Comparison of abduction orthosis and closed reduction treatments in patients with hip displasia greater than 6 months

Aim: Various treatment options are available for patients with hip dysplasia older than 6 months. These consist of abduction orthoses, closed reduction and casting techniques, and open reduction. In this study, we compared the results of patients treated with only rigid abduction orthosis and patients who were treated with closed reduction pelvipedal casting in operating room conditions. Material and Method: The data of patients who were admitted to the outpatient clinic between 2015 and 2020 for DDH and who were treated with rigid abduction orthosis and patients who underwent closed reduction pelvipedal casting under operating room conditions were retrospectively reviewed. 63 hips of 39 patients, 4 male, 35 female, in the abduction orthosis group, who were older than 6 months and whose follow-up period was at least 6 months; 63 hips of 42 patients, 4 male, 37 female, in the closed reduction group were included in the study. Of the 81 patients included in the study, 18 had left hip involvement, 18 had right hip, and 45 had bilateral hip involvement. When the treatment was initiated, the mean age of the patients was 8.66 months in the abduction orthosis group and 9.68 months in the closed reduction group. For pre-treatment radiological evaluations of the patients, the degree of displacement defined by Tönnis on plain radiographs and acetabular index measurement with the Hilgenreiner method were performed. After the treatment was initiated, the patients' Tönnis grades and acetabular index values ​​were measured in the follow-up examinations, and the patients were evaluated in terms of treatment complications such as AVN and skin problems. Evidence: In the patient group with closed reduction, 39 of 63 hips were evaluated as Tönnis type 1 and 24 as Tönnis type 2. Of the 63 hips whose rigid abduction orthosis was started, 49 were evaluated as Tönnis type 1 and 14 as Tönnis type 2 before treatment. After 3 months of treatment, in the closed reduction group, 23 of 24 patients who were Tönnis type 2 before the treatment returned to Tönnis type 1. In the rigid abduction orthosis group, it was observed that 11 of 14 patients who were Tönnis type 2 before 6 treatment returned to Tönnis type 1. When the success of these two methods in Tönnis type 2 patients was compared, no statistically significant difference was found. (P> 0.05) The pre-treatment mean acetabular index value of 39 Tönnis type 1 patients who were applied closed reduction therapy was 29.87. The average acetabular index value of these patients was calculated as 26.08 at the 3rd month of treatment and 24.21 at the 6th month. In the group receiving rigid abduction orthosis, the pre-treatment mean acetabular index value of 49 Tönnis type 1 patients was 29.20, this value was calculated as 25.33 in the third month of treatment and 23.41 in the 6th month of treatment. When the two treatment methods were compared statistically, no significant difference was found in terms of acetabular index reduction success. (p> 0.05) Result: Rigid abduction orthosis is as successful as closed reduction pelvipedal casting in terms of achieving concentric reduction and decreasing acetabular index in patients with a Tönnis type 1 hip older than 6 months. In this patient group, the rigid abduction orthosis may be preferred because it does not require anesthesia, is cheaper and accessible, and is easy to use. In Tönnis type 2 hips, the closed reduction pelvipedal casting method is more successful, although no statistical difference has been shown. Rigid abduction orthosis can be tried in these patients, but patients should be followed closely and be aware of treatment failure.