Abstract
Background
A consecutive series of 76 patients (101 hips) underwent primary open reduction, capsulorrhaphy and innominate osteotomy for late presenting developmental hip dislocation. They were aged 1.5 to 5 years at the time of surgery between 1958 and 1965. This study was designed to review their outcome into middle age.
Methods
We located and reviewed 60 patients (80 hips) using a public records search. This represents a 79% rate of follow-up at 40-48 years post-operatively.
19 patients (24 hips) had undergone total hip replacement and 3 had died. The remaining 38 patients (53 surviving hips) were assessed by the WOMAC¯ and Oxford hip outcome questionnaires, physical examination and standing pelvic radiograph. The radiographs were analysed for minimum joint space width and the Kellgren and Lawrence score. Accepted indices of hip dysplasia were measured.
Results
Kaplan-Meier survival analysis is presented using the end point of total hip replacement. Survival rates at 30, 40 and 45 years post-reduction are 99% (95% CI +/−2.4), 86% (+/− 6.9) and 54% (+/−16.4) respectively. Average Oxford and WOMAC¯ scores for surviving hips were 16.8 (range 0-82) and 16.7 (range 0-71) respectively. Of 51 surviving hip radiographs, 38 had a minimum joint space width in excess of 2.0mm, 13 had definite osteoarthritis (OA) on this criterion. 29 were Kellgren and Lawrence grade 0/1(no or doubtful signs of OA), 7 grade 2 (mild OA), 15 grade 3 or 4 (moderate or severe OA). The average centre-edge and acetabular angles were 40° (range 0-61°) and 32° (20-43°) respectively. There was no significant association between outcome and the modifiable risk factors of body mass or age at surgery.
Conclusion
This method of treatment achieves a 54% rate of hip survival at 45 years. Two thirds of surviving hips have an excellent prognosis at this stage.
