PROGNOSTIC VALUE OF POST-REDUCTION COMPUTED TOMOGRAPHY AFTER CLOSED REDUCTION FOR DEVELOPMENTAL DYSPLASIA OF THE HIP
DOI:
https://doi.org/10.53582/51hbf910Keywords:
closed reduction, computed tomography, developmental dysplasia of the hip, prognosis, residual dysplasiaAbstract
Introduction: Assessment of hip position after closed reduction for developmental dysplasia of the hip (DDH) is challenging using plain radiography because of cartilaginous anatomy and cast-related artifacts. Post-reduction computed tomography (CT) performed in a narrow window may improve detection of inadequate reduction and guide early management.
Aim: To evaluate the prognostic and decision-making value of post-reduction narrow window CT compared to plain radiography after closed reduction for DDH.
Material and methods: A prospective clinical study included 50 children treated with closed reduction for DDH. Twenty-five patients underwent native radiography and post-reduction CT in a narrow window protocol. CT parameters assessing quality of reduction were analyzed and compared to early need for re-intervention, persistent dysplasia and radiographic outcome at follow-up.
Results: CT identified persistent or inadequate reduction in 5 of 39 dislocated hips (12.8%), all of which required immediate change in treatment. In the native radiographs, persistent dislocation was reliably identified in only one case (2 hips), while three cases were initially missed because of poor visualization. None of the CT-derived parameters demonstrated a statistically significant correlation with later residual dysplasia defined by the center–edge angle. However, with another design of the study and a bigger sample, some parameters might show a statistically significant correlation.
Conclusion: Post-reduction narrow window CT provides superior detection of inadequate reduction compared to plain radiography and directly influences early clinical decision-making. However, CT parameters at the moment showed no certain prognostic value for predicting residual acetabular dysplasia.
References
1. Klisić P, Živanović V, Brdar R. Effects of triple prevention of CDH, stimulated by distribution of baby packages. J Pediatr Orthop 1988; 8(1): 9-11. doi: 10.1097/ 01241398-198801000-00002.
2. Komnenovik M, Bozinovski Z, Trajanovski A, Saveski A, Damjanovik D, Atanasovski I. Developmental disorders of the hip treated at the Clinic for Orthopaedic Diseases – in a period of 10 years (2009-2018). Arch Pub Health 2022; 14(1). doi: https://doi.org/10.3889/aph.2022.6050.
3. Bozinovski Z, Doksevska MB, Tokmakova KP. Closed reduction in developmental dysplasia of the hip in patients older than one year. Folia Med 2020; 62(2): 276-281. doi: 10.3897/folmed.62.e48212.
4. Bakarman K, Alsiddiky AM, Zamzam M, Alzain KO, Alhuzaimi FS, Rafiq Z. Developmental Dysplasia of the Hip (DDH): Etiology, Diagnosis, and Management. Cureus 2023; 15(8): e43207. doi: 10.7759/cureus.43207.
5. Storer SK, Skaggs DL. Developmental dysplasia of the hip. Am Fam Physician 2006; 74(8): 1310-1316. PMID: 17087424.
6. Vaquero-Picado A, González-Morán G, Garay EG, Moraleda L. Developmental dysplasia of the hip: update of management. EFORT Open Rev 2019; 4(9): 548-556. doi: 10.1302/2058-5241.4.180019.
7. Sankar WN, Gornitzky AL, Clarke NMP, Herrera-Soto JA, Kelley SP, Matheney T, et al. Closed Reduction for Developmental Dysplasia of the Hip: Early-term Results From a Prospective, Multicenter Cohort. J Pediatr Orthop 2019; 39(3): 111-118. doi: 10.1097/BPO.0000000000000895.
8. Scott EJ, Dolan LA, Weinstein SL. Closed Vs. Open Reduction/Salter Innominate Osteotomy for Developmental Hip Dislocation After Age 18 Months: Comparative Survival at 45-Year Follow-up. J Bone Joint Surg Am 2020; 102(15): 1351-1357. doi: 10.2106/JBJS.19.01278.
9. Walter SG, Bornemann R, Koob S, Ossendorff R, Placzek R. Closed Reduction as Therapeutic Gold Standard for Treatment of Congenital Hip Dislocation. Die geschlossene Reposition der Säuglingshüfte als therapeutischer Goldstandard der kongenitalen Hüftluxation. Z Orthop Unfall 2020; 158(5): 475-480. doi: 10.1055/a-0979-2346.
10. Herrero C, Cerasani MN, Lowe D, Sankar WN, Castaneda P. Closed Reduction of Developmental Dislocation of the Hip with Application of a Waterproof Cast. J Pediatr Soc North Am 2024; 5(2): 650. doi: 10.55275/JPOSNA-2023-650.
