DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20162352

Dysplasia of the hip in children-earlier referrals: a key for better outcomes

Mohammed KM Ali, D. K. Kamachi Kamachi, Robert Burton, Abid Hussain, MM Utukuri

Abstract


Background: Developmental dysplasia of the hip (DDH) is an abnormal alignment of the hip which may present at birth or develop later as the child grows. Closed reduction of the hip with application of a Spica cast is one of the preferred methods of treatment. The aim of our study is to assess the success rate of closed reduction, rate of avascular necrosis, reasons for failure of closed reduction and to suggest ways to improve our current practice.

Methods: We retrospectively studied the medical records of all patients who underwent closed reduction of the hip for DDH at Royal Derby Hospital, UK from October 2008 to June 2014. Seventy-two patients with 88 dysplastic hips met the inclusion criteria of the study.

Results: Sixty-two hips (70.5%) had a very satisfactory outcome. 26 hips (29.5%) were unstable after closed reduction, and open reduction was subsequently performed. Seven hips (7.9%) developed avascular necrosis (AVN). In the case of the 26 failed hips, we found that 92% had delayed referrals according to NIPE guidelines and 94% of these presented at the age of six months or more.

Conclusions: Early referral is one of the important factors which determine a successful outcome following closed reduction of hip in DDH.


Keywords


DDH, Hip, Spica cast

Full Text:

PDF

References


Staheli LT. Fundamentals of Pediatric Orthopedics. 2007. p 13.

Bialik V, Bialik GM, Blazer S, Sujov P, Wiener F, Berant M. Developmental dysplasia of the hip: a new approach to incidence. Pediatrics. 1999;103(1):93-9.

Kokavec M, Bialik V. Developmental dysplasia of the hip. Prevention and real incidence. Bratisl Lek Listy. 2007;108(6):251-4.

Rampal V, Sabourin M, Erdeneshoo E. Closed reduction with traction for developmental dysplasia of the hip in children aged between one and five years. J Bone Joint Surg. 2008;90-B:858-863.

Daoud A, Saighi-Bououina A. Congenital dislocation of the hip in the older child. The effectiveness of overhead traction. J Bone Joint Surg Am. 1996;78:30-40.

DeRosa GP, Feller N. Treatment of congenital dislocation of the hip. Management before walking age. Clin Orthop Relat Res. 1987;225:77-85.

Eamsobhana P, Kamwong S, Sisuchinthara T, Jittivilai T, Keawpornsawan K. The Factor Causing Poor Results in Late Developmental Dysplasia of the Hip (DDH). J Med Assoc Thai. 2015;98(Suppl 8):S32-7.

Tang HC, Lee WC, Kao HK, Yang WE, Chang CH. Surgical Outcomes of Developmental Dysplasia of the Hip With or Without Prior Failed Closed Reduction. J Pediatr Orthop. 2015;35(7):703-7.

Szepesi K, Szücs G, Szeverényi C, Csernátony Z. Long-term follow-up of DDH patients who underwent open reduction without a postoperative cast. J Pediatr Orthop B. 2013;22(2):85-90.

Bergo KK, Rosendahl K. Parent satisfaction with early and delayed abduction splinting therapy of developmental hip dysplasia. Acta Paediatr. 2013;102(7):e339-43.

Gregosiewicz A, Wośko I. Risk factors of avascular necrosis in the treatment of congenital dislocation of the hip. J Pediatr Orthop. 1988;8:17-9.

Langenskiöld A, Paavilainen T. The effect of prereduction traction on the results of closed reduction of developmental traction on the results of closed reduction of developmental dislocation of the hip. J Pediatr Orthop. 2000;4:471-4.

Kahle WK, Anderson MB, Alpert J, Stevens PM, Coleman SS. The value of preliminary traction in the treatment of congenital dislocation of the hip. J Bone Joint Surg Am. 1990;72:1043-7.

Kutlu A, Ayata C, Ogun TC, Kapicioglu MI, Mutlu M. Preliminary traction as a single determinant of avascular necrosis in developmental dislocation of the hip. J Pediatr Orthop. 2000;5:579-84.

Sibiński M, Murnaghan C, Synder M. The value of preliminary overhead traction in the closed management of DDH. International Orthopaedics. 2006;30:268-71.

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/256488/21_nhs_newborn_and_infant_physical_examination.pdf.

Tafazal S, Flowers MJ. Do we need to follow up an early normal ultrasound with a later plain radiograph in children with a family history of developmental dysplasia of the hip? Eur J Orthop Surg Traumatol. 2015;25(7):1171-5.

Bucholz RW, Ogden JA. Patterns of ischemic necrosis of the proximal femur in nonoperatively treated congenital hip disease. In: The hip. Proceedings of the Sixth Open Scientific Meeting of the Hip Society. Mosby, St. Louis, 1978. p. 43-63.

Bednarczyk K, Szulc W. Leczenie wrodzonego zwichnięcia stawu biodrowego wyciągiem ponad głową. Chir Narz Ruchu Ortop Pol. 1988;2:106-12.

Timothy Woodacre, A. Dhadwal, T. Ball et al. The costs of late detection of developmental dysplasia of the hip. J Child Orthop J Child Orthop. 2014;8(4):325-32.

Cashman JP, Round J, Taylor G, Clarke NM. The natural history of developmental dysplasia of the hip after early supervised treatment in the Pavlik harness. A prospective, longitudinal follow-up. J Bone Joint Surg Br. 2002;84(3):418-25.

Novais EN, Hill MK, Carry PM, Heyn PC. Is Age or Surgical Approach Associated With Osteonecrosis in Patients With Developmental Dysplasia of the Hip? A Meta-analysis. Clin Orthop Relat Res. 2016;474(5):1166-77.

Gul R, Coffey JC, Khayyat G, McGuinness AJ. Late presentation of developmental dysplasia of the hip. Ir J Med Sci. 2002;171(3):139-40.