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Predictors for secondary procedures in walking DDH
Purushottam A Gholve1, John M Flynn, Matthew R Garner
1Department of Orthopedic Surgery, Children's Hospital Boston, Boston, MA 02115, USA.
Insights
Open reduction for developmental dysplasia of the hip (DDH) in children often requires further surgery. Performing open reduction without concurrent femoral osteotomy significantly increases the need for secondary procedures.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Hip biomechanics
Background:
- Developmental dysplasia of the hip (DDH) can lead to persistent or recurrent hip instability in walking children.
- Secondary procedures are often necessary to manage complications following initial treatment for DDH.
Purpose of the Study:
- To identify predictors for secondary procedures after open reduction of the hip in walking children with DDH.
- To analyze factors influencing reoperation rates in pediatric hip dysplasia cases.
Main Methods:
- Retrospective case series (Level IV evidence) of walking children with idiopathic DDH.
- Analysis of perioperative factors in 49 open hip reductions with a mean follow-up of 9.7 years.
- Evaluation of acetabular remodeling using serial measurements of the acetabular index.
Main Results:
- 49% of patients required at least one secondary surgery for hip dysplasia.
- Open reduction without concurrent femoral osteotomy was a significant predictor of reoperation (73% required secondary procedures).
- Maximum acetabular remodeling occurred within the first 4 years post-reduction, improving the acetabular index from 43.9 to 20.3 degrees.
Conclusions:
- Nearly half of the children treated with open reduction for DDH needed additional surgical interventions.
- Concurrent femoral osteotomy during open reduction is crucial for reducing the likelihood of secondary procedures.
- Significant acetabular remodeling is achievable within the initial 4 years following open reduction surgery.
Background:
Persistent or recurrent hip dysplasia and/or loss of reduction can complicate the treatment of developmental dysplasia of the hip (DDH) in walking children. In this study, we identify predictors for secondary procedures after open reduction of the hip in walking children with DDH.
Methods:
We performed a retrospective study of walking children with idiopathic DDH treated with open reduction of the hip and followed up for >5 years. Perioperative factors were analyzed to investigate predictors of reoperation. Factors associated with the need for secondary procedures were identified. Acetabular remodeling was analyzed with a graphical plot of serial (0, 6 and 12 mo, and yearly) mean acetabular index and SD.
Results:
There were 49 open reductions of the hip in 42 patients (34 female, 8 male) at a mean age of 31.3 months (range, 15.3 to 92.6 mo), with a mean follow-up of 9.7 years (5 to 16.9 y). Twelve (24%) patients had open reduction only, 15 (31%) had concurrent pelvic osteotomy, 4 (8%) had femoral osteotomy, and 18 (37%) had both femoral and pelvic osteotomy. Four (8%) patients required repeat open reduction at a mean of 5.1 months (range, 4 to 7.5 mo) after index surgery. Twenty-four (49%) patients had at least 1 secondary surgery for dysplasia at a mean of 3.2 years after index surgery. Six of the 24 (25%) had 2 and 2/24 (8.3%) had 3 additional operations. Of the 27 patients who did not have concurrent femoral osteotomy at index surgery, 19/27 (73%) required a secondary procedure; this significantly predicted the need for reoperation (P<0.001). Only 5/22 patients with femoral osteotomy at index surgery required a secondary procedure. Maximum acetabular remodeling was observed in the first 4 years after primary reduction, and the mean acetabular index remodeled from 43.9 to 20.3 degrees during this period.
Conclusions:
Forty-nine percent of the patients in this cohort required secondary procedures to treat hip dysplasia. Open reduction without concurrent femoral osteotomy strongly predicted the need for a secondary procedure. Maximum acetabular remodeling was observed in the first 4 years after open reduction.
Level Of Evidence:
Retrospective case series, level IV.
