Surgical outcome of one-stage treatment of developmental dysplasia of the hip in children of walking age

Abstract

Introduction: Developmental dysplasia of the hip (DDH) is a term that encompasses a wide spectrum of pathology ranging from mild acetabular dysplasia with or without instability to a complete dislocation at birth which may or may not be reducible. The purpose of this study is to assess the results of one-stage combined operative management of developmental dysplasia of the hip in children of walking age. Methods: is a retrospective study involving 21 hips in 17 children with DDH, who underwent surgical operation at the department of orthopaedic surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, from January 2014 to December 2019.Tönnis and Severin grading systems were used to classify the radiographic status of the hip in pre-and postoperative period respectively. The operative procedure included open reduction, capsulorraphy, Salter's osteotomy and a femoral derotation osteotomy. Catteral's 'test of Stability' was used after open reduction as an indicator for need of pelvic and femoral osteotomy. The children were evaluated clinically on McKay's criteria and radiologically on Severin's criteria. Result: Among the 17 cases, 11(64.7%) were female and 6(35.3%) were male; 4(23.52%) children had bilateral involvement; 9(52.94%) had left-sided and 4(23.52%) had right-sided involvement. The average age was 3.3 years (range 18 months-8 yrs.) at the time of operation. Follow-up range between 1 to 3.8 years. At the time of last follow-up, 8(38.09%) children had excellent outcomes, 10(47.61%) had good, 2(9.52%) had fair, and 1(4.76%) had poor outcomes on McKay's criteria. Avascular necrosis of femoral head was noted in 2(9.52%) and hip re-dislocation was observed in 1(4.76%) hip. Conclusion: One-stage surgery which include open reduction, capsulorraphy, Salter's and femoral derotation osteotomy in walking age children with DDH is a safe and highly effective method. Complication rate and the need for repeat surgery is very low.