{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T12:15:12Z","timestamp":1779106512735,"version":"3.51.4"},"reference-count":21,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T00:00:00Z","timestamp":1779062400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T00:00:00Z","timestamp":1779062400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100005005","name":"Ben-Gurion University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100005005","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Orthop Surg Traumatol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Developmental dysplasia of the hip (DDH) remains a therapeutic challenge and treatment strategies remain controversial in children diagnosed after the age of one year.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>The study aim was to evaluate various treatment methods for DDH in children aged 1\u20134 years and to determine whether open reduction improved outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>41 children (48 affected hips) aged\u2009\u2265\u20091 year with DDH were included in the study. They were treated surgically between 2012 and 2021 at a tertiary university hospital and had a documented follow up of \u2265\u200918 months. Patients were divided into two groups: those who underwent closed reduction (CR) and those who underwent open reduction (OR). Femoral shortening, varisation and pelvic extracapsular osteotomies (PO) were performed depending on case and surgeon preference. Outcomes were evaluated radiographically using the Severin classification, functionally using the Children\u2019s Hospital of Oakland Hip Evaluation Score (CHOHES). Avascular necrosis (AVN) if present was documented using the Kalamchi\u2013MacEwen (K&amp;M) classification. Optimal outcomes were defined when: quality of reduction is Severin\u2009\u2264\u20092, CHOHES\u2009\u2265\u200985 and absence of AVN. Statistical analyses were performed using R version 4.3.1, with categorical data compared using the chi-square test.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Optimal outcomes were observed in 19 of 21 hips treated with OR (90.5%) and 19 of 27 hips treated with CR 70.4% (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.089). AVN occurred infrequently, and in several cases, resolved during follow-up.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>OR with Femoral shortening and PO provided the most favorable outcomes. This approach may minimize AVN, and potentially delay degenerative changes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00590-026-04775-1","type":"journal-article","created":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T11:35:08Z","timestamp":1779104108000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Surgical alternatives for treatment of developmental dysplasia of the hip in children aged 1\u20134 years: does open reduction improve the outcomes?"],"prefix":"10.1007","volume":"36","author":[{"given":"Eugen","family":"Cohen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mariya","family":"Fiterman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bryan","family":"Itkowitz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ali","family":"Elaobda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ron","family":"Rotkopf","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muhamad","family":"Eldada","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vadim","family":"Benkovich","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,5,18]]},"reference":[{"issue":"8","key":"4775_CR1","doi-asserted-by":"publisher","first-page":"733","DOI":"10.1007\/s00132-013-2225-7","volume":"43","author":"C Multerer","year":"2014","unstructured":"Multerer C, D\u00f6derlein L (2014) Angeborene H\u00fcftdysplasie und -luxation: Bew\u00e4hrte und neue Verfahren in Diagnostik und Therapie. Orthopade 43(8):733\u2013741. https:\/\/doi.org\/10.1007\/s00132-013-2225-7","journal-title":"Orthopade"},{"issue":"10","key":"4775_CR2","doi-asserted-by":"publisher","first-page":"853","DOI":"10.1007\/s00132-022-04298-7","volume":"51","author":"T Seidl","year":"2022","unstructured":"Seidl T, Chiari C (2022) Status quo H\u00fcftdysplasiescreening. Orthopadie (Heidelb) 51(10):853\u2013862. https:\/\/doi.org\/10.1007\/s00132-022-04298-7","journal-title":"Orthopadie (Heidelb)"},{"issue":"1","key":"4775_CR3","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1007\/s001320050066","volume":"26","author":"F Grill","year":"1997","unstructured":"Grill F, M\u00fcller D (1997) Ergebnisse des H\u00fcftultraschallscreenings in \u00d6sterreich. Orthopade 26(1):25\u201332. https:\/\/doi.org\/10.1007\/s001320050066","journal-title":"Orthopade"},{"issue":"3","key":"4775_CR4","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1097\/01202412-200505000-00001","volume":"14","author":"R