Outcomes of open reduction for developmental dysplasia of the hip: Does bilateral dysplasia have a poorer outcome?
Journal
Journal of Bone and Joint Surgery - Series A
Journal Volume
95
Journal Issue
12
Pages
1081
Date Issued
2013-06-19
Author(s)
Abstract
Background: The purpose of this study was to compare the outcomes of surgical treatment in children of walking age with unilateral and bilateral developmental dysplasia of the hip (DDH). Methods: We examined the records of fifty-six children of walking age with bilateral dysplasia and 156 children of walking age with unilateral dysplasia treated with open reduction and pelvic osteotomy with or without femoral osteotomy from 1990 to 2000. The minimum duration of follow-up was five years. The mean age at surgery was thirty-four months in the bilateral group and twenty-five months in the unilateral group. Preoperative radiographs were evaluated to determine the T?nnis grade of the dislocation and the acetabular index, and the latest radiographs were evaluated to determine the Severin classification. The Kalamchi and MacEwen classification was used to assess osteonecrosis, and the McKay classification was used to assess the clinical outcome at the time of the latest follow-up. For the statistical analyses, we selected the worse side in patients in the bilateral group as the index hip if the outcome was asymmetrical and the left hip if the outcome was symmetrical. The Fisher exact and Student t tests were used for comparisons of outcomes between the groups. Multiple logistic regression models were used to analyze factors associated with osteonecrosis and with the McKay classification. Results: Age at surgery and preoperative T?nnis grade differed significantly between the groups. Forty-five (80.3%) of the patients in the bilateral group and 135 (86.5%) of the patients in the unilateral group had a satisfactory Severin classification (Ia, Ib, or II); the difference between the groups was not significant. According to the McKay classification, twentysix (46%) of the patients in the bilateral group had an satisfactory outcome compared with 111 (71%) of the patients in the unilateral group (p = 0.006). Osteonecrosis was significantly greater in the bilateral group as well (p = 0.01). Patient age at surgery and T?nnis grade were risk factors for osteonecrosis. Older age and bilaterality were associated with a poorer McKay classification. The logistic regression analysis was repeated after removing the nineteen patients (34%) in the bilateral group who had an asymmetrical outcome, and this analysis confirmed that asymmetrical outcome was a risk factor for a poorer McKay classification. Conclusions: Our data confirmed that the clinical outcome of bilateral developmental dysplasia of the hip was worse primarily because of asymmetrical outcomes. Age and T?nnis grade played an important role in the risk of occurrence of osteonecrosis. The radiographic outcome according to the Severin classification did not differ significantly between the groups. Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence. Copyright ? 2013 by The Journal of Bone and Joint Surgery, Incorporated.
SDGs
Other Subjects
acetabular index; age; article; bilaterality; bone necrosis; child; comparative study; controlled study; developmental bilateral hip dysplasia; developmental disorder; developmental unilateral hip dysplasia; disease classification; disease course; disease severity; female; femur osteotomy; Fisher exact test; follow up; groups by age; hip dislocation; hip dysplasia; human; kalamchi classification; macewen classification; major clinical study; male; mckay classification; multivariate logistic regression analysis; musculoskeletal system parameters; open reduction; outcome assessment; pelvis osteotomy; physical parameters; preoperative period; preschool child; priority journal; radiological parameters; risk assessment; risk factor; scoring system; sensitivity analysis; severin classification; Student t test; surgical patient; tonnis grading system; walking age; congenital hip dislocation; methodology; osteotomy; pathology; pathophysiology; physiology; postoperative care; postoperative complication; treatment outcome; walking; Age Factors; Child, Preschool; Female; Hip Dislocation, Congenital; Humans; Male; Osteotomy; Postoperative Care; Postoperative Complications; Treatment Outcome; Walking
Publisher
Journal of Bone and Joint Surgery Inc.
Type
journal article