Outcome of one-stage treatment of developmental dysplasia of hip in older children

Abstract

Background: The principles of treatment of congenital dislocation of hip in old children are different than those of infants and neonates. The purpose of this study is to evaluate the radiographic and functional results of one-stage treatment (open reduction, femoral shortening derotation, and Salter's osteotomy) of DDH in older children.

Materials and methods: Between January 2005 and June 2010, 25 patients (30 hips) underwent one-stage triple procedure of open reduction, femoral shortening derotation, and Salter's osteotomy for the treatment of DDH. Preoperatively, they were classified according to the Tönnis class. Clinical outcomes were assessed using the modified McKay's criteria to measure pain symptoms, gait pattern, Trendelenburg sign status, and the range of hip joint movement. Radiographic assessment was made using Severin's scoring method to measure the centre-edge angle and dysplasia.

Results: The mean age at the time of operation was 3.9 years (range 1.6-8 years), and the average duration of followup was 4.1 years (range 2-7.6 years). The McKay's score was excellent in 13 hips, good in 14 hips, fair in 2, and poor in 1 hip. The Severin's class I and II was found in 25 (83.3%) hips at the time of final evaluation as compared to none at the time of presentation.

Conclusions: Young children having DDH can safely be treated with an extensive one-stage triple procedure of open reduction, femoral shortening derotation, and Salter's osteotomy, without increasing the risk of AVN. Early diagnosis and intervention is the successful treatment of patients suffering from DDH.

Keywords: Developmental dysplasia; derotation; femoral shortening; hip; salter's osteotomy.

Figure 1

Peroperative photographs showing (a) Bikini incision; (b) exposure of the hip joint; (c) femoral osteotomy fixed with 4-hole small fragment plate; (d) pelvic osteotomy performed by using a Gigli saw; (e) bone graft taken from the proximal fragment of the ilium; (f) pelvic osteotomy fixed with a triangular bone graft and two K-wires; (g) reduction of the hip joint

Figure 2

A 4.7-year-old male child with A–P radiograph of right hip joint (Case 17) showing (a) dislocation; (b) adequate reduction at 8 months after surgery; (c) well-reduced hip joint within the remodeled acetabulum at 5.7 years followup

Figure 3

(a) X-ray pelvis including both hip shows DDH of left hip (Case 20) in a 6.9 year old girl (b) X-ray of same patient at 2.7 year followup shows concentric reduction with radiographic result Severin's class I

Figure 4

A 2.5-year-old boy with untreated DDH of the left hip joint; postoperative X-ray left hip anteroposterior view (Case 7) showing (a) DDH of left hip (b) postoperative well reduced hip joint after single-stage triple procedure; (c) reduction maintained at 3.9 years after surgery

Figure 5

Preoperative X-ray pelvis anteroposterior view of a 3.9 year old girl (Case 13) showing (a) bilateral DDH; (b) followup X-ray 2.2 years after surgery shows well-reduced hip joints; (c) well functional result with patient sitting cross legged

Figure 6

Anteroposterior radiograph of a 5.8-year-old girl (case 16) showing (a) unilateral dislocation of the hip right side; (b) followup radiograph 7 months after surgery with adequate reduction; (c) followup radiograph after 7.6 years of surgery, with well-developed congruous hip joint

Figure 7

Anteroposterior ratiograph of right hip joint of a 5.7-year-old male child (case 21) showing (a) untreated DDH (b) immediate postoperative X-ray with residual dislocation; (c) Severin's class VI at the latest followup, 3.9 years after surgery