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Early Outcomes of Arthroscopic Versus Open Reduction for Developmental Dysplasia of the Hip in Children: A Randomized

Abdulkadr Muhammed S Alany¹, Dedawan Rasul², Ahmed Ibrahim Hussein Berzenji³

¹Surgery, College of Medicine, Hawler Medical University, Erbil, IRQ.

|February 7, 2025

Insights

Arthroscopic hip surgery for developmental dysplasia of the hip (DDH) showed 0% redislocation rates, significantly lower than open surgery. This minimally invasive approach also reduced operative time and blood loss in children.

Area of Science:

Pediatric Orthopedics
Minimally Invasive Surgery

Background:

Developmental dysplasia of the hip (DDH) is a common pediatric orthopedic condition.
Surgical hip reduction is often necessary for moderate to severe cases.
Traditional open reduction can be associated with significant morbidity.

Purpose of the Study:

To compare the early outcomes of arthroscopic-assisted reduction versus open reduction for DDH.
To evaluate redislocation rates, operative time, blood loss, and complications like avascular necrosis (AVN).

Main Methods:

A randomized controlled trial (RCT) involving 43 children (12-24 months) with DDH (Tönnis grade II+).
Patients were randomized to arthroscopic-assisted reduction (n=19) or open surgical reduction (n=24).
Outcomes measured included redislocation, operative time, blood loss, acetabular index, and AVN at 6, 12, and 24 months.

Main Results:

Arthroscopic reduction had significantly lower redislocation rates (0%) compared to open reduction (44%) (p=0.047).
Arthroscopic procedures were associated with shorter operative times and less blood loss (p<0.001).
No significant differences in acetabular index; AVN rates were numerically higher in the open group but not statistically significant.

Conclusions:

Arthroscopic-assisted reduction offers superior short-term outcomes for DDH, including reduced redislocation, operative time, and blood loss.
While AVN rates were not statistically different, arthroscopy may preserve vascularity, potentially reducing long-term complications.
Further multicenter trials with longer follow-up are recommended to validate these findings.

Read full analysis

Abstract

Aim:

This study aims to assess and compare the early outcomes of arthroscopic-assisted reduction with open reduction techniques in the surgical treatment of developmental dysplasia of the hip (DDH) in children. The trial was conducted in two tertiary care hospitals specializing in pediatric orthopedic surgery in Erbil, Iraq.

Materials And Methods:

This parallel-group, randomized controlled trial (RCT) included a total of 43 children aged 12-24 months with DDH (Tönnis grade II or higher) who were randomly allocated into two groups: arthroscopic-assisted reduction (n = 19) and open surgical reduction (n = 24). Exclusion criteria included neuromuscular disorders, teratologic hip dislocations, and previous hip surgery. The patients were treated by either arthroscopic-assisted or open reduction according to the randomization. The postoperative treatment was the same for all groups, comprising hip spica casting. The study's main outcome measures were clinically and radiographically documented redislocation rates at 6, 12, and 24 months postoperatively, operative time, estimated blood loss, radiographic measurements of the acetabular index, and complications such as avascular necrosis (AVN).

Results:

Redislocation rates were significantly lower in the arthroscopic-assisted reduction group (0%) compared to that of the open surgical reduction group (44%) (p = 0.047). The arthroscopic-assisted reduction resulted in shorter operative times (mean 94.3 minutes) and lower estimated blood loss (mean 141.9 mL) compared to open reduction techniques (p < 0.001). No significant differences were observed in the acetabular index across groups at six months, one year, or two years postoperatively (p > 0.05). AVN rates were highest in the open surgical reduction group (44%) compared to the arthroscopic group (21%), but this difference was not statistically significant (p = 0.074).

Conclusion:

Arthroscopic-assisted reduction demonstrated superior short-term outcomes in terms of redislocation rates, operation time, and blood loss compared with open surgical techniques. Although the rates of AVN did not reach statistical significance, the possibility of preserving vascularity in arthroscopic procedures is promising for reducing long-term complications. Longer follow-up and further multicenter trials are required to confirm these findings.

Keywords:

avascular necrosis developmental dysplasia of the hip minimally invasive surgery randomized controlled trial surgical outcomes

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