Özgür DOĞAN, Emrah ÇALIŞKAN, Batuhan GENCER, Ali BİÇİMOĞLU

Is male gender a prognostic factor for developmental dysplasia of the hip? Mid-long-term results of posteromedial limited surgery

Objective: The aim of this study was to determine if male sex is a poor prognostic factor for developmental dysplasia of the hip (DDH) and to determine the mid-long-term radiological and clinical results of male patients in comparison with female patients following an open reduction with posteromedial limited approach. Methods: We examined 54 hips of 41 male patients (12.38 ± 4.82 months) and 96 hips of 82 female patients (11.11 ± 4.93 months) with DDH. All the patients underwent open reduction with posteromedial limited approach. The average follow-up time was 108 months for the male patients and 110 months for the female patients. The Tonnis grade, acetabular index, Kalamchi and MacEwen classi € fication, and Severin classifications were determined for all patients. The Mc Kay classification system was used to evaluate the functional results. Results: From the total, 25 (60%) male and 70 (85%) female patients had satisfactory radiographic outcomes (Severin Ia, Ib, or II) according to the Severin classification. There was a significant difference between the two groups in terms of the Severin classification (P ¼ 0.04). Residual acetabular dysplasia (RAD) was observed in 12 (15%) female and 17 (41%) male patients (P ¼ 0.001). Grade 2 or higher osteonecrosis was observed in 7 (9%) patients in female and 6 (15%) patients in male group. The clinical outcomes in terms of the Mc Kay classification showed satisfactory outcomes in 72 (87%) female and 34 (82%) male patients. Further, 8 (9.7%) female patients and 6 (14.6%) male patients underwent a second operation. However, there was no difference between the two groups in terms of postoperative osteonecrosis presence (P ¼ 0.982), functional outcomes (P ¼ 0.571), and secondary operation rates (P ¼ 0.298). Male sex was associated with poor outcomes in terms of the Severin classification (P ¼ 0.04) and RAD (P ¼ 0.001). Conclusion: Although our results indicated that male sex is a poor prognostic factor for radiological results and RAD, there was no difference between male and female patients in terms of osteonecrosis, redislocations, and functional outcomes. Secondary surgical interventions should not be delayed in the absence of the spontaneous development of acetabulum.

___

1. Ponseti IV. Morphology of the acetabulum in congenital dislocation of the hip. Gross, histological and roentgenographic studies. J Bone Joint Surg (Am). 1978;60(5):586e599.

2. Shorter D, Hong T, Osborn DA. Cochrane review: screening programmes for developmental dysplasia of the hip in newborn infants. Evid Based Child Health. 2013;8(1):11e54.

3. Swaroop VT, Mubarak SJ. Difficult-to-treat Ortolani-positive hip: improved success with new treatment protocol. J Pediatr Orthop. 2009;29(3):224e230.

4. Weinstein SL, Mubarak SJ, Wenger DR. Developmental hip dysplasia and dislocation: part II. Instr Course Lect. 2004;53:531e542.

5. Massa BSF, Guarniero R, Godoy RM, Rodrigues Jr JC, Montenegro NB, Cordeiro FG. Use of inlet radiographs in the assessment of reduction after the surgical treatment of developmental dysplasia of the hip. Bone Joint J. 2017;99- B(5):697e701.

6. Ryan MG, Johnson LO, Quanbeck DS, Minkowitz B. One-stage treatment of congenital dislocation ofthe hip in children three to ten years old. Functional and radiographic results. J Bone Joint Surg Am. 1998;80(3):336e344.

7. Wang TM, Wu KW, Shih SF, Huang SC, Kuo KN. Outcomes of open reduction for developmental dysplasia of the hip: does bilateral dysplasia have a poorer outcome? J Bone Joint Surg Am. 2013;95(12):1081e1086.

8. Eamsobha P, Kamwong S, Sisuchinthara T, Jittivilai T, Keawpornsawan KJ. The factor causing poor results in late developmental dysplasia of the hip. J. Med Assoc Thai. 2015;98(8):32e37.

9. Grauer JN. Orthopaedic Knowledge Uptade. 12th ed. Connecticut: American Academy of Orthopaedic Surgeons; 2017.

10. Biçimoglu A, Agus H, Omeroglu H, Tumer Y. Posteromedial limited surgery in developmental dysplasia of the hip. Clin Orthop Relat Res. 2008;466(4): 847e855.

11. Barrett WP, Staheli LT, Chew DE. The effectiveness of the Salter innominate osteotomy in the treatment of congenital dislocation of the hip. J Bone Joint Surg Am. 1986;68(1):79e87.

12. Severin E. Contribution to the knowledge of congenital dislocation of the hip joint: late results of closed reduction and arthrographic studies of recent cases. Acta Chir Scand. 1941;84(63):1e142.

13. Baki ME, Baki C, Aydın H, Arı B, Ozcan M. Single-stage medial open reduction € and Pemberton acetabuloplasty in developmental dysplasia of the hip. J Pediatr Orthop B. 2016;25(6):504e508.

14. Cai Z, Li L, Zhang L, Ji S, Zhao O. Dynamic long leg casting fixation for treating 12- to 18-month-old infants with developmental dysplasia of the hip. J Int Med Res. 2017;45(1):272e281.

15. Moussa M, Al-Othman A. Bilateral developmental dysplasia of the hip; asymmetric outcome in the older child. Clin Orthop Relat Res. 2001;392(11): 358e365.

16. Cha SM, Shin HD, Shin BK. Long-term results of closed reduction for developmental dislocation of the hip in children of walking age under eighteen months old. Int Orthop. 2018;42(1):175e182.

17. Kersnic B, Iglic A, Kralj-Iglic V, Srakar F, Antolic V. Increased incidence of arthrosis in women could be related to femoral and pelvic shape. Arch Orthop Trauma Surg. 1997;116(6e7):345e347.

18. Vandergugten S, Traore SY, Docquier PL. Risk factors for additional surgery after closed reduction of hip developmental dislocation. Acta Orthop Belg. 2016;82(4):787e796.

19. Herring JA. Tachdjian’s Pediatric Orthopaedics. 5th ed. Philadelphia,PA: WB SaundersCompany; 2014:483e579.

20. Farsetti P, Caterini R, Potenza V, Ippolito E. Developmental dislocation of the hip successfully treated by preoperative traction and medial open reduction. Clin Orthop Relat Res. 2015;473(8):2658e2669.