Publication:

Dysplasia of the hip in children-earlier referrals: a key for better outcomes

Background Developmental dysplasia of the hip (DDH) is an abnormal alignment of the hip which may present at birth or develop later as the child grows. Closed reduction of the hip with application of a Spica cast is one of the preferred methods of treatment. The aim of our study is to assess the success rate of closed reduction, rate of avascular necrosis, reasons for failure of closed reduction and to suggest ways to improve our current practice.

Methods We retrospectively studied the medical records of all patients who underwent closed reduction of the hip for DDH at Royal Derby Hospital, UK from October 2008 to June 2014. Seventy-two patients with 88 dysplastic hips met the inclusion criteria of the study.

Results Sixty-two hips (70.5%) had a very satisfactory outcome. 26 hips (29.5%) were unstable after closed reduction, and open reduction was subsequently performed. Seven hips (7.9%) developed avascular necrosis (AVN). In the case of the 26 failed hips, we found that 92% had delayed referrals according to NIPE guidelines and 94% of these presented at the age of six months or more.

Conclusions Early referral is one of the important factors which determine a successful outcome following closed reduction of hip in DDH.