Long-term results of closed reduction for developmental dislocation of the hip in children of walking age under eighteen months old

Abstract

Background: Developmental dysplasia of the hip (DDH) diagnosed in older postnatal children can be effectively treated by closed reduction (CR) alone. However, no prospective or comparative trial to explore the differential effectiveness of CR between non-walking and walking postnatal children has yet been reported. This study investigated the clinical and radiologic outcomes of CR in the age range of interest (12-18 months old) via a prospective trial and compared these results with those of a younger age group who also underwent CR.

Patients and methods: Between 1999 and 2009, 56 children diagnosed with DDH were enrolled. Of these, 45 were followed after CR for a period of at least seven years. The anatomical parameters of the hip/pelvis, including arthrograms, were evaluated and compared before and after CR. The final radiologic status, including the occurrence of avascular necrosis (AVN), and clinical outcomes were evaluated and compared.

Results: The mean ages at the start of treatment were 6.11 and 15.29 months old in group 1 and group 2, respectively. None of the children required surgical open reduction during the follow-up period. The final status of hips were classified according to the Bucholz-Ogden system. Two type II hips and one type I hip were found in group 1. In group 2, two type I hips and one type III hip were observed at the final follow-up. The overall clinical outcomes were satisfactory in both groups, according to McKay's criteria. No significant differences in clinical outcomes between the two groups were found (P = 0.382). Surgery was performed for just one patient in group 2 at seven years old.

Conclusions: CR in DDH for postnatal children 12-18 months old may provide similar results to the non-walking age group if performed with preliminary traction, gentle CR under general anaesthesia, percutaneous adductor tenotomy, and the minimization of forceful abduction.

Keywords: Avascular necrosis; Closed reduction; Developmental dysplasia of the hip; Walking age.