Management of developmental dysplasia of the hip in less than 24 months old children

Abstract

Background:There is no consensus on the treatment of developmental dysplasia of the hip in children less than 24 months of age. The aim of this study was to present the results of open reduction and concomitant primary soft-tissue intervention in patients with developmental dysplasia of the hip in children less than 24 months of age.Materials and Methods:Sixty hips of 50 patients (4 male, 46 female) with mean age of 14.62 ± 5.88 (range 5-24 months) months with a mean followup of 40.00 ± 6.22 (range 24-58 months) months were included. Twenty five right and 35 left hips (10 bilaterally involved) were operated. Open reduction was performed using the medial approach in patients aged < 20 months (with Tönnis type II-III and IV hip dysplasias) and for those aged 20-24 months with Tönnis type II and III hip dysplasias (n = 47). However for 13 patients aged 20-24 months with Tönnis type IV hip dysplasias, anterior bikini incision was used.Results:Mean acetabular index was 41.03 ± 3.78° (range 34°-50°) in the preoperative period and 22.98 ± 3.01° (range 15°-32°) at the final visits. Mean center-edge angle at the final visits was 22.85 ± 3.35° (18°-32°). Based on Severin radiological classification, 29 (48.3%) were type I (very good), 25 (41.7%) were type II (good) and 6 (10%) were type III (fair) hips. According to the McKay clinical classification, postoperatively the hips were evaluated as excellent (n = 42; 70%), good (n = 14; 23.3%) and fair (n = 4; 6.7%). Reduction of all hip dislocations was achieved. Additional pelvic osteotomies were performed in 14 (23.3%) hips for continued acetabular dysplasia and recurrent subluxation. (Salter [n = 12]/Pemberton [n = 2] osteotomy was performed). Avascular necrosis (AVN) developed in 7 (11.7%) hipsConclusion:In DDH only soft-tissue procedures are not enough, because of the high rate of the secondary surgery and AVN for all cases aged less than 24 months. Bone procedures may be necessary in the walking age group with high acetabular index.

Comparison of the clinical and radiological outcomes of open reduction via medial and anterior approach in devleopmental dysplasia of the hip

“…Its disadvantages include a lengthier operation, more dissection of the soft tissues, increased blood loss and it is more difficult to reach the structures which hinder reduction in medial approach. [6,8,[12][13][14] Successful results have been reported in various studies using both approaches. [9,13,[15][16][17][18] Avascular necrosis (AVN) and the need for revision surgery are reported at various rates.…”

“…[1,2,6,8,10] Various successful results have been reported about open reduction treatment with anterior and medial approaches. [2,5,11,12] However, sufficient comparative evidence is not available about the superiorities of open reduction with AOR or MOR approach to each other or which approach should be preferred.…”

“…[11,12] In this study, we used a posteromedial approach in the MOR group and bikini incision in the AOR group. Two patients had histories of unsuccessful treatment with previous conservative and closed reduction attempts.…”

“…[9,13,[15][16][17][18] Avascular necrosis (AVN) and the need for revision surgery are reported at various rates. [2,11,12] Limited number of studies are available comparing the results of open reduction with anterior or medial approach. [11,12] However comparative evidence about the preference for each approach in treatment of DDH in patients between 6-18 months and the benefits of each is not sufficient.…”

“…These disadvantages include a limited view which does not allow capsule plication and the risk of disruption of the medial circumflex artery. [6,[10][11][12] Open reduction with an anterior approach is used more frequently and provides a larger angle of view. It enables both capsular plication and pelvic osteotomy with the same incision.…”