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Residual Hip Dysplasia in Children With Unilateral Hip Dislocation-Does Side Matter?
Hsin-Ying Lin1, Suzanne de Vos-Jakobs, Stijn Westerbos
1Department of Orthopaedics and Sports Medicine, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands.
Insights
Developmental dysplasia of the hip (DDH) outcomes are similar for right and left hip dislocations. This study found no significant differences in residual dysplasia, surgeries, or complications after 8 years of follow-up for right-sided versus left-sided DDH.
Area of Science:
- Pediatric Orthopedics
- Musculoskeletal Abnormalities
- Developmental Dysplasia of the Hip (DDH)
Background:
- Developmental dysplasia of the hip (DDH) is a common infant musculoskeletal condition.
- While left hip involvement is more frequent, poorer outcomes for right-sided DDH have been suggested.
- This study investigated potential outcome disparities between right and left unilateral hip dislocations in DDH.
Purpose of the Study:
- To compare the outcomes of right-sided versus left-sided unilateral hip dislocation in DDH.
- To evaluate residual dysplasia, surgical interventions, and complication rates over an 8-year follow-up period.
- To test the hypothesis that right-sided DDH dislocation leads to poorer outcomes.
Main Methods:
- Retrospective analysis of DDH patients diagnosed before age 1 with at least 8 years follow-up.
- Inclusion criteria: unilateral hip dislocation, DDH diagnosis before 1 year, minimum 8-year follow-up.
- Outcome measures included residual dysplasia (acetabular index >18°, center-edge angle <15°), surgical rates, and complications (avascular necrosis, redislocation).
Main Results:
- No significant differences in residual dysplasia were observed between right and left-sided DDH at 1, 2, 5, or 8 years follow-up.
- Surgical intervention rates for additional reduction or residual dysplasia treatment showed no significant difference.
- Complication rates, including avascular necrosis and redislocation, were comparable between the right and left hip dislocation groups.
Conclusions:
- Unilateral right-sided hip dislocation in DDH does not appear to result in poorer outcomes compared to left-sided dislocation.
- The study findings challenge the hypothesis of worse outcomes for right-sided DDH.
- Long-term follow-up indicates similar developmental trajectories and complication risks for both sides.
Background:
Developmental dysplasia of the hip (DDH) is the most common musculoskeletal abnormality in infants and young children. Despite the fact that the left hip is most frequently affected, literature and clinical experience suggest a poorer outcome for right-sided hip dislocation in DDH. On the basis of this hypothesis, we studied the outcomes (residual dysplasia, number of surgeries, and complication rate) of right-sided unilateral hip dislocation in comparison with left-sided unilateral hip dislocation in DDH up to 8 years follow-up.
Methods:
We identified all patients with unilateral hip dislocation at Erasmus MC Sophia Children's Hospital from 2002 to 2012, diagnosed with DDH before the age of 1 year and with a minimum follow-up of 8 years. The primary outcome was residual dysplasia (based on an acetabular index (AI) >18 degrees and center-edge angle of Wiberg (CEA) <15 degrees) at the age of 8 years. Secondary outcome measures were residual dysplasia at the ages of 1, 2, and 5 years, successful surgical reduction rates, additional surgery, and complication rates.
Results:
Out of a consecutive series of 555 patients, 298 could be included (17 males; median age at diagnosis 4.0 [IQR 3.0 to 5.5] months): 107 patients (35.9%) had right-sided unilateral hip dislocation. There was no significant difference in residual dysplasia between the unilateral left-sided and unilateral right-sided hip dislocation groups, respectively, at 1-year follow-up (34.0% vs. 24.2%, P =0.107), 2-year follow-up (74.1% vs. 70.1%, P =0.565), 5-year follow-up (74.1% vs. 66.2%, P =0.261), and 8-year follow-up (65.3% vs. 53.8%, P =0.199). There was no significant difference in surgical interventions between the left-sided and right-sided hip dislocation groups, respectively: additional surgical reduction (14.7% vs. 15.0%, P =0.945) and additional surgery for residual dysplasia (8.9% vs. 10.3%, P =0.695). There was no significant difference in complication rate between the unilateral left-sided and unilateral right-sided hip dislocation groups, respectively: avascular necrosis (19.4% vs. 15.9%, P =0.454) and redislocation (11.5% vs. 9.3%, P =0.561).
Conclusions:
The results of our study suggest that in patients with DDH, unilateral right-sided hip dislocation does not have poorer outcomes compared with unilateral left-sided hip dislocation during an 8-year follow-up.
Level Of Evidence:
Level III - retrospective follow-up study.
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