Mid-term Follow-Up after Closed Reduction in Developmental Dysplastic Hips

Abstract

Purpose Closed reduction and subsequent spica casting is the gold standard for treatment of unstable or dislocated developmental dysplastic hips (DDHs). There are few data on mid-term results after treatment of DDH, especially on closed reduction.

Methods Thirty-one consecutive patients with unstable or dislocated hips (n = 36) that were treated by fluoroscopic, contrast agent-supported closed reduction and spica casting were included and evaluated clinically and radiologically 2 and 5 years after treatment.

Results After 2 and 5 years, there were no significant differences between healthy and successfully treated hips that were detectable with respect to acetabular coverage (AC) angle, center-edge angle, and clinical stability of the hip. There was a significant difference at the 2-year follow-up between healthy hips and hips that needed to undergo secondary open reduction surgery (n = 4) with respect to the AC angle (p < 0.001).

Conclusion Closed reduction in DDHs results in acceptable clinical and radiological results in the mid-term follow-up. It remains unclear why some patients with subsequent sonographically matured hips show secondary deterioration and recurrence of dysplasia.

Zusammenfassung

Einleitung: Die geschlossene Reposition und anschließende Anlage eines Beckenbeingipses entspricht dem Goldstandard in der Therapie der instabilen oder luxierten dysplastischen Hüfte. Bisher sind nur wenige Daten verfügbar, die den klinisch-radiologischen Verlauf nach dieser Therapie im mittelfristigen Verlauf beschreiben.

Methoden Konsekutive Patienten mit instabilen oder luxierten Hüften (n = 36), die mittels kontrastmittelgestützter geschlossener Reposition und anschließender Beckenbeingipsanlage versorgt wurden, wurden zwei und fünf Jahre nach der Therapie klinisch und radiologisch nachuntersucht.

Ergebnisse Nach zwei und fünf Jahren ergab sich kein signifikanter Unterschied zwischen gesunden und erfolgreich therapierten Hüften hinsichtlich des AC-Winkels, des center-edge-Winkels und der klinischen Stabilität des Hüftgelenkes. Ein signifikanter Unterschied bestand bereits im Zweijahresverlauf zwischen gesunden und dysplastischen Hüften, die eine offene, sekundäre Operation benötigten (n = 4) im AC-Winkel (p < 0.001).

Schlussfolgerung Die geschlossene Reposition dysplastischer Hüften zeigt akzeptable klinische und radiologische Ergebnisse im mittelfristigen follow-up. Es ist unklar welche initial erfolgreich behandelten Patienten mit dann sonographisch reifen Hüften, sekundär eine nicht zufriedenstellende Ausreifung der Hüften erfahren.

Keywords

DDH - closed reduction - dysplasia - Graf - hip dislocation

Schlüsselwörter

DDH - geschlossene Reposition - Dysplasie - Graf - Hüftluxation

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