Is concomitant bone surgery necessary at the time of open reduction in developmental dislocation of the hip in children 12–18 months old? Comparison of open reduction in patients younger than 12 months old and those 12–18 months old
It is controversial to perform bone surgery at the time of open reduction in developmental dislocation of the hip in children 12-18 months old. The purpose of this study is to investigate whether concomitant bone surgery is necessary in patients treated with medial open reduction in this age range. Patients that were under 12 months of age at the time of open reduction were compared with patients that were 12-18 months old. Forty-four hips of 30 patients treated with open reduction through Ferguson's medial approach have been included in the study. Mean follow-up was 19.6 years (13-27.5). Age at the time of open reduction was less than 12 months in 21 hips (group A) and 12 months or more in 23 hips (group B). There was no significant difference between two groups concerning avascular necrosis or unsatisfactory radiological outcome (Severin's groups III and IV). A higher rate of secondary bone surgery was necessary in group B than in group A. Although secondary bone surgery is needed at a higher frequency in children 12-18 months old, the radiological outcome is not significantly different for patients younger than 12 months. Therefore, the recommendation of concomitant bone surgery on a routine basis during open reduction in developmental dislocation of the hip in children 12-18 months old is debatable.
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ABSTRACT: Open reduction of developmental hip dysplasia by the medial approach is one of the effective surgical treatment methods during early childhood. Although surgical approaches, fixation and follow-up methods may vary, successful results can be obtained by the algorithm involving the posteromedial approach and arthrographic evaluation. The aim of open reduction by the medial approach should be to obtain Tönnis grade I arthrographic reduction of the dysplastic hip and to maintain it. Avascular necrosis of the femoral head is a potential complication of this method. Even though actual evaluation of this problem requires monitoring patients until maturity, it is essential that special attention be given to the most effective factors (minimal invasive surgical technique, correct reduction, and appropriate position for fixation) for preventing this complication.
Available from: ncbi.nlm.nih.gov
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ABSTRACT: Ludloff’s medial approach has been described as a simple procedure for open reduction of developmental dysplasia of the hip (DDH) requiring minimal dissection and tissue disruption. Many patients undergo subsequent reconstruction of the acetabulum after skeletal maturity for residual dysplasia. Femoral head deformity reportedly influences the long-term outcome of these osteotomies. The literature suggests this deformity may be related to the patient’s age at the time of a medial approach. We therefore asked whether femoral head deformity (roundness index, femoral head enlargement) at skeletal maturity correlates with patient age at surgery. We assessed the radiographs of 40 patients (42 hips). Their mean age at surgery was 14.3 months (range, 6–31 months); the minimum followup was 10 years (mean, 15.8 years; range, 10–27 years). The mean roundness index at skeletal maturity correlated with increased age at the time of the operation (mean index, 58.3; range, 47–79) while enlargement did not. Using a medial approach for correction of DDH in older patients increases the risk of femoral head deformity at skeletal maturity.
Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
Available from: Tae-Joon Cho
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