Abstract
Purpose
To document the success rate of closed reduction and soft tissue release in the treatment of bilateral true dislocation in developmental dysplasia of the hip (DDH).
Methods
Case-note review of 22 children (44 hips) with idiopathic bilateral hip dislocation referred to a tertiary centre before walking age. The management protocol was as follows:
Examination under general anaesthesia, arthrogram, closed reduction and appropriate soft tissue release (adductors/psoas), application of a ‘frog’ cast.
CT scan at 2 weeks to confirm reduction.
Change of cast and arthrogram at 6 weeks to confirm improving position and stability.
Cast removal at 12 weeks, and application of an abduction brace for 6 weeks.
Treatment failure could occur on day 1 (failure of reduction), at week 2 (failure to maintain reduction), at week 6, or after cast removal.
Results
Median age at presentation was 3.8m (2w-7.5m). 19/22 were girls. 7 had a caesarean section for breech presentation, 16/22 had had prior Pavlik harness treatment. All hips were Tonnis 2 or more. Mean age at surgery was 7 months (range 3-12m). 9/44 hips failed on day 1. 13/44 hips failed at 2 weeks. 1/44 hip failed at 6 weeks. 8/22 patients had bilateral failure. 7/22 patients maintained a unilateral hip reduction and 7/22 patients maintained a bilateral reduction after treatment. Mean follow-up was 25m (range 6-71m). 1 patient has bilateral AVN. Successful results were not associated with presentation, previous treatment given, the level of dislocation (Tonnis) or patient age at time of treatment.
Conclusion
Following a successful initial reduction, this protocol failed to maintain reduction in 13/35 (40%) hips at 2 weeks: significantly worse than our presented results for unilateral dislocation.
Significance
With our current protocol, the percentage chance of reducing at least one of bilateral idiopathic dislocated hips is 64% (14/22) but parents should be told that there is only a 1:3 chance of a successful outcome for both hips following closed reduction.
