Arthroscopic-assisted reduction for developmental dysplasia of the hip in children: A systematic review

Abstract

Background

Developmental dysplasia of the hip (DDH) is a pediatric orthopedic condition characterized by abnormal hip joint formation, leading to subluxation or dislocation of the femoral head from the acetabulum. Early diagnosis and treatment are essential to prevent long-term disability. Conservative treatments are effective if diagnosed early, but late diagnosis often requires more invasive interventions, such as closed or open reduction. Open reduction, although practical, carries significant risks, including avascular necrosis (AVN). Arthroscopic reduction has emerged as a less invasive alternative with potential benefits.

Material and Methods

This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, including a thorough search of five main databases: PubMed, Scopus, Embase, Medline, and Cochrane. Eligible articles were evaluated according to predefined criteria for levels of evidence (LoE), with retrospective studies assessed using the Coleman Methodology Score (mCMS). This systematic review was registered in the International Prospective Registry of Systematic Reviews (PROSPERO).

Results

The review included 11 studies involving 169 patients with 195 hips treated arthroscopically for DDH. The majority of the patients were female (136, 80.5%). The ages of the patients ranged from 3 months to 3.4 years. The follow-up period ranged from 9 months to 9 years after treatment. Success rates of arthroscopic reduction ranged from 70% to 100%, with a median AVN rate of 10.2%. Complications included AVN (11.3%), redislocation (8.2%) and the need for secondary procedures (29.7%). Most of the studies used sub-adductor and anterolateral portals.

Conclusions

Arthroscopic-assisted reduction for DDH is a viable and less invasive treatment method that offers good clinical and radiological results. This technique can be particularly beneficial for pediatric patients when performed by experienced surgeons. This study's findings contribute to the growing body of evidence supporting the use of arthroscopic reduction as a possible alternative to open reduction in treating DDH. However, further high-quality research is needed to confirm these results and improve the validity of the data.