The prevalence of clinically significant proximal femoral growth disturbance following open versus closed reduction in dysplastic hips performed after 6 months: A systematic review and meta-analysis of 150 studies.

Background: Late diagnosis of developmental hip dysplasia (DDH) may warrant either open or closed reduction of the hip. Proximal femoral growth disturbance (PFGD) is a possible complication following these procedures. Methods: A systematic search of PubMed, Embase, Web of Science, The Cochrane Library and OrthoSearch from the date of inception of each database through to the 2 February 2025 was performed. The primary outcome of interest was the prevalence of clinically significant PFGD following open or closed reduction after 6 months of age. This was defined as Kalamchi-MacEwen or Bucholz-Ogden Type 2 or above. Results: The prevalence of clinically significant PFGD in patients undergoing open reduction was 12.47% (95% Confidence interval (CI): 10.39-14.69), whereas the prevalence of clinically significant PFGD in patients undergoing closed reduction was 9.53% (95% CI: 6.91-12.46). Multivariate analysis suggested that mean age at time of reduction was associated with an increase in the prevalence of PFGD in patients undergoing closed reduction ( Conclusion: We described the prevalence of clinically significant PFGD following closed reduction and open reduction. In both open and closed reduction groups, we observed a high relative heterogeneity ( PROSPERO Registration No: CRD420251015622.