Outcome of one stage combined open reduction, pelvic and derotation femoral osteotomy in congenital dislocated hips of children younger than three years age

Abstract

Objective: To determine the outcome of one-stage combined operative management of congenital dislocation of hips in children aged 18-36 months.

Methods: The descriptive case series study was conducted at the Department of Orthopaedic Surgery, Jinnah Postgraduate Medical Centre, Karachi, from January 2005 to December 2011. Children aged 18-36 months suffering from congenital dislocation of hips were included. Those with Tonnis stage III and IV were managed with one-stage operative procedure without preliminary traction. The operative procedure included adductor tenotomy, open reduction, capsulorraphy, Salter's osteotomy and a femoral derotation osteotomy. Catteral's 'Test of Stability' was used after open reduction as an indicator for need of pelvic and femoral osteotomies. Follow-up ranged between 1 and 7 years. The patients were evaluated clinically on McKay's criteria and radiologically on Severin's criteria. Klisic's overall rating was used to know mean of the assessments.

Results: There were 38 patients with 50 congenital dislocations of hip. There were 26 (68.42%) females and 12 (31.57%) males with a female-to-male ratio of 2:1. Mean age at the time of operation was 24.26 ± 7.6 months. Of the total, 12 (31.57%) patients had bilateral involvement, 11 (28.94%) had right-sided and 15 (39.47%) had left-sided involvement. Right side to Left ratio was 1:1.2. At the time of last follow-up, 25 (50%) hips behaved excellent on McKay's criteria. According to radiographic classification on Severin's criteria, 24 (48%) hips were in excellent class. Avascular necrosis of femoral head was noted in 3 (6%) hips, re-subluxation/re-dislocations were observed in 3 (6%) hips and 1 (2.6%) patient had 1 cm femoral lengthening.

Conclusion: One-stage open reduction, capsulorrapyhy, Salter's osteotomy and femoral derotation osteotomy without preliminary traction to re-locate congenital dislocation of hips in late presenting children is a safe and highly effective method. It produces a low rate of complication and need for repeat surgery. It reduces the cost of treatment, minimises socio-economic burden and psychological trauma incurred by lengthy hospitalisation of treatment with traction followed by closed reduction.