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DDH in the Walking Age: Review of Patients with Long-Term Follow-Up

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Abstract

Introduction

The best treatment option in children with late detected DDH is still a subject of much controversy and only few studies have investigated the long-term outcome of treatment in such patients. We performed a systematic review to assess long-term outcome of late detected DDH hips treated after walking age.

Methods

Studies met inclusion criteria if they: (1) reported at least 30 hips treated; (2) included children aged between 9 months and 12 years; (3) treatment indication was late detected DDH after walking age; (4) presented a minimum follow-up of 10 years; (5) reported a clinical or radiological outcome. The Kaplan–Meier method was used to evaluate long-term survival according to clinical and radiological outcomes. The rate of total hip replacement (THR) was retrieved.

Results

From a total of 6561 articles, 13 articles with grade IV level of evidence were included in our review. A total of 988 hips in 800 patients with a mean follow-up of 27.9 years (range 10–67) were included. The mean age at surgery was 3.3 years (range, 9 months–12 years). The rate of THR increased according to the length of final follow-up. In particular, all studies reported no case of THR at 23.5 years of follow-up, a rate of 10.2% of THR between 30 and 40 years of follow-up and a rate of 35.6% of THR in patients with follow-up more than 40 years.

Conclusions

In patients with late detected DDH, most THR became necessary more than 30 years after the index procedure and their number increased further after 40 years and more of follow-up. Late detected DDH diagnosed after walking age is a life-long disease.

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Author notes

  1. Giovanni Lucchesi and Riccardo Sacco contributed equally to this work.

Authors and Affiliations

  1. Orthopaedic Clinic, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy

    Giovanni Lucchesi

  2. Department of Orthopedic and Traumatology, Orthopedic and Trauma Center, Turin, Italy

    Riccardo Sacco

  3. Department of Pediatric Orthopaedics, Shengjing Hospital of China Medical University, Shenyang, China

    Weizheng Zhou

  4. GuangZhou Women and Children’s Medical Center, GuangZhou Medical University, 9th JinSui Road, GuangZhou, 510623, China

    YiQiang Li

  5. Department of Pediatric Orthopaedics, Shengjing Hospital of China Medical University, Shenyang, China

    Lianyong Li

  6. Department of Pediatric Orthopedic Surgery, Lille University Centre, Jeanne de Flandre Hospital, 59000, Lille, France

    Federico Canavese

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  1. Giovanni Lucchesi
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Correspondence to Federico Canavese.

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Lucchesi, G., Sacco, R., Zhou, W. et al. DDH in the Walking Age: Review of Patients with Long-Term Follow-Up. JOIO 55, 1503–1514 (2021). https://doi.org/10.1007/s43465-021-00531-1

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