Single-stage open reduction, Salter innominate osteotomy, and proximal femoral osteotomy for the management of developmental dysplasia of the hip in children between the ages of 2 and 4 years

Abstract

The management of neglected developmental dysplasia of the hip in walking children has always been a challenge to orthopedic surgeons. The aim of this study was to access the early clinical and radiographic results of surgical treatment of such cases using one-stage open reduction, Salter innominate osteotomy, and proximal femoral osteotomy. Seventy-one surgeries were performed in 55 patients. Favorable clinical and radiographic outcomes were comparable to other studies. We concluded that this single-stage surgery is a technically demanding, but satisfactory procedure in the management of neglected developmental dysplasia of the hip patients, and when performed adequately in indicated patients in specialized centers, it is expected to give good short-term results.

Effect of Age and Surgical Procedure on Clinical and Radiological Outcomes in Children with Developmental Dysplasia of the Hip: A Comparative Study

“…Conservative treatments and closed/open reduction of the hip are sufficient for reshaping the acetabulum and femur in the pre-18-month period when bone and soft tissue pathologies are unclear, whereas femoral/acetabular osseous correction surgeries that establish the anatomical and physiological integrity of the hip must be performed at a later stage, particularly after the age of 18 months, when the pathologies are clear (10,11). Good results have been reported in the literature with the inclusion of primary open reduction and femoral and/or pelvic osteotomies after 18 months (12)(13)(14)(15).…”

“…At the start of this study, osteotomy was also needed in addition to open reduction because diagnoses and initial treatments of patients were performed at older ages for various There are various treatment options for DDH based on the different age groups. Closed or open reduction performed with conservative methods or under anesthesia can be sufficient in DDH patients who are diagnosed before toddlerhood, whereas bone surgery directed at the proximal femur and acetabulum may be necessary in and after toddlerhood (9)(10)(11)(12)(13)(14). Although the performed treatments are standardized in some of the studies in the literature that compare various ages (8,29,30), others lack standardization (25,31,32).…”

How Does Bony Surgery Affect Results of Anterior Open Reduction in Walking-age Children With Developmental Hip Dysplasia?

“…In the literature anterior open reduction has been used in isolation in this age group but has also been combined with pelvic osteotomy [7,14,22,28,30,32,40,44,46], proximal femoral osteotomy [28,31,38,46], or both in a single stage [3,10,11,26,31,39]. It is unclear which surgical procedure or combination of procedures is least likely to result in clinically relevant AVN (K&M Types II-IV or equivalent) and most likely to provide satisfactory radiological and clinical results (Severin I or II or equivalent and McKay excellent or good rating or equivalent, respectively), while minimizing the requirement for further surgical intervention.…”

“…The effectiveness of these different surgical interventions is varied with reports of the incidence of clinically relevant AVN (Kalamchi & MacEwen Types II to IV or equivalent) varying from 0% to 39% [5,22,26], a satisfactory radiological result (Severin Grade I/II) 83% to 96% [10,32], and a satisfactory clinical result (McKay rating excellent or good) 71% to 100% [5,44]. Reports often pool results from a variety of different surgical approaches undertaken in ill-defined patient groups with broad age ranges and varying degrees of followup [25,27,35].…”

Treatment of Adolescents with a Periacetabular Osteotomy After Previous Pelvic Surgery

“…Various surgical procedures, including the Salter, Pemberton, Steel, and Tönnis osteotomies and shelf acetabuloplasty, have addressed the different pathologic components of the dysplastic hip. However, their success rates based on radiographs and self-reported patient outcomes have been variable [8,16,26,32,33,39,43,44,46] and the choice for the optimal surgical procedure to correct acetabular dysplasia continues to be controversial.…”