Skip to main content

Advertisement

SpringerLink
Log in

Retrospective Comparison of Outcomes Between Closed and Open Reduction for Developmental Dysplasia of the Hip in Children Aged 6–24 Months

  • Original Article
  • Published:
Indian Journal of Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

We aimed to compare the outcomes between closed reduction (CR) and open reduction (OR) in children aged 6–24 months with developmental dysplasia of the hip (DDH) who could be reduced safely and stably by the closed reduction operation.

Methods

We retrospectively reviewed the medical records of 77 patients who underwent CR or OR for DDH. Fifty-one patients (56 hips) underwent CR, 26 (29 hips) underwent OR. The demographic data, International Hip Dysplasia Institute classification and acetabular index (AI) before reduction and the centre-edge angle (CEA), AI, Alsberg angle (AA), Reimer’s migration index (RMI), and height-to-width index (HWI) of the epiphysis were compared between two groups at the final follow-up. The percentage of coxa magna > 15% of the normal side and AA > 81° were calculated.

Results

At the final follow-up, the mean AA in the CR and OR groups were 77.66° (60°–89°) and 81.97° (73°–91°) (p = 0.001), respectively, there were 32.14% and 58.62% of the hips with an AA > 81° (p = 0.019). The frequency of coxa magna > 15% of the normal side was higher in the OR group (60.9%) than in the CR group (6.5%) (p < 0.001). There was no difference in the improvement of AI, CEA, HWI, and RMI.

Conclusion

In children aged 6–24 months with DDH, if a stable and safe CR can be obtained but with medial joint space up to 6mm, CR should be attempted first.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Vitale, M. G., & Skaggs, D. L. (2001). Developmental dysplasia of the hip from six months to four years of age. Journal of American Academy of Orthopaedic Surgeons, 9(6), 401–411.

    Article  CAS  Google Scholar 

  2. Li, Y., Zhou, Q., Liu, Y., Chen, W., Li, J., Canavese, F., & Xu, H. (2019). Closed reduction and dynamic cast immobilization in patients with developmental dysplasia of the hip between 6 and 24 months of age. European Journal of Orthopaedic Surgery & Traumatology, 29(1), 51–57.

    Article  Google Scholar 

  3. Tennant, S. J., Eastwood, D. M., Calder, P., Hashemi-Nejad, A., & Catterall, A. (2016). A protocol for the use of closed reduction in children with developmental dysplasia of the hip incorporating open psoas and adductor releases and a short-leg cast: Mid-term outcomes in 113 hips. The Bone & Joint Journal, 98-B(11), 1548–1553.

    Article  CAS  Google Scholar 

  4. Talathi, N. S., Chauvin, N. A., & Sankar, W. N. (2018). Docking of the femoral head following closed reduction for DDH: Does it really occur. Journal of Pediatric Orthopedics, 38(8), e440–e445.

    Article  Google Scholar 

  5. Zhou, W., Sankar, W. N., Zhang, F., Li, L., Zhang, L., & Zhao, Q. (2020). Evolution of concentricity after closed reduction in developmental dysplasia of the hip. The Bone & Joint Journal, 102-B(5), 618–626.

    Article  Google Scholar 

  6. Cooper, A. P., Doddabasappa, S. N., & Mulpuri, K. (2014). Evidence-based management of developmental dysplasia of the hip. Orthopedic Clinics of North America, 45(3), 341–354.

    Article  Google Scholar 

  7. Li, Y., Xu, H., Li, J., Yu, L., Liu, Y., Southern, E., & Liu, H. (2015). Early predictors of acetabular growth after closed reduction in late detected developmental dysplasia of the hip. Journal of Pediatric Orthopedics Part B, 24(1), 35–39.

    Article  Google Scholar 

  8. Vaquero-Picado, A., González-Morán, G., Garay, E. G., & Moraleda, L. (2019). Developmental dysplasia of the hip: Update of management. EFORT Open Reviews, 4(9), 548–556.

