Outcomes Of Open Reduction For Developmental Dysplasia Of The Hip In Children Aged 6-18 Months And Analysis Of Influence Factors

BackgroundFor management for developmental dysplasia of the hip(DDH),the earlier DDH is detected,the simpler and more effective the treatment is.The primary aim of this treatment is to achieve a stable concentric reduction of the hip to enable normal joint development.For management for patients with DDH aged 6 to 18 months,expert-system guide of our country recommend to do closed or open reduction.But the guide dosen’t define specific conditions to do CR or OR.Because of lack of adequate study of high quality,this topic is always much debated.ObjectiveThe aim of this study was to define the clinical indications and outcomes of patients under going open reduction for developmental dysplasia of the hip(DDH),in order to improve the outcomes of patients and analysis the factors impacting the treatment for DDHMethodsWe retrospectively reviewed 88 children(93 hips)hospitalized with developmental dysplasia of the hip between January 2011 and November 2018.Patients aged 6-18 months were treated with open reduction.There were 14 males(9 at left side,4 at right side and 11 at bilateral sides)and 74 females(48 at left side,22 at right side and 4 at bilateral sides).Mean age at the time of surgery was 12.8± 3.7 months(range,6-18months).Mean follow-up time was 29± 14.2 onths(minimum,12 months).Before surgery,the patients were treated by ovearhead traction.Closed reduction by Ortolani method was performed under general anesthesia,and adductor(or iliopsoas)tenotomy was performed if the adductor tightness was considered as a factor preventing reduction.Arthrography was performed in all patients to assess the most stable reduction by evaluating the hip joint at diferent fexion and abduction angles.Open reduction was performed when we can’t achieve stable concentric reduction.After surgery,a hip spica cast was applied to hold the hip joint.Outcome measures included IHDI classification,the acetabular index(AI),centre-edge angle of Wiberg(CEA),eentre-head distance discrepancy(CHDD),development of ossific nucleus,Salter’s criteria and need for further surgery.ResultsSalter innominnate osteotomy+femoral shortening and derotational osteotomy for three hips(2 at right side and 1 at left side)for redislocation,Salter innominnate osteotomy for two hiPs(one bilateral sides)for acetabular dysplasia(5.4%,5/93).An ossific nucleus was present in 65 hips and absence in 28 hips before open reduction,with the following distribution across the IHDI classification:Ⅰ,three hips;Ⅱ,eighteen hips;Ⅲ,forty-four;Ⅳ,twenty-eight.An ossific nucleus was present in all hips after open reduction,with the following distribution across the Salter criteria:SO,eighty-three hips;S2,one hip;S3,one hip;S4,five hips;and S3 + S4,three hips.Across the IHDI classification:I,ninety hips;Ⅱ,three hips.The AI all showed statistically significant improvement after open reduction(P<0.001).55 hips in patients whose age more than three years meet CEA measurement criteria.In 40 hips of 55 hips,the CEA all show more than 20°.The mean CEA was 29.4°±6.6°.The mean CHDD was 7.4%±5.6%after open reduction.ConclusionsThe patients with DDH undergoing OR have good outcomes in terms of short term outcome.Low age is not only the factor to decide to perform CR for DDH.How to store the potential development of the hip is the most important thing.OR could be the first choice if there were unsatisfactory reduction quality or failure outcome by CR,which could promote the development of the hip.