Acetabular reaming and sartorius muscle pedicle iliac bone grafting in the treatment of developmental dysplasia of the hip in older children: a retrospective study of 15 patients with more than two years follow-up

Abstract

Purpose: Despite the early diagnosis and treatment of developmental dysplasia of the hip (DDH), some older children still need open reduction. It is usually difficult to get a satisfactory reduction particularly in patients with acetabular defect. The purpose of this study was to evaluate the short-term outcomes of acetabulum reaming and sartorius muscle pedicle iliac bone grafting in the treatment of older children with DDH and acetabular defect.

Methods: The records of 15 patients with DDH (mean age 113.9 months (sd 29); 17 hips) who were treated with the reported technique between February 2015 and January 2017 were retrospectively reviewed. All patients acquired regular clinical and radiographic follow-ups, and alterations in the acetabular index, centre-edge angle and acetabular head index were measured. Joint function and radiographic results were evaluated with McKay and Severin modified criteria, respectively.

Results: A total of 15 patients were followed up for mean 32.4 months (sd 6.9). The percentages of excellent and good conditions were 94.1% (16/17) according to the Severin modified criteria and 88.2% (15/17) according to the McKay modified criteria. Avascular necrosis of the femoral head and redislocation only occurred in one hip. No cases of ankylosis or bone graft absorption occurred during the follow-up.

Conclusion: Reaming the acetabulum and sartorius muscle pedicle iliac bone grafting for repairing the acetabular defect can recover the arcuate structure by increasing the volume of the acetabulum, which is beneficial for achieving a concentric reduction. The short-term outcome was satisfactory, while the long-term results need to be further observed.

Level of evidence: IV - retrospective study.

Keywords: acetabular defect; acetabular ream; dysplasia of the hip; iliac bone flap with sartorius.

Fig. 1.

Diagrams illustrate sartorius muscle pedicle iliac bone grafting to repair acetabular defects and ream the acetabulum: a) acetabular defect/false acetabulum and proliferating cartilage tissues; b) sartorius muscle pedicle iliac bone and ream of the acetabulum; c) sartorius muscle pedicle iliac bone graft and repair of the acetabular defect. The acetabulum covered the femur head appropriately.

Fig. 2.

Surgical technique: a) and b) obtaining the sartorius iliac crest flap; c) and d) acetabulum reaming; e) sartorius muscle pedicle iliac bone graft for repairing the acetabular defect.

Fig. 3.

Female patient diagnosed with developmental dysplasia of the right hip. Surgery was performed at the age of seven years: a) preoperative radiograph; b) six weeks after surgery; c) 13 months after surgery; d), e), f) and g) functional imaging 13 months after surgery.

Fig. 4.

Female patient diagnosed with bilateral developmental dysplasia of the hip. Surgery of the right hip was performed at nine years, nine months old, and surgery of the left hip was performed at ten years, four months old: a) preoperative radiograph; b), c), d) and e) radiographs during a follow-up; f) radiograph after removing the internal fixation; g), h) and i) functional imaging.