Analyses of outcomes of one-stage operation for treatment of late-diagnosed developmental dislocation of the hip: 864 hips followed for 3.2 to 8.9 years

BMC Musculoskeletal Disorders

Jun Sun¹  Sichng Zhang¹  Jie Yao¹  Yi Yuan¹  Bo Ning¹ 

[1] Department of Pediatric Orthopaedic, Anhui Provincial Children’s Hospital, 39, Wangjiang Road, 230051 Hefei, China

关键词: Osteonecrosis;    Age;    One-stage operation;    Developmental dislocation of the hip;   

Others  :  1091387
DOI  :  10.1186/1471-2474-15-401

 received in 2014-03-27, accepted in 2014-11-20,  发布年份 2014

【 摘 要 】

Background

The one-stage procedure for treatment of older developmental dislocation of the hip (DDH) is used widely. However, the best age group for this operation is still unknown. The aims of our study were to evaluate middle-term outcomes of one-stage surgical treatment of a large number of patients with late-diagnosed DDH, and to explore the best age group for treatment.

Methods

We retrospectively reviewed 652 patients with a total of 864 hip joints with DDH, all aged >18 months. All the hip joints were treated with one-stage procedures including open reduction, pelvic osteotomy, and femoral shortening. The patients were divided into three groups according to age at surgery: Group I: 1.5–2.5 years; Group II: 2.5–8 years; and Group III: >8 years. The latest clinical and radiographic outcomes, complications and avascular necrosis (AVN) of the femoral head were evaluated and compared among the three groups.

Results

The mean age at surgery was 5.8 years (range: 1.5–13.2 years). The average time of follow-up was 6.2 years (range: 3.2–8.9 years). A total of 79.4% of good or excellent outcomes were obtained for clinical functional evaluation according to the McKay classification. For radiographic outcomes, 732 hips (84.7%) were classified as good or excellent according to the Severin classification. A total of 27.4% of all hips had a poor outcome according to the Kalamchi and MacEwen classification for AVN. The poorest outcomes were observed for clinical, radiographic and AVN results in Group III (p < 0.001). Compared with Group I, the better results for clinical and AVN outcomes were found in Group II (p < 0.001). However, similar clinical outcomes were observed between Groups I and II (p > 0.05). A significantly higher incidence of redislocation and residual acetabular dysplasia was observed in Tonnis grade II and III hip dislocation (p < 0.001).

Conclusions

One-stage treatment of late-diagnosed DDH had a good outcome in young and middle group. Younger patients achieved better results than older patients. However, the best age group was 2.5–8 years. Tonnis grade II and III DDH is a risk factor for redislocation and residual acetabular dysplasia after the one-stage operation.

【 授权许可】

   
2014 Ning et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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