F Thielemann1, A Schneider, T Köhler, V Dürrschmidt, K P Günther. 1. Orthopädische Klinik und Poliklinik, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Germany. Falk.Thielemann@mailbox.tu-dresden.de
Abstract
AIM: The aim of the present study was to obtain long-term functional and radiographic results after a pericapsular osteotomy of the ilium (Pemberton) and a simultaneously performed derotation-varisation osteotomy of the proximal femur in children with developmental dysplasia of the hip (DDH) after the end of the maturity process. METHOD: The clinical results and x-ray measurements of 79 patients with 100 operated hips were analysed. The average follow-up time after surgery was 14 years and 7 months (range: 10.4 to 19.5 years). The indication for operation was determined using the acetabular angle of more than two standard deviations. RESULTS: The clinical investigation shows that 85 % of the operated patients had no functional limitations. 14 % of the patients had minor limitations and 1 % had major limitations in their hip movement. No patient suffered constant hip pain; 62 % had no pain even after long walking; 32 % had pain after walking for more than an hour; 6 % complained of hip pain after walking for less than an hour. The radiological measurements show that 95.9 % of the patients had normal or mildly pathological ACM angle scores, and 92.8 % had normal or mildly pathological CE angle scores. CONCLUSION: Surgical treatment of residual hip dysplasia by simultaneously performed pericapsular ilium and proximal femur osteotomy is very effective. Although a radiographically almost normal acetabulum could be documented in patients after the end of the maturity process, revalgisation of the proximal femur occurred. With an appropriate acetabular correction additional osteotomy of the femur might therefore be unnecessary.
AIM: The aim of the present study was to obtain long-term functional and radiographic results after a pericapsular osteotomy of the ilium (Pemberton) and a simultaneously performed derotation-varisation osteotomy of the proximal femur in children with developmental dysplasia of the hip (DDH) after the end of the maturity process. METHOD: The clinical results and x-ray measurements of 79 patients with 100 operated hips were analysed. The average follow-up time after surgery was 14 years and 7 months (range: 10.4 to 19.5 years). The indication for operation was determined using the acetabular angle of more than two standard deviations. RESULTS: The clinical investigation shows that 85 % of the operated patients had no functional limitations. 14 % of the patients had minor limitations and 1 % had major limitations in their hip movement. No patient suffered constant hip pain; 62 % had no pain even after long walking; 32 % had pain after walking for more than an hour; 6 % complained of hip pain after walking for less than an hour. The radiological measurements show that 95.9 % of the patients had normal or mildly pathological ACM angle scores, and 92.8 % had normal or mildly pathological CE angle scores. CONCLUSION: Surgical treatment of residual hip dysplasia by simultaneously performed pericapsular ilium and proximal femur osteotomy is very effective. Although a radiographically almost normal acetabulum could be documented in patients after the end of the maturity process, revalgisation of the proximal femur occurred. With an appropriate acetabular correction additional osteotomy of the femur might therefore be unnecessary.