A novel subsartorial approach in open reduction of developmental dysplasia of the hip: a preliminary 2-year follow-up report of 20 hips

Abstract

Background: The anterior (Smith-Peterson) and medial (Ludloff) procedures are the most common approaches used for subluxation or dislocation in developmental dysplasia of the hip that cannot be treated conservatively. If conservative treatment has failed, additional procedures on the pelvic or femoral side may become necessary. Methods: In this prospective study we used a new subsartorial approach in the surgical treatment of 20 hips (17 patients of whom three had bilateral hip dysplasia) with a mean follow-up of 23.9 mo (range 22-26 mo). There were 16 hips in 13 girls and four unilateral hips in four boys. At surgery, the ages ranged from 9 to 24 mo, with a mean of 16.5 mo. The degree of initial hip subluxation was graded according to the Tönnis classification, with two hips (10%) type II, eight hips (40%) type III, and 10 hips (50%) type IV. We evaluated the clinical and radiographic outcomes of the patient cohort with the McKay and Severin classifications, respectively. Results: Clinically there were 15 hips (75%) with an excellent results and five hips with good results. According to the radiographic Severin classification, nine hips had an excellent result (type I), 10 had a good result (type II), and one hip had a fair result (type III). One hip (5%) developed avascular necrosis according to the Kalmachi and MacEwan classification but eventually had good clinical outcome precluding any surgical intervention. Two girls (10%) developed left lateral subluxation 3 mo postoperatively. Femoral derotation osteotomy was done 6 mo postoperatively. Conclusions: The subsartorial approach was a safe, reliable, and reproducible approach in the pediatric hip in patients younger than 2 yr of age who had not had a previous operation or a history of paralytic hip dislocation. We recommend this approach for surgeons who are familiar with the pediatric hip.

Modified Capsulorrhaphy Technique in Open Reduction of Developmental Dysplasia of the Hip

“…The most popular capsulorrhaphy technique reported in the literature was a T-shaped incision, with a horizontal limb parallel and around 5 mm lateral to the acetabular rim, with or without excision of a part of the capsule. 9,[14][15][16][17][18][19][20][21] There were several limitations and difficulties encountered using the T-shaped capsulorrhaphy technique including:…”

“…The most popular capsulorrhaphy technique reported in the literature was a T-shaped incision, with a horizontal limb parallel and around 5 mm lateral to the acetabular rim, with or without excision of a part of the capsule 9,14–21 …”

“…Cordier et al 9 created a triangular flap with its base dorsolaterally and advanced this flap inferiorly. Ibrahim et al 16 and Samir Barakat Mostafa et al 17 used a T-shaped capsular incision, and on repair, suturing of the lateral flaps was done medially beyond the anterior inferior iliac spine. Jia et al 22 used a capsular incision described as “Translational tighten sutures,” where an oblique capsular incision is made rather than the T incision, and the lateral flap was sutured at a more inferior level in the acetabular rim medially, so that tightening would bring down the superior part of the capsule.…”

“…Cordier et al 9 created a triangular flap with its base dorsolaterally and advanced this flap inferiorly. Ibrahim et al16 and Samir Barakat Mostafa et al17 used a T-shaped capsular incision, and on repair, suturing of the lateral flaps was done medially beyond the anterior inferior iliac spine. Jia et al22 used a capsular incision described as "Translational tighten sutures,"…”