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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

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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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References

  1. Tarassoli, P., Gargan, M. F., Atherton, W. G., & Thomas, S. R. Y. W. (2014). The medial approach for the treatment of children with developmental dysplasia of the hip. Bone and Joint Journal, 96, 406–413.

    PubMed  Google Scholar 

  2. Novais, E. N., Hill, M. K., Carry, P. M., & Heyn, P. C. (2016). Is age or surgical approach associated with osteonecrosis in patients with developmental dysplasia of the hip? A meta-analysis. Clinical Orthopaedics and Related Research, 474, 1166–1177.

    PubMed  Google Scholar 

  3. Biçimoglu, A., Ag, H., Ömeroglu, H., & Tümer, Y. (2003). Six years of experience with a new surgical algorithm in developmental dysplasia of the hip in children under 18 months of age. Journal of Pediatric Orthopedics, 23, 693–698.

    PubMed  Google Scholar 

  4. Gardner, R. O., Bradley, C. S., Sharma, O. P., Feng, L., Shin, M. E., Kelley, S. P., et al. (2016). Long-term outcome following medial open reduction in developmental dysplasia of the hip: A retrospective cohort study. Journal of Children’s Orthopaedics, 10, 179–184.

    PubMed  PubMed Central  Google Scholar 

  5. Murphy, R. F., & Kim, Y.-J. (2016). Surgical management of pediatric developmental dysplasia of the hip. Journal of American Academy of Orthopaedic Surgeons, 24, 615–624.

    Google Scholar 

  6. Hoellwarth, J. S., Kim, Y. J., Millis, M. B., Kasser, J. R., Zurakowski, D., & Matheney, T. H. (2015). Medial versus anterior open reduction for developmental hip dislocation in age-matched patients. Journal of Pediatric Orthopedics, 35, 50–56.

    PubMed  Google Scholar 

  7. Mankey, M. G., Arntz, G., & Staheli, L. T. (1993). Open reduction through a medial approach for congenital dislocation of the hip. A critical review of the Ludloff approach in sixty-six hips. Journal of Bone Joint Surgery America, 75, 1334–1345.

    CAS  Google Scholar 

  8. Koizumi, W., Moriya, H., Tsuchiya, K., Takeuchi, T., Kamegaya, M., & Akita, T. (1996). Ludloff’s medial approach for open reduction of congenital dislocation of the hip: A 20-year follow-up. Journal of Bone and Joint Surgery. British Volume, 78, 924–929.

    CAS  Google Scholar 

  9. Konigsberg, D. E., Karol, L. A., Colby, S., & O’Brien, S. (2003). Results of medial open reduction of the hip in infants with developmental dislocation of the hip. Journal of Pediatric Orthopedics, 23, 1–9.

    PubMed  Google Scholar 

  10. Morcuende, J. A., Meyer, M. D., Dolan, L. A., & Weinstein, S. L. (1997). Long-term outcome after open reduction through an anteromedial approach for congenital dislocation of the hip. Journal of Bone and Joint Surgery. American Volume, 79, 810–817.

    CAS  Google Scholar 

  11. Tumer, Y., Ward, W. T., & Grudziak, J. (1997). Medial open reduction in the treatment of developmental dislocation of the hip. Journal of Pediatric Orthopedics, 17, 176–180.

    CAS  PubMed  Google Scholar 

  12. Ucar, D. H., Isiklar, Z. U., Stanitski, C. L., Kandemir, U., & Tumer, Y. (2004). Open reduction through a medial approach in developmental dislocation of the hip: A follow-up study to skeletal maturity. Journal of Pediatric Orthopedics, 24, 493–500.

    PubMed  Google Scholar 

  13. Kiely, N., Younis, U., Day, J., & Meadows, T. (2004). The Ferguson medial approach for open reduction of developmental dysplasia of the hip: A clinical and radiological review of 49 hips. Journal of Bone and Joint Surgery. British Volume, 86, 430–433.

    CAS  Google Scholar 

  14. Okano, K., Yamada, K., Takahashi, K., Enomoto, H., Osaki, M., & Shindo, H. (2009). Long-term outcome of Ludloff’s medial approach for open reduction of developmental dislocation of the hip in relation to the age at operation. International Orthopaedics, 33, 1391–1396.

    PubMed  PubMed Central  Google Scholar 

  15. Duman, S., Camurcu, Y., Sofu, H., Ucpunar, H., Akbulut, D., & Yildirim, T. (2019). Arthroscopic versus open, medial approach, surgical reduction for developmental dysplasia of the hip in patients under 18 months of age. Acta Orthopaedics, 90, 1–7.

