Gradual Reduction Using Overhead Traction for Developmental Dysplasia of The Hip After Walking Age: A 30-year Retrospective Study
Volume 6 | Issue 2 | May-August 2020 | Page: 12-17 | Hiroshi Kaneko, Hiroshi Kitoh, Koji Iwata, Kenichi Mishima, Masaki Matsushita, Naoki Ishiguro, Tadashi Hattori
Authors : Hiroshi Kaneko [1], Hiroshi Kitoh [1], Koji Iwata [1], Kenichi Mishima [2], Masaki Matsushita [2], Naoki Ishiguro [2], Tadashi Hattori [1]
[1] Department of Orthopaedic Surgery, Aichi Children’s Health and Medical Center, Obu, Aichi, Japan.
[2] Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
Address of Correspondence
Dr. Hiroshi Kitoh,
Department of Orthopaedic Surgery, Aichi Children’s Health
and Medical Center, 7-426 Moriokacho, Obu, Aichi, 474-8710, Japan.
E-mail: hiroshi_kitou@sk00106.achmc.pref.aichi.jp
Abstract
Background: The optimal management for untreated developmental dysplasia of the hip (DDH) after walking age remains controversial.
Methods: We retrospectively reviewed 80 DDH patients (85 hips) diagnosed at one through 3 years of age who underwent gradual reduction (GR) using overhead traction (OHT) with a mean follow-up of 8.2 years. We investigated radiological severity of DDH, successful reduction, avascular necrosis (AVN) of the femoral head, residual dysplasia, secondary procedures, and Severin classification. The data were compared between patients under (42 hips) and over (43 hips) 18 months of age at diagnosis.
Results: Eighty-three hips (98%) were successfully reduced by OHT. Three hips (4%) re-dislocated later and needed closed reduction or open reduction with Salter osteotomy. No AVN occurred during follow-up. Sixty-eight hips were observed without further treatment beyond 5 years of age, of which 52 (76%) remained acetabular dysplasia and 47 (69%) underwent Salter osteotomy with or without femoral osteotomy. We could finally evaluate 69 hips using Severin classification, and 52 (75%) were classified in Group I, 10 (14%) in Group II, and seven (10%) in Group III. Radiological severity of DDH at diagnosis was the only significant variable between the groups: High hip dislocation was more frequently observed in the older age group (p = 0.0131).
Conclusions: GR using OHT is a beneficial initial treatment with a high reduction rate and a low incidence of complications for DDH after walking age, from 1 to 3 years of age. Salter osteotomy performed during preschool ages can provide a satisfactory mid-term outcome for hips with residual acetabular dysplasia after OHT.
Level of Evidence: Therapeutic studies, level IV (case series).
Keywords: Developmental dysplasia of the hip; Walking age; Gradual reduction; Overhead traction; Salter innominate osteotomy.
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| How to Cite this Article: Kaneko H, HKitoh H, Iwata K, Mishima K, Matsushita M, Ishiguro N, Hattori T | Gradual Reduction Using Overhead Traction for Developmental Dysplasia of The Hip After Walking Age: A 30-year Retrospective Study | International Journal of Paediatric Orthopaedics | May-August 2020; 6(1): 12-16. |
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