Vol. 10, Issue 3 (2024)

Objective: The aim of this study was to analyse results of our treated patients of Developmental Dislocation of the Hip (DDH) in the age range from birth to 5 years.

Materials and Methods: This was a retrospective observational and analytical study. One hundred & fifty-three dislocated hips in 111 patients (42 male & 69 females) in age range from birth to 5 years were included. The minimum follow-up was 36 months in this study with a mean follow up of 86 months. On the basis of the management modality adopted, we chose to divide all the patients into 3 main groups; group 1-Pavlik harness-assisted reduction or closed reduction under general anaesthesia, with 34 patients, group 2-open reduction alone with 46 patients, and group 3- open reduction with supplementary procedures with 31 patients. The management results were assessed using both clinical (modified Mc Kay) and radiological assessment (Severin) criteria applicable to each group. Salter and Thompson classification was used to assess AVN.

Results: At the final follow-up, the results were evaluated in accordance to individual groups. Descriptive statistical analysis was carried out. Categorical data were presented in number and percentage. Residual acetabular dysplasia, re-dislocation, stress fracture and avascular necrosis were the complications in our study. On the basis of clinical criteria, in 34 patients in group 1, 100 percent patients had excellent to good outcome (34). In second group with 46 patients, 95.6 percent patients had excellent to good outcome (44) and 4.3 percent (2) patients had fair outcome. In third group with 31 patients, 90.3 percent patients had excellent to good outcome (28) and 9.6 percent (3) patients had fair outcome. No patients in either of the groups showed poor result.

In group 1, 97.95 percent (48 hips) had good radiological outcome on basis of Severin criteria (Severin type I and II) and 2.04 percent (1 hip) had fair result (Severin type III). In group 2, 94.91 percent (56 hips) had good result (Severin type I and II) and 5.08 percent (3 hips) had fair result (Severin type III). In group 3, 95.55 percent (43 hips) had good result (Severin type I and II) and 4.44 percent (2 hips) had fair result (Severin type III).

AVN was seen in 4 hips in group 3, out of which only one had class B presentation as per Salter Thompson classification (Severin type III).

Conclusion: Most studies in literature have concentrated on using age as the criteria to assign treatment which denies flexibility in tackling patients with DDH who lie at the intersection of such groups. Operative management of DDH is more likely in patients beyond one year of age. Assessment and analysis of non-operative and operated patients of DDH cannot be combined together as factors leading to adverse outcomes like RAD, AVN etc, are more likely to occur in the latter group. Irrespective of the treatment modality used in these dislocated hips, there should always be emphasis on the concentric reduction without undue pressure on femoral head. Supplementary procedures like appropriate pelvic osteotomy, or pelvic along with femoral osteotomy would be necessary to maintain reduction in older children.

Level of evidence: Level IV-Retrospective observational and analytical study.