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Topic:

Developmental Dysplasia of the Hip

Issue:

Hip

Category:

Developmental

Title:

The Optimal Age for Surgical Management of DDH Differs by Treatment Method

Author:

Martino, Rachael BA; Carry, Patrick PhD; Adams, Jordyn BA; Brandt, Aaron MD; Sink, Ernest MD; Selberg, Courtney MD

Journal:

Journal of Pediatric Orthopaedics

Date:

January 2024

Reference:

44(1): p 7-14, DOI: 10.1097/BPO.0000000000002569

Level Of Evidence:

III

# of Patients:

195

Study Type:

Retrospective cohort study

Location:

Single institution (likely pediatric center)

Summary:

This study compares radiographic and clinical outcomes of patients with developmental dysplasia of the hip (DDH) treated with closed reduction (CR), open reduction (OR), and open reduction with concomitant pelvic osteotomy (ORP), aiming to identify the optimal age for surgery for each treatment method.

Methods:

Inclusion Criteria: Patients who underwent CR, OR, or ORP between January 1, 2004, and September 23, 2020. Exclusion Criteria: Not specified. Intervention: Comparison of outcomes based on the age at surgery and type of procedure (CR, OR, ORP). Outcomes Measured: Radiographic Outcomes: Acetabular index, The International Hip Dysplasia Institute classification, acetabular depth ratio. Further Corrective Surgery (FCS): Need for additional femoral and/or pelvic osteotomy before skeletal maturity.

Exclusions:

Not specified

Results:

Incidence of FCS: CR group: 13.8% OR group: 29.2% ORP group: 9.2% Effect of Age on FCS: Earlier surgery was protective against FCS in CR and OR groups. Older age at surgery in the ORP group was associated with a lower incidence of FCS. Optimal Age for Surgery: CR: 9.9 months OR: 11.5 months ORP: 21.4 months Radiographic Outcomes: Younger patients experienced a larger decrease in acetabular index and a larger increase in acetabular width during the first 5 years post-surgery.

Conclusions:

Age at the index surgical procedure was correlated with both clinical and radiographic outcomes. CR should be performed before 9.9 months, and OR before 11.5 months, to minimize the risk of FCS. The study emphasizes the importance of considering age-related heterogeneity in DDH treatment outcomes.

Relevance:

Limitations:

Perspective:

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