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Closed Reduction for Developmental Dysplasia of the Hip: Early-term Results From a Prospective, Multicenter Cohort

Wudbhav N Sankar1, Alex L Gornitzky1, Nicholas M P Clarke2

  • 1Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, PA.

Journal of Pediatric Orthopedics
|February 8, 2019
PubMed

Insights

Closed reduction for infantile hip dysplasia shows a 9% failure rate and 25% avascular necrosis risk. Early outcomes are not influenced by reducibility, age, or prior bracing.

Area of Science:

  • Orthopedics
  • Pediatric Orthopedics
  • Hip Dysplasia Treatment

Background:

  • Infantile developmental dysplasia of the hip (DDH) is commonly treated with closed reduction (CR).
  • Early outcomes of CR for DDH require further investigation.

Purpose of the Study:

  • To determine the early outcomes following closed reduction for infantile developmental dysplasia of the hip.
  • To assess the incidence of failure, avascular necrosis (AVN), and residual dysplasia after CR.

Main Methods:

  • Prospective, international, multicenter observational study of 78 patients (87 hips) treated from 2010-2014.
  • Minimum 1-year follow-up, defining failure as IHDI grade 3/4 hip or need for open reduction.
  • Assessed AVN, residual dysplasia, need for further surgery, and factors influencing outcomes.

Main Results:

  • 91% of initially successful CRs remained stable at median 22-month follow-up.
  • 25% of successfully reduced hips developed AVN; 11% required osteotomy for residual dysplasia.
  • No significant correlation found between CR success/AVN and initial reducibility, age at CR, or prior bracing.

Conclusions:

  • Closed reduction for infantile DDH has an early-term failure rate of 9% and AVN rate of 25%.
  • Factors like femoral head reducibility, prior bracing, and age at CR did not impact success or AVN risk.
  • Longer follow-up is needed to establish definitive success and complication rates for CR in infantile DDH.
Abstract

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