Background: Late diagnosis of developmental hip dysplasia (DDH) may warrant either open or closed reduction of the hip. Proximal femoral growth disturbance (PFGD) is a possible complication following these procedures. Methods: A systematic search of PubMed, Embase, Web of Science, The Cochrane Library and OrthoSearch from the date of inception of each database through to the 2 February 2025 was performed. The primary outcome of interest was the prevalence of clinically significant PFGD following open or closed reduction after 6 months of age. This was defined as Kalamchi–MacEwen or Bucholz–Ogden Type 2 or above. Results: The prevalence of clinically significant PFGD in patients undergoing open reduction was 12.47% (95% Confidence interval (CI): 10.39–14.69), whereas the prevalence of clinically significant PFGD in patients undergoing closed reduction was 9.53% (95% CI: 6.91–12.46). Multivariate analysis suggested that mean age at time of reduction was associated with an increase in the prevalence of PFGD in patients undergoing closed reduction ( p = 0.022). Conclusion: We described the prevalence of clinically significant PFGD following closed reduction and open reduction. In both open and closed reduction groups, we observed a high relative heterogeneity ( I 2 ), but acceptable absolute heterogeneity ( τ 2 ), and pooled prevalence estimates should be interpreted with caution. Further studies exploring the influence of disease severity and age on treatment method is required to allow reliable comparisons between open and closed reduction. PROSPERO Registration No.: CRD420251015622
Cheok et al. (Mon,) studied this question.