Simultaneous versus  two stage surgical treatment of developmental dislocation of the hip with excessive femoral anteversion in children under the age of three years

Background: Delayed diagnosis and improper treated cases of developmental dysplasia of the hip (DDH) in the presence of excessive anteversion of femoral head may lead to undesirable consequences, including more extensive interventions with severe complications and functional disability. This study aimed to compare the clinical, radiological, and complication outcomes of simultaneously versus two-stage surgical procedures (open reduction and proximal femoral derotation osteotomy) in the treatment of DDH with excessive femoral anteversion among a sample of Iraqi children aged less than three years old. Methods: A total of 26 DDH cases were treated in two groups (GI, GII) at Al-Wasity Teaching Hospital (Baghdad, Iraq) from January 2014 to March 2015. GI (15 hips) in 13 patients subjected to simultaneous open reduction (with/without salter osteotomy) and proximal femoral derotation osteotomy. GII (18 hips) in 13 patients operated in two stages procedure; open reduction (with/without salter osteotomy) followed by proximal femoral derotation osteotomy six weeks later. Results: At the time of operation, the average age was 21.79±3.51months (range: 18-30). The mean follow-up period was 10.36 ±1.45 months (range, 8 -12). Statistically, the postoperative clinical, radiological, and complication findings were not significantly different between the two groups. However, in post-operative clinical assessment (McKay's criteria), the satisfying results (excellent and good) were 93% in GI and 88% in GII, respectively. Moreover, in radiological assessment (Severins classification), the satisfying results (excellent and good) were 94% in GI and 83% in GII, respectively. Two cases of re-dislocation and avascular necrosis (AVN) were reported in GII. Conclusion: When the clinical and radiological findings of one and two-stage open reduction and proximal femoral derotation osteotomy procedures are similar, the one-stage is more likely to overcome the two-stage in terms of minimizing the cost, length of stay and the risk of AVN of the femoral head.

Download Full-text

EVALUATION OF AVASCULAR NECROSIS DURING MIDTERM FOLLOW UP IN DDH CASES TREATED BY SINGLE STAGE SURGERY IN THE WALKING AGE GROUP

Journal of Critical Reviews ◽

10.31838/jcr.07.14.991106ej ◽

2021 ◽

pp. 6005-6010

Keyword(s):

Femoral Head ◽

Surgical Procedures ◽

Open Reduction ◽

Soft Tissues ◽

Developmental Dysplasia ◽

Single Stage ◽

Age Group ◽

Developmental Dysplasia Of Hip ◽

Walking Age

Developmental dysplasia of hip (DDH) represents a spectrum of disorders in which the femoral head has an abnormal relationship to the acetabulum. Management of DDH presenting in walking stage are primarily surgical because of changes in femoral head, acetabulum and soft tissues around joint. We looked at the incidence of AVN during midterm follow up period in DDH patients in the walking age group who had undergone single stage surgery. Also it evaluates association of different variables with occurrence of AVN. The AVN of head of femur is assessed according to Kalamchi and MacEwen’s classification and AVN gradings were compared with different surgical procedures. In our study, higher incidence of AVN was seen patients who were operated at a higher age, who had higher preoperative Tonnis grading and those who required osteotomies with open reduction. But statistically significant correlation could not be established independently with any of the above mentioned variables.

Download Full-text

Clinical and radiographic medium‐term evaluation on patients with developmental dysplasia of the hip, who were submitted to open reduction, capsuloplasty and Salter osteotomy

Revista Brasileira de Ortopedia (English Edition) ◽

10.1016/j.rboe.2014.01.006 ◽

2014 ◽

Vol 49 (1) ◽

pp. 51-55

Author(s):

Válney Luiz da Rocha ◽

Guilherme Lima Marques ◽

Leonardo Jorge da Silva ◽

Tiago Augusto di Macedo Bernardes ◽

Frederico Barra de Moraes

Keyword(s):

Open Reduction ◽

Developmental Dysplasia ◽

Medium Term ◽

Salter Osteotomy ◽

Term Evaluation ◽

Dysplasia Of The Hip

Download Full-text

Comparison of Salter osteotomy and Tonnis lateral acetabuloplasty with simultaneous open reduction for the treatment of developmental dysplasia of the hip

Journal of Pediatric Orthopaedics B ◽

10.1097/bpb.0000000000000297 ◽

2016 ◽

Vol 25 (6) ◽

pp. 493-498 ◽

Cited By ~ 3

Author(s):

Ilhan A. Bayhan ◽

Kubilay Beng ◽

Timur Yildirim ◽

Evren Akpinar ◽

Cagri Ozcan ◽

...

