DDH in the Walking Age: Review of Patients with Long-Term Follow-Up

Giovanni Lucchesi; Riccardo Sacco; Weizheng Zhou; YiQiang Li; Lianyong Li; Federico Canavese

doi:10.1007/s43465-021-00531-1

DDH in the Walking Age: Review of Patients with Long-Term Follow-Up

Indian J Orthop. 2021 Sep 29;55(6):1503-1514. doi: 10.1007/s43465-021-00531-1. eCollection 2021 Dec.

Authors

Giovanni Lucchesi^#¹, Riccardo Sacco^#², Weizheng Zhou³, YiQiang Li⁴, Lianyong Li³, Federico Canavese⁵

Affiliations

¹ Orthopaedic Clinic, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy.
² Department of Orthopedic and Traumatology, Orthopedic and Trauma Center, Turin, Italy.
³ Department of Pediatric Orthopaedics, Shengjing Hospital of China Medical University, Shenyang, China.
⁴ GuangZhou Women and Children's Medical Center, GuangZhou Medical University, 9th JinSui Road, GuangZhou, 510623 China.
⁵ Department of Pediatric Orthopedic Surgery, Lille University Centre, Jeanne de Flandre Hospital, 59000 Lille, France.

^# Contributed equally.

Abstract

Introduction: The best treatment option in children with late detected DDH is still a subject of much controversy and only few studies have investigated the long-term outcome of treatment in such patients. We performed a systematic review to assess long-term outcome of late detected DDH hips treated after walking age.

Methods: Studies met inclusion criteria if they: (1) reported at least 30 hips treated; (2) included children aged between 9 months and 12 years; (3) treatment indication was late detected DDH after walking age; (4) presented a minimum follow-up of 10 years; (5) reported a clinical or radiological outcome. The Kaplan-Meier method was used to evaluate long-term survival according to clinical and radiological outcomes. The rate of total hip replacement (THR) was retrieved.

Results: From a total of 6561 articles, 13 articles with grade IV level of evidence were included in our review. A total of 988 hips in 800 patients with a mean follow-up of 27.9 years (range 10-67) were included. The mean age at surgery was 3.3 years (range, 9 months-12 years). The rate of THR increased according to the length of final follow-up. In particular, all studies reported no case of THR at 23.5 years of follow-up, a rate of 10.2% of THR between 30 and 40 years of follow-up and a rate of 35.6% of THR in patients with follow-up more than 40 years.

Conclusions: In patients with late detected DDH, most THR became necessary more than 30 years after the index procedure and their number increased further after 40 years and more of follow-up. Late detected DDH diagnosed after walking age is a life-long disease.

Keywords: Avascular necrosis; Children; Closed reduction; DDH; Developmental dysplasia of the hip; Hip dislocation; Open reduction; Outcome; Skeletal traction; Walking age.

Publication types

Review