Is Prior Nonoperative or Operative Treatment of Dysplasia of the Hip Associated With Poorer Results of Periacetabular Osteotomy?

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: Each author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request. 7. Chang Gung Med J. 2010 May-Jun;33(3):266-73. Early reduction for congenital dislocation of the knee within twenty-four hours of birth. Cheng CC(1), Ko JY. Author information: (1)Department of Orthopedic Surgery, Antai Medical Care Cooperation, Antai Tian-Sheng Memorial Hospital. BACKGROUND: Congenital dislocation of the knee (CDK) is a very rare condition that comprises a spectrum of deformities from subluxation to complete dislocation. The incidence of CDK is estimated at 1 per 100,000 live births, which is 1% of the incidence of developmental dysplasia of the hip (DDH). Moreover, 40-100% of patients with CDK have additional musculoskeletal anomalies, the most common being DDH and clubfoot. In general, the diagnosis is established immediately after birth according to the position of the knee recurvatum. Treatment with conservative methods at an early stage is most likely to yield successful results. We report here successful treatment of a series of CDK patients with early reduction. METHODS: From July 1990 to June 2007, 19 patients with CDK (affecting 25 knees) were treated with early reduction. Of these, 6 knees had dislocation, and 19 had subluxation. Since 1990, treatment has been guided by a protocol that considers patient age and the severity of the condition. In patients examined within 24 hours of birth, early, direct reduction under gentle, persistent manual traction was attempted. Birth history and perinatal course were obtained from medical records. Associated musculoskeletal anomalies were observed and treated after reduction of the knee joint. A Pavlik harness was used for at least 4 months in the concomitant treatment of DDH and CDK. Knee function was graded as excellent, good, fair, or poor. Radiographs were used to assess DDH during follow-up. RESULTS: After an average follow-up duration of 4.3 years, 18 patients showed an excellent or good outcome. One patient, whose knee could not be reduced, had severe multiple anomalies and died 16 days after birth. Fifteen of the nineteen patients had associated musculoskeletal anomalies, including DDH and foot deformity. Two cases of residual hip dysplasia after Pavlik harnessapplication required an acetabular osteotomy. CONCLUSIONS: For CDK patients, early and direct closed reduction within 24 hours of birth affords outcomes graded as either excellent or good.