Intraoperative Hip Arthrography During Closed Reduction for Developmental Dysplasia of the Hip in Infants: A Comparative Study of Surgical Decision-Making and Secondary Intervention Risk

This study evaluated whether intraoperative hip arthrography performed during closed reduction for developmental dysplasia of the hip (DDH) in infants provides prognostic information regarding treatment failure and the need for secondary surgery and examined the influence of patient age. This retrospective comparative study included 88 hips in 79 patients aged ≤1 year who underwent closed reduction followed by hip spica casting. Patients were grouped according to intraoperative assessment method: fluoroscopy alone (Group 1) or fluoroscopy combined with arthrography (Group 2). The primary outcome was treatment failure, defined as secondary open reduction for redislocation in Group 1 and intraoperative conversion to open reduction due to nonconcentric reduction in Group 2. Secondary outcomes included avascular necrosis (AVN), acetabular index (AI) at 24 months, and lateral center–edge angle (LCEA) at 5 years. Subgroup analyses were performed for patients aged ≤6 months and 6–12 months. Overall failure rates were similar between groups (18.8% vs 20.0%, p=1.000). However, the timing of failure differed: failures in Group 2 were detected and managed intraoperatively, whereas those in Group 1 presented later and required additional surgery. Radiographic outcomes and AVN incidence were comparable (p>0.05). Failure rates were substantially higher in patients older than 6 months. Although arthrography did not reduce overall failure or improve radiographic results, it enabled early identification of nonconcentric reduction and immediate definitive management, thereby supporting intraoperative decision-making and potentially reducing delayed secondary procedures.