Abstract
Purpose of study
To assess the risk of early re—dislocation following closed reduction (CR) of the hip for idiopathic developmental dysplasia of the hip (DDH).
Methods
Review of case notes and radiographs of all who underwent CR for DDH between January 2005 and January 2010 was undertaken. Parameters recorded included sex, side of dysplasia, age at the time of attempted reduction and concomitant complications. The main outcome measure was clinical and radiographic evidence of successful reduction. Early failure of reduction was regarded as loss of concentric reduction requiring an open procedure within a year of CR. CR was performed via a standardised protocol under general anaesthetic, with arthrographic control, adductor tenotomy as required and hip spica application. Post procedure reduction was confirmed with MRI and the spica was maintained for 12 weeks.
Results
45 patients with 52 dysplastic hips treated with CR were identified. Teratological hips were excluded and 5 patients were lost to follow-up, thereby leaving 36 patients with 40 dysplastic hips. Male to female ratio was 4:32, 4 patients had bilateral dysplasia, 11 right and 21 left. Successful CR was achieved in 29 hips and early failure observed in 11 hips (27.5%). The mean age of CR in the failed group was 1.65 years as compared to 0.90 years in the successful group. T-test analysis demonstrated this difference to be significant (p=0.0063). In the successful CR group 3 from 29 hips developed AVN (10%), as compared 3 from 11 hips (27%) in the failed group.
Conclusion
CR of the dysplastic hip using our current protocol yields similar results to several previously published studies, and we suggest that our results are set as a benchmark by which future practice can be audited against. We stress the significant rate of early re-dislocation and urge vigilance in those practicing this technique; especially in the older child.
