Abstract
AIMS
We present a retrospective study of bilateral CDH. We analysed the correlation of complications to the confounding factors.
MATERIAL AND METHODS
We reviewed all bilateral CDH patients treated by the same surgeon at Southampton between 1988-2006. The patient recruitment was carried out as follows:
Group A – failed Pavlik harness;
Group B – late presentations not treated in Pavlik harness.
RESULTS
The series included 50 patients (5 males; 45 females). The average age at presentation was 21 weeks (1-160). The average age at reduction was 15 months (4-45). The average follow-up was 6.7 years (4-15).
4 hips required revision due to loss of reduction. The number of surgical interventions throughout the treatment course ranged 4-12 (average – 7.3).
AVN occurred in 17 hips (17%). Previous Pavlik harness treatment, CR and higher height of dislocation (HD) were associated with an increased rate of AVN.
42 pelvic (PO) and 12 femoral (FO) osteotomies (54%) were performed. CR and greater HD increased the pelvic osteotomy rate, while Pavlik harness treatment failure did not affect it.
The mean AI demonstrated a gradual decline following reduction. While there was no difference between OR vs CR, and Group A vs B, the HD≥3 was associated with a significant acetabular development delay when compared to HD≤2.
CONCLUSIONS
Despite the complexity of CDH cases, it is possible to achieve an acceptable level of inevitable complication (AVN – 17%, PO – 42%, FO – 12%, revision reduction – 4%). The rate of AVN was independently negatively affected by CR and prolonged immobilisation. Only the hips with initial HD of ≤2 had their acetabular index return to normal (<21°) before the age of 4 years.
This is the first comprehensive analysis of bilateral CDH cases, emphasising the difficulty of treatment of this condition and providing the foundation for an outcomes-predicting system.
