A Comparative Study of Clinical and Radiological Outcomes of Open Reduction Using the Anterior and Medial Approaches for the Management of Developmental Dysplasia of the Hip

Abstract

Background

The literature is scanty on reports directly comparing the outcomes of anterior open reduction (AOR) and medial open reduction (MOR) in the management of developmental dysplasia of the hip (DDH).

Purpose of the Study

To compare clinical and radiographic outcomes of surgical treatment using either AOR or MOR in children with DDH aged < 24 months and to evaluate the procedure-inherent risks of avascular necrosis of the femoral head (AVN) and need for further corrective surgery (FCS).

Methods

61 children who underwent surgical treatment for DDH were categorized into two groups: AOR (31 hips of 28 patients) and MOR (39 hips of 33 patients). The mean age was 17 ± 5.85 (range 7–24) months in group AOR and 13 ± 5.31 (range 6–24) months in group MOR. The mean follow-up was 118 ± 41.2 (range 24–192) months and 132 ± 36.7 (range 24–209) months in group AOR and MOR. At the final follow-up, mid- to long-term clinical and radiographic outcomes were assessed. FCS was recorded.

Results

Regarding McKay’s clinical criteria, both groups exhibited similar results (p = 0.761). No significant differences were observed between the groups in both the center–edge–angle (p = 0.112) and the Severin score (p = 0.275). The AVN rate was 32% in the AOR group and 20% in the MOR group (p = 0.264). The FCS rate was 22% in the AOR group and 12% in the MOR group (p = 0.464).

Conclusions

This study showed similar clinical and radiological outcomes with AOR and MOR with no significant relation to AVN and FCS.

Level of Evidence

Level III.

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ÖNE: Substantial contributions to the conception, design of the work, the acquisition, analysis and interpretation of data for the work. MD: Substantial contributions to the conception, design of the work, the acquisition, analysis and interpretation of data for the work. EM: The acquisition, analysis and interpretation of data for the work. VŞ: Analysis and interpretation of data for the work. FB: Substantial contributions to the conception, design of the work, and final approval of the version to be published.

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Correspondence to Omer Naci Ergin.

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Ergin, O.N., Demirel, M., Meric, E. et al. A Comparative Study of Clinical and Radiological Outcomes of Open Reduction Using the Anterior and Medial Approaches for the Management of Developmental Dysplasia of the Hip. JOIO (2020). https://doi.org/10.1007/s43465-020-00171-x

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Keywords

  • Developmental dysplasia of the hip
  • Open reduction
  • Anterior open reduction
  • Medial open reduction
  • Avascular necrosis of the femoral head