ONE-STAGE OPERATIVE TREATMENT OF CONGENITAL DYSPLASIA OF THE HIP IN CHILDREN OF WALKING AGE

Abstract

Introduction: This retrospective study was conducted to determine the efficacy and complication rates associated with treating children of ambulatory age with idiopathic developmental dysplasia of the hip with open reduction and combined femoral and pelvic osteotomies.
Patients and methods: In this study, we reviewed the results of the one-staged open reduction, femoral derotation and Salter’s osteotomy in 18 hips of the 14 patients who had been operated between 1995 and 2003. There were one male and 13 female patients with 4 bilateral, 5 left and 5 right hips. Patients age at the time of operation was 29.7 months (range, 17-63 months). Avascular necrosis was evaluated according to the Kalamchi and MacEwen classification, radiological results according to the acetabular index and clinical results according to Mc Kay classification.
Results: The average follow-up was 44.4 months (range, 18 to 84 months). The acetabular index averaged 40.7° preoperatively and 20.8° at last follow-up according to Tönnis’ classification. Dysplasia was seen 33% of the hips at follow up x rays. Clinically, 14 (78%) of the hips were rated as excellent, 1 (5%) were rated good and 3 (17%) were rated as fair. Avascular necrosis was observed in 7 hips and all of them were found to be consistent with type I classificaiton of Kalamchi- McEwen. There were Kirschner wire migration in two patients and fractures of the both femur after removing the plates in one.
Discussion: One- stage operative procedure consisting of open reduction, femoral derotation osteotomy and Salter’s innominate osteotomy for previously untreated developmental dysplasia of the hip in children walking age can result in satisfactory clinical outcome at midterm follow-up.