Evaluation of closed reduction treatment results of international hip dysplasia institute (IHDI) classification stage 3-4 patients

Purpose: This study aims to investigate the success rates of closed reduction in patients with Developmental Dysplasia of the Hip (DDH) stage 3-4 according to the IHDI classification and to evaluate the prognostic factors by identifying the cases requiring additional surgery after reduction loss. In particular, to investigate the effect of adductor and iliopsoas tenotomy on closed reduction. Materials and Methods: In this study, the medical records of DDH patients who underwent CR at Harran University Medical Faculty Hospital between January 2020 and June 2024 were retrospectively reviewed. Patients who were treated with CR in our clinic between the ages of 4 and 18 months during the specified date range and who were classified as IHDI stage 3-4 according to the IHDI classification on preoperative pelvic AP radiographs before CR were included in the study. A total of 117 hips belonging to 81 patients were included in the study. In addition, Tonnis classification was performed on the patients and their AI values were measured. It was recorded whether adductor and iliopsoas tenotomy procedures were applied during CR application. The success of closed reduction was evaluated by determining the IHDI types of the patients according to the IHDI classification on postoperative, postoperative 3rd month, postoperative 6th month and postoperative 12th month pelvic AP radiographs. Hips classified as stage 3 and stage 4 according to the IHDI classification were considered as unsuccessful reduction. Patients who required an abduction orthosis and additional surgery within 1 year after CR were considered unsuccessful. Results: 117 hips of 81 patients included in the study were evaluated. The mean age of the patients was 8.55 months, and 83.95% were female. Hip involvement was bilateral in 44.44%, left in 35.80%, and right in 19.75%. CR success rate was determined as 52.14% (61 hips), while failure rate was 47.86%. The presence of ossific nucleus was observed in 53.85% of the patients. According to the IHDI classification, 87 hips (74.36%) were evaluated as stage 3, 30 hips (25.64%) as stage 4. In CR application, 79 hips (67.52%) with adductor tenotomy, 9 hips (7.69%) with adductor and ilopsoas tenotomy, and 29 hips (24.79%) without tenotomy were determined. Of the 56 hips that were considered as CR failures, 14 were considered as failures due to secondary intervention (RAO, repeat CR). Conclusion: We observed that CR treatment yielded more successful results, especially in the younger age group. Therefore, early diagnosis and initiation of treatment at the most appropriate age range will positively affect treatment results. In our study, it was seen that the tenotomy decision was largely made for the adductor muscle. However, iliopsoas tenotomy was performed in only a small number of patients and its effect on CR success was not apparent.