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Purpose: This study aims to evaluate (1) the probability to achieve normal pelvic radiographs in children with developmental dysplasia of the hip (DDH) treated by closed reduction and (2) the amount of time needed to achieve normal pelvic radiographs and to assess what factors influence both probability and time to achieve normal radiographic parameters following CR and spica cast immobilization for DDH.Methods: We retrospectively reviewed 436 patients (393 girls, 43 boys; 507 hips) with DDH treated by closed reduction (CR). Tönnis grade, AVN, acetabular index (AI), centre-edge angle (CEA), and Severin radiographic grade were evaluated on plain radiographs. Criteria to rate pelvis radiographs as normal were established. Cox regression was used to evaluate the factors influencing the probability and the time to achieve normal radiographs.Results: According to our criteria, 167 hips (32.9%) achieved normal radiographic parameters during follow-up. The overall amount of time to achieve normal pelvis radiographs was 36.1 ± 15.5 months. Patients older than 24 months of age at the time of CR needed longer time to achieve normal radiographic parameters (55.2 ± 28 months) compared with other age groups. Cox regression analysis suggested the overall cumulative probability of recovery increased by 46% at five years following CR, then it tended to plateau with an annual increase less than 5%. Age older than 24 months, bilateral dislocation, pre-operative AI greater than 40°, and AVN were risk factors for reduced probability of achieving normal radiographic parameters.Conclusions: The cumulative probability of achieving normal pelvis radiographs increases linearly during the first five years following CR, then it tends to plateau. Age older than 24 months and Tönnis grade III and IV are associated with longer time to achieve normal radiographic parameters. Age older than 24 months, bilateral dislocation, pre-operative AI greater than 40°, and AVN are risk factors for reduced probability of achieving normal radiographic parameters in children with DDH treated by closed means. [ABSTRACT FROM AUTHOR]

Purpose: Increased femoral anteversion can be associated with hip instability, redislocation after closed reduction, and subsequent early degenerative arthritis. Our study compared proximal femoral anteversion of affected and unaffected sides of patients with unilateral developmental dysplasia of the hip (DDH) on two-dimensional computed tomography. The primary aim was to evaluate whether femoral anteversion at the time of treatment affected the outcome of patients with unilateral DDH treated by closed reduction.Methods: A retrospective review of 89 patients (82 females; 53 left; mean age: 26.6 months) with unilateral DDH was performed. Anteversion angle (AA) of the femur and acetabular index (AI) of both affected (AAa; AIa) and unaffected (AAu; AIu) hips were measured on two-dimensional CT scan performed no more than seven days prior to the index surgical procedure.Results: Among the 89 patients, 50 underwent closed reduction (56.2%), 38 underwent open reduction with or without pelvic osteotomy (42.7%), and one patient refused treatment (1.1%). Overall, the mean AAa was 28.1° ± 10.2° (range: 6.3°-54°) and mean AAu was 25.2° ± 9.9° (range: 1.9°-52.5°) (t = 3.2, p = 0.002). Tönnis type 2 hips did not show any statistically significant difference between AAa and AAu (p = 0.386), while Tönnis types 3 and 4 hips had significantly higher AAa than did AAu (t = 3.7, p = 0.001). There were significant correlations between age and AAa (coefficient = 0.4; p < 0.001) and AAu (coefficient = 0.304; p = 0.004). Correlation analysis showed that AIa did not improve with age in any Tönnis group (r: - 0.24, p = 0.823; F = 0.039, p = 0.962). AAa, AIa, AAD, AID, and Tönnis grade distribution were similar in patients with good (no redislocation) and poor outcomes (redislocation) (p > 0.05).Conclusion: In patients with unilateral DDH, anteversion angle (AA) was found to be significantly different between affected and unaffected sides. However, the difference had very limited or no clinical significance, as redislocation/sub-luxation was not influenced by AA values. [ABSTRACT FROM AUTHOR]

Purpose: Our objective was to find the best predictor of late residual acetabular dysplasia in developmental dysplasia of the hip (DDH) after closed reduction (CR) and discuss the indications for secondary surgery.Methods: We retrospectively reviewed the records of 89 patients with DDH (mean age 16.1 ± 4.6 months; 99 hips) who were treated by CR. Hips were divided into three groups according to final outcomes: satisfactory, unsatisfactory and operation. The changes in the acetabular index (AI), centre-edge angle of Wiberg (CEA), Reimer's index (RI) and centre-head distance discrepancy (CHDD) over time among groups were compared. The power of predictors for late residual acetabular dysplasia of AI, CEA, RI and CHDD at different time points was analysed by logistic regression analysis. Receiver operating characteristics (ROC) curve analysis was used to determine cutoff values and corresponding sensitivity, specificity and diagnostic accuracy for these parameters.Results: Both AI and CEA improved in all groups of patients following CR. In the satisfactory group, AI progressively decreased until seven to eight years, while CEA increased until nine to ten years (P < 0.05). In the unsatisfactory group, AI and CEA ceased to improve three and two years after CR, respectively (P < 0.05). CEA and RI were significantly better in the satisfactory group compared with the unsatisfactory group at all time points (P < 0.05). Following CR, both RI and CHDD remained stable over time in all groups. Final outcome following CR could be predicted by AI, CEA and RI at all time points (P < 0.01). Cutoff values of AI, CEA and RI were 28.4°, 13.9° and 34.5%, respectively, at one year and 25°, 20° and 27%, respectively, at two to four years post-CR. A total of 80-88% of hips had an unsatisfactory outcome if AI > 28.4° and >25 at one and two to four years following CR, respectively. However, if CEA was less than or RI was larger than the cutoff values at each time point, only 40-60% of hips had an unsatisfactory outcome. Mean sensitivity (0.889), specificity (0.933) and diagnostic accuracy (92.1%) of AI to predict an unsatisfactory outcome were significantly better compared with CEA (0.731; 0.904; 78.2%) and RI (0.8; 0.655; 70.8%) (P < 0.05).Conclusions: Satisfactory and unsatisfactory hips show different patterns of acetabular development after reduction. AI, CEA and RI are all predictors of final radiographic outcomes in DDH treated by CR, although AI showed the best results. AI continues to improve until seven years after CR in hips with satisfactory outcomes, while it ceases to improve three to four years after CR in hips with unsatisfactory outcomes. According to our results, surgery is indicated if AI >28° 1 year following CR or AI >25° two to four years after CR. CEA and RI should be used as a secondary index to aid in the selection of patients requiring surgery. [ABSTRACT FROM AUTHOR]