Skip to main content

Advertisement

SpringerLink
Log in

Radiographic outcome of children older than twenty-four months with developmental dysplasia of the hip treated by closed reduction and spica cast immobilization in human position: a review of fifty-one hips

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

This study aimed to investigate the radiographic outcomes, rate of redislocation, and avascular necrosis of proximal femoral epiphysis (AVN) in patients aged 24 to 36 months with developmental dysplasia of the hip (DDH) treated by closed reduction (CR) and spica cast immobilization in human position.

Material and methods

We reviewed the medical records of 39 patients (51 hips) aged 24 to 36 months with DDH treated by CR and spica cast immobilization in human position. The Tönnis grade, rate of redislocation and AVN, acetabular index (AI), centre-edge angle (CEA), and Severin radiographic grade were evaluated on plain radiographs.

Results

Among the included 39 patients (51 hips), 15 hips (29.4%) were Tönnis grade II, 24 hips (47.1%) were grade III, and 12 hips (23.5%) were grade IV. In 47 hips (92.2%), the ossific nucleus was present at the time of CR. Stable reduction was achieved by CR in 39/51 hips (76.5%) and redislocation occurred in 12/51 hips (23.5%). Among the 12 hips that redislocated, 11 underwent open reduction and one repeated CR. Two out of 40 hips (5%) treated by CR developed AVN. Overall, 54.6% of the hips had satisfactory outcomes (39.2% Severin type I and 17.6% type II), while 45.4% had unsatisfactory outcomes (39.2% Severin type III and 3.9% type IV). Of the 40 hips treated by CR, 57.5% and 42.5% of cases had satisfactory outcomes and residual acetabular dysplasia, respectively. Six out of 11 hips (54.6%) treated by open reduction and pelvic osteotomy had satisfactory outcomes.

Conclusions

Our study showed that stable CR could be achieved in 76.5% of patients aged 24 to 36 months with DDH at the time of index procedure. Satisfactory outcomes can be expected in 56.4% of the cases (5.0% AVN rate), although late acetabular dysplasia may develop in 43.6% of the hips.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Tönnis D (1987) Congenital dysplasia and dislocation of the hip in children and adults. Springer Verlag, Berlin

    Book  Google Scholar 

  2. Cooper AP, Doddabasappa SN, Mulpuri K (2014) Evidence-based management of developmental dysplasia of the hip. Orthop Clin North Am 45(3):341–354. https://doi.org/10.1016/j.ocl.2014.03.005

    Article  PubMed  Google Scholar 

  3. Li Y, Guo Y, Li M, Zhou Q, Liu Y, Chen W, Li J, Canavese F, Xu H (2018) Acetabular index is the best predictor of late residual acetabular dysplasia after closed reduction in developmental dysplasia of the hip. Int Orthop 42(3):631–640. https://doi.org/10.1007/s00264-017-3726-5

    Article  Google Scholar 

  4. Ge Y, Wang Z, Xu Y (2018) Clinical study of anterior hip ultrasound (van Douveren’s method)-assisted Pavlik harness. Int Orthop. https://doi.org/10.1007/s00264-018-4103-8

  5. Yong B, Li Y, Li J, Andreacchio A, Pavone V, Pereria B, Xu H, Canavese F (2018) Post-operative radiograph assessment of children undergoing closed reduction and spica cast immobilization for developmental dysplasia of the hip: does experience matter? Int Orthop. https://doi.org/10.1007/s00264-018-4038-0

  6. Herring JA (2014) Tachdjian’s pediatric orthopaedics from the Texas Scottish Rite Hospital for Children. Elsevier Saunders, Philadelphia

  7. Arrest NA, Ramachandran M, Paterson MJMH, Barry M (2016) Paediatric orthopaedics in clinical practice. Springer-Verlag, London

    Book  Google Scholar 

  8. Quinn RH, Renshaw TS, DeLuca PA (1994) Preliminary traction in the treatment of developmental dislocation of the hip. J Pediatr Orthop 14(5):636–642