Ganger","year":"2005","unstructured":"Ganger R, Radler C, Petje G, Manner HM, Kriegs-Au G, Grill F (2005) Treatment options for developmental dislocation of the hip after walking age. J Pediatr Orthop B 14(3):139\u2013150. https:\/\/doi.org\/10.1097\/01202412-200505000-00001","journal-title":"J Pediatr Orthop B"},{"issue":"6","key":"4775_CR5","doi-asserted-by":"publisher","first-page":"1503","DOI":"10.1007\/s43465-021-00531-1","volume":"55","author":"G Lucchesi","year":"2021","unstructured":"Lucchesi G, Sacco R, Zhou W et al (2021) DDH in the Walking Age: Review of Patients with Long-Term Follow-Up. Indian J Orthop 55(6):1503\u20131514. https:\/\/doi.org\/10.1007\/s43465-021-00531-1","journal-title":"Indian J Orthop"},{"issue":"1","key":"4775_CR6","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1097\/BPO.0000000000000733","volume":"38","author":"BA De La Ramo","year":"2018","unstructured":"Ramo BA, De La Rocha A, Sucato DJ, Jo C-H (2018) -A new radiographic classification system for developmental hip dysplasia is reliable and predictive of successful closed reduction and late pelvic osteotomy. J Pediatr Orthopaed 38(1):16\u201321 https:\/\/doi.org\/10.1097\/BPO.0000000000000733","journal-title":"J Pediatr Orthopaed"},{"issue":"5","key":"4775_CR7","doi-asserted-by":"publisher","first-page":"656","DOI":"10.2106\/00004623-199705000-00004","volume":"79","author":"WT Ward","year":"1997","unstructured":"Ward WT, Vogt M, Grudziak JS, T\u00fcmer Y, Cook PC, Fitch RD (1997) Severin classification system for evaluation of the results of operative treatment of congenital dislocation of the hip. A study of intraobserver and interobserver reliability. J Bone Joint Surg Am 79(5):656\u2013663. https:\/\/doi.org\/10.2106\/00004623-199705000-00004","journal-title":"J Bone Joint Surg Am"},{"issue":"2","key":"4775_CR8","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1177\/112070001002000205","volume":"20","author":"H Agus","year":"2010","unstructured":"Agus H, Omeroglu H, Bi\u00e7imoglu A, T\u00fcmer Y (2010) Is Kalamchi and MacEwen Group I avascular necrosis of the femoral head harmless in developmental dysplasia of the hip? Hip Int 20(2):156\u2013162. https:\/\/doi.org\/10.1177\/112070001002000205","journal-title":"Hip Int"},{"issue":"7","key":"4775_CR9","doi-asserted-by":"publisher","first-page":"1369","DOI":"10.1016\/j.apmr.2005.01.008","volume":"86","author":"CM Aguilar","year":"2005","unstructured":"Aguilar CM et al (2005) Clinical evaluation of avascular necrosis in patients with sickle cell disease: Children\u2019s Hospital Oakland Hip Evaluation Scale. Arch Phys Med Rehabil 86(7):1369\u20131375. https:\/\/doi.org\/10.1016\/j.apmr.2005.01.008","journal-title":"Arch Phys Med Rehabil"},{"key":"4775_CR10","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1186\/1471-2474-15-401","volume":"15","author":"B Ning","year":"2014","unstructured":"Ning B, Yuan Y, Yao J, Zhang S, Sun J (2014) Analyses of outcomes of one-stage operation for treatment of late-diagnosed developmental dislocation of the hip. BMC Musculoskelet Disord 15:401. https:\/\/doi.org\/10.1186\/1471-2474-15-401","journal-title":"BMC Musculoskelet Disord"},{"issue":"9","key":"4775_CR11","doi-asserted-by":"publisher","first-page":"615","DOI":"10.5435\/JAAOS-D-15-00154","volume":"24","author":"RF Murphy","year":"2016","unstructured":"Murphy RF, Kim YJ (2016) Surgical management of pediatric developmental dysplasia of the hip. J Am Acad Orthop Surg 24(9):615\u2013624. https:\/\/doi.org\/10.5435\/JAAOS-D-15-00154","journal-title":"J Am Acad Orthop Surg"},{"key":"4775_CR12","doi-asserted-by":"publisher","first-page":"101712","DOI":"10.1016\/j.jcot.2021.101712","volume":"24","author":"K Venkatadass","year":"2021","unstructured":"Venkatadass K, Prasad VD, Jain D, Rajasekaran S (2021) Short-term outcomes of treatment in children presenting with DDH in walking age. J Clin Orthop Trauma 24:101712. https:\/\/doi.org\/10.1016\/j.jcot.2021.101712","journal-title":"J Clin Orthop Trauma"},{"issue":"4","key":"4775_CR13","doi-asserted-by":"publisher","first-page":"322","DOI":"10.1097\/BPB.0000000000001122","volume":"33","author":"JL Cummings","year":"2024","unstructured":"Cummings JL et al (2024) Severity of hip dysplasia as the major factor affecting outcome of closed reduction in children with hip dysplasia. J Pediatr Orthop B 33(4):322\u2013327. https:\/\/doi.org\/10.1097\/BPB.0000000000001122","journal-title":"J Pediatr Orthop B"},{"issue":"9","key":"4775_CR14","doi-asserted-by":"publisher","first-page":"2485","DOI":"10.1007\/s11999-010-1400-y","volume":"468","author":"GB Firth","year":"2010","unstructured":"Firth GB, Robertson