Optimal Age for DDH Surgery Varies by Method

Research study background

Treatment for developmental dysplasia of the hip (DDH) depends on the child’s age at the time of diagnosis and the severity of the dysplasia. Surgical intervention may be required when a diagnosis is delayed or if bracing or harnessing fails to realign a dislocated hip. Surgical methods include closed reduction (CR), open reduction (OR) and OR combined with a concomitant pelvic osteotomy (ORP). A lack of consensus on the ideal age for these surgical interventions may be a factor in the significant proportion of patients (30% to 80%) who require further corrective surgery before reaching skeletal maturity.

In this study, researchers from the Hip Preservation Program in the Orthopedics Institute at Children's Hospital Colorado sought to identify the optimal treatment age for each surgical method. As part of a retrospective review, the team compared outcomes for 256 hips in 195 patients with DDH who underwent OR, CR or ORP at Children’s Colorado between 2000 and 2018. They also measured radiographic outcomes, including acetabular index, International Hip Dysplasia Institute classification and acetabular depth ratio for each group. The researchers further calculated the incidence of additional surgery for residual dysplasia prior to skeletal maturity.

Hip dysplasia classification and age at surgery varied significantly among the surgical methods. After adjusting for age and sex, the cumulative incidence of further corrective surgery was 13.8% in the CR group, 29.2% in the OR group and 9.2% in the ORP group. Operating at an earlier age for CR and OR and an older age for ORP index procedure was found to be protective against additional surgical correction. Over time, all surgical interventions appeared to have a positive impact on hip development, but children who were younger at the index procedure had the most improvement in radiographic parameters of dysplasia.

Based on these findings, study authors suggest the following age-specific cutoffs for surgical treatment of DDH to reduce the risk of further corrective surgery in childhood: <9.9 months for CR, <11.5 months for OR and >21.4 months for ORP.

Clinical implications

The decision for further corrective surgery following OR or CR remains subjective and there are no standard parameters applied across the U.S. to this group of patients. Study authors also recognized that children between 11.5 and 21.4 months who present with DDH currently fall within a gray area for surgical intervention that’s at the discretion of the treating surgeon. Additional studies are needed to determine the impact of childhood surgical treatment on outcomes at skeletal maturity, and to create age standards for surgical intervention.