Keyword(s):

Open Reduction ◽

Developmental Dysplasia ◽

Salter Osteotomy ◽

Dysplasia Of The Hip

Download Full-text

Dega pelvic osteotomy: indications, results and complications

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.12.180091 ◽

2018 ◽

Vol 12 (4) ◽

pp. 342-348 ◽

Cited By ~ 8

Author(s):

J. Czubak ◽

K. Kowalik ◽

A. Kawalec ◽

M. Kwiatkowska

Keyword(s):

Femoral Head ◽

Open Reduction ◽

Age Groups ◽

Pelvic Osteotomy ◽

Developmental Dysplasia ◽

Femoral Osteotomy ◽

Complication Rates ◽

Level Of Evidence ◽

Significant Difference ◽

Dysplasia Of The Hip

Purpose Developmental dysplasia of the hip (DDH) after walking age is difficult to treat. Dega pelvic osteotomy is combined with open reduction and femoral osteotomy to obtain concentric stable reduction with good coverage of the femoral head. The purpose of this study is to evaluate the use of the Dega osteotomy in the treatment of DDH in two different age groups. Methods A total of 45 patients (52 hips) with a mean age of 3.9 years (1.2 to 12.8) were treated with open reduction, Dega osteotomy and femoral osteotomy. There were 38 dislocated and 14 subluxated hips. Bilateral DDH was observed in seven female patients. Radiographic parameters included acetabular index, centre-edge angle of Wiberg and migration percentage. The final radiographic outcome was evaluated according to the Severin classification. Results The mean follow-up period was four years (3 to 9). According to the Severin criteria 78.8% were types I or II whereas 21.2% showed types III or IV. There was no statistically significant difference in final outcome between children less than three years of age and older children at the time of surgery. One hip in children with unilateral involvement had developed coxa magna, that interfered with hip concentricity. Three hips (5.8%) showed avascular necrosis of the femoral head. Conclusion Dega osteotomy is a safe and adequate procedure for the management of developmental dysplasia of the hip in walking patients with low complication rates. Restoring the acetabulum to normal or nearly normal can result in good medium-term results. Level of Evidence III

Download Full-text

Long-term outcome after anterolateral open reduction and Salter osteotomy for late presenting developmental dysplasia of the hip

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.12.180076 ◽

2018 ◽

Vol 12 (4) ◽

pp. 364-368 ◽

Cited By ~ 2

Author(s):

S. R. Y. W. Thomas

Keyword(s):

Femoral Head ◽

Open Reduction ◽

Skeletal Maturity ◽

Hip Dislocation ◽

Term Outcome ◽

Long Term Outcome ◽

Femoral Head Osteonecrosis ◽

Salter Osteotomy ◽

Innominate Osteotomy

IntroductionOnly a handful of studies report outcomes after open reduction for developmental hip dislocation beyond skeletal maturity. For successfully reduced hips it is the outcome into late adulthood on which the results of this intervention should be judged. These studies indicate clearly the importance of preservation of the acetabular growth centres during surgery. The acetabulum must also be addressed when insufficient growth remains reliably to remodel residual dysplasia even after stable, concentric reduction.SummaryComparing the longest-term outcome studies for open reduction to less invasive, but mainly historical, techniques of gradual traction reduction it is unsettling to note that the latter protocols are associated with the best results. Whereas open reduction and innominate osteotomy are practised as originally described by Salter, gradual traction reduction has largely been abandoned.ConclusionsThere are probably aspects of the more time-consuming methods of gradual reduction that do not violate the hip joint capsule that expose the femoral head to a lower risk of femoral head osteonecrosis leading to better long-term outcomes.

