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Soft-tissue interposition after closed reduction in developmental dysplasia of the hip. The long-term effect on
1Department of Orthopaedic Surgery, Nagoya University School of Medicine, Showa-ku, Japan.
Insights
Soft-tissue interposition after hip dysplasia reduction does not predict long-term outcomes. However, significant interposition (>3.5 mm) increases the need for secondary surgery, impacting final results.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Radiology
Background:
- Developmental dysplasia of the hip (DDH) is a common pediatric condition.
- Closed reduction is a primary treatment for DDH.
- Arthrography is used to assess hip joint status post-reduction.
Purpose of the Study:
- To evaluate the long-term impact of soft-tissue interposition on acetabular development and avascular necrosis after closed reduction in DDH.
- To determine if arthrographic findings at the time of reduction predict final radiological outcomes.
Main Methods:
- Review of 98 children (133 hips) with DDH treated with closed reduction and immediate arthrography.
- Long-term follow-up to skeletal maturity.
- Assessment of acetabular development, avascular necrosis, and need for secondary surgery.
Main Results:
- Soft-tissue interposition and limbus shape on initial arthrograms did not correlate with final radiological results or avascular necrosis.
- Spontaneous resolution of soft-tissue interposition occurred in 71% of cases by age five.
- Higher rates of secondary surgery were observed in hips with >3.5 mm of interposition, with worse outcomes in the non-resolving group.
Conclusions:
- Initial arthrographic findings of soft-tissue interposition alone should not dictate surgical intervention.
- Persistent soft-tissue interposition (>3.5 mm) is associated with poorer long-term outcomes and increased need for revision surgery.
- Careful monitoring and consideration of persistent interposition are crucial for optimal DDH management.
Abstract:
We reviewed 98 children (133 hips) with developmental dysplasia of the hip who underwent arthrography immediately after closed reduction by overhead traction. We followed the patients to skeletal maturity to investigate whether soft-tissue interposition influences acetabular development and avascular necrosis over the long term. The shape of the limbus and the thickness of the soft-tissue interposition at the acetabular floor, as shown on arthrograms at the time of reduction, were not directly related to the final radiological results or to the incidence of avascular necrosis. Even if marked soft-tissue interposition was found on the initial arthrogram, spontaneous disappearance was noted in 71% up to the age of five years. The final radiological results showed no difference between those in which the interposition disappeared and those with none at the time of closed reduction. However, the requirement for secondary surgery at the age of five years was significantly higher in those with more than 3.5 mm of soft-tissue interposition. In the no-disappearance group (group C) further operation was necessary in 100% and the results were significantly worse at maturity according to Severin's classification. We suggest that the indications for open reduction should not be based solely on the arthrographic findings at the time of closed reduction.