    Article  Google Scholar 

  9. Alsiddiky, A. M., Bakarman, K. A., Alzain, K. O., Aljassir, F. F., Al-Ahaideb, A. S., Kremli, M. K., Zamzam, M. M., & Mervyn Letts, R. (2012). The early detection and management of unstable concentric closed reduction of DDH with percutaneous K-wire fixation in infants 6 to 12 months of age. Journal of Pediatric Orthopedics, 32(1), 64–69.

    Article  Google Scholar 

  10. Tarassoli, P., Gargan, M. F., Atherton, W. G., & Thomas, S. R. (2014). The medial approach for the treatment of children with developmental dysplasia of the hip. The Bone & Joint Journal, 96-B(3), 406–413.

    Article  CAS  Google Scholar 

  11. Abousamra, O., Deliberato, D., Singh, S., & Klingele, K. E. (2020). Closed vs open reduction in developmental dysplasia of the hip: The short-term effect on acetabular remodeling. Journal of Clinical Orthopaedics and Trauma, 11(2), 213–216.

    Article  Google Scholar 

  12. Tennant, S. J., Hashemi-Nejad, A., Calder, P., & Eastwood, D. M. (2019). Bilateral developmental dysplasia of the hip: Does closed reduction have a role in management? Outcome of closed and open reduction in 92 hips. Journal of Pediatric Orthopedics, 39(4), e264–e271.

    Article  Google Scholar 

  13. Ramsey, P. L., Lasser, S., & MacEwen, G. D. (1976). Congenital dislocation of the hip. Use of the Pavlik harness in the child during the first six months of life. Journal of Bone and Joint Surgery, 58(7), 1000–4.

    Article  Google Scholar 

  14. Dhar, S., Taylor, J. F., Jones, W. A., & Owen, R. (1990). Early open reduction for congenital dislocation of the hip. Journal of Bone and Joint Surgery. British Volume, 72(2), 175–180.

    Article  CAS  Google Scholar 

  15. Gui, R., Canavese, F., Liu, S., Li, L., Zhang, L., & Li, Q. (2020). The potential role of the Alsberg angle as a predictor of lateral growth disturbance of the capital femoral epiphysis in children with developmental dysplasia of the hip treated by closed reduction. Journal of Children’s Orthopaedics, 14(2), 106–111.

    Article  Google Scholar 

  16. Reimers, J. (1980). The stability of the hip in children. A radiological study of the results of muscle surgery in cerebral palsy. Acta Orthopaedica Scandinavica, 184, 1–100.

    Article  CAS  Google Scholar 

  17. Gamble, J. G., Mochizuki, C., Bleck, E. E., & Rinsky, L. A. (1985). Coxa magna following surgical treatment of congenital hip dislocation. Journal of Pediatric Orthopedics, 5(5), 528–533.

    Article  CAS  Google Scholar 

  18. Li, L. Y., Zhang, L. J., Li, Q. W., Zhao, Q., Jia, J. Y., & Huang, T. (2012). Development of the osseous and cartilaginous acetabular index in normal children and those with developmental dysplasia of the hip: A cross-sectional study using MRI. Journal of Bone and Joint Surgery. British Volume, 94(12), 1625–1631.

    Article  CAS  Google Scholar 

  19. Tönnis, D. (1976). Normal values of the hip joint for the evaluation of X-rays in children and adults. Clinical Orthopaedics and Related Research, 119, 39–47.

    Google Scholar 

  20. Drummond, D. S., O’Donnell, J., Breed, A., Albert, M. J., & Robertson, W. W. (1989). Arthrography in the evaluation of congenital dislocation of the hip. Clinical Orthopaedics and Related Research, 243, 148–156.

    Article  Google Scholar 

  21. Albinana, J., Dolan, L. A., Spratt, K. F., Morcuende, J., Meyer, M. D., & Weinstein, S. L. (2004). Acetabular dysplasia after treatment for developmental dysplasia of the hip. Implications for secondary procedures. The Journal of Bone and Joint Surgery. British Volume, 86(6), 876–886.

