The natural history of acetabular dysplasia and later total hip arthroplasty in late-detected DDH: 48 patients with closed reduction followed to a mean age of 62 years
DOI:
https://doi.org/10.2340/17453674.2023.11664Keywords:
Acetabular dysplasia, Developmental dislocation of the hip, Hip, Long-term outcome, Osteoarthrosis, Pelvic osteotomy, Total hip arthroplastyAbstract
Background and purpose: The long-term prognosis of acetabular dysplasia without subluxation in developmental dislocation of the hip (DDH) is uncertain. The aim of this study was to assess the consequence of having acetabular dysplasia at skeletal maturity on the need for having a total hip arthroplasty (THA) up to the age of 60 years.
Patients and methods: Inclusion criteria were age at diagnosis 0.5–3.0 years, initial treatment with skin traction to obtain closed reduction during 1958–1962, and no acetabular procedures to improve femoral head coverage. 48 patients (57 hips) met these criteria, 41 girls and 7 boys. Hip dysplasia was defined as a center–edge (CE) angle at skeletal maturity of 10–19°, and hips with CE angles in the range 20–25° were termed borderline dysplastic.
Results: At skeletal maturity, 18 hips had acetabular dysplasia with a mean CE angle of 15.8° (10–19), whereas 19 hips were borderline with CE angles 20–25°, and 20 hips were normal (CE angles ≥ 26°). During the follow-up period 16 hips had undergone THA, 11 of 18 hips with dysplasia, 4 of 19 with borderline dysplasia, and 1 of 20 hips without dysplasia (p < 0.001). Hip survival in the 18 dysplastic hips, with THA as the endpoint, was 100% up to patient age 40 years; thereafter survival fell to 83% at 50 years and 39% at 60 years. There was no significant correlation between CE angle at skeletal maturity and age at THA (p = 0.2). The mean age at the last follow-up in patients without THA was 62 years (60–64).
Conclusion: Acetabular dysplasia without subluxation was a risk factor for THA, but less than one-fifth of the hips had undergone THA up to patient age 50 years.
Downloads
References
Salter R B. Innominate osteotomy in the treatment of congenital dislocation and subluxation of the hip. J Bone Joint Surg Br 1961; 43: 518-39. DOI: https://doi.org/10.1302/0301-620X.43B3.518
Ganz R, Klaue K, Vinh T S, Mast J W. A new periacetabular osteotomy for the treatment of hip dysplasia: technique and preliminary results. Clin Orthop Relat Res 1988; 232: 26-36. DOI: https://doi.org/10.1097/00003086-198807000-00006
Holm A G V, Reikerås O, Terjesen T. Long-term results of a modified Spitzy shelf operation for residual hip dysplasia and subluxation: a fifty year follow-up study of fifty-six children and young adults. Int Orthop 2017; 41: 415-21. DOI: https://doi.org/10.1007/s00264-016-3286-0
Terjesen T. Residual hip dysplasia as a risk factor for osteoarthritis in 45 years follow-up of late-detected hip dislocation. J Child Orthop 2011; 5: 425-31. 2011. DOI: https://doi.org/10.1007/s11832-011-0370-2
Wiberg G. Studies on dysplastic acetabula and congenital subluxation of the hip joint. Acta Chir Scand (Suppl. 58) 1939; 83: 7-135.
