Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

ACC 2024 Congress

Catch up on all the top stories and latest evidence in cardiology research with our ACC 2024 Congress hub page.
ADVANCED SEARCH
Log in
Top
Clinical Orthopaedics and Related Research®
Published in: Clinical Orthopaedics and Related Research® 5/2016

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

Have Changes in Treatment of Late-detected Developmental Dysplasia of the Hip During the Last Decades Led to Better Radiographic Outcome?

Authors: Terje Terjesen, MD, PhD, Joachim Horn, MD, PhD

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

Login to get access

Abstract

Background

Despite considerable changes in the treatment of of late-detected congenital or developmental hip dislocation (DDH) during the last 50 years, it is unclear whether and to what degree these changes have led to better long-term outcome for the patients.

Questions/purposes

The aims of this study were to see whether decreasing use of skin traction and instead a more aggressive approach to open reduction resulted in (1) reduced use of secondary procedures; (2) improved radiographic appearance of the hips at long-term followup; and (3) changes in the proportion of patients developing avascular necrosis.

Methods

Two groups of patients were compared retrospectively. Inclusion criteria were patient age older than 3 months and younger than 5 years at the initiation of treatment, no associated anomaly, no previous treatment in other hospitals, and available radiographs from the time of diagnosis to skeletal maturity. Group A consisted of 56 patients (51 girls [91%]; 74 hips) primarily treated during the period 1958 to 1962. Group B comprised 38 patients (36 girls [95%]; 40 hips) treated during the period 1996 to 2002. The mean age at the time of hip reduction was 20 months (SD 9.6) in Group A and 17 months (SD 11.9) in Group B. The mean time in skin traction had decreased from 35 days (SD 12.5) to 11 days (SD 5.7) over the years (p < 0.001). Open reduction was performed in six of 74 hips (8%) in Group A and 15 of 40 hips (37%) in Group B (p < 0.001). The immobilization time in the hip spica had decreased from 9 to 6 months (p < 0.001). The indication for secondary procedures to correct residual dysplasia was center-edge angle < 20° and was similar in both groups. A modified version of the radiographic classification of Severin was used to compare the results.

Results

Secondary procedures to correct residual dysplasia were performed in 28 of 74 hips (38%) in Group A and seven of 40 hips (18%) in Group B (odds ratio [OR], 0.35; 95% confidence interval [CI], 0.14–0.89; p = 0.025) At skeletal maturity, the proportion of patients with satisfactory radiographic results (Severin Grades I/II) was larger in Group B (33 of 40 hips [82%]) than in Group A (46 of 74 hips [62%]; OR, 0.35; CI, 0.14–0.89; p = 0.025). Femoral head coverage, assessed as the center-edge angle, was greater in Group B than in Group A (mean 26° versus 22°; CI, 0.8–7.9; p = 0.016). There was no difference in the proportion of avascular necrosis of the femoral head (seven of 74 hips [9%] in Group A and five of 40 [13%] in Group B; OR, 1.4; CI, 0.4–4.6; p = 0.614).

Conclusions

The move away from prolonged use of skin traction and toward more frequent open reduction for children with a late diagnosis of DDH appears to result in fewer secondary procedures and a better radiographic appearance of the hip at skeletal maturity. Based on the present results, we cannot conclude whether preliminary traction is needed; this question should be evaluated in future long-term studies with a prospective, randomized design.

