A study on the complications of surgical treatment for bilateral developmental dysplasia of the hip and a comparison of two osteotomy techniques.

Naci Ezirmik,Kadri Yildiz

doi:10.5152/eajm.2011.38

Abstract

This study aims to present a review about complications of surgical treatment of Developmental Dysplasia of the Hip and comparing the kinds and ratios of two osteotomy technique (Salter Innominate Osteotomy and Pemberton Pericapsular Osteotomy). Fifty-seven patients of 126 that had bilateral developmental dysplasia of the hip are the case series that had undewent to Salter Innominate Osteotomy for one hip and Pemberton Pericapsular Osteotomy for other hip by one surgeon in one stage. Avascular Necrosis ratio was 19.29% on hips with Salter Innominate Osteotomy, and 8.77% on hips with Pemberton Pericapsular Osteotomy. Salter Innominate Osteotomy made lower limb discrepency with 0.47 cm mean in all patients. There were 17 general complications on hips with Salter Innominate Osteotomy (SIO) (14.91%) and 9 general complications on hip with Pemberton Pericapsular Osteotomy (PPO) (7.89%). As looking for general complications, SIO/PPO ratio were 1.8 (17/9). By the comparing two osteotomy technique for complication ratios, SIO had two-fold of complications than PPO. SIO had 65% more complications as to PPO.

Highlights

Complications that can accompany surgical treatment of developmental dysplasia of the hip (DDH) include subluxation-redislocation, K-wire migration, implant loss, avascular necrosis (AVN) of the femoral head, lower limb discrepancy, infection, joint stiffness, malunion or nonunion of the osteotomy line, graft problems, lateralization defects of the femoral head, and sciatic nerve damage.Complications of Salter innominate osteotomy (SIO) include early postoperative complications, sciatic nerve damage, K-wire migration, K-wire luxation/breakage, medial displacement of the distal fragment, resubluxation/redislocation, correction loss by graft breakage, supracondylar femoral fracture, and avascular necrosis of the femoral head
One-stage procedures were applied by a single surgeon, Salter innominate osteotomy for one hip and Pemberton pericapsular osteotomy for the other hip
Lower limb discrepancy, which entails a risk for pelvic biomechanics, was found to be absent from 4 patients

Summary

Introduction

Complications that can accompany surgical treatment of developmental dysplasia of the hip (DDH) include subluxation-redislocation, K-wire migration, implant loss, avascular necrosis (AVN) of the femoral head, lower limb discrepancy, infection, joint stiffness, malunion or nonunion of the osteotomy line, graft problems, lateralization defects of the femoral head, and sciatic nerve damage. Complications of Salter innominate osteotomy (SIO) include early postoperative complications, sciatic nerve damage, K-wire migration, K-wire luxation/breakage, medial displacement of the distal fragment, resubluxation/redislocation, correction loss by graft breakage, supracondylar femoral fracture, and avascular necrosis of the femoral head. Lower limb discrepancy can be observed especially with unilateral DDH. Complications of Pemberton pericapsular osteotomy (PPO) include avascular necrosis of the femoral head, early closing of Y cartilage, and damage to the ephysial center

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Discussion

Conclusion