The effect of Dega acetabuloplasty and Salter innominate osteotomy on acetabular remodeling monitored by the acetabular index in walking DDH patients between 2 and 6 years of age: Short- to middle-term follow-up

Abstract

Introduction The surgical management of neglected developmental dysplasia of the hip (DDH) in walking children has always been a challenge to orthopedic surgeons. The aim of this study was to evaluate the short-to middle-term clinical and radiographic results of the management of DDH. Patients and methods Patients less than 6 years old using two of the most commonly used osteotomies, namely, Salter innominate osteotomy and the Dega acetabuloplasty. Special attention was paid to acetabular remodeling after concentric reduction, which was monitored by the acetabular index, that, in turn, was measured preoperatively, immediately postoperatively, every 6 months, and at the final follow-up examination. Results The final overall clinical end results were favorable (excellent or good) in 93 hips (85.3 %). There was a marked improvement of the acetabular coverage during the follow-up period, which proved the good remodeling potential of the acetabulum for this particular age group after concentric reduction was achieved and maintained. Conclusion Both osteotomy types were found to be adequate for the management of neglected walking DDH patients under the age of 6 years.

Evidence-based Management of Developmental Dysplasia of the Hip

“…El-Sayed and colleagues 99 reported a series of 109 hips, 61 of which underwent an SIO and 48 of which underwent a Dega acetabuloplasty based on the treating surgeon's preference. The worst outcome was seen in the group less than 4 years of age treated by Dega osteotomy, and this was attributed to the more technically demanding procedure of the smaller ilium.…”

Hip-joint congruity after Dega osteotomy in patients with cerebral palsy: long-term results

“…If the lateralisation is >40 % or the hip is dislocated, a bony reconstruction is necessary, and in recent years combining reconstruction with soft-tissue procedures has become the standard treatment to improve function. Reconstruction of the acetabulum using the technique of Dega stabilises the pelvis better than the techniques described by Chiari or Salter because it is a stable and incomplete osteotomy [15] and the medial corticalis of the os ilium is not affected.…”

Comparison of salter osteotomy results in two different age groups in the treatment of developmental hip dislocation

“…Barrett et al [16] stated that in the 7-year followup of 4 different groups undergoing Salter osteotomy, they reduced the acetabular index by an average of 16 degrees. El-Sayed et al [17] reported that they achieved 18-19-degree corrections in two different groups under and over 4 years of age using Salter osteotomy. In a study by Ahmed Essam et al [18] it was stated that they reduced the preoperative mean acetabular index from 47.8 degrees to 26.7 degrees after Salter osteotomy in patients with DDH.…”