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Long-term Outcome of Gradual Reduction Using Overhead Traction for Developmental Dysplasia of the Hip Over 6 Months of Age

Kaneko, Hiroshi MD; Kitoh, Hiroshi MD; Mishima, Kenichi MD; Matsushita, Masaki MD; Ishiguro, Naoki MD

Journal of Pediatric Orthopaedics: September 2013 - Volume 33 - Issue 6 - p 628–634
doi: 10.1097/BPO.0b013e31829b2d8b

Background: In children over 6 months of age with developmental dysplasia of the hip (DDH), achieving a concentrically reduced hip while avoiding avascular necrosis (AVN) is challenging. The utility of gradual reduction (GR) using traction has insufficient evidence. We therefore report the long-term outcome of GR using overhead traction (OHT).

Methods: We retrospectively reviewed 67 patients with DDH (75 hips) treated with GR using OHT over 6 months of age. The age at reduction ranged from 7 months to 4 years. All patients were followed up until skeletal maturity with a mean duration of 15.6 years. Pelvic radiographs were used to assess AVN, acetabular development, and the Severin classification. We determined the factors affecting the outcome at skeletal maturity.

Results: Seventy-two hips (96%) were successfully reduced, 2 required subsequent closed reduction and 1 underwent open reduction. AVN occurred in 2 hips (2.7%). Among 48 hips (64%) with residual acetabular dysplasia, 31 were treated with Salter innominate osteotomy (SIO) between 5 and 6 years of age. Finally, 62 hips (82.7%) showed satisfactory outcome (56 in Severin class I and 6 in class II), whereas 13 showed unsatisfactory outcome (class III). Although we found no significant factors affecting the outcome, most of the hips treated with SIO were included in the satisfactory group.

Conclusions: GR using OHT could effectively minimize the risk of developing AVN in patients with DDH over 6 months of age at presentation. SIO at preschool age may play a beneficial role in the long-term outcome of GR using OHT.

Level of Evidence: Level IV—therapeutic studies (case series).

Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan

None of the authors received financial support for this study.

The authors declare no conflict of interest.

Reprints: Hiroshi Kitoh, MD, Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan. E-mail:

© 2013 by Lippincott Williams & Wilkins