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Treatment outcome of neonatal hip instability
Mari Maikku1,2, Pasi Ohtonen3, Marita Valkama4,5
1Division of Orthopedic and Trauma Surgery, Department of Surgery, Oulu University Hospital, Oulu, Finland.
Insights
Treatment for neonatal hip instability (NHI) did not significantly impact long-term quality of life or hip function. However, NHI patients showed increased hip discomfort in clinical tests after 18 years.
Area of Science:
- Orthopedics
- Pediatric Orthopedics
- Hip Dysplasia Research
Background:
- Neonatal hip instability (NHI) is a condition requiring early intervention.
- Long-term outcomes of NHI treatment, particularly regarding hip-related quality of life and clinical findings, require further investigation.
Purpose of the Study:
- To compare hip-related quality of life and clinical findings in individuals treated for NHI with age- and sex-matched controls.
- To test the hypothesis that NHI treatment predisposes individuals to long-term hip discomfort.
Main Methods:
- A population-based study included 96 patients treated for NHI with Von Rosen-like splinting before one month of age.
- 94 age- and sex-matched controls were recruited for comparison.
- The Copenhagen Hip and Groin Outcome Score (HAGOS) and physical examinations were used to assess outcomes after a mean follow-up of 18.2 years.
Main Results:
- No clinically relevant differences in HAGOS scores (pain, function, quality of life) were found between the NHI treatment group and controls.
- A statistically significant difference was observed in the HAGOS Symptoms subscale (p = 0.033).
- Patients treated for NHI demonstrated a higher frequency of positive clinical hip tests and reported more groin pain during passive hip flexion.
Conclusions:
- While neonatal hip instability treatment can lead to increased hip discomfort in clinical assessments, it does not appear to cause clinically relevant long-term differences in pain experience, physical function, or hip-related quality of life.
- The findings suggest that early treatment for NHI is effective in preventing significant long-term functional deficits and quality of life impairments.
Aims:
We aimed to determine hip-related quality of life and clinical findings following treatment for neonatal hip instability (NHI) compared with age- and sex-matched controls. We hypothesized that NHI would predispose to hip discomfort in long-term follow-up.
Methods:
We invited those born between 1995 and 2001 who were treated for NHI at our hospital to participate in this population-based study. We included those that had Von Rosen-like splinting treatment started before one month of age. A total of 96 patients treated for NHI (75.6 %) were enrolled. A further 94 age- and sex-matched controls were also recruited. The Copenhagen Hip and Groin Outcome Score (HAGOS) questionnaire was completed separately for both hips, and a physical examination was performed.
Results:
The mean follow-up was 18.2 years (14.6 to 22.0). The HAGOS scores between groups were similar and met statistical and clinical significance only in the Symptoms subscale (mean difference 3.80, 95% confidence interval (CI) 0.31 to 7.29; p = 0.033). Those patients who had undergone treatment for NHI had a higher frequency of positive flexion-adduction-internal rotation test (odds ratio (OR) 2.6, 95% CI 1.2 to 5.6; p = 0.014), resisted straight leg rise test (OR 4.5, 95% CI 1.4 to 14.9; p = 0.014), and also experienced more pain in the groin during passive end range hip flexion (OR 2.5, 95% CI 1.2 to 5.3; p = 0.015) than controls.
Conclusion:
NHI predisposes to hip discomfort in clinical tests, but no clinically relevant differences in experience of pain, physical function, and hip-related quality of life could be observed between the treated group and matched controls in 18 years of follow-up. Cite this article: Bone Joint J 2020;102-B(12):1767-1773.
