Is male gender a prognostic factor for developmental dysplasia of the hip? Mid-long-term results of posteromedial limited surgery

Bilateral Involvement in Developmental Dislocation of the Hip: Analysis of 561 Patients Operated on Using the Limited Posteromedial Approach

Our objective was to scrutinize the risk factors related to bilateral involvement in the developmental dysplasia of the hip (DDH) and to inspect the impact of bilaterality on the enduring results of the DDH. All patients, aged between 6 and 18 months, who underwent surgery using the limited posteromedial approach (734 hips from 561 patients), were included in this study. The number of births, birth type, history of consanguineous marriage, family history, and swaddling were analyzed. Physical examination and complaints of the patients were evaluated, and direct radiographs were examined in terms of the redislocation, avascular necrosis, and residual acetabular dysplasia. Among the 561 patients, bilateral DDH was observed in 173 patients (30.8%). The use of swaddling was found to be statistically significant between groups (p = 0.012). The use of swaddling for more than one month was associated with a higher odds ratio for bilaterality (p = 0.001, OR = 1.56, 95% CI: 1.2-2.0). Furthermore, bilaterality was associated with a higher risk for redislocation in DDH (p = 0.001, OR = 4.25, 95% CI: 1.6-11.2). The study concludes that swaddling for over a month is strongly linked with the bilateral involvement in DDH. It is important to note that bilaterality plays a crucial role in the development of redislocation after open reduction in DDH.

Redislocation After Posteromedial Open Reduction in Developmental Dysplasia of the Hip: Analyzing the Risk Factors and Determining the Optimal Treatment Method

BACKGROUND

Redislocation, which is one of the most serious problems in developmental dysplasia of the hip (DDH), might occur because of several reasons. Regardless of the treatment, redislocations are reported to be associated with high complication rates in the literature. Our objective was to identify the risk factors for redislocation in the patients treated for DDH and to determine the optimal treatment method for redislocations.

METHODS

Patients with DDH who were treated with the limited posteromedial approach in our clinic between 1993 and 2021 and followed up prospectively were examined in this single-centered study. The participants were assigned into 2 groups: a study group consisting of 25 hips of 17 patients with redislocation and a control group consisting of 502 hips of 390 patients without redislocation. To determine the risk factors for redislocation, demographic data, known risk factors for DDH, preoperative Tönnis stage, and whether the capsule was opened or not were evaluated. To determine the optimal treatment method, a subgroup analysis based on applied treatment (closed reduction and cast replacement vs. repeating open reduction) was conducted, and recurrent redislocation, complication, and secondary surgery rates were evaluated.

RESULTS

Bilaterality and high-grade hip dislocations were found to be associated with higher odds ratio (OR) for redislocation [ P =0.007, OR=3.64, 95% confidence interval (CI), 1.3 to 8.8; and P =0.006, OR=4.52, 95% CI, 1.37 to 14.91, respectively]. Recurrent redislocation and complication rates were found to be significantly higher in redislocations treated with closed reduction and cast replacement ( P =0.007 and P =0.015, respectively).

CONCLUSIONS

Bilaterality and higher preoperative Tönnis stage are critical risk factors for redislocation after open reduction in DDH. It should be kept in mind that closed reduction and cast replacement is associated with higher rates of recurrent redislocation and complications, and redislocation cases should be treated by repeating open reduction.

LEVEL OF EVIDENCE

Level II-therapeutic study.

Effect of acetabular morphological parameters applied in proximal femoral varus osteotomy on the treatment of developmental dysplasia of the hip in children

BACKGROUND

The study was carried out based on the background that though proximal femoral varus osteotomy is one of the most effective methods in treating developmental dysplasia of the hip (DDH), its surgical efficiency and effect need to be improved.

METHODS

The neck shaft angle and acetabular morphological parameters were measured before and after operation and during clinical follow-up. The Severin criteria and McKay criteria were both adopted to score the measurements. The distance from the center of the femoral head to the medial cutting bone (expressed as C value) and the shortened lengths of the proximal femur (expressed as Δ S) calculated by formula and obtained by actual measurement were compared.

RESULTS

The neck shaft angle and acetabular morphological parameters after operation and during clinical follow-up were significantly lower than those before operation (P<0.05). The proportion of children with McKay scores of I, II, III, and IV after operation was 50.00%, 41.67%, 8.33%, and 0.00%, respectively; while the proportion of children with Severin scores of I, II, III, and IV was 55.00%, 38.33%, 6.67%, and 0.00%, respectively. There were no significant differences in the C value and Δ S obtained after formula calculation and actual measurement (P>0.05).

CONCLUSIONS

The acetabular morphological parameters applied in proximal femoral varus osteotomy are of great value for the treatment of DDH in children.