Tratamento cirúrgico de displasia de desenvolvimento do quadril de apresentação tardia depois da idade da marcha

Abstract

OBJECTIVE: Cases of developmental dislocation of the hip (DDH) still occur after walking age because of late or missed diagnosis and failed conservative treatment. The choice of treatment for DDH after walking age continues to be controversial, and one of the options is open reduction combined with innominate osteotomy. METHODS: Twenty patients with 26 surgically treated hips with DDH, were evaluated from 2005 to 2008, using innominate osteotomy by Salter's technique after open reduction and capsulorraphy. The age of patients, fifteen females and five males, at time of surgery ranged from 12 to 18 months (mean age 14.7 months). Six patients had bilateral dislocation and in the remaining, nine had their left hip dislocated and five had their right hip dislocated. RESULTS: The results were evaluated according to modified McKay criteria and to Severin radiological criteria, after a mean follow-up of 46.7 months. Eighty - nine percent of hips were rated as excellent or good by McKay criteria. There were no poor results. According to Severin criteria, 77% were type I and II while 23% showed type III and IV, no hips were rated as Severin's group V or VI. There was one case (3.8%) of re-dislocation, but revision surgery resulted in stable, concentric, and permanent reduction. No cases of infection, graft fracture and vascular or nervous injury were reported. CONCLUSION: Open reduction combined with Salter osteotomy does not hurt the hip with regard to acetabular remodeling for children between 12 and 18 months of age. Level of Evidence IV, Case Series.

Analyses of outcomes of one-stage operation for treatment of late-diagnosed developmental dislocation of the hip: 864 hips followed for 3.2 to 8.9 years

“…The mean time of follow-up was 6.2 years (range: 3.2–8.9 years). Clinical data including pain, gait pattern, range of hip joint motion, and status of Trendelenburg sign were evaluated for each patient at the latest follow-up, using the McKay classification [ 23 , 24 ] by two senior authors. The Severin grading system [ 24 , 25 ] was used to evaluate the latest radiographic outcome.…”

“…Clinical data including pain, gait pattern, range of hip joint motion, and status of Trendelenburg sign were evaluated for each patient at the latest follow-up, using the McKay classification [ 23 , 24 ] by two senior authors. The Severin grading system [ 24 , 25 ] was used to evaluate the latest radiographic outcome. AVN of the femoral head was assessed using the Kalamchi and MacEwen classification [ 24 , 26 ].…”

“…The Severin grading system [ 24 , 25 ] was used to evaluate the latest radiographic outcome. AVN of the femoral head was assessed using the Kalamchi and MacEwen classification [ 24 , 26 ]. Postoperative complications and subsequent surgery were observed during the follow-up period.…”

Dega pelvic osteotomy: Indications, results and complications

“…In late presenting children, pelvic osteotomy is needed to achieve a stable concentric reduction. 2 – 5 …”

Dynamic long leg casting fixation for treating 12- to 18-month-old infants with developmental dysplasia of the hip

“…For example, increasingly more surgeons advocate an early operation, 1 but reports on the long-term effects of the conservative treatment for patients older than 12 months are very rare. 2 As a noninvasive treatment method, conservative treatment results in less trauma, so it is easier for patients and their families to accept, but the applicable age has been a controversial issue. 3 To date, a number of different types of conservative treatment have been used, such as frog fixation and human position fixation.…”