In spite of good neonatal screening programs and a global push towards early diagnosis of infants with DDH, we continue to see children with DDH and dislocated hips that need surgical intervention.
Holman et al conducted a study at University of Utah to answer the following questions: a) what is the long-term result of open reduction surgery in developmental dysplasia of the hip, and b) is there an age at surgery above which the outcome was too poor to recommend the operation?
Over a 40-year period, 148 patients with 179 dislocated hips had open reduction surgery for developmental dysplasia of the hip. Of these, 53 patients with 66 dislocated hips were available for follow-up. Almost half the children needed a second surgical procedure. Redislocation and avascular necrosis of the femoral head predicted poor outcomes. These authors also noted that the opposite hip may develop dysplasia even though it appeared normal initially.
This article is similar to April’s review from The Children’s Hospital Boston and The Children’s Hospital of Philadelphia because it also shows the unpredictable success rate following surgical procedures related to delayed treatment of hip dysplasia (with hip dislocation in children of walking age). Many factors play a role in outcome and despite knowing as much as we think we know, there may be many factors that we are unaware of and many that may be beyond our control from a treatment perspective.
The International Hip Dysplasia Institute is committed to resolving some of these issues through cooperative research at multiple academic institutions.