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

Abstract

ObjectiveThe aim of this study was to determine if male sex is a poor prognostic factor for developmental dysplasia of the hip (DDH) and to determine the mid-long-term radiological and clinical results of male patients in comparison with female patients following an open reduction with posteromedial limited approach.MethodsWe examined 54 hips of 41 male patients (12.38 ± 4.82 months) and 96 hips of 82 female patients (11.11 ± 4.93 months) with DDH. All the patients underwent open reduction with posteromedial limited approach. The average follow-up time was 108 months for the male patients and 110 months for the female patients. The Tönnis grade, acetabular index, Kalamchi and MacEwen classification, and Severin classifications were determined for all patients. The Mc Kay classification system was used to evaluate the functional results.ResultsFrom the total, 25 (60%) male and 70 (85%) female patients had satisfactory radiographic outcomes (Severin Ia, Ib, or II) according to the Severin classification. There was a significant difference between the two groups in terms of the Severin classification (P = 0.04). Residual acetabular dysplasia (RAD) was observed in 12 (15%) female and 17 (41%) male patients (P = 0.001). Grade 2 or higher osteonecrosis was observed in 7 (9%) patients in female and 6 (15%) patients in male group. The clinical outcomes in terms of the Mc Kay classification showed satisfactory outcomes in 72 (87%) female and 34 (82%) male patients. Further, 8 (9.7%) female patients and 6 (14.6%) male patients underwent a second operation. However, there was no difference between the two groups in terms of postoperative osteonecrosis presence (P = 0.982), functional outcomes (P = 0.571), and secondary operation rates (P = 0.298). Male sex was associated with poor outcomes in terms of the Severin classification (P = 0.04) and RAD (P = 0.001).ConclusionAlthough our results indicated that male sex is a poor prognostic factor for radiological results and RAD, there was no difference between male and female patients in terms of osteonecrosis, redislocations, and functional outcomes. Secondary surgical interventions should not be delayed in the absence of the spontaneous development of acetabulum.Level of evidenceLevel III, prognostic study.

Effect of growth hormone and somatomedin-C axis on fracture healing

“…Open reduction and soft tissue loosening was performed via limited posteromedial approach to the patients in the first group, as this technique is our routine approach to DDH, and commonly used in our clinic. The limited posteromedial approach technique was previously discussed in our studies [16,17]. The posterior margin of tendineum adductor longus was incised 5 cm and layers were cut until tendon was reached.…”

Bilateral Involvement in Developmental Dislocation of the Hip: Analysis of 561 Patients Operated on Using the Limited Posteromedial Approach

“…Redislocation, residual acetabular dysplasia (RAD), and avascular necrosis of the femoral head (AVN) are among the most prevalent complications following developmental dysplasia of the hip (DDH). By identifying the factors that contribute to these complications and adopting preventative measures, one can mitigate the morbidity and disability associated with DDH [6][7][8][9]. In a recent study performed, it was determined that bilateral involvement is an important risk factor for redislocation [7].…”

Effect of acetabular morphological parameters applied in proximal femoral varus osteotomy on the treatment of developmental dysplasia of the hip in children

“…Therefore, it is of positive significance to adopt effective treatment for DDH. Proximal femoral varus osteotomy, as one of the most effective methods for the treatment of DDH, has been the subject of clinical testing for decades and has been supported by many clinical researchers (7)(8)(9). However,…”