Open Reduction for Developmental Dysplasia of the Hip in the Newborn Hip Screening Era: Changing Patient Characteristics and Surgical Strategies Without Compromising Outcomes

Introduction: Newborn hip ultrasound scan (USS) for developmental dysplasia of the hip (DDH) has significantly reduced the number of delayed cases. However, open reduction (OR) is still required when nonsurgical treatment fails in properly screened patients, as well as in neglected and late-presenting cases. The aim of this study is to compare the clinical and radiologic outcomes of OR for DDH between screened and neglected cases. Methods: Patients diagnosed with DDH and who underwent OR at a single center were included and categorized into 2 groups: Screened patients with an unsuccessful nonoperative treatment attempt (group 1), and neglected patients due to misdiagnosis or lack of USS (group 2). Comparisons were performed between groups for demographic parameters, surgical characteristics, pre- and postoperative radiographic analyses, radiologic and clinical outcome assessments, and complications. Results: One hundred thirteen patients (148 hips) were included (group 1=66 and group 2=82). Group 1 had younger median age at the time of OR (11 vs. 23.2 mo, P <0.001), less IHDI grade 3-4 ratio (74% vs. 90%, P <0.001) higher medial/anterior OR ratio (55% vs. 15%, P <0.001), lower rate of concomitant femoral (35% vs. 71%, P <0.001) and pelvic osteotomy (38% vs. 78%, P <0.001) as compared with group 2. PFGD (proximal femur growth disturbance) rates were similar between the 2 groups. No difference noted for Severin grade (good to excellent result 89% vs. 92%, P =0.42), McKay (excellent result 83% vs. 77%, P =0.21), revision (9.8% vs. 6.4%, P =0.33), reoperation for implant removal (14 vs. 20, P =0.23), and for pelvic osteotomy due to residual acetabular dysplasia (6 vs. 5, P =0.58). Conclusion: Early detection of DDH through USS not only reduced delayed presentations but also altered the demographic, clinical, and surgical characteristics of patients requiring OR. Despite failed initial conservative management, screened patients achieved comparable radiologic and clinical outcomes to those of unscreened patients, with similar rates of complications and residual acetabular dysplasia. These findings suggest that newborn hip USS enables less extensive surgical management without compromising outcomes. Level of Evidence: Level III—retrospective comparative study.