Analysis of the causes of unfavorable outcomes of functional treatment for infants with developmental hip dislocation

BACKGROUND: The functional method is currently considered an effective treatment approach for children with developmental hip dislocation. This method involves the gradual centering of the femoral head within the acetabulum and fixation of the lower extremities using an orthosis with preserving motion in the hip and knee joints. However, complications may occur, including postreduction avascular necrosis of the femoral head and joint instability. These complications contribute to severe irreversible changes, early development of dysplastic coxarthrosis, and patient disability. The analysis of the factors leading to these adverse outcomes may improve treatment effectiveness; however, these issues remain understudied.

AIM: This study aimed to identify and analyze the main causes of unfavorable outcomes of functional treatment for dislocated developmental dysplasia of the hip in infants.

METHODS: The study was based on the examination of 56 children aged 1 to 3 years with a history of developmental hip dislocation who had received outpatient functional treatment at their place of residence, as well as a questionnaire survey of their parents. Exclusion criteria were neurological disorders and teratogenic or pathological hip dislocations. The main group comprised 26 children with unfavorable treatment outcomes, whereas the control group comprised 30 children without complications. The survey was conducted using a specially developed questionnaire designed to assess the timeliness of diagnosis and quality of outpatient orthopedic care provided to the children. Statistical analysis of the collected data was performed.

RESULTS: The main causes of treatment failure at the outpatient stage of orthopedic care were noncompliance with orthosis use by parents, prolonged disregard of the child’s anxiety during treatment, incomplete adherence to medical recommendations, and delayed attendance at scheduled follow-up visits with an orthopedic specialist.

CONCLUSION: The development of complications during functional treatment of children with developmental hip dislocation largely depends on social factors. These factors may be considered by outpatient orthopedic specialists to reduce the incidence of complications and, in most cases, help prevent the need for surgery.