    Google Scholar 

  16. Pollet, V., Van Dijk, L., Reijman, M., Castelein, R. M. C., & Sakkers, R. J. B. (2018). Long-term outcomes following the medial approach for open reduction of the hip in children with developmental dysplasia. Journal of Bone and Joint Surgery. British Volume, 100, 822–827.

    Google Scholar 

  17. Ozkut, A. T., Iyetin, Y., Unal, O. K., Soylemez, M. S., Uygur, E., & Esenkaya, I. (2018). Radiological and clinical outcomes of medial approach open reduction by using two intervals in developmental dysplasia of the hip. Acta Orthopaedica et Traumatologica Turcica, 52, 81–86.

    PubMed  PubMed Central  Google Scholar 

  18. Youssef, A. O. (2018). Medial approach open reduction with ligamentum teres partial excision and plication for the management of congenital hip dislocation. Journal of Pediatric Orthopedics. Part B, 27, 244–249.

    PubMed  Google Scholar 

  19. Çıtlak, A., Saruhan, S., & Baki, C. (2013). Long-term outcome of medial open reduction in developmental dysplasia of hip. Archives of Orthopaedic and Trauma Surgery, 133, 1203–1209.

    PubMed  Google Scholar 

  20. Iyetin, Y., Turkmen, I., Saglam, Y., Akcal, M. A., Unay, K., & Unsac, B. (2015). A modified surgical approach of the hip in children: Is it safe and reliable in patients with developmental hip dysplasia? Journal of Children’s Orthopaedics, 9, 199–207.

    PubMed  PubMed Central  Google Scholar 

  21. Farsetti, P., Caterini, R., Potenza, V., & Ippolito, E. (2015). Developmental dislocation of the hip successfully treated by preoperative traction and medial open reduction: A 22-year mean followup. Clinical Orthopaedics and Related Research, 473, 2658–2669.

    CAS  PubMed  PubMed Central  Google Scholar 

  22. Yamada, K., Mihara, H., Fujii, H., & Hachiya, M. (2014). A long-term follow-up study of open reduction using Ludloff’s approach for congenital or developmental dislocation of the hip. Bone and Joint Research., 3, 1–6.

    CAS  PubMed  Google Scholar 

  23. Berkeley, M. E., Dickson, J. H., Cain, T. E., & Donovan, M. M. (1984). Surgical therapy for congenital dislocation of the hip in patients who are twelve to thirty-six months old. Journal of Bone and Joint Surgery. American Volume, 66, 412–420.

    CAS  Google Scholar 

  24. Galpin, R. D., Roach, J. W., Wenger, D. R., Herring, J. A., & Birch, J. G. (1989). One-stage treatment of congenital dislocation of the hip in older children, including femoral shortening. Journal of Bone and Joint Surgery. American Volume, 71, 734–741.

    CAS  Google Scholar 

  25. Ordier, W., Tönnis, D., Kalchschmidt, K., Storch, K. J., & Katthagen, B. D. (2005). Long-term results after open reduction of developmental hip dislocation by an anterior approach lateral and medial of the iliopsoas muscle. Journal of Pediatric Orthopaedics, 14, 79–87.

    Google Scholar 

  26. Barrett, W. P., Staheli, L., & Chew, D. E. (1986). The effectiveness of the Salter innominate osteotomy in the treatment of congenital dislocation of the hip. Journal of Bone and Joint Surgery. American Volume, 68, 79–87.

    CAS  Google Scholar 

  27. Gulman, B., Tuncay, I. C., Dabak, N., & Karaismailoglu, N. (1994). Salter’s innominate osteotomy in the treatment of congenital hip dislocation: A long-term review. Journal of Pediatric Orthopedics, 14, 662–666.

    CAS  PubMed  Google Scholar 

  28. Wenger, D. R., Lee, C.-S., & Kolman, B. (1995). Derotational femoral shortening for developmental dislocation of the hip: Special indications and results in the child younger than 2 years. Journal of Pediatric Orthopedics, 15, 768–779.

    CAS  PubMed  Google Scholar 

  29. Alassaf, N. (2018). Predictors of femoral shortening for pediatric developmental hip dysplasia surgery: An observational study in 435 patients. Patient Safety Surgery, 12, 29.

    Google Scholar 

  30. Emara, K., Kersh, M. A. A., & Hayyawi, F. A. (2019). Duration of immobilization after developmental dysplasia of the hip and open reduction surgery. International Orthopaedics, 43, 405–409.

