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Clinical Orthopaedics and Related Research®
Published in: Clinical Orthopaedics and Related Research® 5/2016

01-05-2016 | Symposium: The Hip From Childhood to Adolescence

How Does Bony Surgery Affect Results of Anterior Open Reduction in Walking-age Children With Developmental Hip Dysplasia?

Authors: Alpesh Kothari, MRCS, MSc, George Grammatopoulos, FRCS (Tr & Orth), DPhil, Sally Hopewell, DPhil, Tim Theologis, MSc, PhD

Published in: Clinical Orthopaedics and Related Research® | Issue 5/2016

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Abstract

Background

Anterior open reduction is commonly used to treat hip subluxation or dislocation in developmental dysplasia of the hip (DDH) in walking-age children. Pelvic and/or femoral osteotomy may be used in addition, but it is unclear how this affects avascular necrosis (AVN) risk and radiological and clinical results.

Questions/purposes

The purpose of this study was to review studies of walking-age patients treated either with an open reduction alone or combined with pelvic and/or femoral osteotomies and determine whether there is a difference between groups in the proportion of patients: (1) developing clinically relevant femoral head AVN (Kalamchi & MacEwen Types II to IV or equivalent); (2) achieving a satisfactory radiological result (Severin Grade I/II or equivalent); (3) achieving a satisfactory clinical result (McKay excellent or good rating or equivalent); and (4) requiring further nonsalvage surgery.

Methods

MEDLINE, Embase, the Cochrane Centre Register of Controlled Trials, and ClinicalTrials.gov were searched for studies of anterior open reduction for DDH in children aged 12 months to 6 years old. We assessed AVN, clinical and radiological results, and requirement for further procedures. The effect of failed conservative management, traction, age at operation, and followup duration was also assessed. Eighteen studies met the review eligibility criteria.

Results

Open reduction alone had a lower risk of AVN than open reduction combined with pelvic and femoral osteotomy (4% versus 24%), but there was no significant difference compared with open reduction with either pelvic (17%) or femoral osteotomy (18%). More hips treated with open reduction alone had satisfactory radiological results than open reduction combined with pelvic and femoral osteotomy (97% versus 83%) and satisfactory clinical results than all other interventions. More hips treated with open reduction alone required further surgical management (56%) compared with open reduction and pelvic osteotomy (11%) and combined pelvic and femoral osteotomies (8%).

Conclusions

Open reduction with concomitant pelvic osteotomy is the most appropriate option to provide durable results with the lowest risk of AVN and best radiological and clinical results. There is no evidence that addition of a femoral osteotomy provides any additional benefit to the patient, although it may be necessary to achieve reduction.

Level of Evidence

Level III, therapeutic study.
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Metadata
Title
How Does Bony Surgery Affect Results of Anterior Open Reduction in Walking-age Children With Developmental Hip Dysplasia?
Authors
Alpesh Kothari, MRCS, MSc
George Grammatopoulos, FRCS (Tr & Orth), DPhil
Sally Hopewell, DPhil
Tim Theologis, MSc, PhD
Publication date
01-05-2016
Publisher
Springer US
Published in
Clinical Orthopaedics and Related Research® / Issue 5/2016
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-015-4598-x

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