One-Stage Combined Surgical Treatment of Developmental Dysplasia of the Hip in the Children Aged Over 18 Months

Abstract

BACKGROUND/AIMS: This retrospective study aimed to evaluate the early-term radiological and functional outcomes of one-stage combined surgical treatment in children aged over 18 months with developmental dysplasia of the hip (DDH).MATERIALS AND METHODS: Thirty-two (32) patients (44 hips) with DDH were included in the study. The T & ouml;nnis classification system was used to assess the pre-operative dysplasia grade of the hips. The acetabular index (AI) was measured on AP pelvic radiographs performed preoperatively and at the last control examination. Radiological evaluation was performed according to Severin's criteria, whereas modified McKay's criteria were applied for clinical evaluation. Kalamchi and MacEwen's criteria were preferred for the evaluation of avascular necrosis (AVN).RESULTS: The mean preoperative AI value of the hips was 44.7 +/- 5.0 degrees, whereas that value at the last control AI was 23.5 +/- 3.7 degrees (p<0.001). According to T & ouml;nnis classification, 10 hips were type II, 11 hips were type III, and 23 hips were type IV among 44 hips. According to the modified McKay criteria, excellent clinical results were obtained in 39 (88.7%) hips, good in 4 (9%) hips, and fair in 1 (2.3%) hip. According to Severin's criteria, class 1 radiological results were obtained in 29 (66%) hips, class 2 in 13 (29.5%) hips, and class 3 in 2 (4.5%) hips. The evaluation based on Kalamchi and MacEwen's criteria revealed AVN in 8 (18.2%) hips.CONCLUSION: Combined surgical procedures involving pelvic and femoral osteotomy with open reduction are effective in the management of DDH in children over 18 months of age. In addition, femoral derotation osteotomy is necessary for stable reduction in children after walking age.