Surgical alternatives for treatment of developmental dysplasia of the hip in children aged 1–4 years: does open reduction improve the outcomes?

Background: Developmental dysplasia of the hip (DDH) remains a therapeutic challenge and treatment strategies remain controversial in children diagnosed after the age of one year. Aim: The study aim was to evaluate various treatment methods for DDH in children aged 1–4 years and to determine whether open reduction improved outcomes. Methods: 41 children (48 affected hips) aged ≥ 1 year with DDH were included in the study. They were treated surgically between 2012 and 2021 at a tertiary university hospital and had a documented follow up of ≥ 18 months. Patients were divided into two groups: those who underwent closed reduction (CR) and those who underwent open reduction (OR). Femoral shortening, varisation and pelvic extracapsular osteotomies (PO) were performed depending on case and surgeon preference. Outcomes were evaluated radiographically using the Severin classification, functionally using the Children’s Hospital of Oakland Hip Evaluation Score (CHOHES). Avascular necrosis (AVN) if present was documented using the Kalamchi–MacEwen (K&M) classification. Optimal outcomes were defined when: quality of reduction is Severin ≤ 2, CHOHES ≥ 85 and absence of AVN. Statistical analyses were performed using R version 4.3.1, with categorical data compared using the chi-square test. Results: Optimal outcomes were observed in 19 of 21 hips treated with OR (90.5%) and 19 of 27 hips treated with CR 70.4% (p = 0.089). AVN occurred infrequently, and in several cases, resolved during follow-up. Conclusions: OR with Femoral shortening and PO provided the most favorable outcomes. This approach may minimize AVN, and potentially delay degenerative changes.