Xiong Zhao1, Ya-Bo Yan1, Peng-Chong Cao1, Yi-Shan Ma1, Zi-Xiang Wu1, Yang Zhang1, Yuan Zang1, Qiang Jie2, Wei Lei3. 1. Department of Orthopeadics, Xijing Hospital, The Fourth Military Medical University, Xi'an, P.R. China. 2. Department of Orthopeadics, Xijing Hospital, The Fourth Military Medical University, Xi'an, P.R. China. Electronic address: jiqiang@fmmu.edu.cn. 3. Department of Orthopeadics, Xijing Hospital, The Fourth Military Medical University, Xi'an, P.R. China. Electronic address: wlspine@163.com.
Abstract
BACKGROUND: The surgical management of developmental dysplasia of the hip (DDH) in older children has been the subject of controversy. The purpose of this study was to evaluate the outcome in patients with neglected DDH who underwent individual procedures based on using three-dimensional computed tomography. METHODS: Forty-seven patients (59 hips) were treated using Pemberton osteotomy or Dega plus Pemberton osteotomy. Subtrochanteric transverse femoral shortening and derotation osteotomy were performed for all patients. The average age at the time of surgery was 10.5 y for group 1 (bilateral dislocation, 24 hips) and 11.2 y for group 2 (unilateral dislocation, 35 hips). Mean follow-up was 5.3 y for group 1 and 5.8 y for group 2. RESULTS: At the end of follow-up, 13 hips (54.2%) were rated excellent, eight hips (33.3%) were good, and three hips (12.5%) were fair in group 1. In group 2, 20 hips (57.1%) were rated excellent, 10 hips (28.6%) were good, and five hips (14.3%) were fair. There were five patients who had a limb length discrepancy of approximately 1.5 cm in group 2. Six hips in group 1 and seven hips in group 2 had osteonecrosis of varying severity. CONCLUSIONS: We believe that preoperation three-dimensional computed tomography evaluation, personalized operation plans, and experience with the surgical procedure are the main reasons for the satisfactory therapeutic effects achieved in this study in older children with DDH.
BACKGROUND: The surgical management of developmental dysplasia of the hip (DDH) in older children has been the subject of controversy. The purpose of this study was to evaluate the outcome in patients with neglected DDH who underwent individual procedures based on using three-dimensional computed tomography. METHODS: Forty-seven patients (59 hips) were treated using Pemberton osteotomy or Dega plus Pemberton osteotomy. Subtrochanteric transverse femoral shortening and derotation osteotomy were performed for all patients. The average age at the time of surgery was 10.5 y for group 1 (bilateral dislocation, 24 hips) and 11.2 y for group 2 (unilateral dislocation, 35 hips). Mean follow-up was 5.3 y for group 1 and 5.8 y for group 2. RESULTS: At the end of follow-up, 13 hips (54.2%) were rated excellent, eight hips (33.3%) were good, and three hips (12.5%) were fair in group 1. In group 2, 20 hips (57.1%) were rated excellent, 10 hips (28.6%) were good, and five hips (14.3%) were fair. There were five patients who had a limb length discrepancy of approximately 1.5 cm in group 2. Six hips in group 1 and seven hips in group 2 had osteonecrosis of varying severity. CONCLUSIONS: We believe that preoperation three-dimensional computed tomography evaluation, personalized operation plans, and experience with the surgical procedure are the main reasons for the satisfactory therapeutic effects achieved in this study in older children with DDH.