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The predictability of acetabular development after closed reduction for congenital dislocation of the hip
D I Brougham1, N S Broughton, W G Cole
1Department of Orthopaedics, Royal Children's Hospital, Parkville, Victoria, Australia.
Insights
The h/b ratio on radiographs can predict hip dysplasia development in children after closed reduction. Persistent dysplasia after one year warrants further acetabular surgery consideration.
Area of Science:
- Pediatric Orthopedics
- Radiology
- Developmental Dysplasia of the Hip
Background:
- Congenital dislocation of the hip (CDH) requires effective management to ensure proper acetabular development.
- Predicting long-term acetabular development after closed reduction is crucial for guiding treatment decisions.
Purpose of the Study:
- To identify a reliable radiological measurement for predicting acetabular development following closed reduction in pediatric CDH.
- To evaluate the efficacy of different radiographic parameters in forecasting outcomes.
Main Methods:
- Retrospective review of serial radiographs from 63 hips in 53 children treated for CDH via closed reduction.
- Long-term follow-up (over seven years) to assess acetabular development and dysplasia.
- Analysis of radiographic measurements including the h/b ratio and acetabular index at reduction and during the first year.
Main Results:
- Failure to achieve concentric reduction or loss of reduction within one year were the strongest predictors of persistent acetabular dysplasia.
- The h/b ratio effectively quantitated the risk of ongoing dysplasia.
- Acetabular index measurements were found to be unreliable predictors.
- Late treatment and avascular necrosis did not significantly impact acetabular development.
Conclusions:
- The h/b ratio is a valuable tool for predicting acetabular development after closed reduction for CDH.
- Persistent acetabular dysplasia, indicated by the h/b ratio, should prompt consideration of surgical intervention.
- Early and concentric reduction is key to favorable long-term outcomes in pediatric hip dysplasia.
Abstract:
We have reviewed the serial radiographs of 63 hips in 53 children treated by closed reduction for congenital dislocation with a view to finding a radiological measurement which can predict subsequent acetabular development. All had been followed for more than seven years, and at latest review, 34 hips were dysplastic. Failure to obtain concentric reduction or its loss by migration of the femoral head within one year of reduction were the best predictors of persisting acetabular dysplasia and were best quantitated by the h/b ratio (Smith et al. 1968). The acetabular index at reduction or its decrease in the first year were not reliable predictors. Late treatment was less likely to lead to normal acetabular development, but avascular necrosis did not appear to have a significant influence. The average age at which the acetabulum stopped developing was five years, but ranged from 17 months to eight years. The failure of a dysplastic acetabulum to improve in each annual radiograph after closed reduction should lead to consideration of operation on the acetabulum.