The natural history of acetabular dysplasia and later total hip arthroplasty in late-detected DDH: 48 patients with closed reduction followed to a mean age of 62 years

BACKGROUND AND PURPOSE: The long-term prognosis of acetabular dysplasia without subluxation in developmental dislocation of the hip (DDH) is uncertain. The aim of this study was to assess the consequence of having acetabular dysplasia at skeletal maturity on the need for having a total hip arthroplasty (THA) up to the age of 60 years. PATIENTS AND METHODS: Inclusion criteria were age at diagnosis 0.5–3.0 years, initial treatment with skin traction to obtain closed reduction during 1958–1962, and no acetabular procedures to improve femoral head coverage. 48 patients (57 hips) met these criteria, 41 girls and 7 boys. Hip dysplasia was defined as a center–edge (CE) angle at skeletal maturity of 10–19°, and hips with CE angles in the range 20–25° were termed borderline dysplastic. RESULTS: At skeletal maturity, 18 hips had acetabular dysplasia with a mean CE angle of 15.8° (10–19), whereas 19 hips were borderline with CE angles 20–25°, and 20 hips were normal (CE angles ≥ 26°). During the follow-up period 16 hips had undergone THA, 11 of 18 hips with dysplasia, 4 of 19 with borderline dysplasia, and 1 of 20 hips without dysplasia (p < 0.001). Hip survival in the 18 dysplastic hips, with THA as the endpoint, was 100% up to patient age 40 years; thereafter survival fell to 83% at 50 years and 39% at 60 years. There was no significant correlation between CE angle at skeletal maturity and age at THA (p = 0.2). The mean age at the last follow-up in patients without THA was 62 years (60–64). CONCLUSION: Acetabular dysplasia without subluxation was a risk factor for THA, but less than one-fifth of the hips had undergone THA up to patient age 50 years.