Acetabular development after open reduction to treat developmental dysplasia of the hip after walking age

Abstract

Objectives: Treatment of developmental dysplasia of the hip (DDH) with high hip dislocation in children using a one-stage operation appears tedious and associated with complications. This study aimed to assess a less traumatic approach for the surgical treatment of irreducible hips among children with DDH after walking age. The treatment strategy involved open reduction (OR) alone and non-invasive monitoring of acetabular development. Methods: This was a retrospective analysis of 22 hips of 20 female patients with complete dislocation of the hip and a mean age of 25.09 ± 4.6 months, performed between February 2013 and February 2018. All DDH patients underwent OR alone and had an irreversible hip dislocation. After surgery, a spica cast was applied for 6 weeks and then reduced to a broomstick cast for a considerable period. Finally, night abduction brace was placed until a normal acetabular index (AI) was obtained. The mean follow-up was 44.60 ± 12.36 months. Results: Out of 20 patients with DDH, 18 (90%) were successfully treated by OR alone. The main pre-operative AI of 41.82° ± 5.54° decreased to 16.19° ± 7.09° at the final follow-up (P < 0.001). An initial negative center-edge angle at the pre-operative stage gradually increased to a mean of 26.86° ± 6.56° during the follow-up period. Conclusion: Relatively less invasive approach adopted in this study not only obviated the need for an additional procedure but also had a favorable effect on the acetabular and hip joint development.