively collected data from an international multicenter study group was analyzed for patients treated from 2010 to 2014. Baseline demographics, clinical exam, radiographic/ultrasonographic data, and history of previous orthotic treatment were assessed. At minimum 1-year follow-up, failure was defined as an IHDI grade 3 or 4 hip and/or need for open reduction. The incidence of avascular necrosis (AVN), residual dysplasia, and need for further surgery was assessed.
A total of 78 patients undergoing CR for 87 hips were evaluated with a median age at initial reduction of 8 months (range, 1 to 20 mo). Of these, 8 hips (9%) were unable to be closed reduced initially. At most recent follow-up (median 22 mo; range, 12 to 36 mo), 72/79 initially successful CRs (91%) remained stable. The likelihood of failure was unaffected by initial clinical reducibility of the hip (P=0.434), age at initial CR (P=0.897), or previous treatment in brace (P=0.222). Excluding those hips that failed initial CR, 18/72 hips (25%) developed AVN, and the risk of osteonecrosis was unaffected by prereduction reducibility of the hip (P=0.586), age at CR (P=0.745), presence of an ossific nucleus (P=0.496), or previous treatment in brace (P=0.662). Mean acetabular index on most recent radiographs was 25 degrees (±6 degrees), and was also unaffected by any of the above variables. During the follow-up period, 8/72 successfully closed reduced hips (11%) underwent acetabular and/or femoral osteotomy for residual dysplasia.
Following an initially successful CR, 9% of hips failed reduction and 25% developed radiographic AVN at early-term follow-up. History of femoral head reducibility, previous orthotic bracing, and age at CR did not correlate with success or chances of developing AVN. Further follow-up of this prospective, multicenter cohort will be necessary to establish definitive success and complication rates following CR for infantile developmental dysplasia of the hip.
Level II-prospective observational cohort.