Prognostic Value of Hip Arthrography After Closed Reduction for Developmental Dysplasia of the Hip

Abstract

The purpose of intraoperative arthrography is to assist in the acceptance of closed reduction, although the prognostic significance of femoral-head coverage, the medial dye pool, labral morphology, and the qualitative reduction is still uncertain. The search of PubMed/MEDLINE and PubMed Central was carried out from the beginning up to 13 September 2026. A study on idiopathic DDH which had been treated by closed reduction was included if an intraoperative arthrogram parameter was associated with failed reduction, residual acetabular dysplasia, osteonecrosis, or the need for secondary surgery. The definitions of the predictors and the outcomes were prepared separately. A meta-analysis was not carried out when fewer than three cohorts that were compatible reported the same predictor-outcome relationship. The study included fourteen cohorts. Femoral-head coverage was the most reproducible longterm predictor: in one cohort consisting of 139 hips, a threshold of 30% was identified, below which 81.8% of the cases developed late acetabular dysplasia, and another cohort with 110 hips gave an adjusted relative-risk estimate of 0.956 for each one-percentage-point increase. A cohort of 187 hips found that poor arthrographic delineation was a strong predictor of initial failure (adjusted RR 10.995, 95% CI 3.333-36.265) and noted a higher rate of failure when the medial dye pool was 6 mm or more. In a cohort of 182 hips, labral infolding was associated with both age and the severity of dislocation, but did not independently predict dysplasia or the need for secondary surgery; in another cohort of 110 hips, labral inversion was linked to osteonecrosis. Since the definitions and effect measures were too heterogeneous, a valid pooling could not be carried out. In conclusion, femoral-head coverage is the best arthrographic predictor of residual dysplasia, but a coverage of 30% should be seen as a warning sign rather than as a definite indication for open reduction; poor visualization together with a large medial dye pool may indicate that the reduction is mechanically inadequate, and inversion of the labrum on its own has inconsistent independent prognostic value.