    Article  CAS  PubMed  Google Scholar 

  9. Gage JR, Winter RB (1972) Avascular necrosis of the capital femoral epiphysis as a complication of closed reduction of congenital dislocation of the hip. A critical review of twenty years’ experience at Gillette Children’s Hospital. J Bone Joint Surg Am 54(2):373–388

    Article  CAS  PubMed  Google Scholar 

  10. Brougham DI, Broughton NS, Cole WG, Menelaus MB (1990) Avascular necrosis following closed reduction of congenital dislocation of the hip. Review of influencing factors and long-term follow-up. J Bone Joint Surg (Br) 72(4):557–562

    Article  CAS  Google Scholar 

  11. Rampal V, Sabourin M, Erdeneshoo E, Koureas G, Seringe R, Wicart P (2008) Closed reduction with traction for developmental dysplasia of the hip in children aged between one and five years. J Bone Joint Surg (Br) 90(7):858–863. https://doi.org/10.1302/0301-620x.90b7.20041

    Article  CAS  Google Scholar 

  12. Kelly DM (2013) Congenital and developmental anomalies of the hip and pelvis. In: Canale ST, Beaty JH (ed) Campbell’s operative orthopaedics, 12th edn. Elsevier Mosby, Philadelphia, pp. 1079–1117

  13. Eamsobhana P, Kamwong S, Sisuchinthara T, Jittivilai T, Keawpornsawan K (2015) The factor causing poor results in late developmental dysplasia of the hip (DDH). J Med Assoc Thail 98(Suppl 8):S32–S37

    Google Scholar 

  14. Terjesen T, Horn J, Gunderson RB (2014) Fifty-year follow-up of late-detected hip dislocation: clinical and radiographic outcomes for seventy-one patients treated with traction to obtain gradual closed reduction. J Bone Joint Surg Am 96(4):e28. https://doi.org/10.2106/jbjs.m.00397

    Article  PubMed  Google Scholar 

  15. Vandergugten S, Traore SY, Docquier PL (2016) Risk factors for additional surgery after closed reduction of hip developmental dislocation. Acta Orthop Belg 82(4):787–796

    CAS  PubMed  Google Scholar 

  16. Sibinski M, Synder M, Domzalski M, Grzegorzewski A (2004) Risk factors for avascular necrosis after closed hip reduction in developmental dysplasia of the hip. Ortop Traumatol Rehabil 6(1):60–66

    PubMed  Google Scholar 

  17. Xu M, Gao S, Sun J, Yang Y, Song Y, Han R, Lei G (2013) Predictive values for the severity of avascular necrosis from the initial evaluation in closed reduction of developmental dysplasia of the hip. J Pediatr Orthop B 22(3):179–183. https://doi.org/10.1097/BPB.0b013e32835f1f7a

    Article  PubMed  Google Scholar 

  18. Li Y, Xu H, Li J, Yu L, Liu Y, Southern E, Liu H (2015) Early predictors of acetabular growth after closed reduction in late detected developmental dysplasia of the hip. J Pediatr Orthop B 24(1):35–39. https://doi.org/10.1097/bpb.0000000000000111

    Article  PubMed  Google Scholar 

  19. Firth GB, Robertson AJ, Schepers A, Fatti L (2010) Developmental dysplasia of the hip: open reduction as a risk factor for substantial osteonecrosis. Clin Orthop Relat Res 468(9):2485–2494. https://doi.org/10.1007/s11999-010-1400-y

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Agus H, Omeroglu H, Ucar H, Bicimoglu A, Turmer Y (2002) Evaluation of the risk factors of avascular necrosis of the femoral head in developmental dysplasia of the hip in infants younger than 18 months of age. J Pediatr Orthop B 11(1):41–46

    Article  PubMed  Google Scholar 

  21. Gregosiewicz A, Wosko I (1988) Risk factors of avascular necrosis in the treatment of congenital dislocation of the hip. J Pediatr Orthop 8(1):17–19

