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Closed vs open reduction in developmental dysplasia of the hip: The short-term effect on acetabular remodeling
Oussama Abousamra1, David Deliberato2, Satbir Singh1
1Department of Orthopedic Surgery, Nationwide Children's Hospital, Columbus, OH, USA.
Insights
Open reduction with capsulorrhaphy may improve acetabular remodeling in developmental dysplasia of the hip (DDH) compared to closed reduction in young children. Higher remodeling is expected with open reduction, though avascular necrosis (AVN) remains a risk.
Area of Science:
- Pediatric Orthopedics
- Developmental Dysplasia of the Hip (DDH)
- Surgical Techniques
Background:
- Developmental Dysplasia of the Hip (DDH) is a common pediatric condition.
- Early intervention is crucial for optimal outcomes.
- Acetabular remodeling is a key factor in long-term hip health.
Purpose of the Study:
- To compare acetabular remodeling after closed versus open hip reduction in children under two years old with DDH.
- To evaluate the incidence of residual dysplasia and avascular necrosis (AVN) based on the reduction method.
Main Methods:
- Retrospective review of children with DDH who underwent closed or open reduction.
- Acetabular index (AI) measured pre-reduction and at age 4.
- Analysis of radiographic outcomes, including residual dysplasia (AI ≥ 30°) and AVN.
Main Results:
- 42 hips had closed reduction; 26 had open reduction.
- Higher rates of residual dysplasia (outcome AI ≥ 30°) were observed in the successful closed reduction group (29% vs. 19%).
- Avascular necrosis (AVN) incidence was higher in the open reduction group (13% vs. 7%).
Conclusions:
- Open reduction with capsulorrhaphy may offer superior acetabular remodeling compared to closed reduction in DDH patients under two, even with maintained reduction.
- While AVN is a consideration, open reduction may lead to better long-term acetabular development.
Background:
This study aims to assess acetabular remodeling following closed vs, open hip reduction in children younger than 2 years of age.
Methods:
Records of children with DDH, who underwent closed or open reduction, were reviewed. Acetabular index (AI) was measured on radiographs taken prior to reduction and on outcome radiographs taken at age 4 years. Radiographic outcomes were analyzed and residual dysplasia (outcome AI ≥ 30) degrees recorded.
Results:
42 hips had closed reduction; and 26 hips had open reduction. A higher percentage of hips treated with successful closed reduction, had outcome AI ≥ 30° (29% vs. 19% p = 0.387). Residual dysplasia was more common in IHDI-IV hips than IHDI-III hips for both groups. A higher incidence of AVN was seen in the open reduction group (13% vs. 7%; p = 0.43).
Conclusion:
In children with DDH under the age of two, open reduction with capsulorrhaphy may benefit acetabular remodeling more so than closed reduction despite maintenance of reduction. Although AVN remains a risk, higher remodeling might be expected with open reduction.
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