Level of Evidence

Level III, therapeutic study.
Literature
1.
Akilapa O. The medial approach open reduction for developmental dysplasia of the hip: do the long-term outcomes validate this approach. A systematic review of the literature. J Child Orthop. 2014;8:387–397.
2.
Berkeley ME, Dickson JH, Cain TE, Donovan MM. Surgical therapy for congenital dislocation of the hip in patients who are twelve to thirty-six months old. J Bone Joint Surg Am. 1984;66:412–420.PubMed
3.
Brougham DI, Broughton NS, Cole WG, Menelaus MB. Avascular necrosis following closed reduction of congenital dislocation of the hip. J Bone Joint Surg Br. 1990;72:557–562.PubMed
4.
Chang CH, Yang WE, Kao HK, Lee WC, Shih CH, Kuo KN. Prognostic radiographic factors in developmental dysplasia of the hip following Salter osteotomy. J Pediatr Orthop B. 2015;24:31–34.CrossRefPubMed
5.
Forlin E, Choi IH, Guille JT, Bowen JR, Glutting J. Prognostic factors in congenital dislocation of the hip treated with closed reduction. J Bone Joint Surg Am. 1992;74:1140–1152.PubMed
6.
Gibson PH, Benson MKD. Congenital dislocation of the hip. J Bone Joint Surg Br. 1982;64:169–175.PubMed
7.
Holman J, Carroll KL, Murray KA, MacLeod LM, Roach JW. Long-term follow-up of open reduction surgery for developmental dislocation of the hip. J Pediatr Orthop. 2012;32:121–124.CrossRefPubMed
8.
Kalamchi A, MacEwen GD. Avascular necrosis following treatment of congenital dislocation of the hip. J Bone Joint Surg Am. 1980;62:876–888.PubMed
9.
Kaneko H, Kitoh H, Mishima K, Matsushita M, Ishiguro N. Long-term outcome of gradual reduction using overhead traction for developmental dysplasia of the hip over 6 months of age. J Pediatr Orthop. 2013;33:628–634.CrossRefPubMed
10.
Karlen JW, Skaggs DL, Ramachandran M, Kay RM. The Dega osteotomy: a versatile osteotomy in the treatment of developmental and neuromuscular hip pathology. J Pediatr Orthop. 2009;29;676–682.CrossRefPubMed
11.
Kasser JR, Bowen JR, MacEwen GD. Varus derotation osteotomy in the treatment of persistent dysplasia in congenital dysplasia of the hip. J Bone Joint Surg Am. 1985;67:195–202.PubMed
12.
Kleinberg S, Lieberman HS. The acetabular index in infants in relation to congenital dislocation of the hip. Arch Surg. 1936;32:1049–1054.CrossRef
13.
Malvitz TA, Weinstein SL. Closed reduction for congenital dysplasia of the hip. Functional and radiographic results after an average of thirty years. J Bone Joint Surg Am. 1994;76:1777–1792.PubMed
14.
Morcuende JA, Beyer MD, Dolan LA, Weinstein SL. Long-term outcome after open reduction through an anteromedial approach for congenital dislocation of the hip. J Bone Joint Surg Am. 1997;79:810–817.PubMed
15.
Morin CM, Bisogno J, Kulkarni S, Morel G. Treatment of late-presenting developmental dislocation of the hip by progressive orthopaedic reduction and innominate osteotomy. Our results with more than 30 years of follow-up. J Child Orthop. 2011;5:251–260.
16.
Quinn RH, Renshaw TS, DeLuca PA. Preliminary traction in the treatment of developmental dislocation of the hip. J Pediatr Orthop. 1994;14:636–642.CrossRefPubMed
17.
Rampal V, Sabourin M, Erdeneshoo E, Koureas G, Seringe R, Wicart P. Closed reduction with traction for developmental dysplasia of the hip in children aged between one and five years. J Bone Joint Surg Br. 2008;90:858–863.CrossRefPubMed
18.
Reimers J. The stability of the hip in children. Acta Orthop Scand. 1980;51(Suppl 84):4–91.
19.
Salter RB. Innominate osteotomy in the treatment of congenital dislocation and subluxation of the hip. J Bone Joint Surg Br. 1961;43:518–539.
20.
Salter RB, Kostuik J, Dallas S. Avascular necrosis of the femoral head as a complication of treatment for congenital dislocation of the hip in young children: a clinical and experimental investigation. Can J Surg. 1969;12:44–61.PubMed
21.
Sankar WN, Young CR, Lin AG, Crow SA, Baldwin KD, Moseley CF. Risk factors for failure after open reduction for DDH: a matched cohort analysis. J Pediatr Orthop. 2011;31:232–239.CrossRefPubMed
22.
Severin E. Contribution to the knowledge of congenital dislocation of the hip joint. Acta Chir Scand. 1941;84(Suppl 63):1–142.
23.
24.
Somerville EW, Scott JC. The direct approach to congenital dislocation of the hip. J Bone Joint Surg Br. 1957;39:623–640.PubMed
25.
Spitzy H. [Acetabular shelf reconstruction] [in German]. Z Orthop. 1924;43:284–294.
26.
Szepesi K, Szücs G, Szeverenyi C, Csernatony Z. Long-term follow-up of DDH patients who underwent open reduction without a postoperative cast. J Pediatr Orthop B. 2013;22:85–90.CrossRefPubMed
27.
Terjesen T, Halvorsen V. Long-term results after closed reduction of late-detected hip dislocation. 60 patients followed up to skeletal maturity. Acta Orthop. 2007;78:236–246.CrossRefPubMed
28.
Terjesen T, Horn J, Gunderson RB. Fifty-year follow-up of late-detected hip dislocation. J Bone Joint Surg Am. 2014;96:e28.1–9.
29.
Wiberg G. Studies on dysplastic acetabula and congenital subluxation of the hip joint. Acta Chir Scand. 1939;83(Suppl 58):7–135.
30.
Williamson DM, Benson MKD. Late femoral osteotomy in congenital dislocation of the hip. J Bone Joint Surg Br. 1988;70:614–618.PubMed
31.
Yamada N, Maeda S, Fujii G, Kita A, Funayama K, Kokubun S. Closed reduction of developmental dislocation of the hip by prolonged traction. J Bone Joint Surg Br. 2003;85:1173–1177.CrossRefPubMed
32.
Zionts LE, MacEwen GD. Treatment of congenital dislocation of the hip in children between the ages of one and three years. J Bone Joint Surg Am. 1986;68:829–846.PubMed
Metadata
Title
Have Changes in Treatment of Late-detected Developmental Dysplasia of the Hip During the Last Decades Led to Better Radiographic Outcome?
Authors
Terje Terjesen, MD, PhD
Joachim Horn, MD, 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/s11999-015-4491-7

Other articles of this Issue 5/2016

Clinical Orthopaedics and Related Research® 5/2016 Go to the issue

Clinical Faceoff

Clinical Faceoff: Do We Need Special Strategies for Asian Patients with TKA?

Basic Research

Does Sclerostin Depletion Stimulate Fracture Healing in a Mouse Model?

Clinical Research

Universal Health Insurance Coverage in Massachusetts Did Not Change the Trajectory of Arthroplasty Use or Costs

Reply to the Letter to the Editor

Reply to the Letter to the Editor: Does Combined Intra- and Extraarticular ACL Reconstruction Improve Function and Stability? A Meta-analysis

Editorial

Editorial: ORCID is a Wonderful (But Not Required) Tool for Authors

Symposium: The Hip From Childhood to Adolescence

Acetabuloplasties at Open Reduction Prevent Acetabular Dysplasia in Intentionally Delayed Developmental Dysplasia of the Hip: A Case-control Study