11. Smith BG, Kasser JR, Hey LA, Jaramillo D, Millis MB. Postreduction computed tomography in developmental dislocation of the hip: part I: analysis of measurement reliability. J Pediatr Orthop 1997; 17(5): 626-630. doi: 10.1097/00004694-199709000-00010.
12. Smith BG, Millis MB, Hey LA, Jaramillo D, Kasser JR. Postreduction computed tomography in developmental dislocation of the hip: part II: predictive value for outcome. J Pediatr Orthop 1997; 17(5): 631-636. doi: 10.1097/00004694-199709000-00011.
13. Liu J, Gao T, Li J, et al. Evaluation of the short-term curative effect of closed reduction in the treatment of developmental dysplasia of the hip based on three-dimensional magnetic resonance imaging finite element analysis. BMC Musculoskelet Disord 2022; 23: 455. doi: 10.1186/s12891-022-05401-x.
14. Smith BG, Kasser JR, Hey LA, Jaramillo D, Millis MB. Postreduction computed tomography in developmental dislocation of the hip: part I: analysis of measurement reliability. J Pediatr Orthop 1997; 17(5): 626-630. doi: 10.1097/00004694-199709000-00010.
15. Cooper A, Evans O, Ali F, Flowers M. A novel method for assessing postoperative femoral head reduction in developmental dysplasia of the hip. J Child Orthop 2014; 8(4): 319-324. doi: 10.1007/s11832-014-0600-5.
16. Mendonça RP, Estrela C, Bueno MR, Carvalho TCASG, Estrela LRA, Chilvarquer I. Principles of radiological protection and application of ALARA, ALADA, and ALADAIP: a critical review. Braz Oral Res 2025; 39: e14. doi: 10.1590/1807-3107bor-2025.vol39.014.
17. Ramsey PL, Lasser S, MacEwen GD. Congenital dislocation of the hip. Use of the Pavlik harness in the child during the first six months of life. J Bone Joint Surg 1976; 58(7): 1000-1004. PMID: 977608.
18. Buckley SL, Sponseller PD, Magid D. The acetabulum in congenital and neuromuscular hip instability. J Pediatr Orthop 1991; 11(4): 498-501. doi: 10.1097/01241398-199107000-00015.
19. McKay DW. A comparison of the innominate and the pericapsular osteotomy in the treatment of congenital dislocation of the hip. Clin Orthop Relat Res 1974; (98): 124-132. doi: 10.1097/00003086-197401000-00013.
20. Kotlarsky P, Haber R, Bialik V, Eidelman M. Developmental dysplasia of the hip: What has changed in the last 20 years? World J Orthop 2015; 6(11): 886-901. doi: 10.5312/wjo.v6.i11.886.
21. Mootha AK, Saini R, Dhillon MS, Aggarwal S. Single slice computed tomography in the evaluation of femoral head reduction after closed reduction in developmental dysplasia of hip in children. Acta Orthop Belg 2005; 71(6): 688-693.
22. Hernandez RJ. Concentric reduction of the dislocated hip. Computed-tomographic evaluation. Radiology 1984; 150(1): 266-268. doi: 10.1148/radiology.150.1.6689774.
23. Toby EB, Koman LA, Bechtold RE, Nicastro JN. Postoperative computed tomographic evaluation of congenital hip dislocation. J Pediatr Orthop 1987; 7(6): 667-670. PMID: 3429651.
24. Edelson JG, Hirsch M, Weinberg H, Attar D, Barmeir E. Congenital dislocation of the hip and computerised axial tomography. J Bone Joint Surg Br 1984; 66(4): 472-478. doi: 10.1302/0301-620X.66B4.6746676.
25. Yong B, Li Y, Li J, Andreacchio A, Pavone V, Pereria B, et al. Post- operative radiograph assessment of children undergoing closed reduction and spica cast immobilization for developmental dysplasia of the hip: does experience matter? Int Orthop 2018; 42(11): 2725-2731. doi: 10.1007/s00264-018-4038-0.
26. Tachdjian's Pediatric Orthopaedics: From the Texas Scottish Rite Hospital for Children, 6th edition. ISBN: 9780323567695.
27. Weiner LS, Kelley MA, Ulin RI, Wallach D. Development of the acetabulum and hip: computed tomography analysis of the axial plane. J Pediatr Orthop 1993; 13(4): 421-425. doi: 10.1097/01241398-199307000-00001.
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Copyright (c) 2026 Milena Bogojevska Doksevska, Zoran Bozinovski, Daniela Georgieva, Vilijam Velkovski, Danica Popovska, Marina Komnenovik, Teodora Todorova, Teodora Bozinovska, Milan Samardziski
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