Surgical intervention including open reduction of hip in children of walking age is often fraught with secondary surgical procedures as the failure is not infrequent. The resultant persistent dysplasia and/ or loss of reduction can complicate the treatment of DDH in walking children.
Gholve et al conducted a study to identify predictors for secondary procedures after open reduction of the hip in walking children with DDH. They performed a retrospective study of walking children with idiopathic DDH treated with open reduction of the hip and followed up for >5 years in two outstanding institutions (Children’s Hospital of Boston and Children’s Hospital of Philadelphia).
There were 49 open reductions of the hip in 42 patients at a mean age of 31.3 months (range, 15.3 to 92.6 mo), with a mean follow-up of 9.7 years (5 to 16.9 y). Twelve patients had open reduction only, 15 had concurrent pelvic osteotomy, 4 had femoral osteotomy, and 18 had both femoral and pelvic osteotomy.
Four (8%) patients required repeat open reduction at a mean of 5.1 months after index surgery. Twenty-four (49%) patients had at least one secondary surgery for dysplasia at a mean of 3.2 years after index surgery. Of these 24, six patients had 2 and two patients had 3 additional operations. Of the 27 patients who did not have concurrent femoral osteotomy at index surgery, 19 required a secondary procedure (this was a significant finding).
Forty-nine percent of the patients in this cohort required secondary procedures to treat hip dysplasia. Open reduction without concurrent femoral osteotomy strongly predicted the need for a secondary procedure. Acetabular remodeling continued following surgery and maximum remodeling was observed in the first 4 years after open reduction.
Comments:
Clinicians and Parents should be realistic in their expectations from surgical procedures related to delayed treatment of hip dysplasia (with hip dislocation in children of walking age). Even at leading children’s hospitals, half of the children needed a second surgical procedure following an initial procedure for hip dysplasia. We must not jump to conclusions although this study suggests that femoral osteotomy may help decrease the need for secondary surgical procedures.
This study makes it clear that our current methods are not as successful as everyone would like them to be, even in the best of hands. The International Hip Dysplasia Institute is committed to resolving some of these issues through cooperative research at multiple academic institutions. Our multi-center data registry should be able to expand on this study that was conducted at two major centers in the United States, but the IHDI has cooperation with leading centers around the world that have a variety of different methods for surgical treatment. With accurate comparisons, we hope to determine the best methods. Your support is helpful in this effort.
Reference:
Gholve PA, Flynn JM, Garner MR, Millis MB, Kim YJ. J Pediatr Orthop. 2012 Apr;32(3):282-9.
