Preop traction may degrade clinical outcomes for DDH

Researchers saw no significant difference between groups in terms satisfactory radiographic outcomes, although patients treated with traction had more complications.

Preoperative traction appears to negatively affect clinical outcomes in older children treated with one-stage combined surgery for developmental dysplasia of the hip, a retrospective study found.

Gunduz Tezeren, MD, and colleagues at Cumhuriyet Universitesi in Sivas, Turkey, reviewed the records for 28 hips in 21 children treated for developmental dysplasia at a mean age of 5.8 years. In all cases, surgeons used a combined surgical procedure involving open reduction, Salter's innominate osteotomy and femoral shortening with derotation varus osteotomy.

Preoperatively, surgeons applied traction to 12 hips in nine children for an average duration of 15.9 days, ranging from 7 to 20 days depending on the degree of contracture present. The researchers compared outcomes for these patients to 16 hips in 12 patients treated with the combined surgery alone.

The results are published in the Journal of Orthopaedic Surgery.

Follow-up averaged 5.9 years. Among patients treated with preoperative traction, one hip (8%) demonstrated excellent clinical outcomes, four hips (33%) had good outcomes, five (42%) had fair outcomes and two hips (17%) had fair results, as assessed using the McKay criteria.

Among patients treated with combined surgery alone, five hips (31%) had excellent outcomes, eight (50%) had good outcomes, two (13%) had fair outcomes and one (6%) had a poor outcome, according to the study.

"Thus, five (42%) of the hips in group 1 (traction) and 13 (81%) in group 2 (no traction) had satisfactory results, whereas seven (58%) of the hips in group 1 and three (19%) in group 2 had unsatisfactory results," the authors said in the study, noting the difference was significant (P=.049).

No significant difference was seen between groups in terms of the number of hips with satisfactory radiographic outcomes, the authors said.

Patients treated with traction also had more complications. In the traction group, four hips had avascular necrosis and leg length discrepancies. One hip in the no traction group had avascular necrosis without a leg length discrepancy, according to the study.

For more information:
Tezeren G, Tukenmez M, Bulut O, et al. One-stage combined surgery with or without preoperative traction for developmental dislocation of the hip in older children. J Orthop Surg (Hong Kong). 2006;14:259-264.