Comparison of total cost and outcomes between single-stage open reduction and Pemberton periacetabular osteotomy operation and two separate consecutive operations in treatment of bilateral developmental hip dysplasia in children at walking age

Abstract

Open reduction and Pemberton periacetabular osteotomy (PPO) is one of the most preferred techniques for the treatment of developmental hip dyslaplasia (DDH) after the walking age. Performing the surgery as a one-stage operation or two separate consecutive operations is a controversial issue. In this study, we aimed to compare the outcomes, length of hospitalization and total cost between the patients whom had single-stage open reduction and PPO or two consecutive operations due to bilateral DDH in the walking age children. One hundred thirty patients with bilateral DDH had undergone open reduction and PPO for both hips. Seventy-five patients had one-stage open reduction and PPO for both of the hips, whereas 55 patients have two separate consecutive operations. Total time of exposure to anesthetics, blood loss and duration of operation were noted. Hospitalization period and total treatment costs were also noted for each patient. There was no statistically significant difference between the groups regarding the preoperative and postoperative AIs (P > 0.05). Comparing the total cost, length of hospitalization, exposure to anesthetics, perioperative blood loss, there was statistically significant difference between the groups (P < 0.005). Single-stage surgery had favorable outcomes. Major benefits of single-stage surgery for treatment of bilateral DDH are the reduced costs, anesthesia duration, intraoperative blood loss and hospitalization period. Also it can be presumed that prolonged immobilization can lead to loss of bone strength and resulting in fragility fractures. So single-stage open reduction and PPO for bilateral DDH can be preferred in experienced clinics.

Simultaneous versus staged surgeries for the treatment of bilateral developmental hip dysplasia in walking age: A comparison of complications and outcomes

“…That is why the simultaneous surgery is advised to be performed by experienced surgeons. [9,10,14] In the literature, treatment of bilateral DDH yields favorable or similar radiological and clinical outcomes than unilateral cases. Wang et al [16] compared 56 bilateral cases with 156 unilateral cases and reported 80.4% satisfactory outcomes in bilateral and 86.5% in unilateral cases according to the Severin classification.…”

“…[ 8 , 13 , 14 ] As a result of aforementioned properties, PPO has proven to be a safe, reliable option even in simultaneous surgeries. [ 6 , 10 , 14 , 15 ] Yilar et al[ 10 ] reported simultaneous PPO to reduce cost and rate of complications with similar outcomes. Still, simultaneous PPO and OR surgery have certain challenges including difficulty for the surgeon due to the prolonged stressful surgery.…”

“…That is why the simultaneous surgery is advised to be performed by experienced surgeons. [ 9 , 10 , 14 ]…”

“…[ 9 ] Most of the studies have compared bilateral cases with unilateral cases with DDH, except for our previous study, which had bilateral cases in both groups. [ 10 ]…”

“…[9] Most of the studies have compared bilateral cases with unilateral cases with DDH, except for our previous study, which had bilateral cases in both groups. [10] Bilateral DDH surgery has been performed either in a single stage or two separate stages in our clinic. We usually observe better outcomes in single-stage surgery.…”