A Prospective, Multicenter Study of Developmental Dysplasia of the Hip: What Can Patients Expect After Open Reduction?

被引:9
作者
Kiani, Sara L. [1 ]
Gornitzky, Alex H. [1 ]
Matheney, Travis K. [2 ]
Schaeffer, Emily [3 ]
Mulpuri, Kishore H. [3 ]
Shah, Hitesh [4 ]
Yihua, Ge [5 ]
Upasani, Vidyadhar [6 ]
Aroojis, Alaric [7 ]
Krishnamoorthy, Venkatadass N. [8 ]
Sankar, Wudbhav [1 ,9 ]
机构
[1] Childrens Hosp Philadelphia, Dept Orthopaed Surg, Philadelphia, PA USA
[2] Boston Childrens Hosp, Dept Orthopaed, Boston, MA USA
[3] Univ British Columbia, Dept Orthopaed, Vancouver, BC, Canada
[4] Kasturba Med Coll & Hosp, Dept Orthopaed, Manipal, Karnataka, India
[5] Bai Jerbai Wadia Hosp Children, Dept Orthopaed, Mumbai, Maharashtra, India
[6] Ganga Hosp, Dept Orthopaed, Coimbatore, Tamil Nadu, India
[7] Shanghai Childrens Med Ctr, Dept Orthopaed, Shanghai, Peoples R China
[8] Rady Childrens Hosp, Dept Orthopaed, San Diego, CA USA
[9] Childrens Hosp Philadelphia, Dept Orthopaed, Philadelphia, PA 19146 USA
关键词
Developmental Dysplasia of the Hip (DDH); Open Reduction; Re-dislocation; Avascular Necrosis; Proximal Femoral Growth Disturbance (6); SALTER INNOMINATE OSTEOTOMY; CONGENITAL DISLOCATION; AVASCULAR NECROSIS; OSSIFIC NUCLEUS; CHILDREN; OUTCOMES; MANAGEMENT; DDH;
D O I
10.1097/BPO.0000000000002383
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Background:: Although there are several predominantly single-center case series in the literature, relatively little prospectively collected data exist regarding the outcomes of open hip reduction (OR) for infantile developmental dysplasia of the hip (DDH). The purpose of this prospective, multi-center study was to determine the outcomes after OR in a diverse patient population.Methods: The prospectively collected database of an international multicenter study group was queried for all patients treated with OR for DDH. Minimum follow-up was 1 year. Proximal femoral growth disturbance (PFGD) was defined by consensus review using Salter's criteria. Persistent acetabular dysplasia was defined as an acetabular index >90th percentile for age. Statistical analyses were performed to compare preoperative and operative characteristics that predicted re-dislocation, PFGD, and residual acetabular dysplasia.Results: A cohort of 232 hips (195 patients) was identified; median age at OR was 19 months (interquartile range 13 to 28) and median follow-up length was 21 months (interquartile range 16 to 32). Re-dislocation occurred in 7% of hips (n=16/228). The majority (81%; n=13/16) occurred in the first year after initial OR. Excluding patients with repeat dislocation, 94.5% of hips were IHDI 1 at most recent follow-up. On the basis of strict radiographic review, some degree of PFGD was present in 44% of hips (n=101/230) at most recent follow-up. Seventy-eight hips (55%) demonstrated residual dysplasia compared with established normative data. Hips that had a pelvic osteotomy at index surgery had about half the rate of residual dysplasia (39%; n=32/82) versus those without a pelvic osteotomy with at least 2 years follow-up (78%; n=46/59).Conclusions: In the largest prospective, multicenter study to date, OR for infantile DDH was associated with a 7% risk of re-dislocation, 44% risk of PFGD, and 55% risk of residual acetabular dysplasia at short term follow-up. The incidence of these adverse outcomes is higher than previous reports. Patients treated with concomitant pelvic osteotomy had lower rates of residual dysplasia. These prospectively collected, multicenter data provide better generalizable information to improve family education and appropriately set expectations.
引用
收藏
页码:279 / 285
页数:7
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