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Closed Vs. Open Reduction/Salter Innominate Osteotomy for Developmental Hip Dislocation After Age 18 Months:
Elizabeth J Scott1, Lori A Dolan, Stuart L Weinstein
1Department of Orthopedic Surgery and Rehabilitation, University of Iowa, Iowa City, Iowa.
The Journal of Bone and Joint Surgery. American Volume
|August 10, 2020
Summary
Open reduction and pelvic osteotomy for developmental dysplasia of the hip (DDH) is debated. While both closed reduction (CR) and open reduction with innominate osteotomy (OR/IO) offer benefits, OR/IO showed a higher survival rate at 48 years.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Hip dysplasia research
Background:
- Developmental dysplasia of the hip (DDH) treatment in walking-aged children is controversial.
- Single-stage open reduction and pelvic osteotomy is an aggressive strategy.
- Direct comparison of closed reduction (CR) versus open reduction and Salter innominate osteotomy (OR/IO) is needed.
Purpose of the Study:
- To compare the long-term outcomes of CR versus OR/IO for DDH in children aged 18-60 months.
- To estimate the relative hazard of total hip arthroplasty (THA) and THA-free survival time for each treatment.
Main Methods:
- A cohort of 45 patients (58 hips) received CR and 58 patients (78 hips) received OR/IO.
- Follow-up extended to a minimum of 40 years, with censoring at 48 years.
- Multivariate Cox regression analyzed THA hazard based on treatment, age at reduction, and bilaterality.
Main Results:
- At 48 years, 69% of OR/IO hips survived versus 50% of CR hips.
- Survival probability at 45 years was 0.63 for OR/IO and 0.55 for CR.
- In bilateral cases, CR at 18 months reduced THA hazard (HR=0.16), while CR at 36 months increased it (HR=4.23).
Conclusions:
- THA is more likely after CR than OR/IO, though unadjusted survival times showed no significant difference.
- In bilateral DDH, older age at CR increased THA hazard compared to OR/IO.
- Both CR and OR/IO provide benefits over natural history, but THA is a likely long-term outcome.
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