    Article  CAS  PubMed  Google Scholar 

  22. Novais EN, Hill MK, Carry PM, Heyn PC (2016) Is age or surgical approach associated with osteonecrosis in patients with developmental dysplasia of the hip? A meta-analysis. Clin Orthop Relat Res 474(5):1166–1177. https://doi.org/10.1007/s11999-015-4590-5

    Article  PubMed  Google Scholar 

  23. Pospischill R, Weninger J, Ganger R, Altenhuber J, Grill F (2012) Does open reduction of the developmental dislocated hip increase the risk of osteonecrosis? Clin Orthop Relat Res 470(1):250–260. https://doi.org/10.1007/s11999-011-1929-4

    Article  PubMed  Google Scholar 

  24. Wang YJ, Yang F, Wu QJ, Pan SN, Li LY (2016) Association between open or closed reduction and avascular necrosis in developmental dysplasia of the hip: a PRISMA-compliant meta-analysis of observational studies. Medicine 95(29):e4276. https://doi.org/10.1097/md.0000000000004276

    Article  PubMed  PubMed Central  Google Scholar 

  25. Severin E (1941) Contribution to the knowledge of congenital dislocation of the hip joint. Acta Chir Scand 84(Suppl 63):1–142

    Google Scholar 

  26. Salter RB, Kostuik J, Dallas S (1969) Avascular necrosis of the femoral head as a complication of treatment for congenital dislocation of the hip in young children: a clinical and experimental investigation. Can J Surg 12(1):44–61

    CAS  PubMed  Google Scholar 

  27. Bucholz R.W. OJA (1978) Patterns of ischemic necrosis of the proximal femur in nonoperatively treated congenital hip disease. Paper presented at the Proceedings of the Sixth Open Scientific Meeting of the Hip Society, St Louis, MI

  28. Crego CH Jr, Schwartzmann JR (1948) Follow-up study of the early treatment of congenital dislocation of the hip. J Bone Joint Surg Am 30A(2):428–442

    Article  PubMed  Google Scholar 

  29. Esteve R (1960) Congenital dislocation of the hip. A review and assessment of results of treatment with special reference to frame reduction as compared with manipulative reduction. J Bone Joint Surg (Br) 42-b:253–263

    Article  CAS  Google Scholar 

  30. Herold HZ (1980) Avascular necrosis of the femoral head in congenital dislocation of the hip. Isr J Med Sci 16(4):295–300

    CAS  PubMed  Google Scholar 

  31. Kruczynski J (1996) Avascular necrosis of the proximal femur in developmental dislocation of the hip. Incidence, risk factors, sequelae and MR imaging for diagnosis and prognosis. Acta Orthop Scand 268:1–48

    CAS  Google Scholar 

  32. Bradley CS, Perry DC, Wedge JH, Murnaghan ML, Kelley SP (2016) Avascular necrosis following closed reduction for treatment of developmental dysplasia of the hip: a systematic review. J Child Orthop 10(6):627–632. https://doi.org/10.1007/s11832-016-0776-y

    Article  PubMed  PubMed Central  Google Scholar 

  33. Segal LS, Boal DK, Borthwick L, Clark MW, Localio AR, Schwentker EP (1999) Avascular necrosis after treatment of DDH: the protective influence of the ossific nucleus. J Pediatr Orthop 19(2):177–184

    Article  CAS  PubMed  Google Scholar 

  34. Clarke NM, Jowett AJ, Parker L (2005) The surgical treatment of established congenital dislocation of the hip: results of surgery after planned delayed intervention following the appearance of the capital femoral ossific nucleus. J Pediatr Orthop 25(4):434–439

    Article  PubMed  Google Scholar 

  35. Niziol R, Elvey M, Protopapa E, Roposch A (2017) Association between the ossific nucleus and osteonecrosis in treating developmental dysplasia of the hip: updated meta-analysis. BMC Musculoskelet Disord 18(1):165. https://doi.org/10.1186/s12891-017-1468-6

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Albinana J, Dolan LA, Spratt KF, Morcuende J, Meyer MD, Weinstein SL (2004) Acetabular dysplasia after treatment for developmental dysplasia of the hip. Implications for secondary procedures. J Bone Joint Surg (Br) 86(6):876–886

