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Prediction of the requirement of open reduction for developmental dysplasia of the hip
1Department of Surgical Specialties, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia.
Insights
This study developed a predictive model to estimate the need for open reduction in developmental dysplasia of the hip (DDH) cases treated with closed reduction (CR). The model uses age, IHDI grade, and acetabular index to determine the likelihood of requiring surgery.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Hip dysplasia research
Background:
- Developmental dysplasia of the hip (DDH) often requires surgical intervention.
- Closed reduction (CR) is a non-surgical approach for DDH, with success confirmed intraoperatively.
- Predicting the need for open reduction (OR) preoperatively can optimize treatment planning.
Purpose of the Study:
- To develop and validate a preoperative model estimating the probability of requiring open reduction (OR) for developmental dysplasia of the hip (DDH).
Main Methods:
- Cross-sectional study of patients under 2 years undergoing attempted CR.
- Analysis of diagnostic determinants including age, IHDI grade, and acetabular index (AI).
- Logistic regression model developed and validated using bootstrapping, with intraoperative arthrogram as the reference standard.
Main Results:
- A total of 164 hips were analyzed; 72.2% of cases underwent successful CR.
- Independent predictors for OR included older age, higher International Hip Dysplasia Institute (IHDI) grade, and lower acetabular index (AI).
- The developed logistic regression equation demonstrated an area under the curve of 0.79.
Conclusions:
- The derived equation provides an objective tool for estimating the probability of requiring open reduction in DDH patients.
- This preoperative estimation can aid in surgical decision-making for DDH treatment.
- The model incorporates key clinical and radiographic factors to predict surgical necessity.
Abstract:
Objective Closed reduction (CR) is a noninvasive treatment for developmental dysplasia of the hip (DDH), and this treatment is confirmed intraoperatively. This study aimed to develop a preoperative estimation model of the probability of requiring open reduction (OR) for DDH. Methods The study design was cross-sectional by screening all patients younger than 2 years who had attempted CR between October 2012 and July 2016 by a single surgeon. Potential diagnostic determinants were sex, age, side, bilaterality, International Hip Dysplasia Institute (IHDI) grade, and acetabular index (AI). An intraoperative arthrogram was the reference standard. A logistic regression equation was built from a reduced model. Bootstrapping was performed for internal validity. Results A total of 164 hips in 104 patients who met the inclusion criteria were analysed. The prevalence of CR was 72.2%. Independent factors for OR were older age, higher IHDI grade, and lower AI. The probability of OR = 1/[1 + exp - (-2.753 + 0.112 × age (months) + 1.965 × IHDI grade III (0 or 1) + 3.515 × IHDI grade IV (0 or 1) - 0.058 × AI (degrees)]. The area under the curve was 0.79. Conclusion This equation is an objective tool that can be used to estimate the requirement for OR.
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