BACKGROUND: A consecutive series of seventy-six patients (101 hips)
underwent primary open reduction, capsulorrhaphy, and innominate osteotomy for
late-presenting developmental dislocation of the hip. They were between 1.5
and five years old at the time of surgery, which was done between 1958 and
1965. The present study was designed to review the outcome of these patients
into middle age.
METHODS: We located and reviewed the cases of sixty patients (eighty
hips), which represents a 79% rate of follow-up at forty to forty-eight years
postoperatively. Nineteen patients (twenty-four hips) had undergone total hip
replacement, and three (three hips) had died of unrelated causes. The
remaining thirty-eight patients (fifty-three hips) were assessed by the WOMAC
(Western Ontario and McMaster Universities Osteoarthritis Index) and Oxford
hip score questionnaires, physical examination, and a standing anteroposterior
pelvic radiograph. The radiographs were analyzed to determine the minimum
joint space width and the Kellgren and Lawrence score. Accepted indices of hip
dysplasia were measured.
RESULTS: With use of Kaplan-Meier survival analysis and with the end
point defined as total hip replacement, the survival rates at thirty, forty,
and forty-five years after the reduction were 99% (95% confidence interval,
± 2.4%), 86% (95% confidence interval, ± 6.9%), and 54% (95%
confidence interval, ± 16.4%), respectively. The average Oxford hip
score and WOMAC score for the surviving hips were 16.8 (range, 0 to 82) and
16.7 (range, 0 to 71), respectively. Of the fifty-one hips for which
radiographs were available, thirty-eight demonstrated a minimum joint space
width of >2.0 mm and thirteen demonstrated definite osteoarthritis on the
basis of this criterion. Osteoarthritis, according to the system of Kellgren
and Lawrence, was grade 0 or 1 in twenty-nine hips, grade 2 in seven hips, and
grade 3 or 4 in fifteen hips. The average centeredge and acetabular angles
were 40° (range, 0° to 61°) and 32° (range, 20° to
43°), respectively. With the numbers studied, no significant association
was detected between outcome and the modifiable risk factors of body mass
index or age at the time of surgery. Hips in patients with bilateral
involvement were at significantly greater risk of failure (p = 0.02).
CONCLUSIONS: This method of treatment achieves a 54% rate of
survival of the hip at forty-five years. Two-thirds of the surviving hips have
an excellent prognosis forty to forty-eight years after the index procedure
according to the Kellgren and Lawrence score.
LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions to Authors
for a complete description of levels of evidence.
ORIGINAL ABSTRACT CITATION: "Outcome at Forty-five Years After Open
Reduction and Innominate Osteotomy for Late-Presenting Developmental
Dislocation of the Hip"