Late closed or open reduction of developmental dysplasia of the hip: a systematic review and meta-analysis of outcomes
Bibliographic record
Abstract
Background For late-detected developmental dysplasia of the hip (DDH) (6–24 months), it remains unclear whether open reduction (OR) offers better outcomes than closed reduction (CR), despite being more invasive. The primary concern for families and surgeons is the need for secondary surgery to correct residual dysplasia (RD) following delayed treatment. This meta-analysis compares OR and CR by evaluating their association with the need for secondary surgery, RD, and avascular necrosis (AVN). Methods A systematic review and meta-analysis were conducted. Studies published prior to December 2024 comparing OR and CR for DDH in children aged 6–24 months with ≥2 years of follow-up were included. Two authors independently screened studies based on predetermined criteria, performed data extraction, and assessed quality. Results Nine high-quality retrospective studies yielded data from 1044 hips (CR: 540 hips; OR: 504 hips). The mean age at intervention was 8.62 months for CR and 9.64 months for OR. Pooled analysis showed that CR significantly increases the risk for the need of secondary surgery when compared to OR (risk ratio [RR] = 1.48; 95% confidence interval [CI], 1.18–1.85; I 2 = 69%). A sensitivity analysis removing 1 study showed that the new RR was 1.88 (95% CI, 1.46–2.43; I 2 = 0%). OR showed a trend toward greater radiographic improvement when compared to CR. No significant difference in AVN or RD was identified between the OR and CR groups. Conclusion Our results indicate that CR for developmental dysplasia of the hip (DDH) is linked to a higher risk of secondary surgery in children aged 6–24 months compared to OR. These findings may help surgeons better counsel families regarding long-term outcomes and the likelihood of further intervention following CR or OR for late-presenting DDH. Future research comparing OR versus CR, the need for secondary surgery, and the potential influence of surgeon bias in treatment decisions would further help the decision-making process in the treatment of late-detected DDH. Level of Evidence Level III
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.016 | 0.038 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.021 | 0.035 |
| Bibliometrics | 0.006 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".