    PubMed  Google Scholar 

  31. Kothari, A., Grammatopoulos, G., Hopewell, S., & Theologis, T. (2016). How does bony surgery affect results of anterior open reduction in walking-age children with developmental hip dysplasia? Clinical Orthopaedics and Related Research, 474, 1199–1208.

    PubMed  Google Scholar 

  32. Arsian, H., Sucu, E., Ozkul, E., Gem, M., & Kisin, B. (2014). Should routine pelvic osteotomy be added to the treatment of DDH after 18 months. Acta Orthopaedica Belgica, 80, 205–210.

    Google Scholar 

  33. Mehmet, G., Arslan, H., Özkul, E., Alemda, C., Azboy, İ., & Demirtaş, A. (2014). One-stage bilateral open reduction using the anterior iliofemoral approach in developmental dysplasia of the hip. Acta Orthopaedica Belgica, 80, 211–215.

    Google Scholar 

  34. Szepesi, K., Szücs, G., Szeverényi, C., & Csernátony, Z. (2013). Long-term follow-up of DDH patients who underwent open reduction without a postoperative cast. Journal of Pediatric Orthopedics. Part B, 22, 85–90.

    PubMed  Google Scholar 

  35. Szepesi, K., Biró, B., Fazekas, K., & Szücs, G. (1995). Preliminary results of early open reduction by an anterior approach for congenital dislocation of the hip. Journal of Pediatric Orthopedics. Part B, 4, 171–178.

    CAS  PubMed  Google Scholar 

  36. Agus, H., Ömeroglu, H., Uçar, H., Biçimoglu, A., & Tümer, Y. (2002). Evaluation of the risk factors of avascular necrosis of the femoral head in developmental dysplasia of the hip in infants younger than 18 months of age1. Journal of Pediatric Orthopedics. Part B, 1, 41–46.

    Google Scholar 

  37. Thomas, I., Dunin, A., Cole, W., & Menelaus, M. B. (1989). Avascular necrosis after open reduction for congenital dislocation of the hip: Analysis of causative factors and natural history. Journal of Pediatric Orthopedics, 9, 525–531.

    CAS  PubMed  Google Scholar 

  38. Clarke, N. M., Jowett, A. J., & Parker, L. (2005). The surgical treatment of established congenital dislocation of the hip: Results of surgery after planned delayed intervention following the appearance of the capital femoral ossific nucleus. Journal of Pediatric Orthopedics, 25, 434–439.

    PubMed  Google Scholar 

  39. Yorgancıgil, H., & Aslan, A. (2016). Comparison of the clinical and radiological outcomes of open reduction via medial and anterior approach in devleopmental dysplasia of the hip. Eklem hastaliklari cerrahisi., 27, 74–80.

    Google Scholar 

  40. Holman, J., Carroll, K. L., Murray, K. A., MacLeod, L. M., & Roach, J. W. (2012). Long-term follow-up of open reduction surgery for developmental dislocation of the hip. Journal of Pediatric Orthopedics, 32, 121–124.

    PubMed  Google Scholar 

  41. Bulut, M., Gürger, M., Belhan, O., Batur, O. C., Celik, S., & Karakurt, L. (2013). Management of developmental dysplasia of the hip in less than 24 months old children. Indian Journal of Orthopaedics., 47, 578.

    PubMed  PubMed Central  Google Scholar 

  42. Wedge, J. H., Thomas, S. R., & Salter, R. B. (2008). Outcome at forty-five years after open reduction and innominate osteotomy for late-presenting developmental dislocation of the hip. Journal of Bone and Joint Surgery. American Volume, 90, 238–253.

    Google Scholar 

  43. Ludloff, K. (1913). The open reduction of the congenital hip dislocation by an anterior incision. Journal of Bone and Joint Surgery. American Volume, 2, 438–454.

    Google Scholar 

  44. Ferguson, J. R. (1973). Primary open reduction of congenital dislocation of the hip using a median adductor approach. Journal of Bone and Joint Surgery. American Volume, 55, 671–689.

    Google Scholar 

  45. Mckay, D. W. (1974). A comparison of the innominate and the pericapsular osteotomy in the treatment of congenital dislocation of the hip. Clinical Orthopaedics and Related Research, 98, 124–132.

    Google Scholar 

  46. Eek, M. N., Kroksmark, A.-K., & Beckung, E. (2006). Isometric muscle torque in children 5 to 15 years of age: Normative data. Archives of Physical Medicine and Rehabilitation, 87, 1091–1099.