    Article  CAS  Google Scholar 

  37. Naeem ur Razaq M, Younas M, Awan AS, Waqas M, Alam MI, ullah Khan I (2016) Risk factors leading to developmental complications after open reduction in developmental dysplasia of hip. J Ayub Med Coll Abbottabad 28(1):26–28

    PubMed  Google Scholar 

  38. Wenger DR, Frick SL (1999) Early surgical correction of residual hip dysplasia: the San Diego Children’s Hospital approach. Acta Orthop Belg 65(3):277–287

    CAS  PubMed  Google Scholar 

  39. Gillingham BL, Sanchez AA, Wenger DR (1999) Pelvic osteotomies for the treatment of hip dysplasia in children and young adults. J Am Acad Orthop Surg 7(5):325–337

    Article  CAS  PubMed  Google Scholar 

  40. Chaker M, Picault C, Kohler R (2001) Long term results in treatment of residual hip dysplasia by Salter osteotomy (study of 31 cases). Acta Orthop Belg 67(1):6–18

    CAS  PubMed  Google Scholar 

  41. Faciszewski T, Kiefer GN, Coleman SS (1993) Pemberton osteotomy for residual acetabular dysplasia in children who have congenital dislocation of the hip. J Bone Joint Surg Am 75(5):643–649

    Article  CAS  PubMed  Google Scholar 

  42. Fournet-Fayard J, Kohler R, Michel CR (1988) Results of Salter’s innominate osteotomy in residual hip dysplasia in children. Apropos of 60 cases. Rev Chir Orthop Reparatrice Appar Mot 74(3):243–251

    CAS  PubMed  Google Scholar 

  43. Hong K, Yuan Z, Li J, Li Y, Zhi X, Liu Y, Xu H, Canavese F (2018) Femoral anteversion does not predict redislocation in children with hip dysplasia treated by closed reduction. Int Orthop. https://doi.org/10.1007/s00264-018-4090-9

  44. Cha SM, Shin HD, Shin BK (2018, 2018) Long-term results of closed reduction for developmental dislocation of the hip in children of walking age under eighteen months old. Int Orthop 42(1):175–182. https://doi.org/10.1007/s00264-017-3685-x

Download references

Author information

Author notes

  1. YiQiang Li, YueMing Guo, XianTao Shen, Hang Liu and HaiBo Mei contributed equally to this work.

Authors and Affiliations

  1. GuangZhou Women and Children’s Medical Center, GuangZhou Medical University, GuangZhou, China

    YiQiang Li, HongWen Xu & Federico Canavese

  2. Foshan Hospital of TCM, Foshan, China

    YueMing Guo

  3. Wuhan Women and Children Medical Care Center, Wuhan, China

    XianTao Shen

  4. Children’s Hospital of Chongqing Medical University, Chongqing, China

    Hang Liu

  5. Hunan Children’s Hospital, ChangSha, China

    HaiBo Mei

  6. Department of Pediatric Orthopaedics, GuangZhou Women and Children’s Medical Center, 9th JinSui Road, GuangZhou, 510623, China

    Federico Canavese

Authors
  1. YiQiang Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. YueMing Guo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. XianTao Shen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hang Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. HaiBo Mei
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. HongWen Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Federico Canavese
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

Chinese Multi-center Pediatric Orthopedic Study Group (CMPOS)

Corresponding author

Correspondence to Federico Canavese.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures were performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

No patients were involved. This is a retrospective study of patients’ data, and an IRB approval was obtained (GZWCMC 2015020904).

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Li, Y., Guo, Y., Shen, X. et al. Radiographic outcome of children older than twenty-four months with developmental dysplasia of the hip treated by closed reduction and spica cast immobilization in human position: a review of fifty-one hips. International Orthopaedics (SICOT) 43, 1405–1411 (2019). https://doi.org/10.1007/s00264-019-04315-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-019-04315-z

Keywords

Search

Navigation