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Closed Reduction in Developmental Dysplasia of the Hip in Patients Older than One Year
Zoran Bozinovski1, Milena Bogojevska Doksevska1, Keti P Tokmakova2
1University Clinic for Orthopedic Surgery, Medical Faculty, Ss. Cyril and Methodius University, Skopje, Republic of North Macedonia.
Insights
Closed hip reduction is a successful treatment for developmental dysplasia of the hip in children over 12 months. This cost-effective method offers good outcomes with minimal bone structure changes.
Area of Science:
- Orthopedics
- Pediatric Surgery
Background:
- Developmental dysplasia of the hip (DDH) can be missed, leading to gait abnormalities in toddlers.
- Treatment for late-diagnosed DDH is debated, with closed reduction and casting being a common but sometimes unsuccessful option.
Purpose of the Study:
- To evaluate the effectiveness of closed hip reduction for treating developmental dysplasia of the hip in children older than 12 months.
Main Methods:
- A retrospective study of 20 patients (28 hips) diagnosed with DDH after 12 months of age.
- Clinical assessment included range of motion, limp, limb inequality, and pain, evaluated pre-operatively and at 1, 3, and 5 years post-procedure using modified McKay's criteria.
- Radiographic evaluation used Severin's scoring system.
Main Results:
- Clinically, 57% of hips were rated excellent (Grade I), 36% good (Grade II), and 7% fair (Grade III) at final follow-up.
- Radiographically, 43% of hips were Type I, and 29% were Type II according to Severin's criteria.
- Avascular necrosis was observed in 4 hips (14%), with one case developing post-reduction.
Conclusions:
- Closed hip reduction is a justified and cost-effective treatment for late-diagnosed DDH in children over 12 months.
- The procedure avoids direct operative bone changes and yields favorable clinical and radiographic results.
- While avascular necrosis is a potential complication, the overall success rate supports the procedure's use.
Introduction:
Besides an effective screening method for developmental dysplasia of the hip, there is certain number of children in whom the condition has been overseen or they have never been screened and the parents have noticed the odd walking pattern in their toddler. Treatment of such patients is controversial. One of the recommended treatment methods because of the short-term hospitalization, but often considered unsuccessful is closed reduction of the hip followed by cast immobilization.
Hypothesis:
Closed hip reduction in late diagnosed developmental dysplasia of the hip gives good results.
Aim:
Our aim in this retrospective study was evaluation of the success of the treatment with closed reduction of hip dislocation in children older than 12 months.
Patients And Methods:
In the study, we included 20 patients treated at our clinic from June 2004 to May 2017. Of these 20 patients, 8 had bilateral involvement, 12 had unilateral, in a total of 28 hips. In all patients we noted preoperatively the range of movement, the presence of limp, any limb inequality, and hip pain. We used clinical and radiological parameters for evaluation. Clinically, we examined the range of movement, limb inequality as well as limb function and we classified it according to the modified McKay's criteria. Same examinations were done at 1, 3, and 5 years after closed reduction.
Results:
At the last follow-up examination, using McKey's criteria for clinical evaluation we rated the hips in two patients (7%) as grade III, i.e. fair grade, 10 hips (36%) were grade II - rated good, and 16 hips (57%) were evaluated as grade I. In four hips, there were signs of avascular necrosis of the hip, while in one patient the avascular necrosis developed after the closed reduction. Radiographic assessment (Figs 3, 4) using Severin's scoring system showed no hips with types V and VI, type IV was observed in 7%, type III in 21%, type II in 29%, while most of the hips (12, 43%) were type I.
Conclusion:
We concluded that the procedure was justified. An advantage of this method is that it is inexpensive; it entails no direct operative changes of the bone structures and gives good results.
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