    PubMed  Google Scholar 

  47. Thorborg, K., Petersen, J., Magnusson, S. P., & Hölmich, P. (2010). Clinical assessment of hip strength using a hand-held dynamometer is reliable. Scandinavian Journal of Medicine and Science in Sports, 20, 493–501.

    CAS  PubMed  Google Scholar 

  48. Tönnis, D. (1987). General radiography of the hip joint. Congenital dysplasia and dislocation of the hip in children and adults (pp. 100–142). Berlin: Springer.

    Google Scholar 

  49. Omeroglu, H., Kaya, A., & Guclu, B. (2007). Evidence-based current concepts in the radiological diagnosis and follow-up of developmental dysplasia of the hip. Acta Orthopaedica et Traumatologica Turcica, 41(Suppl 1), 14–18.

    PubMed  Google Scholar 

  50. Severin, E. (1941). Contribution to the knowledge of congenital dislocation of the hip joint. Acta Chir Scand, 84, 163.

    Google Scholar 

  51. Kalamchi, A., & MacEwen, G. D. (1980). Avascular necrosis following treatment of congenital dislocation of the hip. Journal of Bone and Joint Surgery. American Volume, 62, 876–888.

    CAS  Google Scholar 

  52. Bache, C. E., Graham, H. K., Dickens, D. R. V., Donnan, L., Johnson, M. B., Nattrass, G., et al. (2008). Ligamentum teres tenodesis in medial approach open reduction for developmental dislocation of the hip. Journal of Pediatric Orthopaedics, 28, 607–613.

    PubMed  Google Scholar 

  53. Gardner, R. O. E., Bradley, C. S., Howard, A., Narayanan, U. G., Wedge, J. H., & Kelley, S. P. (2014). The incidence of avascular necrosis and the radiographic outcome following medial open reduction in children with developmental dysplasia of the hip: A systematic review. The Bone and Joint Journal., 96, 279–286.

    PubMed  Google Scholar 

  54. Carroll, K. L., Murray, K. A., MacLeod, L. M., Hennessey, T. A., Woiczik, M. R., & Roach, J. W. (2011). Measurement of the center edge angle and determination of the Severin classification using digital radiography, computer-assisted measurement tools, and a Severin algorithm: Intraobserver and interobserver reliability revisited. Journal of Pediatric Orthopaedics., 31, e30–e35.

    PubMed  Google Scholar 

  55. Angliss, R., Fujii, G., Pickvance, E., Wainwright, A. M., & Benson, M. K. D. (2005). Surgical treatment of late developmental displacement of the hip: Results after 33 years. The Journal of Bone and Joint Surgery British Volume., 87, 384–394.

    CAS  PubMed  Google Scholar 

  56. Varner, K. E., Incavo, S. J., Haynes, R. J., & Dickson, J. A. (2010). Surgical treatment of developmental hip dislocation in children aged 1 to 3 years: A mean 18-year, 9-month follow-up study. Orthopedics, 33, 3.

    Google Scholar 

  57. Wang, T. M., Wu, K. W., Shih, S. F., Huang, S. C., & Kuo, K. N. (2013). Outcomes of open reduction for developmental dysplasia of the hip: Does bilateral dysplasia have a poorer outcome? Journal of Bone and Joint Surgery. American Volume, 95, 1081–1086.

    Google Scholar 

  58. Baki, C., Sener, M., Aydin, H., Yildiz, M., & Saruhan, S. (2005). Single-stage open reduction through a medial approach and innominate osteotomy in developmental dysplasia of the hip. Journal of Bone and Joint Surgery. British Volume, 87, 380–383.

    CAS  Google Scholar 

  59. Erturk, C., Altay, M. A., Yarimpapuc, R., & Isikan, U. E. (2011). Medial open reduction of developmental dysplasia of the hip using the Weinstein-Ponseti approach. Saudi Medical Journal, 32, 901–906.

    PubMed  Google Scholar 

  60. Biçimoğlu, A., Ağuş, H., Ömeroğlu, H., & Tümer, Y. (2008). Posteromedial limited surgery in developmental dysplasia of the hip. Clinical Orthopaedics and Related Research, 466, 847–855.

    PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey

    Omer Naci Ergin, Mehmet Demirel, Emre Meric & Fuat Bilgili

  2. Department of Orthopaedics and Traumatology, NCR International Hospital, Gaziantep, Turkey

    Volkan Sensoy

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Contributions

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 55, 130–141 (2021). https://doi.org/10.1007/s43465-020-00171-x

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