Prognosis

Prognosis is dependent upon the age at presentation, the extent of treatment needed, and the occurrence of complications. The success of closed or open reduction of a hip dislocation depends upon the remodelling potential of a child's femoral head and acetabulum to achieve an adequately spherical shape with adequate coverage. This remodelling potential is more reliable in younger children, and within the first 12 to 18 months after reduction is achieved. The remodelling potential remains but is likely reduced during the subsequent years of growth.[32]

Long-term follow-up until skeletal maturity, and well into adulthood, is required to assess functional outcomes. Hips with poor radiographic features can function well during childhood and adolescence, but may later become symptomatic.[50] Additionally, delayed development of radiographic complications may occur.[51] Generally, factors associated with poorer prognosis include older age at time of intervention, high dislocation, residual subluxation, and evidence of osteonecrosis.[8][33][47]

Untreated hip subluxations and dislocations

The natural history of untreated hip subluxation includes the development of symptoms at a mean age of mid-30s for women and mid-50s for men.[33] High-riding, complete dislocations may remain minimally symptomatic into mid-adult life, although the presence of a false acetabulum is associated with earlier degenerative arthritis and pain. Untreated unilateral hip dislocations can be more problematic because of limb length inequality, knee valgus, and back pain.[6]

Infants undergoing closed treatment using the Pavlik harness

For patients presenting as infants and using the Pavlik harness, success rates approach 90% and complication rates are considered low. Rates of osteonecrosis range between 1% to 3% for the majority of hips treated. Femoral nerve palsy has an incidence of 2.5% and typically is transient, resolving once the harness is removed.[52]

Older children undergoing open reduction

Outcomes for hips that have presented later and require more aggressive interventions are more guarded. Reported complication rates vary widely from 12% to 60%.[50][53][54] A series of children who had late-presenting developmental dislocations of the hip and had undergone open reduction and innominate osteotomy identified a 99% rate of survival at 30 years of age, an 86% rate of survival at 40 years of age, and a 54% rate of survival at 45 years of age.[55]

Residual abnormalities

Generally, treated and untreated hips seem to respond similarly to residual subluxation and dysplasia. Following the occurrence of pain and radiographic evidence of degenerative changes, progression of osteoarthritis can be rapid.[6] Residually dysplastic hips seem to carry a worse prognosis than a high-riding, complete dislocation.[36]

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