Comparative efficacy of closed reduction versus open reduction with pelvic osteotomy for developmental dysplasia of the hip in children aged 18–24 months: A retrospective cohort study

Abstract

Background Optimal treatment for developmental dysplasia of the hip (DDH) in 18–24-month-old children is debated. This study compares closed reduction (CR) to open reduction with pelvic osteotomy (ORPO) to determine efficacy and complications. Materials and methods Data from 97 patients (131 hips) undergoing CR or ORPO (June 2012 to September 2019) were analyzed. Pre- and postoperative measures including acetabular index (AI), International Hip Dysplasia Institute (IHDI) grade, center-edge angle (CEA), Severin grades, Mckay criteria and avascular necrosis (AVN) were assessed. Statistical analysis compared outcomes and complications. Results Of 131 hips, 101 underwent CR and 30 ORPO. Preoperative characteristics and radiographic outcomes did not significantly differ. Postoperative AI (CR: 25.2 ± 5.3°, ORPO: 24.3 ± 6.1°, P = 0.441) and CEA (CR: 25.6 ± 11.5°, ORPO: 29.2 ± 16.5°, P = 0.263) showed no significant differences. Satisfactory Severin grades were achieved in 58.4% (CR) and 56.6% (ORPO), P = 1.000. Mckay grade II and above were observed in 66.3% of CR group and 66.7% of ORPO group, P = 1.000. AVN above type Ⅱ incidence was 18.9% (CR) and 33.3% (ORPO), P = 0.131. After using multiple linear regression and logistic regression to control confounding factors, we came to the same outcome. No significant differences were observed in postoperative AI, CEA, Severin grade, Mckay grade or AVN. CR had significantly lower total hospitalization costs. Among the CR group, 19 hips (18.8%) underwent secondary surgery. And their postoperative outcomes were comparable to those in the ORPO group. Conclusion Closed reduction with spica cast immobilization is a viable treatment option for DDH in 18–24-month-olds, with close monitoring. Prompt consideration of secondary surgery is advised for residual acetabular dysplasia