Revision open reduction in developmental dysplasia of the hip

Re-dislocation after open reduction remains a challenge in the treatment of developmental dysplasia of the hip (DDH). Few geographically and temporally diverse reports exist on the topic. The aim of this study was to uncover the outcome in a group of DDH patients who underwent repeat open reduction.

All patients who had DDH surgery were screened at one hospital, spanning a ten-year period. Patients who underwent repeat open reduction for re-dislocation were included. Clinical data and radiographic parameters were obtained. This is a retrospective cohort study.

Twenty-three revision open reductions were included. The median age (interquartile range) was 40 (26-61) months and the median follow-up duration was 26 (14-55.50) months. Fifteen revisions (65%) had at least one notable complication. Recurrent instability was found in nine revisions (39%), and other complications included avascular necrosis, stiffness and leg length discrepancy in 12 revisions (52%). Although it did not reach statistical significance (p = 0.13), all hips with pre-revision international hip dysplasia institute grade III (n = 4), compared to grade IV, remained stable after the re-operation.

There is a substantial risk of dismal prognosis after repeat open reduction. Moreover, every precaution should be taken during the first surgery to reduce the risk of re-operation. Findings from this study may help inform surgeons and caregivers about the probable negative outcome when contemplating repeat open reduction.