Closed Reduction as Therapeutic Gold Standard for Treatment of Congenital Hip Dislocation

Abstract

Background Congenital hip dislocation (luxation) has an incidence of 0.4 – 0.7% and is regarded as a prearthrotic deformity. Thus, if not being diagnosed and treated at a very early age, extensive surgical measures are inevitable in childhood and early adulthood.

Methods In the time between 01/2013 and 02/2019 we performed 28 600 hips sonographies in babies as part of general screening measures at U2 or U3. There were 71 instable, dysplastic or dislocated hips diagnosed that were treated by arthrographic, closed reduction. After a hip spica cast was applied, reposition was controlled by MRI, estimating the acetabular head index (ACI), the head coverage index (HCI) as well as the femoral headʼs sphericity or by sonography using the Graf method.

Results Overall success rate was 91.6% for primary closed reduction. Patients with primarily irreducible hips were significantly older (p < 0.003) than patients with primarily successful reducible hips. Congenital dislocated hips had significantly higher ACIs (p < 0.001) and HCIs (p = 0.03) as well as significantly less well rounded femoral heads (sphericity; p < 0.001) compared to stable hips.

Conclusion Early diagnosis and treatment of congenital dislocated hips by closed reduction is essential for a sufficient and regular maturation of the hips without further surgical interventions.

Key messages

1. General hip screening (clinical and sonographic) for neonates is a reliable instrument for diagnosing hip dysplasia and dislocation.

2. Early diagnosis and treatment are essential for successful treatment of congenital hip dysplasia or dislocation.

3. Closed reduction has better success rates than other procedures for treatment of infant hip dislocation.

4. A combination of AHI, HCI and sphericity allow assessment of the reduction result on MRI.

5. Successful reduction regularly results in cartilage and bone maturation of the hips.

Kernaussagen

1. Ein generelles Hüftscreening (klinisch und sonografisch) für Neugeborene ist ein verlässliches Instrument zur Diagnose von Hüftdysplasien und -luxationen.

2. Die frühe Diagnose und Behandlung sind essenziell für eine erfolgreiche Therapie der kongenitalen Hüftdysplasie bzw. -luxation.

3. Die geschlossene Reposition hat bessere Erfolgsraten als andere Verfahren zur Therapie der Säuglingshüftluxation.

4. AKI, KÜX und Sphärizität erlauben in Zusammenschau eine Bewertung des Repositionsergebnisses im MRT.

5. Erfolgreiche Repositionen resultieren regelhaft in knorpeliger und knöcherner Ausreifung der Hüften.

Key words

DDH - closed reduction - ACI - HCI - hip luxation

Publication History

Article published online:
18 September 2019

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