title: Fifty-year follow-up of late-detected hip dislocation: clinical and radiographic outcomes for seventy-one patients treated with traction to obtain gradual closed reduction.
abstract: BACKGROUND
  There is little knowledge concerning outcomes for middle-aged adults who were treated for late-detected developmental dislocation of the hip. The aims of this retrospective study were to evaluate the fifty-year clinical and radiographic results after closed reduction and to identify prognostic factors.
  
  
  METHODS
  Seventy-one patients (ninety hips) with late-detected hip dislocation treated between 1958 and 1962 were assessed clinically and radiographically. The primary treatment was skin traction to obtain a gradual closed reduction. The mean age of the patients at the time of the long-term radiographic examination was 51.6 years (range, forty-four to fifty-five years).
  
  
  RESULTS
  A stable reduction was achieved in eighty-three hips. The mean age at reduction was 1.7 years (range, 0.3 to 5.4 years). Traction failed in six patients (seven hips [8%]), for whom an open reduction was necessary. Twenty-six patients (thirty hips) underwent late surgical procedures because of residual hip dysplasia. A good long-term clinical outcome (a Harris hip score of ≥85 points) after closed reduction was assessed for fifty-two (63%) of the hips. A satisfactory radiographic outcome (no osteoarthritis) was found for fifty-six (67%) of the hips. Osteoarthritis had developed in twenty-seven (33%) of the hips, of which nineteen had undergone total hip replacement, performed at a mean patient age of 43.7 years (range, thirty-one to fifty-four years). Risk factors for osteoarthritis were an older age at the time of reduction, osteonecrosis of the femoral head, residual subluxation, a high acetabular index during childhood, and a classification of Severin grades III or IV at skeletal maturity. A survival analysis showed a reduction in "surviving" hips (no total hip replacement) from 99% at a patient age of thirty years to 74% at the age of fifty-two years.
  
  
  CONCLUSIONS
  With a mean follow-up of fifty years, the clinical and radiographic outcomes after gradual closed reduction by skin traction were satisfactory in approximately two-thirds of eighty-three hips. The most important independent risk factors for a poor long-term outcome were an age of eighteen months or older at the time of reduction, residual subluxation, and osteonecrosis.
authors.affiliation: Department of Orthopaedic Surgery (T.T. and J.H.) and Department of Radiology (R.B.G.), Oslo University Hospital, Rikshospitalet, NO-0027 Oslo, Norway. E-mail address for T. Terjesen: terje.terjesen@rikshospitalet.no.
authors.forename: Terje
authors.initials: T
authors.lastname: Terjesen
authors.affiliation: Department of Orthopaedic Surgery (T.T. and J.H.) and Department of Radiology (R.B.G.), Oslo University Hospital, Rikshospitalet, NO-0027 Oslo, Norway. E-mail address for T. Terjesen: terje.terjesen@rikshospitalet.no.
authors.forename: Joachim
authors.initials: J
authors.lastname: Horn
authors.affiliation: Department of Orthopaedic Surgery (T.T. and J.H.) and Department of Radiology (R.B.G.), Oslo University Hospital, Rikshospitalet, NO-0027 Oslo, Norway. E-mail address for T. Terjesen: terje.terjesen@rikshospitalet.no.
authors.forename: Ragnhild B
authors.initials: RB
authors.lastname: Gunderson
mesh_terms: D000367:Age Factors; D057210:Delayed Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006617:Hip Dislocation / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D006621:Hip Joint / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011859:Radiography; D012189:Retrospective Studies; D014143:Traction; D016896:Treatment Outcome