{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T22:52:08Z","timestamp":1789080728358,"version":"build-2803163510"},"reference-count":18,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"22","license":[{"start":{"date-parts":[[2024,9,18]],"date-time":"2024-09-18T00:00:00Z","timestamp":1726617600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,11,20]]},"abstract":"\n Background:<\/jats:title>\n Patients with developmental dysplasia of the hip (DDH) are at risk for residual acetabular dysplasia even after successful closed reduction. The aim of this study was to identify predictors of long-term outcomes in order to guide prognostication and management.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n Patients who were treated for DDH at 2 institutions between 1970 and 2010 and had follow-up until skeletal maturity were screened for inclusion. Hips that underwent open reduction were excluded to reduce iatrogenic confounding. Syndromal (including neuromuscular and arthrogrypotic) hip instability with collagenopathies were excluded. Demographic characteristics, T\u00f6nnis grade, age at the time of the reduction, surgical treatment, acetabular index, lateral center-edge angle, residual dysplasia graded using the Severin classification, and the presence and type of proximal femoral growth disturbance categorized using the Bucholz and Ogden classification were assessed. In addition, the the acetabular angle was recorded at the latest follow-up before secondary procedures, and the Oxford Hip Score and 5-level EuroQoL (EQ)-5 Dimension score were recorded at the latest follow-up. To account for repeated measures, generalized estimating equations (GEE) logistic regression was utilized for the multivariable analysis. A support vector machine model and a receiver operating characteristic curve analysis were utilized to identify prognostication thresholds.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n One hundred and seven hips (96 female, 11 male) that were followed to skeletal maturity, with a mean follow-up of 20 years (range, 10 to 54 years), were included in the analysis. Eighty-nine hips (83%) demonstrated a good outcome at skeletal maturity, with a Severin grade of I or II. Major growth disturbances of Bucholz and Ogden types II, III, or IV were present in 13 hips (12%). At the latest follow-up after skeletal maturity (before any secondary procedures), the mean acetabular angle was 45\u00b0 \u00b1 4\u00b0 and the mean lateral center-edge angle was 26\u00b0 \u00b1 8\u00b0. The mean Oxford Hip Score and EQ visual analog scale values were 47 and 86, respectively. A GEE logistic regression analysis of 1,135 observations revealed that the acetabular index (odds ratio [OR], 1.16 per degree; p < 0.001) and age (OR, 1.20 per year; p = 0.003) were significant predictors of a poor outcome (i.e., Severin grade III, IV, or V). Significant differences in acetabular indices across all age groups were found between hips with a good outcome and those with a poor outcome. Age-specific acetabular index prognostication cutoff values are presented.<\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n This long-term follow-up study demonstrated that the age-specific acetabular index remains an important predictor of residual dysplasia at skeletal maturity. The proposed prognostication chart and thresholds herein can help to guide orthopaedic surgeons and parents when contemplating the use of an intervention versus surveillance to optimize long-term outcomes.<\/jats:p>\n <\/jats:sec>\n \n Level of Evidence:<\/jats:title>\n \n Prognostic\n Level III<\/jats:underline>\n . See Instructions for Authors for a complete description of levels of evidence.