    Article  CAS  Google Scholar 

  22. Shin, C. H., Yoo, W. J., Park, M. S., Kim, J. H., Choi, I. H., & Cho, T. J. (2016). Acetabular remodeling and role of osteotomy after closed reduction of developmental dysplasia of the hip. Journal of Bone and Joint Surgery. American Volume, 98(11), 952–957.

    Article  Google Scholar 

  23. Alassaf, N. (2020). Treatment of developmental dysplasia of the hip (DDH) between the age of 18 and 24 months. European Journal of Orthopaedic Surgery & Traumatology, 30(4), 637–641.

    Article  Google Scholar 

  24. Pospischill, R., Weninger, J., Ganger, R., Altenhuber, J., & Grill, F. (2012). Does open reduction of the developmental dislocated hip increase the risk of osteonecrosis. Clinical Orthopaedics and Related Research, 470(1), 250–260.

    Article  Google Scholar 

  25. Sankar, W. N., Gornitzky, A. L., Clarke, N., Herrera-Soto, J. A., Kelley, S. P., Matheney, T., Mulpuri, K., Schaeffer, E. K., Upasani, V. V., Williams, N., Price, C. T., International Hip Dysplasia Institute. (2019). Closed reduction for developmental dysplasia of the hip: Early-term results from a prospective, multicenter cohort. Journal of Pediatric Orthopedics, 39(3), 111–118.

    Article  Google Scholar 

  26. Firth, G. B., Robertson, A. J., Schepers, A., & Fatti, L. (2010). Developmental dysplasia of the hip: Open reduction as a risk factor for substantial osteonecrosis. Clinical Orthopaedics and Related Research, 468(9), 2485–2494.

    Article  CAS  Google Scholar 

  27. Novais, E. N., Hill, M. K., Carry, P. M., & Heyn, P. C. (2016). Is age or surgical approach associated with osteonecrosis in patients with developmental dysplasia of the hip? A meta-analysis. Clinical Orthopaedics and Related Research, 474(5), 1166–1177.

    Article  Google Scholar 

  28. Imatani, J., Miyake, Y., Nakatsuka, Y., Akazawa, H., & Mitani, S. (1995). Coxa magna after open reduction for developmental dislocation of the hip. Journal of Pediatric Orthopedics, 15(3), 337–341.

    Article  CAS  Google Scholar 

  29. Gershuni-Gordon, D. H., & Axer, A. (1974). Synovitis of the hip joint—An experimental model in rabbits. The Journal of Bone and Joint Surgery. British Volume, 56(1), 69–77.

    CAS  PubMed  Google Scholar 

  30. Shin, C. H., Hong, W. K., Lee, D. J., Yoo, W. J., Choi, I. H., & Cho, T. J. (2017). Percutaneous medial hemi-epiphysiodesis using a transphyseal screw for caput valgum associated with developmental dysplasia of the hip. BMC Musculoskeletal Disorders, 18(1), 451.

    Article  Google Scholar 

Download references

Acknowledgements

This work was supported by National Nature Science Foundation of China (Grant number: 81772296).

Author information

Authors and Affiliations

  1. Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang, 110004, China

    Shuyu Ma, Weizheng Zhou, Lianyong Li, Enbo Wang, Lijun Zhang & Qiwei Li

Authors
  1. Shuyu Ma
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Weizheng Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lianyong Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Enbo Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lijun Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Qiwei Li
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

SM: data collection and analysis, manuscript preparation. WZ: data collection and analysis, manuscript preparation. LL: project administration, manuscript revision, fund acquisition. EW: data collection and analysis. LZ: data analysis, manuscript revision. QL: data analysis, manuscript revision.

Corresponding author

Correspondence to Lianyong Li.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the Medical Ethics Committee of the authors' institution (Approval No. 2020PS113K).

Informed consent

Informed consent was waived due to the retrospective design of this study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ma, S., Zhou, W., Li, L. et al. Retrospective Comparison of Outcomes Between Closed and Open Reduction for Developmental Dysplasia of the Hip in Children Aged 6–24 Months. JOIO 56, 1640–1646 (2022). https://doi.org/10.1007/s43465-022-00690-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s43465-022-00690-9

Keywords

Search

Navigation