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Outcomes of A Single-Stage Triple Procedure for The Treatment of Developmental Dysplasia of the Hip in Children of Walking Age.
Keywords:
Congenital Hip Dislocations, Hip Dislocations, Congenital, One stage triple procedure, salter’s innominate osteotomy.Abstract
Objective: To evaluate the radiographic and functional outcomes of treating DDH in ambulatory children using single-stage triple surgery, combined with open reduction, femoral varus derotational osteotomy and Salter’s innominate osteotomy.
Methodology: The Department of Orthopaedic Surgery of the Sheikh Khalifa Bin Zayyad Al Nayyan Medical Complex Quetta conducted this descriptive study between January 2017 and December 2020. The study included of 60 patients (96 hips) aged between 18 months and 8 years who were diagnosed with DDH. Severin’s classification was applied to assess radiologic outcomes, while McKay’s criteria were used to evaluate clinical outcomes.
Results: The majority of patients (58.3%) of this study had hips with severe dysplasia (Tönnis Grade IV) preoperatively, with a mean age of 4.6 years. The final procedures performed were Salter’s innominate pelvic osteotomy in 84 hips (87%), Pemberton osteotomy in 8 hips (8.3%), and Chiari’s salvage procedure in 4 hips (4.1%). According to McKay’s criteria, the postoperative results were excellent in 45 patients, good in 8 patients and fair in 5 patients. Radiographically, 84 hips had a type I and 10 hips a type II of the Severin classification.
Conclusions: In particular, severe DDH with walking age group is best treated by single-stage triple procedure. This method yields excellent to good functional and radiographical results. Early recognition and treatment also continue to be important aspects in managing challenging dysplastic hips.
References
1. Treiber M, Korpar B, Sirše M, Merc M. Early neonatal universal ultrasound screening for developmental dysplasia of the hip: a single institution observational study. International Orthopaedics. 2021 Apr;45:991-5.
2. Husum HC, Ghaffari A, Rytoft LA, Svendsson J, Harving S, Kold S, Rahbek O. Positive predictive values in clinical screening for developmental dysplasia of the hip. Acta Paediatrica. 2021 Aug;110(8):2430-4.
3. Pandey RA, Johari AN. Screening of newborns and infants for developmental dysplasia of the hip: A systematic review. Indian Journal of Orthopaedics. 2021 Dec:1-4.
4. Aarvold A, Perry DC, Mavrotas J, Theologis T, Katchburian M. The management of developmental dysplasia of the hip in children aged under three months: a consensus study from the British Society for Children’s Orthopaedic Surgery. The Bone & Joint Journal. 2023 Feb 1;105(2):209-14.
5. Patwardhan S, Madegowda A, Sancheti P. Evaluation of acetabular development following open reduction of developmental dysplasia of hip in children after walking age. Indian Journal of Orthopaedics. 2020 Dec;55:1583-90.
6. Li H, Ye W, Xu L, Li L, Zhu W, Zheng Z. Sequential one-stage combined procedure for treating bilateral developmental hip dysplasia after walking age. Journal of International Medical Research. 2019 Jul;47(7):2901-9.
7. Saqib M, Salman M, Hayat S, Khan MA, Ullah S. Developmental dysplasia of the hip in older children; prospects of functional and radiological outcome following a single stage triple procedure. Journal of Ayub Medical College Abbottabad. 2019 Jul 21;31(3):427-31.
8. Wo?niak ?, Idzior M, Jó?wiak M. Open reduction, Dega osteotomy and proximal femoral osteotomy in delayed diagnosis of developmental hip dislocation: outcome at 40-year follow-up. Journal of Children's Orthopaedics. 2021 Apr;15(2):171-7.
9. St George J, Kulkarni V, Bellemore M, Little DG, Birke O. Importance of early diagnosis for developmental dysplasia of the hip: a 5?Year radiological outcome study comparing the effect of early and late diagnosis. Journal of Paediatrics and Child Health. 2021 Jan;57(1):41-5.
10. Bhatti A, Kumar J, Butt SA. Outcome of one stage combined open reduction, pelvic and derotation femoral osteotomy in congenital dislocated hips of children younger than three years age. J Pak Med Assoc. 2014 Sep 1;64(9):1015-20.
11. Doski JO. Definition of Developmental Dysplasia of the Hip: Literature Review. Mustansiriya Medical Journal. 2022 Jan 1;21(1):1-7.
12. Ovaco Jumbo HD. Procedimientos por imagenología actuales para el diagnóstico y tratamiento precoz de la displasia congénita de cadera.
13. Schaeffer E, Lubicky J, Mulpuri K. AAOS appropriate use criteria: The management of developmental dysplasia of the hip in infants up to 6 months of age: Intended for use by general pediatricians and referring physicians. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2019 Apr 15;27(8):e364-8.
14. Doski JO. Definition of Developmental Dysplasia of the Hip: Literature Review. Mustansiriya Medical Journal. 2022 Jan 1;21(1):1-7.
15. Harsanyi S, Zamborsky R, Krajciova L, Kokavec M, Danisovic L. Developmental dysplasia of the hip: a review of etiopathogenesis, risk factors, and genetic aspects. Medicina. 2020 Mar 31;56(4):153.
16. Köro?lu C, Özdemir E, Çolak M, ?ensöz E, Öztuna FV. Open reduction and Salter innominate osteotomy combined with femoral osteotomy in the treatment of developmental dysplasia of the hip: Comparison of results before and after the age of 4 years. Acta Orthopaedica et Traumatologica Turcica. 2021 Jan;55(1):28.
17. Nadeem IA, Imran M, ul Haq J, uz Zaman A, Saddiq S, Aziz A. A Comparison of Radiological Outcome of Open Reduction in Unilateral VS Bilateral DDH. Journal of Pakistan Orthopaedic Association. 2024 Jun 27;36(02):05-10.
18. Alsiddiky A, Alatassi R, Alqarni MM, Bakerman K. Simultaneous bilateral single-stage combined open reduction and pelvic osteotomy for the treatment of developmental dysplasia of the hip. Journal of Pediatric Orthopaedics B. 2020 May 1;29(3):248-55.
19. Liu C, Xu Z, Zeng JF, Song ZQ, Xie YY, Tang ZW, Wen J, Xiao S. Roles of combined femoral and acetabular anteversion in pathological changes of hip dysplasia and hip reconstructive surgery. World Journal of Orthopedics. 2024 May 5;15(5):390.
20. Zimri FU, Shah SS, Saaiq M, Qayyum F, Ayaz M. Presentation and Management of Neglected Developmental Dysplasia of Hip (DDH): 8-years’ experience with single stage triple procedure at National Institute of Rehabilitation Medicine, Islamabad, Pakistan. Pakistan Journal of Medical Sciences. 2018 May;34(3):682.
