Developmental Dislocation of the Hip Successfully Treated by Preoperative Traction and Medial Open Reduction: A 22-year Mean Followup

Abstract

Background During the last 35 years, the medial approach has been reported more frequently than the anterior approach for open reduction of developmental dislocation of the hip (DDH), however, few studies have followed children treated by medial open reduction to adulthood. Questions/purposes The purposes of our study were: (1) to assess the development of 71 completely dislocated hips after medial open reduction, the incidence of additional surgery and avascular necrosis during the followup period, and the long-term radiographic and functional results; and (2) to compare our results with those obtained by others who performed open reduction either by the medial or anterior approach. Patients and Methods We retrospectively evaluated, after the end of growth, 71 hips in 52 patients who underwent open reduction by the medial approach. The mean age of the patients was 16 months (range, 3-36 months). After surgery, the hips were immobilized in 100°flexion, 60°a bduction, and neutral rotation for an average of 6 months. All patients had staged clinical and radiographic followups until skeletal maturity. The length of followup averaged 22 years (range, 13-32 years). Results In all the surgically treated hips, the acetabular index normalized by the end of growth, the incidence of avascular necrosis was 18%, and additional surgery was required in 15% of our cases. At the last followup, 93% of the hips were classified as Severin Classes I or II and 7% as Class III; 76% of the hips had an excellent result, 17% had a good result, and 7% had a fair result according to the McKay scale as modified by Barrett and colleagues. Conclusions Open reduction of DDH through a medial approach provided good long-term radiographic and functional results in patients 3 to 36 months old and it was the only surgery performed in 85% of our cases. Future comparative studies are needed to confirm our results, especially in older children. Level of evidence Level IV, therapeutic study.

Is male gender a prognostic factor for developmental dysplasia of the hip? Mid-long-term results of posteromedial limited surgery

“…AVN rates after open reduction using the posteromedial limited approach are between 0% and 66% in the literature 10 . In their study of long-term results of open reduction using the posteromedial limited approach, Farsetti et al mentioned that they observed an AVN rate of 18% after 22 years of follow-up 20 . In our study, osteonecrosis rates were 17% for both male and female patients.…”

Letter to the Editor: Developmental Dislocation of the Hip Successfully Treated by Preoperative Traction and Medial Open Reduction: A 22-year Mean Followup

“…Group 3 consisted of 11 patients (18 hips) who were 25 to 36 months old at the time of operation, equaling 25% of all hips in the study. The authors observed avascular necrosis in 44% of these hips [1]. This rate is higher than the other groups in the study.…”

“…In their study, the age groups lack homogenity. We also found patient selection bias [1]. Group 3 consisted of 11 patients (18 hips) who were 25 to 36 months old at the time of operation, equaling 25% of all hips in the study.…”

Degenerative hip disorders in children

“…Среди распространенных методов хирургической коррекции выделяют реконструктивные вмешательства на впадине сустава (остеотомии таза), реконструктивные вмешательства на бедренном компоненте (межвертельные остеотомии) [19]. Открытое вправление применяют при тяжелой степени патологии (вывих) для транспозиции головки в естественную впадину, часто дополняют реконструкцией впадины, иногда -бедра [15,20].…”

“…Среди дегенеративных заболеваний, приобретенных в период роста, наиболее распространена болезнь Легга -Кальве -Пертеса [20]. БЛКП представляет собой идиопатический остеонекроз головки бедра с последующими осложнениями в виде деформации и развития остеоартроза [20]. Заболевание часто встречается у детей в воз- Ортопедия, травматология и восстановительная хирургия детского возраста.…”