Should we try closed reduction and casting treatment first for cases with developmental dysplasia of the hip beyond 18 months of age?

Abstract

This study aims to evaluate the clinical and radiological outcomes of closed reduction and casting in patients older than 18 months with developmental dysplasia of hip (DDH) and to assess the success of this technique. We retrospectively analyzed medical records of DDH patients treated between March 2011 and June 2014. A total of 20 hips from 13 patients (2 boys, 11 girls) aged 18 months or older were included. Among them, 4 had right unilateral involvement, 2 had left unilateral involvement, and 7 had bilateral involvement. The mean age at treatment initiation was 19.4 months. Radiographic evaluations included the acetabular index (AI) using the Hilgenreiner method, Wiberg’s center-edge (CE) angle, acetabular angle (AA), and femoral neck-shaft angle. Hips were classified as normal, slightly dysplastic, or severely dysplastic based on Tönnis’ acetabular index table. Stable reduction was achieved in 12 hips (60%) of 8 patients with closed reduction and casting. However, 8 hips (40%) of 5 patients required acetabular osteotomy due to persistent dysplasia. Our findings suggest that closed reduction and hip spica casting should be considered for DDH in patients older than 18 months based on radiographic outcomes. However, our study is limited by a short follow-up period and a relatively small sample size. Further studies with larger cohorts and long-term follow-ups are necessary for more definitive conclusions.

Keywords

• Developmental dysplasia of the hip
• closed reduction
• hip spica cast

References

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