Traditionally graft displacement following Pemberton and Dega acetabuloplasties involves internal fixation for treatment of developmental dysplasia of hip (DDH). This study was performed to assess the acetabular remodeling by conservative management of graft displacement among patients with DDH. This was a retrospective study of 20 patients 17 (85%) women and 3 (15%) men; mean age 22.90 ± 6.96 months with DDH who underwent Pemberton and Dega acetabuloplasties at King Khalid University Hospital, Riyadh between January 2013 and January 2018. All patients after losing acetabular correction during immediate postoperative period were treated by conservative management. The management involved application of Spica cast for 6 weeks that was trimmed to broomstick cast for an extended period of time and finally replaced by nocturnal abduction brace until normal acetabular index (AI) was achieved. The patients were followed up for a mean period of 44.60 ± 12.36 months. Out of the total, 18 (90%) patients with DDH were successfully treated by conservative management. The mean preoperative AI of 43.70° ± 5.91° improved to 21.35o ± 6.32o at the final follow-up (P < 0.001) which was no different when compared to the mean of unaffected hips (19.70o ± 2.96o; P < 0.44). The mean preoperative CEA of all the patients was negative that improved during the conservative treatment to 29.20° ± 10.0° which was no different when compared with the mean of unaffected (31.70° ± 4.64o; P = 0.32) hips at the final follow-up. doption of less aggressive approach for management of displaced, rotated or impacted autograft following acetabuloplasties among children with DDH was not only a useful conservative approach for remodeling of hips but also obviated the need for additional surgical intervention.
Developmental dysplasia of the hip (DDH) is a complex disorder that refers to different hip problems, ranging from neonatal instability to acetabular or femoral dysplasia, hip subluxation, and hip dislocation. It may result in structural modifications, which may lead to early coxarthrosis. Despite identifying the risk factors, the exact aetiology and pathophysiology are still unclear. Neonatal screening, along with physical examination and ultrasound, is critical for the early diagnosis of DDH to prevent the occurrence of early coxarthrosis. This review summarizes the currently practised strategies for the detection and treatment of DDH, focusing particularly on current practices for managing residual acetabular dysplasia (AD). AD may persist even after a successful hip reduction. Pelvic osteotomy is required in cases of persistent AD. It could also be undertaken simultaneously with an open hip reduction. Evaluation of the residual dysplasia (RD) of the hip and its management is still a highly active area of discussion. Recent research has opened the door to discussion on this issue and suggested treatment options for AD. But there is still room for more research to assist in managing AD.
Objectives:
Treatment of developmental dysplasia of the hip (DDH) with high hip dislocation in children using a one-stage operation appears tedious and associated with complications. This study aimed to assess a less traumatic approach for the surgical treatment of irreducible hips among children with DDH after walking age. The treatment strategy involved open reduction (OR) alone and non-invasive monitoring of acetabular development.
Methods:
This was a retrospective analysis of 22 hips of 20 female patients with complete dislocation of the hip and a mean age of 25.09 ± 4.6 months, performed between February 2013 and February 2018. All DDH patients underwent OR alone and had an irreversible hip dislocation. After surgery, a spica cast was applied for 6 weeks and then reduced to a broomstick cast for a considerable period. Finally, night abduction brace was placed until a normal acetabular index (AI) was obtained. The mean follow-up was 44.60 ± 12.36 months.
Results:
Out of 20 patients with DDH, 18 (90%) were successfully treated by OR alone. The main pre-operative AI of 41.82° ± 5.54° decreased to 16.19° ± 7.09° at the final follow-up (P < 0.001). An initial negative center-edge angle at the pre-operative stage gradually increased to a mean of 26.86° ± 6.56° during the follow-up period.
Conclusion:
Relatively less invasive approach adopted in this study not only obviated the need for an additional procedure but also had a favorable effect on the acetabular and hip joint development.
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