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Outcomes for Patients With Developmental Hip Dysplasia Who Present After Six Months of Age
Insights
Developmental hip dysplasia presenting after six months requires more surgery. However, even late-presenting cases of hip dysplasia can achieve good outcomes with appropriate management.
Area of Science:
- Orthopedics
- Pediatric Orthopedics
- Developmental Dysplasia of the Hip
Background:
- Late presentation of developmental dysplasia of the hip (DDH) remains a challenge despite screening.
- Treatment after six months of age is more complex and associated with higher complication rates.
Purpose of the Study:
- To compare outcomes for patients with DDH presenting before versus after six months of age.
- To identify risk factors for late presentation of DDH.
Main Methods:
- Retrospective review of DDH patients (2003-2012) presenting before 18 months with at least two years of follow-up.
- Cohort divided into presentation before six months (BSM) and after six months (ASM).
- Comparison of demographics, exam findings, and treatment outcomes between groups.
Main Results:
- Identified 36 ASM and 63 BSM patients. Normal newborn exam and unilateral involvement were risk factors for late presentation (p < 0.001).
- Only 6% of ASM patients received non-operative treatment; the ASM group averaged 1.33 procedures.
- ASM patients had 4.91 times higher odds of requiring open reduction for primary procedure (p = 0.001). Limited hip range of motion was the only significant outcome difference (p = 0.03).
Conclusions:
- Management of DDH presenting after six months necessitates increased surgical intervention.
- Despite requiring more surgery, developmental hip dysplasia presenting after six months can achieve satisfactory outcomes.
Purpose:
Late presentation of hip dysplasia persists despite robust screening methods. After 6 months of age, treatment with a hip abduction orthosis becomes challeng-ing, and all other treatment modalities have higher reported rates of complications.
Methods:
We performed a retrospective review of all patients from 2003 to 2012 who had the sole diagnosis of de-velopmental hip dysplasia, who presented before 18 months of age, and who had at least 2 years of follow-up. The cohort was then grouped based on their presentation before (BSM) or after (ASM) 6 months of age. The groups were compared for demographics, exam findings, and outcomes.
Results:
We identified 36 patients with presentation after 6 months and 63 patients who presented before 6 months. Hav-ing a normal newborn hip exam and unilateral involvement were risk factors for late presentation (p < 0.001). Only 6% (2/36) patients in the ASM group were successfully treated non-operatively; the ASM group underwent an average of 1.33 procedures. The odds of utilizing an open reduction for the primary procedure for the late presenting patient was 4.91 times higher than the early presenting group (p = 0.001). Limited hip range of motion, particularly hip external rotation, was the only significantly different out-come (p = 0.03). There was no significance difference in the complications (p = 0.24).
Conclusion:
Management of patients with developmental hip dysplasia presenting after 6 months of age requires more surgical intervention but can result in satisfactory outcomes.
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