Risk factors for failed closed reduction in dislocated developmental dysplastic hips
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ORIGINAL PAPER
Risk factors for failed closed reduction in dislocated developmental dysplastic hips Sebastian Gottfried Walter 1,2 & Christoph Hans-Jürgen Endler 3 & Anna Christina Remig 3 & Julian A. Luetkens 3 & Rahel Bornemann 1 & Richard Placzek 1 Received: 24 March 2020 / Accepted: 26 May 2020 # SICOT aisbl 2020
Abstract Aim of the study The present study aimed to identify risk factors for unsuccessful CR. Introduction Closed reduction (CR) represents the gold standard for treatment of developmental dysplasia of the hip (DDH), but to a minor percentage, it fails to reduce dysplastic hips successfully. Methods Seventy-three dysplastic hips underwent closed reduction and post-interventional MRI of the pelvis. MRIs were evaluated for successful reduction of the hip, volumes of femoral heads, and acetabular diameter. Initial treatment results were correlated to AC angles at two years of follow-up. Contralateral, healthy hips served as control. Results Out of 73 instable, dysplastic hips, there were nine cases of CR failure. These cases showed significantly increased femoral head volumes (p = 0.002) and a significantly (p = 0.02) larger ratio of femoral head volume to acetabular opening area. There was no significant difference (p = 0.15) in acetabular diameter between both groups. At two years of follow-up, AC angles were significantly (p = 0.003) larger and pathologic in cases of CR failure. Conclusion Exclusive enlargement of the femoral head is a risk factor for unsuccessful reduction and its ratio to the acetabular opening surface is predictive for CR success in DDH. Keywords DDH . Closed reduction . Acetabulum . Congenital . Hip dislocation . Femoral head
Introduction Developmental dysplasia of the hip (DDH) is a frequent congenital musculoskeletal deformity with an incidence of 2–4% and hip luxation as its severe form in 0.4–0.7% of all cases [1, 2]. The current gold standard for the early treatment of hip dislocation (in patients younger than 12 months) is fluoroscopic-guided closed reduction (CR) with subsequent spica cast (Fettweis cast) immobilization [3]. Although this
technique is associated with a high success rate, there is dissent on predisposing risk factors for failed CR. In the past, hypertrophic ligaments, an inverted labrum, or adipose tissue have been claimed to obstacle reposition, which could not be verified in recent studies [4, 5]. The present study was set up to evaluate infantile dysplastic hips for risk factors resulting in treatment failure and to correlate post-interventional MRI data to two year radiological follow-up data according to the Tönnis classification.
* Sebastian Gottfried Walter [email protected]
Methods
1
Department of Orthopaedic Surgery, University Hospital Bonn, Bonn, Germany
2
Department of Cardiothoracic Surgery, University Hospital Cologne, Kerpener Str. 63, 50937 Cologne, Germany
3
Department of Radiology, University Hospital Bonn, Bonn, Germany
This is a retrospective study including 65 consecutive patients (73 DDH hips) with hip dislocatio
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