Short term results of Anterolateral approach for open reduction of neglected Developmental Dysplasia of Hip (DDH)
Objective: To determine the short term functional and radiological results of open reduction of Developmental Dysplasia of Hip (DDH) through anterolateral approach.
Methods: This was a descriptive study conducted in Paediatric unit of Orthopaedic department, Khyber teaching hospital, Peshawar from January 2018 to December 2018.Children with DDH fulfilling the inclusion criteria were treated with open reduction via anterolateral approach. Post-operative clinical outcome was assessed with Mckay’s criteria while radiographic outcome was assessed by measuring Acetabular index, neck shaft angle and restoration of Shenton line and concentric reduction.
Results: Total patients were 35(age more than 18 months).Male were 9(25.7%) while female were 26(74.3%). Mean age was 3.1 ± 1.71 years. Family history of DDH was positive in 06 cases (17.1%). According to Mckay’s criteria 20(57.1%) patients had excellent functional outcome, 8(22.8%) had good, 2(5.7%) fair and 5(14.2%) patients had poor results. Mean Pre-operative Acetabular index (AI) was improved from 35.70 ± 5.830 to post-operative 22.50 ± 5.60. Concentric reduction were found in 34(97.1%) patients and subluxation in one (2.8%) patient. About 6(17.1%) patients had femoral head avascular necrosis (AVN). Mean follow up period was 18 months.
Conclusion: Anterolateral approach of hip for open reduction is an excellent approach as it gives better functional and radiological outcome in neglected Developmental Dysplasia of Hip (DDH).
2. Tschauner C, Furntrath F, Saba Y. Developmental Dysplasia of the Hip: Impact of sonographic newborn hip screening on the outcome of early treated decentered hip joints-a single center retrospective comparative cohort study based on Graf’s method of hip ultrasonography. J Child Orthop 2011;5(6):415-24.
3. Puhan MA, Woolacott N, Kleijnen J, Steurer J. Observational studies on ultrasound screening for Developmental Dysplasia of the Hip in newborns-A systematic review. Ultraschall Med 2003;24(6):377-82.
4. Copuroglu C, Ozcan M, Aykac B, Tuncer B,Saridogan K. Reliability of ultrasonographic measurements in suspected patients of developmental dysplasia of the hip and correlation with the acetabular index. Indian J Orthop 2011;45(6):553-7.
5. Tumer Y, Omeroglu H. Prevention of Developmental Hip Dysplasia in Turkey. Acta Orthop Traumatol Turc 1997;31:176-81.
6. Graf R. Fundamentals of sonographic diagnosis of infant hip dysplasia. J Pediatr Orthop 1984;4:735-40.
7. Graf R. The use of ultrasonography in Developmental Dysplasia of the Hip. Acta Orthop Traumatol Turc 2007;41(Suppl 1):6-13.
8. Karakas ES, Baktir A, Argun M, Turk CY. One-stage treatment of congenital dislocation of the hip in older children. J Pediatr Orthop 1995;15:330-6.
9. Koizumi W, Moriya H, Tsuchiya K, Takeuchi T, Kamegaya M, Akita T. Ludloff's medial approach for open reduction of congenital dislocation of the hip. A 20-year follow up. J Bone Joint Surg Br 1996;78:924-9.
10. Kalamchi A, Schmidt TL, Mac Ewen GD. Congenital dislocation of the hip. Open reduction by the medial approach. Clin Orthop Relat Res 1982;169:127-32.
11. Kiely N, Younis U, Day JB, Meadows TM. The ferguson medial approach for open reduction of developmental dysplasia of the hip. A clinical and radiological review of 49 hips. J Bone Joint Surg Br 2004;86:430-3.
12. Ludloff K. The open reduction of the Congenital Hip Dislocation by an anterior incision. Am J Orthop Surg 1913;10:438-54.
13. Ferguson AB. Primary open reduction of congenital dislocation of the hip using a median adductor approach. J Bone Joint Surg Am 1973;55:671-89.
14. Troliae Z, Ljubiae B, Gavrankapetanoviae I, Prliae J, Moro G, Latinciae A. Open reduction of congenital hip dislocation by medial approach: Case series. Croat Med J. 2002;43:312-8.
15. Vitale MG, Skaggs DL. Developmental dysplasia of the hip from six months to four years of age. J Am Acad Orthop Surg 2001; 9: 401-411
16. Eren A. Medial and anterior approach in treatment of Developmental Hip Dysplasia. J Orthop Traumatol-Special Topics 2010;3:6-9.
17. Sener M, Baki C, Aydin H, Yildiz M, Saruhan S. The results of open reduction through a medial approach for Developmental Dysplasia of the Hip in children above 18 months of age. Acta Orthop Traumatol Turc 2004;38:247-51.
18. Johari AN, Wadia FD. Revision surgery for developmental dysplasia of the hip. Indian J Orthop 2003;37:233-6.
19. Dhar S, Taylor JF, Jones WA, Owen R. Early open reduction for congenital dislocation of the hip. J Bone Joint Surg Br 1990; 72:175-80.
20. Luhmann SJ, Basset GS, Gordon JE, Schootman M, Schoenecker PL. Reduction of a dislocation of the hip due to developmental dysplasia. Implication for the need for future surgery. J Bone Joint Surg Am 2003; 85-A:239-43.
21. Morcuende JA, Meyer MD, Dolan LA, Weinstein SL. Long-term outcome after open reduction through an anteromedial approach for congenital dislocation of the hip. J Bone Joint Surg Am 1997; 79:810-7.
22. Gulman B, Tuncay IC, Dabak N, Karaismailoglu N. Salter's innominate osteotomy in the treatment of congenital hip dislocation: a long-term review. J Pediatr Orthop 1994; 14:662-6.
23. Bohm P, Brzuske A. Salter innominate osteotomy for the treatment of developmental dysplasia of the hip in children: results of seventy-three consecutive osteotomies after twenty-six to thirty-five years of follow-up. J Bone Joint Surg Am 2002; 84-A:178-86.
24. Albers WE. Congenital and developmental anomalies of hip and pelvis. In : Canale ST, Beaty JH, editors. Campbell's operative Orthopaedics 10th ed. St Louis, MO: Mosby-Year Book; 2003. 1079-124.
25. Inan M, Harma A, Ertem K, Germen B, Bowen RJ. Successful treatment of high congenital dislocated hips in older children by open reduction, pelvic and femoral osteotomy with external fixator stabilization (average 8.2 years of age). J Pediatr Orthop B. 2005;14:405-9.
26. Papavasiliou VA, Papavasiliou AV. Surgical treatment of developmental dysplasia of the hip in the periadolescent period. J Orthop Sci 2005;10:15-2.
27. Castillo R, Sherman FC. Medial adductor open reduction for congenital dislocation of the hip. J Pediatr Orthop1990;10:335-40.
28. Roose PE, Chingren GL, Klaaren HE, Broock G. Open reduction for congenital dislocation of the hip using the Ferguson procedure. A review of twenty six cases. J Bone Joint Surg Am 1979;61:915-21.
29. Kalamchi A, MacEwen GD. Avascular necrosis following treatment of congenital dislocation of the hip. J Bone Joint Surg Am 1980;62:876-88.
30. Bulut M, Gurger M, Belhan O, Batur OC, Celik S, Karakurt L. Management of developmental dysplasia of the hip in less than 24 months old children. Indian J Orthop. 2013;47(6):578-84.
31. Bhatti A, Jamali AR, Mehboob G. Influence of age on the outcome of single stage reconstructive surgery for congenital dislocation of the hip joint. J Coll Phys Surg Pak 2009;19(1):43-8.