Long-term survival after hip dysplasia similar with open, closed reduction techniques
Click Here to Manage Email Alerts
Patients with developmental hip dysplasia who underwent either closed reduction or open reduction and Salter innominate pelvic osteotomy achieved a long-term survival time free of total hip arthroplasty, researchers of this study found.
However, THA and osteoarthritis were more likely after use of the closed reduction technique, according to study results that Stuart L. Weinstein, MD, of University of Iowa, in Iowa City, Iowa, presented at the Pediatric Orthopaedic Society of North America Annual Meeting.
“This unique comparative study showed that both treatments likely improved total hip-free survival relative to the actual history for dislocated hips after the age of 18 months, but neither prevented the eventual development of osteoarthritis and the need for total hip arthroplasty in the majority of patients,” Weinstein said.
Researchers included 58 hips in 45 pediatric patients who had their dislocated hips treated with open reduction from 1933 to 1942, and 78 hips in 58 patients who had their dislocated hips treated with open reduction and innominate pelvic osteotomy from 1958 to 1965. Physicians at two institutions performed the reductions.
All patients were followed for a minimum of 40 years or to the point of THA. The patients all met the Thomas inclusion criteria for having undergone hip reduction only when they were aged 18 to 60 months.
“At 48-year follow-up, a greater percentage of patients in the closed reduction group eventually underwent total hip arthroplasty, but note that the time to total hip replacement was similar in both groups,” Weinstein said.
In all, 29 hips treated with closed reduction and 44 hips treated with open reduction and innominate osteotomy had a survival time of 48 years.
The multivariate regression analysis done to estimate patients’ odds of undergoing THA, given various risk factors, showed the probability for THA was 20% higher in unilateral hips treated with closed reduction regardless of the patient’s age at the time of reduction. Researchers noted in the abstract the probability for THA was significantly lower among patients whose dislocated bilateral hips were treated with open reduction and innominate osteotomy.
The indication for additional procedures was reported for 17% of patients in the closed reduction group and 22% of patients in the open reduction and innominate osteotomy group, according to the results.
Weinstein said the small sample size was a weakness of the study, among other factors.
Furthermore, “Neither series described here represents the independent effect of either treatment as secondary procedures were performed after the index reduction in both cohorts and elements of both treatment protocols changed over time and differ from modern practices,” he said.
Perspective
Back to Top
Travis Matheney, MD, MLA
This study evaluates the effect of two commonly implemented treatments for late-diagnosed hip dislocation in infant and young children. Historically, this group of pediatric hips has generated angst among orthopedic surgeons as the general perception of long-term outcomes has vacillated between doing very well to a less than optimistic outcome and requiring total hip arthroplasty. Concern for eventual failure often increases with increasing age of the child and bilaterality. What has been lacking is a better understanding of the actual long-term outcomes. As this particular hip problem is less common and availability of long-term outcome data is even less common, the authors evaluated data from two hospitals that surgically treated infant and young children with hip dysplasia and dislocation performed with either closed reduction or open reduction and innominate osteotomy after a minimum of 40 years. Their end point for “failure” was THA. At 48 years’ follow-up, a large percentage of hips were still surviving. When considering those requiring later THA, what the authors determined was, in fact, the effect of treatment did differ depending upon age at surgery and bilaterality. Moreover, the probability of THA was less in both unilateral and bilateral cases with open reduction and innominate osteotomy. Also noted was a fair percentage of hips required additional procedures after the index reduction. What was not described here was whether this finding modified risk of THA.
Long-term outcome studies are exceedingly difficult, but are ultimately what are required to better understand conditions we treat in pediatric patients. This study adds important information and informs us both that treatment of infant and young child hip dysplasia and dislocation can be successful for many decades but unfortunately, as perceived, does go on to require further treatments and THA in a large percentage of cases.
Collapse
Scott E, et al. Paper 56. Presented at: Pediatric Orthopaedic Society of North America Annual Meeting; May 13, 2020 (virtual meeting).
Click Here to Manage Email Alerts