Download Full-text

DEVELOPMENTAL DYSPLASIA OF THE HIP AT SEVEN YEARS OF AGE TREATED WITH OPEN REDUCTION AND FEMORAL DEROTATION OSTEOTOMY AND PEMBERTON ACETABULOPLASTY: A CASE REPORT

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2014/2190 ◽

2014 ◽

Vol 3 (10) ◽

pp. 2668-2674

Author(s):

Sridhara Murthy J N ◽

Rakesh Mohan R ◽

Yathish R ◽

Arun Kumar Arun Kumar

Keyword(s):

Case Report ◽

Open Reduction ◽

Developmental Dysplasia ◽

Derotation Osteotomy ◽

Dysplasia Of The Hip

Download Full-text

One stage surgery using subtrochanteric osteotomy versus two stage surgery using supracondylar femoral derotation osteotomy in treatment of developmental dysplasia of the hip joint for older children

The Medical Journal of Basrah University ◽

10.33762/mjbu.2013.90716 ◽

2013 ◽

Vol 31 (2) ◽

pp. 68-74

Author(s):

Ali A. Ahmed Al-Iedan

Keyword(s):

Hip Joint ◽

Developmental Dysplasia ◽

Older Children ◽

Two Stage ◽

One Stage ◽

Derotation Osteotomy ◽

Dysplasia Of The Hip

Download Full-text

A Newly Modified Salter Osteotomy Technique for Treatment of Developmental Dysplasia of Hip That Is Associated with Decrease in Pressure on Femoral Head and Triradiate Cartilage

BioMed Research International ◽

10.1155/2019/6021271 ◽

2019 ◽

Vol 2019 ◽

pp. 1-9

Author(s):

Seyed Mokhtar Esmaeilnejad-Ganji ◽

Seyed Mohammad Reza Esmaeilnejad-Ganji ◽

Mohammad Zamani ◽

Hesam Alitaleshi

Keyword(s):

Femoral Head ◽

Developmental Dysplasia ◽

Developmental Dysplasia Of Hip ◽

Center Edge ◽

Salter Osteotomy ◽

Innominate Osteotomy ◽

Femoral Shortening ◽

Osteotomy Technique ◽

The Mean

Background and Purpose. The Salter innominate osteotomy has been an effective method to treat the developmental dysplasia of hip (DDH) over the past decades; however, several postoperative complications and deficiencies were reported. In this study, we evaluated outcome of a newly modified Salter osteotomy in patients presenting with DDH. Methods. We reviewed retrospectively 76 patients (90 hips) with DDH aged ≥ 18 months, who underwent open reduction and a modified osteotomy by a single surgeon. The distal osteotomy segment of pelvis was shifted anterolaterally in the amount of osteotomy cross-section, but not downwards. The mean age at surgery was 2 years and 11 months (1.5 to 16 years). Femoral shortening was conducted when necessary. The duration of operation varied between 60 and 90 minutes. The mean follow-up was 4 years and one month (range 15 months to 7 years and 9 months). All patients were followed up both clinically (based on the modified MacKay criteria) and radiologically (based on the modified Severin criteria). Results. Clinically, 94.5% of hips had excellent and good results at final follow-up, and only 5.5% had a fair condition. Radiographically, at the final follow-up 77.8% of hips were grade IA (excellent), 12.2% were grade IB, 6.7% were grade II, and 3.3% were grade III (fair). The preoperative mean acetabular index was 47.85° (41° to 59), which decreased to 17.16° (13° to 22°) immediately after the surgery (p<0.0001) and progressed to 11.24° (7° to 19°) at the final follow-up (p<0.0001). The mean initial postoperative center-edge angle was 30.3° (25° to 42°) significantly improved to 39.1 (31° to 56°) at the final follow-up (p<0.0001). Avascular necrosis of femoral head occurred in 4.4% of hips (4 patients). Conclusion. The results show that our modified Salter osteotomy is safe and associated with significant benefit for the management of patients suffering from DDH.

Download Full-text