AJ, Schepers A, Fatti L (2010) Developmental dysplasia of the hip: open reduction as a risk factor for substantial osteonecrosis. Clin Orthop Relat Res 468(9):2485\u20132494. https:\/\/doi.org\/10.1007\/s11999-010-1400-y Epub 2010 Jun 8. PMID: 20532719; PMCID: PMC2919866","journal-title":"Clin Orthop Relat Res"},{"issue":"4","key":"4775_CR15","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1302\/1863-2548.12.180078","volume":"12","author":"P Casta\u00f1eda","year":"2018","unstructured":"Casta\u00f1eda P, Masrouha KZ, Ruiz CV, Moscona-Mishy L (2018) Outcomes following open reduction for late-presenting developmental dysplasia of the hip. J Child Orthop 12(4):323\u2013330. https:\/\/doi.org\/10.1302\/1863-2548.12.180078","journal-title":"J Child Orthop"},{"issue":"2","key":"4775_CR16","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1016\/j.ocl.2005.11.005","volume":"37","author":"E Forlin","year":"2006","unstructured":"Forlin E, Munhoz da Cunha LA, Figueiredo DC (2006) Treatment of developmental dysplasia of the hip after walking age with open reduction, femoral shortening, and acetabular osteotomy. Orthop Clin North Am 37(2):149\u2013160. https:\/\/doi.org\/10.1016\/j.ocl.2005.11.005","journal-title":"Orthop Clin North Am"},{"issue":"4","key":"4775_CR17","doi-asserted-by":"publisher","first-page":"637","DOI":"10.1007\/s00590-019-02601-5","volume":"30","author":"N Alassaf","year":"2020","unstructured":"Alassaf N (2020) Treatment of developmental dysplasia of the hip (DDH) between the age of 18 and 24 months. Eur J Orthop Surg Traumatol 30(4):637\u2013641. https:\/\/doi.org\/10.1007\/s00590-019-02601-5Epub 2019 Dec 21. PMID: 3186545","journal-title":"Eur J Orthop Surg Traumatol"},{"issue":"1","key":"4775_CR18","doi-asserted-by":"publisher","first-page":"250","DOI":"10.1007\/s11999-011-1929-4","volume":"470","author":"R Pospischill","year":"2012","unstructured":"Pospischill R, Weninger J, Ganger R, Altenhuber J, Grill F (2012) Does open reduction of the developmental dislocated hip increase the risk of osteonecrosis? Clin Orthop Relat Res 470(1):250\u2013260. https:\/\/doi.org\/10.1007\/s11999-011-1929-4 Epub 2011 Jun 4","journal-title":"Clin Orthop Relat Res"},{"issue":"2","key":"4775_CR19","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1007\/s00264-003-0522-1","volume":"28","author":"M Domzalski","year":"2004","unstructured":"Domzalski M, Synder M (2004) Avascular necrosis after surgical treatment for developmental dysplasia of the hip. Int Orthop 28(2):65\u201368. https:\/\/doi.org\/10.1007\/s00264-003-0522-1","journal-title":"Int Orthop"},{"issue":"3","key":"4775_CR20","doi-asserted-by":"publisher","first-page":"232","DOI":"10.1302\/1863-2548.15.200246","volume":"15","author":"RN Hussain","year":"2021","unstructured":"Hussain RN, Rad D, Watkins WJ, Carpenter C (2021) The incidence of avascular necrosis following treatment for DDH in a single tertiary centre. J Child Orthop 15(3):232\u2013240. https:\/\/doi.org\/10.1302\/1863-2548.15.200246","journal-title":"J Child Orthop"},{"issue":"7","key":"4775_CR21","doi-asserted-by":"publisher","first-page":"676","DOI":"10.1097\/BPO.0b013e3181efb8c7","volume":"30","author":"BJ Bolland","year":"2010","unstructured":"Bolland BJ, Wahed A, Al-Hallao S, Culliford DJ, Clarke NM (2010) Late reduction in congenital dislocation of the hip and the need for secondary surgery: radiologic predictors and confounding variables. J Pediatr Orthop 30(7):676\u2013682. https:\/\/doi.org\/10.1097\/BPO.0b013e3181efb8c7","journal-title":"J Pediatr Orthop"}],"container-title":["European Journal of Orthopaedic Surgery &amp; Traumatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00590-026-04775-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00590-026-04775-1","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00590-026-04775-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T11:35:09Z","timestamp":1779104109000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00590-026-04775-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,18]]},"references-count":21,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["4775"],"URL":"https:\/\/doi.org\/10.1007\/s00590-026-04775-1","relation":{},"ISSN":["1432-1068"],"issn-type":[{"value":"1432-1068","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,18]]},"assertion":[{"value":"21 January 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 April 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 May 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors that they have declare no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Is not applicable due to the retrospective nature of the study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}],"article-number":"194"}}