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.2106\/jbjs.23.01484","type":"journal-article","created":{"date-parts":[[2024,9,18]],"date-time":"2024-09-18T14:00:28Z","timestamp":1726668028000},"page":"2094-2101","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":7,"title":["Prognosticating Residual Dysplasia at Skeletal Maturity Following Closed Reduction for Developmental Dysplasia of the Hip"],"prefix":"10.2106","volume":"106","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1361-4733","authenticated-orcid":false,"given":"Janus Siu Him","family":"Wong","sequence":"first","affiliation":[{"name":"Department of Orthopaedics and Traumatology, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR"},{"name":"Duchess of Kent Children\u2019s Hospital at Sandy Bay, Pok Fu Lam, Hong Kong SAR"},{"name":"Hong Kong Children\u2019s Hospital, Kowloon, Hong Kong SAR"},{"name":"Queen Mary Hospital, Pok Fu Lam, Hong Kong SAR"},{"name":"The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7615-4768","authenticated-orcid":false,"given":"Evelyn Eugenie","family":"Kuong","sequence":"additional","affiliation":[{"name":"Duchess of Kent Children\u2019s Hospital at Sandy Bay, Pok Fu Lam, Hong Kong SAR"},{"name":"Hong Kong Children\u2019s Hospital, Kowloon, Hong Kong SAR"},{"name":"Queen Mary Hospital, Pok Fu Lam, Hong Kong SAR"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael Kai Tsun","family":"To","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR"},{"name":"Duchess of Kent Children\u2019s Hospital at Sandy Bay, Pok Fu Lam, Hong Kong SAR"},{"name":"Hong Kong Children\u2019s Hospital, Kowloon, Hong Kong SAR"},{"name":"Queen Mary Hospital, Pok Fu Lam, Hong Kong SAR"},{"name":"The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfred Lok Hang","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Prince of Wales Hospital, Sha Tin, Hong Kong SAR"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noah Lok Wah","family":"So","sequence":"additional","affiliation":[{"name":"Duchess of Kent Children\u2019s Hospital at Sandy Bay, Pok Fu Lam, Hong Kong SAR"},{"name":"Hong Kong Children\u2019s Hospital, Kowloon, Hong Kong SAR"},{"name":"Queen Mary Hospital, Pok Fu Lam, Hong Kong SAR"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wang","family":"Chow","sequence":"additional","affiliation":[{"name":"Duchess of Kent Children\u2019s Hospital at Sandy Bay, Pok Fu Lam, Hong Kong SAR"},{"name":"Hong Kong Children\u2019s Hospital, Kowloon, Hong Kong SAR"},{"name":"Queen Mary Hospital, Pok Fu Lam, Hong Kong SAR"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2024,9,18]]},"reference":[{"issue":"3","key":"bib1-20250430","doi-asserted-by":"crossref","first-page":"235","DOI":"10.2106\/JBJS.20.00562","article-title":"Secondary Surgery and Residual Dysplasia Following Late Closed or Open Reduction of Developmental Dysplasia of the Hip","volume":"103","author":"Morris","year":"2021","journal-title":"J Bone Joint Surg Am."},{"issue":"4","key":"bib2-20250430","doi-asserted-by":"crossref","first-page":"e248","DOI":"10.1097\/BPO.0000000000001505","article-title":"Developmental Dysplasia of the Hip: An Examination of Care Practices of Pediatric Orthopaedic Surgeons in North America","volume":"40","author":"Taylor","year":"2020","journal-title":"J Pediatr Orthop."},{"issue":"2","key":"bib3-20250430","first-page":"117","article-title":"The diagnosis of congenital hip-joint dislocation by the ultrasonic Combound treatment. Archives of orthopaedic and traumatic surgery","volume":"97","author":"Graf","year":"1980","journal-title":"Arch Orthop Unfallchir."},{"issue":"6","key":"bib4-20250430","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1097\/01241398-199511000-00015","article-title":"The c\/b ratio in the radiological monitoring of the hip joint in congenital dislocation of the hip","volume":"15","author":"Li","year":"1995","journal-title":"J Pediatr Orthop."},{"issue":"9","key":"bib5-20250430","doi-asserted-by":"crossref","first-page":"2120","DOI":"10.1097\/CORR.0000000000001289","article-title":"Which Acetabular Landmarks are the Most Useful for Measuring the Acetabular Index and Center-edge Angle in Developmental Dysplasia of the Hip? A Comparison of Two Methods","volume":"478","author":"Shin","year":"2020","journal-title":"Clin Orthop Relat Res."},{"issue":"1","key":"bib6-20250430","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1302\/0301-620X.71B1.2915007","article-title":"Reliability of radiological measurements in the assessment of the child\u2019s hip","volume":"71","author":"Broughton","year":"1989","journal-title":"J Bone Joint Surg Br."