Albinana J, Dolan L A, Spratt K F, Morcuende J, Meyer M D, Weinstein S L. Acetabular dysplasia after treatment for developmental dysplasia of the hip: implications for secondary procedures. J Bone Joint Surg Br 2004; 86-B: 876-86. DOI: https://doi.org/10.1302/0301-620X.86B6.14441
Malvitz T A, Weinstein S L. Closed reduction for congenital dysplasia of the hip. Functional and radiographic results after an average of thirty years. J Bone Joint Surg Am 1994; 76: 1777-92. DOI: https://doi.org/10.2106/00004623-199412000-00004
Thomas S R, Wedge J H, Salter R B. Outcome at forty-five years after open reduction and innominate osteotomy for late-presenting developmental dislocation of the hip. J Bone Joint Surg Am 2007; 89: 2341-50. DOI: https://doi.org/10.2106/JBJS.F.00857
Lerck D, Steppacher S D, Liechti F, Tannast M, Siebenrock K A. One-third of hips after periacetabular osteotomy survive 30 years with good clinical results, no progression of arthritis, or conversion to THA. Clin Orthop Rel Res 2017; 475: 1154-68. DOI: https://doi.org/10.1007/s11999-016-5169-5
Wells J, Millis M, Kim Y-J, Bulat E, Miller P, Matheney T. Survivorship of the Bernese periacetabular osteotomy: what factors are associated with long-term failure? Clin Orthop Relat Res 2017; 475: 396-405. DOI: https://doi.org/10.1007/s11999-016-4887-z
Terjesen T, Horn J, Gunderson R B. Fifty-year follow-up of latedetected hip dislocation. Clinical and radiographic outcomes for seventyone patients treated with traction to obtain gradual closed reduction. J Bone Joint Surg Am 2014; 96: e28(1-9). DOI: https://doi.org/10.2106/JBJS.M.00397
Reimers J. The stability of the hip in children. Acta Orthop Scand 1980 (Suppl. 184); 51: 4-91. DOI: https://doi.org/10.3109/ort.1980.51.suppl-184.01
Kalamchi A, MacEwen G D. Avascular necrosis following treatment of congenital dislocation of the hip. J Bone Joint Surg Am 1980; 62: 876-88. DOI: https://doi.org/10.2106/00004623-198062060-00002
Espehaug B, Furnes O, Havelin L I, Engesæter L B, Vollset S E, Kindseth O. Registration completeness in the Norwegian Arthroplasty Register. Acta Orthop 2006; 77: 49-56. DOI: https://doi.org/10.1080/17453670610045696
Cooperman D R, Wallensteen R, Stulberg S D. Acetabular dysplasia in the adult. Clin Orthop Relat Res 1983; (175): 79-85. DOI: https://doi.org/10.1097/00003086-198305000-00013
Ziran N, Varcadipane J, Kadri O, Ussef N, Kanim L, Foster A, et al. Ten- and 20-year survivorship of the hip after periacetabular osteotomy for acetabular dysplasia. J Am Acad Orthop Surg 2019; 27: 247-55. DOI: https://doi.org/10.5435/JAAOS-D-17-00810
McClincy M P, Wylie J D, Yen Y-M, Novais E N. Mild or borderline hip dysplasia: are we characterizing hips with a lateral center–edge angle between 18° and 25° appropriately? Am J Sports Med 2019; 47: 112-22. DOI: https://doi.org/10.1177/0363546518810731
Nepple J J, Wells J, Ross J R, Bedi A B, Schoenecker P L, Clohisy J C. Three patterns of acetabular deficiency are common in young adult patients with acetabular dysplasia. Clin Orthop Relat Res 2017; 475: 1037-44. DOI: https://doi.org/10.1007/s11999-016-5150-3
Wenger D. Is there a role for acetabular dysplasia correction in an asymptomatic patient? J Pediatr Orthop 2013; 33: S8-S12. DOI: https://doi.org/10.1097/BPO.0b013e3182771764
Willemsen K, Doelman C J, Sam A S Y, Seevinck P R, Sakkers R J B, Weinans H, et al. Long-term outcomes of the hip shelf arthroplasty in adolescents and adults with residual hip dysplasia: a systematic review. Acta Orthop 2020; 91: 383-9. DOI: https://doi.org/10.1080/17453674.2020.1747210
Swarup I, Zaltz I, Robustelli S, Sink E. Outcomes of periacetabular osteotomy for borderline hip dysplasia in adolescent patients. J Hip Preserv Surg 2020; 7: 249-55. DOI: https://doi.org/10.1093/jhps/hnaa012
Baghdadi S, Sankar W. Residual acetabular dysplasia in the reduced hip. Indian J Orthop 2021; 55: 1480-9. DOI: https://doi.org/10.1007/s43465-021-00515-1
Additional Files
Published
How to Cite
License
Copyright (c) 2023 Terje Terjesen
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
