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International Orthopaedics

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01-01-2018 | Original Paper

Long-term results of closed reduction for developmental dislocation of the hip in children of walking age under eighteen months old

Authors: Soo Min Cha, Hyun Dae Shin, Byung Kon Shin

Published in: International Orthopaedics | Issue 1/2018

Abstract

Background

Developmental dysplasia of the hip (DDH) diagnosed in older postnatal children can be effectively treated by closed reduction (CR) alone. However, no prospective or comparative trial to explore the differential effectiveness of CR between non-walking and walking postnatal children has yet been reported. This study investigated the clinical and radiologic outcomes of CR in the age range of interest (12–18 months old) via a prospective trial and compared these results with those of a younger age group who also underwent CR.

Patients and methods

Between 1999 and 2009, 56 children diagnosed with DDH were enrolled. Of these, 45 were followed after CR for a period of at least seven years. The anatomical parameters of the hip/pelvis, including arthrograms, were evaluated and compared before and after CR. The final radiologic status, including the occurrence of avascular necrosis (AVN), and clinical outcomes were evaluated and compared.

Results

The mean ages at the start of treatment were 6.11 and 15.29 months old in group 1 and group 2, respectively. None of the children required surgical open reduction during the follow-up period. The final status of hips were classified according to the Bucholz-Ogden system. Two type II hips and one type I hip were found in group 1. In group 2, two type I hips and one type III hip were observed at the final follow-up. The overall clinical outcomes were satisfactory in both groups, according to McKay’s criteria. No significant differences in clinical outcomes between the two groups were found (P = 0.382). Surgery was performed for just one patient in group 2 at seven years old.

Conclusions

CR in DDH for postnatal children 12–18 months old may provide similar results to the non-walking age group if performed with preliminary traction, gentle CR under general anaesthesia, percutaneous adductor tenotomy, and the minimization of forceful abduction.

Kahle KW, Anderson MB, Alpert J, Stevens PM, Coleman SS (1996) The value of preliminary traction in the treatment of congenital dislocation of the hip. J Bone Joint Surg Am 72:1043–1047CrossRef

Sharpe P, Mulpuri K, Chan A, Cundy PJ (2006) Differences in risk factors between early and late diagnosed developmental dysplasia of the hip. Arch Dis Child Fetal Neonatal Ed 91(3):F158–F162CrossRefPubMed

Heesakkers NA, Witbreuk MM, Besselaar PP, Van Der Sluijs JA (2013) Retrospective radiographic evaluation of treatment results of developmental dysplasia of the hip in walking-age children. J Pediatr Orthop B 22(5):427–431CrossRefPubMed

Imatani J, Miyake Y, Nakatsuka Y, Akazawa H, Mitani S (1995) Coxa magna after open reduction for developmental dislocation of the hip. J Pediatr Orthop 15(3):337–341CrossRefPubMed

Zionts LE, MacEwen GD (1986) Treatment of congenital dislocation of the hip in children between the ages of one and three years. J Bone Joint Surg Am 68:829–846CrossRefPubMed

Mitani S et al (1997) Treatment of developmental dislocation of the hip in children after walking age. J Bone Joint Surg 79(5):710–718CrossRef

Quinn RH, Renshaw TS, DeLuca PA (1994) Preliminary traction in the treatment of developmental dislocation of the hip. J Pediatr Orthop 14:636–642CrossRefPubMed

Berkeley ME et al (1984) Surgical therapy for congenital dislocation of the hip in patients who are twelve to thirty-six months old. J Bone Joint Surg 66(3):412–420CrossRefPubMed

Lee YK, Chung CY, Koo KH (2011) Measuring acetabular dysplasia in plain radiographs. Arch Orthop Trauma Surg 131(9):1219–1226CrossRefPubMed

10.

Cashman JP, Round J, Taylor G, Clarke NM (2002) The natural history of developmental dysplasia of the hip after early supervised treatment in the Pavlik harness. A prospective, longitudinal follow-up. J Bone Joint Surg Br 84(3):418–425CrossRefPubMed

11.

Liu JS, Kuo KN, Lubicky JP (1996) Arthrographic evaluation of developmental dysplasia of the hip. Outcome prediction. Clin Orthop Relat Res 326:229–237CrossRef

12.

Joseph K, MacEwen GD, Boos ML (1982) Home traction in the management of congenital dislocation of the hip. Clin Orthop 165:83–90

13.

Bucholz RW, Ogden JA (1978) Patterns of ischemic necrosis of the proximal femur in nonoperatively treated congenital hip disease. In: The hip. Proceedings of the Sixth Open Scientific Meeting of the Hip Society. CV Mosby Co., St. Louis, pp 43–63

14.

Zadeh HG, Catterall A, Hashemi-Nejad A, Perry RE (2000) Test of stability as an aid to decide the need for osteotomy in association with open reduction in developmental dysplasia of the hip. J Bone Joint Surg Br 82(1):17–27CrossRefPubMed

15.

Mitani S, Nakatsuka Y, Akazawa H, Aoki K, Inoue H (1997) Treatment of developmental dislocation of the hip in children after walking age. Indications from two-directional arthrography. J Bone Joint Surg Br Sep 79(5):710–718CrossRef

16.

Tonnis D (1982) Congenital hip dislocation. Thieme-Stratton Inc, New York

17.

DeRosa GP, Feller N (1987) Treatment of congenital dislocation of the hip. Management before walking age. Clin Orthop 225:77–85

18.

Race C, Herring JA (1983) Congenital dislocation of the hip: an evaluation of closed reduction. J Pediatr Orthop 3:166–172CrossRefPubMed

19.

Malvitz TA, Weinstein SS (1994) Closed reduction for congenital dysplasia of the hip. Functional and radiographic results after an average of thirty years. J Bone Joint Surg Am 76:1777–1792CrossRefPubMed

20.

Murray T, Cooperman DR, Thompson GH, Ballock T (2007) Closed reduction for treatment of development dysplasia of the hip in children. Am J Orthop (Belle Mead NJ) 36(2):82–84

21.

Badgley CE (1949) Etiology of congenital dislocation of the hip. J Bone Joint Surg Am 31(2):341–356CrossRef

Title: Long-term results of closed reduction for developmental dislocation of the hip in children of walking age under eighteen months old
Authors: Soo Min Cha
Hyun Dae Shin
Byung Kon Shin
Publication date: 01-01-2018
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 1/2018
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-017-3685-x

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Long-term results of closed reduction for developmental dislocation of the hip in children of walking age under eighteen months old

Abstract

Background

Patients and methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Patients and methods

Results

Conclusions

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