},{"issue":"4","key":"bib7-20250430","first-page":"374","article-title":"Reliability of radiological parameters measured on anteroposterior pelvis radiographs of patients with developmental dysplasia of the hip","volume":"67","author":"Tan","year":"2001","journal-title":"Acta Orthop Belg."},{"issue":"2","key":"bib8-20250430","doi-asserted-by":"crossref","first-page":"195","DOI":"10.2106\/00004623-198567020-00003","article-title":"Varus derotation osteotomy in the treatment of persistent dysplasia in congenital dislocation of the hip","volume":"67","author":"Kasser","year":"1985","journal-title":"J Bone Joint Surg Am."},{"issue":"8","key":"bib10-20250430","doi-asserted-by":"crossref","first-page":"1010","DOI":"10.1302\/0301-620X.89B8.19424","article-title":"The use of the Oxford hip and knee scores","volume":"89","author":"Murray","year":"2007","journal-title":"J Bone Joint Surg Br."},{"issue":"7","key":"bib11-20250430","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1097\/00005650-199907000-00007","article-title":"Determining correspondence between scores on the EQ-5D \u201cthermometer\u201d and a 5-point categorical rating scale","volume":"37","author":"Badia Llach","year":"1999","journal-title":"Med Care."},{"issue":"4","key":"bib12-20250430","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1097\/BPB.0000000000000426","article-title":"Normal radiographic parameters in paediatric pelvic radiographs from a Chinese population","volume":"26","author":"Kuong","year":"2017","journal-title":"J Pediatr Orthop B."},{"issue":"11","key":"bib13-20250430","doi-asserted-by":"crossref","first-page":"952","DOI":"10.2106\/JBJS.15.00992","article-title":"Acetabular Remodeling and Role of Osteotomy After Closed Reduction of Developmental Dysplasia of the Hip","volume":"98","author":"Shin","year":"2016","journal-title":"J Bone Joint Surg Am."},{"issue":"6","key":"bib14-20250430","doi-asserted-by":"crossref","first-page":"876","DOI":"10.1302\/0301-620X.86B6.14441","article-title":"Acetabular dysplasia after treatment for developmental dysplasia of the hip. Implications for secondary procedures","volume":"86","author":"Albinana","year":"2004","journal-title":"J Bone Joint Surg Br."},{"issue":"29","key":"bib15-20250430","doi-asserted-by":"crossref","first-page":"e4276","DOI":"10.1097\/MD.0000000000004276","article-title":"Association between open or closed reduction and avascular necrosis in developmental dysplasia of the hip: A PRISMA-compliant meta-analysis of observational studies","volume":"95","author":"Wang","year":"2016","journal-title":"Medicine (Baltimore)."},{"issue":"6","key":"bib16-20250430","doi-asserted-by":"crossref","first-page":"810","DOI":"10.2106\/00004623-199706000-00002","article-title":"Long-term outcome after open reduction through an anteromedial approach for congenital dislocation of the hip","volume":"79","author":"Morcuende","year":"1997","journal-title":"J Bone Joint Surg Am."},{"key":"bib17-20250430","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1097\/00003086-198110000-00002","article-title":"Patterns of deformity of the developing hip","volume":"160","author":"Siffert","year":"1981","journal-title":"Clin Orthop Relat Res."},{"issue":"2","key":"bib18-20250430","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1530\/EOR-21-0066","article-title":"Pelvic osteotomies in hip dysplasia: why, when and how?","volume":"7","author":"Venkatadass","year":"2022","journal-title":"EFORT Open Rev."},{"issue":"2","key":"bib19-20250430","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1177\/230949901101900214","article-title":"Screening for developmental dysplasia of the hip in Hong Kong","volume":"19","author":"Tong","year":"2011","journal-title":"J Orthop Surg (Hong Kong)."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.23.01484","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:51:33Z","timestamp":1787752293000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.23.01484"}},"subtitle":["A Long-Term Study with an Average 20-Year Follow-up"],"short-title":[],"issued":{"date-parts":[[2024,9,18]]},"references-count":18,"journal-issue":{"issue":"22","published-print":{"date-parts":[[2024]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.23.01484","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9,18]]}}}