Fifty-Year Follow-up of Late-Detected Hip Dislocation: Clinical and Radiographic Outcomes for Seventy-one Patients Treated with Traction to Obtain Gradual Closed Reduction

• Published in: Journal of bone and joint surgery. American volume 2014-02, Vol.96 (4), p.e28-e28
• Main Authors: Terjesen, Terje, Horn, Joachim, Gunderson, Ragnhild B
• Format: Article
• Language: English
• Subjects: Age Factors; Delayed Diagnosis; Female; Follow-Up Studies; Hip Dislocation - diagnosis; Hip Dislocation - diagnostic imaging; Hip Dislocation - surgery; Hip Joint - diagnostic imaging; Hip Joint - surgery; Humans; Infant; Male; Middle Aged; Prognosis; Radiography; Retrospective Studies; Traction; Treatment Outcome
• ISSN: 0021-9355; 1535-1386
• DOI: 10.2106/JBJS.M.00397

BACKGROUND:There is little knowledge concerning outcomes for middle-aged adults who were treated for late-detected developmental dislocation of the hip. The aims of this retrospective study were to evaluate the fifty-year clinical and radiographic results after closed reduction and to identify prognostic factors. METHODS:Seventy-one patients (ninety hips) with late-detected hip dislocation treated between 1958 and 1962 were assessed clinically and radiographically. The primary treatment was skin traction to obtain a gradual closed reduction. The mean age of the patients at the time of the long-term radiographic examination was 51.6 years (range, forty-four to fifty-five years). RESULTS:A stable reduction was achieved in eighty-three hips. The mean age at reduction was 1.7 years (range, 0.3 to 5.4 years). Traction failed in six patients (seven hips [8%]), for whom an open reduction was necessary. Twenty-six patients (thirty hips) underwent late surgical procedures because of residual hip dysplasia. A good long-term clinical outcome (a Harris hip score of ≥85 points) after closed reduction was assessed for fifty-two (63%) of the hips. A satisfactory radiographic outcome (no osteoarthritis) was found for fifty-six (67%) of the hips. Osteoarthritis had developed in twenty-seven (33%) of the hips, of which nineteen had undergone total hip replacement, performed at a mean patient age of 43.7 years (range, thirty-one to fifty-four years). Risk factors for osteoarthritis were an older age at the time of reduction, osteonecrosis of the femoral head, residual subluxation, a high acetabular index during childhood, and a classification of Severin grades III or IV at skeletal maturity. A survival analysis showed a reduction in “surviving” hips (no total hip replacement) from 99% at a patient age of thirty years to 74% at the age of fifty-two years. CONCLUSIONS:With a mean follow-up of fifty years, the clinical and radiographic outcomes after gradual closed reduction by skin traction were satisfactory in approximately two-thirds of eighty-three hips. The most important independent risk factors for a poor long-term outcome were an age of eighteen months or older at the time of reduction, residual subluxation, and osteonecrosis. LEVEL OF EVIDENCE:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.