Is varus osteotomy necessary in one-stage treatment of developmental dislocation of the hip in older children?

Abstract

Purpose Innominate osteotomy, varisation–derotation osteotomy, and shortening osteotomy are the most common surgical procedures used to achieve pelvifemoral realignment in the treatment of children over three years of age with developmental hip dislocation. It is well known that varus osteotomy can improve the acetabular index but it does have some disadvantages. The aim of this study was to discuss the results obtained with patients treated only with Salter osteotomy, derotation osteotomy, and shortening, without varus osteotomy, and to evaluate the need for varisation on the basis of these results. Methods Between 1996 and 2001, twenty-four hips, sixteen unilateral and four bilateral, of a total of twenty patients treated with this method and available for final controls were evaluated. The study included sixteen female and four male patients with a mean age of 4 years 2 months (ranging between 2 years 10 months and 8 years). The mean follow-up period was determined as 6.57 years (range 5–10 years). McKay’s clinical criteria, Sever’s radiological criteria, and the evaluation system modified by Trevor et al. were used for evaluation of the results. Results Based on McKay’s clinical criteria, eighteen hips (75%) were classified as type I, four hips (16%) as type II, and two hips (9%) as type III. According to Sever’s radiological criteria, thirteen hips (54%) were graded as grade I, nine hips (37.5%) as grade II, and two (8.5%) as grade III. According to the modified evaluation system of Trevor et al. the results were categorized as excellent in thirteen hips, good in nine hips, and moderate in two hips. Pre-operative mean acetabular index was measured as 37.3° (28°–50°) and early post-operative mean acetabular index as 26° (18°–38°). In the final radiological examination the mean acetabular index was measured as 18.3° and the mean CE angle as 30.1° (15°–38°). Avascular necrosis affecting the results developed in five hips. Conclusion It is concluded that in older children with developmental dislocation of the hip (DDH) treated with one-stage combined surgical intervention, adequately stable concentric reduction can be achieved without varisation and that varus osteotomy is not always necessary.

Arthroscopic reduction and acetabuloplasty for the treatment of dislocated hips in children of walking age: a preliminary report

“…Arslan et al note that during surgery it is often difficult to achieve an exact collum diaphyseal angle of 100°-110°and therefore there is a significant risk of a coxa vara which often does not remodel in older children. The authors therefore do not recommend performing a varus osteotomy in most cases [4]. Other authors are hesitant with regard to derotation since this can promote a repeat dislocation in the posterior direction [7,17].…”

“…While most cases of hip dislocation can be easily treated in infancy using a retention therapy, such as a plaster cast or a Pavlik harness, more extensive measures are needed for children of walking age. Children of walking age are treated through open reduction, possibly with acetabuloplasty, with or without femoral osteotomy [3][4][5][6][7]. The necessity of and the type of femoral osteotomy are controversially debated [3][4][5].…”

“…Children of walking age are treated through open reduction, possibly with acetabuloplasty, with or without femoral osteotomy [3][4][5][6][7]. The necessity of and the type of femoral osteotomy are controversially debated [3][4][5]. Complications include avascular necrosis, repeat dislocation, differences in leg lengths and muscular insufficiency.…”

Medium-term results following arthroscopic reduction in walking-age children with developmental hip dysplasia after failed closed reduction

“…Open reduction, sometimes combined with acetabuloplasty and femoral osteotomy, remains the standard treatment after failed closed reduction [ 3 – 6 ]. However, serious complications [ 7 , 8 ], including avascular necrosis of the femoral head, may occur following open reduction and negatively affect patient outcomes.…”

Die intertrochantäre Femurosteotomie

“…Eine grundsätzliche Indikation zur ergänzenden intertrochantären Varisierung auch bei jüngeren Patienten besteht nicht. Sie sollte nur durchgeführt werden, wenn ein Zentrierungsgewinn resultiert [1]. Auch wenn für isolierte varisierende intertrochantäre Osteotomien bei ausgewählten Patienten im Langzeitverlauf sehr gute Ergebnisse berichtet werden [13], sollte bedacht werden, dass nicht am eigentlichen Ort der Pathologie korrigiert wird, und eine Varisierung des Schenkelhalses die Anatomie verändert und negative Effekte mit sich bringen kann.…”