Medial versus anterior approach for open reduction of hip in children with DDH under two years - A meta-analysis of comparative studies

Karthick Rangasamy; Akash Kumar Ghosh; Vivek P Ksheerasagar; Nirmal Raj Gopinathan; Pebam Sudesh

doi:10.1016/j.jor.2023.11.017

Medial versus anterior approach for open reduction of hip in children with DDH under two years - A meta-analysis of comparative studies

J Orthop. 2023 Nov 11:47:72-79. doi: 10.1016/j.jor.2023.11.017. eCollection 2024 Jan.

Authors

Karthick Rangasamy^{1

2}, Akash Kumar Ghosh³, Vivek P Ksheerasagar², Nirmal Raj Gopinathan², Pebam Sudesh²

Affiliations

¹ Paediatric Orthopaedic Division, Victoria Hospital, London Health Sciences Centre, London, Ontario, Canada.
² Department of Orthopaedics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
³ Paediatric Orthopaedic division, Department of Orthopaedics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.

PMID: 38059048
PMCID: PMC10696192 (available on 2025-01-01)
DOI: 10.1016/j.jor.2023.11.017

Abstract

Purpose: Open reduction (OR) is usually required in developmental dysplasia of hip (DDH) for children below 24 months of age, those who failed to achieve a satisfactory reduction by the closed method. OR in this age group can be performed either through a medial or anterior approach. However, there is a paucity of literature and a lack of more substantial evidence regarding which approach (medial versus anterior) is superior for performing OR in this age group with minimal complications.

Methods: Four databases (PubMed, Embase, Scopus, and Cochrane Library) were searched for relevant articles reporting outcomes and complication rates of DDH children less than 24 months undergone OR either through medial or anterior approach using pre-defined keywords. Data on avascular necrosis (AVN) rates, further corrective surgery (FCS) rates, and clinical and radiological grading using McKay clinical criteria and Severin radiological criteria were assessed. Meta-analysis was carried out using RevMan (Review Manager 5.4) software.

Results: Five comparative studies, having a minimum of two-year follow-up, were included for final analysis. According to the MINORS tool assessment, all five studies were of good to high quality. Of 257 hips, 151 and 106 underwent OR through medial and anterior approaches, respectively. Our meta-analysis showed a statistically significant (p = 0.01) number of AVN cases with the anterior approach compared to the medial approach. The overall random effect showed the odds of having AVN with an anterior approach to be 2.27 (95% CI: 1.18,4.38) times more than the same with a medial approach. Regarding FCS rates, the meta-analysis depicted no significant difference between the two groups (p = 0.63). The two groups had no statistically significant difference regarding clinical and radiological outcomes using McKay and Severin criteria, respectively. Following surgery, improvement in the acetabular index from pre-operative value showed no statistically significant difference between the two groups (p = 0.48).

Conclusions: Medial approach is safe and effective for OR of the hip in DDH up to 24 months of age. Our analysis showed that AVN rates are lower with a medial approach than the anterior approach, with similar clinical and radiological outcomes and rates of FCS. However, one should consider the surgeon's expertise while choosing between these approaches.

Keywords: AVN; Anterior; Approach; DDH; Developmental dysplasia of hip; Further corrective surgery; Level of evidence: Ⅲ; Medial; Meta-analysis of comparative studies.

Publication types

Review