Single-stage medial open reduction and Pemberton acetabuloplasty in developmental dysplasia of the hip

Introduction: Early diagnosis and early treatment have become the gold standard for management of developmental dysplasia of the hip. Surgery is required in case of failed initial treatment. Innominate pelvic osteotomy of Salter (SIO), Pemberton’s pericapsular osteotomy (PPO) and Dega’s acetabuloplasty (DA) are among the most used procedures. We performed a systematic review and meta-analysis of the past 57 years in order to assess the mid- and long-term outcome of these techniques. Methods: Studies met inclusion criteria if they: (1) reported at least 5 cases treated by 1 of the abovementioned surgical techniques; (2) included children aged between 1 and 8 years; (3) surgical indication was late detected DDH or a failed initial treatment; (4) presented a minimal follow-up of 24 months; (5) reported the radiological score of Severin and/or the clinical score of McKay. Clinical and radiological outcomes were dichotomised into favourable and unfavourable outcome and weighted summary rates were determined using meta-analysis models. Results: From a total of 7391 articles, 48 level of evidence grade IV articles were included in our review. A total of 2143 cases with a mean follow up of 112.4 months were included. Pooled Severin score indicated a statistically better outcome for PPO and DA compared to SIO ( p = 0.0003 and p = 0.002, respectively). By dichotomising the results in favourable and unfavourable outcome, PPO showed the best results ( p = 0.0002 vs. SIO, p = 0.01 vs. DA). Pooled McKay score showed a statistically better outcome for PPO and DA compared to SIO ( p < 0.0001 and p = 0.03, respectively) as well as better outcomes for PPO compared to DA ( p = 0.01). By dichotomising the results in favourable and unfavourable, PPO showed the best results. Conclusions: Even if our review demonstrates slightly better radiological and clinical results with the PPO, the currently available and limited data do not allow for clear recommendation towards one of these techniques.

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“…Table 3 shows the retrieved articles, population characteristics and the surgical strategy. 17,23,27 –71…”

Section: Resultsmentioning

confidence: 99%

Mid- and long-term outcome of Salter’s, Pemberton’s and Dega’s osteotomy for treatment of developmental dysplasia of the hip: a systematic review and meta-analysis

et al. 2020

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“…Baki et al also used the Severin classification in their study to analyze the radiological results of patients who underwent the posteromedial limited approach and Pemberton osteotomy. Only 1 of the 22 patients was a male 13 . In their study of mid-term radiological results after the posteromedial limited approach, Biçimoğlu et al concluded that sex does not make a difference in terms of radiological results.…”

Section: Discussionmentioning

confidence: 99%

“…Although it is known that female sex is a risk factor for DDH, its effects on prognosis are unclear. In the current literature, male and female patients were studied together, and male patients constituted only a small part of the cohorts 13, 14. To the best of our knowledge, this is the first study comparing male and female patients based on the mid-long-term results of the posteromedial limited approach.…”

Section: Discussionmentioning

confidence: 99%

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

Doğan¹,

Caliskan²,

Gencer³

et al. 2019

Acta Orthopaedica et Traumatologica Turcica

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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.

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“…La corrección de la DDC en pacientes de edad ambulatoria tiene diferentes tipos de tratamiento quirúrgico, algunas de estas opciones van desde la colocación de una tracción pre o transoperatoria para facilitar la reducción de la cadera y disminuir el riesgo de necrosis avascular, 17 otra opción quirúrgica es una cirugía de un solo paso, pero con la variante de una reducción abierta a través de un abordaje medial, seguido de una osteotomía de Pemberton por vía anterior. 18 En este estudio se evaluó una técnica integral de un solo paso para realizar la corrección completa de las deformidades óseas y las alteraciones de los tejidos blandos de la cadera.…”

Section: Discussionunclassified

Beneficios del tratamiento en un solo evento quirúrgico de la displasia del desarrollo de la cadera en niños en etapa ambulatoria

Rodarte-Fernández-de-Castro¹,

Muñoz-García²,

Rodarte-Avalos³

et al. 2020

Revista Mexicana De Ortopedia Pediátrica

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Introduction: Developmental dysplasia of the hip (DDH) has different surgical treatment strategies, which have been proposed to reduce the hip on children an ambulatory stage. In order to have a reduced and stable hip. However, few authors describe the results of single-event surgical treatment. Objective: Is present results of surgical treatment in a single-event of DDH on children in an ambulatory stage. Material and methods: In this case-review study, clinical and radiological information was collected from 29 children, 37 hips with DDH treated with a single-event surgical treatment. Results: Thirty-seven with DDH treated in a single-event surgical treatment were analyzed, we found that 23 hips have an excellent recovery and 14 were classified as a good recovery in agreeing to Barret classification and, any were evaluated as regular or poor. Concerning Severin's classification, we found 23 hips as excellent; 14 hips with good results and none with regular or poor results. Only 3 hips were surgically re-intervened and 3 had avascular necrosis Kalamchi type I as a complication. Conclusion: Single-event surgical treatment for CDD offers excellent to good results with a low percentage of reinterventions and complications such as avascular necrosis.

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Single-stage medial open reduction and Pemberton acetabuloplasty in developmental dysplasia of the hip

Cited by 12 publications

References 25 publications

Mid- and long-term outcome of Salter’s, Pemberton’s and Dega’s osteotomy for treatment of developmental dysplasia of the hip: a systematic review and meta-analysis

Mid- and long-term outcome of Salter’s, Pemberton’s and Dega’s osteotomy for treatment of developmental dysplasia of the hip: a systematic review and meta-analysis

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

Beneficios del tratamiento en un solo evento quirúrgico de la displasia del desarrollo de la cadera en niños en etapa ambulatoria

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