Key result
Age 18 months or older at the time of initial closed reduction for developmental dysplasia of the hip significantly increased the risk of residual acetabular dysplasia (OR 4.000).
Why the study?
It remains controversial whether older age at closed reduction of developmental dysplasia of the hip leads to a higher incidence of complications.
Does age at closed reduction affect the failure rate and complications in pediatric patients with developmental dysplasia of the hip?
Observational (n=107)
No
Does age at closed reduction affect the failure rate and complications in pediatric patients with developmental dysplasia of the hip?
Odds Ratio: 4 (95% CI 1.361–11.755)
p-value: p=0.012
In pediatric patients with developmental dysplasia of the hip, closed reduction after 18 months of age is associated with a higher risk of residual acetabular dysplasia, and failure is more likely in patients older than 12.5 months.
May support earlier closed reduction before 18 months in DDH; leaves open prospective validation of optimal timing.
Background It remains controversial whether the older age at closed reduction (CR) of developmental dysplasia of the hip (DDH), the higher incidence of complications. The aim of this study is to evaluate the Mid-term outcome of CR for DDH among difference age groups, and to analyze and identify risk factors for the failure of this procedure. Methods Clinical data of DDH patients, who received CR, were retrospectively reviewed. Hips were divided into three groups according to initial age (Group I: <12 months; Group II: 12 months to ≤18 months; Group III: >18 months). The presence of avascular necrosis (AVN), residual acetabular dysplasia (RAD), re-dislocation, further surgeries (FS) and failure of CR were observed. The risk factors were identified for those outcomes abovementioned. Receiver operating characteristics (ROC) curve analysis based on age, pre-op AI and post-op AI for failure was conducted.Results A total of 107 patients (156 hips) undergoing CR were evaluated with a median age at initial reduction of 13.0 months (range, 4 to 28 mo). Mean follow-up time in this study was 6.7 years (range, 3-8 years). The incidence of AVN, RAD and re-dislocation was 15.4% (24/156), 17.3% (27/156) and 14.7% (23/156). For AVN, RAD and re-dislocation, the risk factors were pre-op IHDI IV (p=0.033), age≥18 months (p=0.012), and pre-op IHDI IV and walking (p=0.004 and p=0.011), respectively. The areas under the ROC curve of failure were 0.841 (post-op AI), 0.688 (pre-op AI) and 0.650 (age).Conclusions RAD is a complication that must be carefully considered for severe patients older than 18 months before CR. Re-dislocation is associated with pre-op IHDI IV and walking. Patients, who are older than 12.5 months or have a pre-op AI of 38.7° or a post-op AI of 26.4°, are more likely fail of CR.
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Zhang et al. (2020) conducted an observational in Developmental dysplasia of the hip (n=107). Age ≥ 18 months at initial closed reduction vs. Age < 18 months at initial closed reduction was evaluated on Residual acetabular dysplasia (RAD) (OR 4.000, 95% CI 1.361-11.755, p=0.012). Age 18 months or older at the time of initial closed reduction for developmental dysplasia of the hip significantly increased the risk of residual acetabular dysplasia (OR 4.000).
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