Abstract

PurposeThe anterior and medial approaches in open reduction for developmental dysplasia of the hip (DDH) had been widely used. The former could not directly approach the intra-articular interposition, while the latter had been associated with injury to blood vessel and avascular necrosis (AVN) of the femoral head. Meanwhile, the bikini incision had also been mentioned in some studies. The purpose of this study was to introduce a modified anterior approach through a mini-bikini incision and report its short-term outcomes.MethodsData of DDH patients younger than 2 years at the time of surgery who had received this mini-bikini incision between June 2013 and December 2018 were collected. The surgical technique, operation duration, intraoperative blood loss, and length of incision were recorded in detail. In the latest follow up, the objective measurement of the scar and the subjective feeling towards the scar were collected. X-ray and magnetic resonance imaging (MRI) were performed at the last follow-up, and the incidence of residual dysplasia, redislocation, and femoral head AVN was analyzed.ResultsForty-three cases (49 hips) were included with an averaged follow-up of 43 months. The operation duration was 22 min, and the blood loss was 9.8 ml on average. The length of the scar averaged 2.6 cm. The mean University of North Carolina “4P” scar scale (UNC4P) for the scar was 0.92, and no patients complained numbness. Overall, all the parents were satisfied with the cosmetic appearance. The mean acetabular index (AI) was 27.42° ± 6.41° in dislocated hip in the last follow-up. One hip redislocated soon after the operation and was reduced in a closed manner right away. MRI showed improved coverage but still some residual dysplasia that was in accordance with the post-operative recovery nature. Four hips (8%) had signs of AVN in X-ray.ConclusionOpen reduction through the anterior approach with the mini-bikini incision was a safe procedure with comparable outcomes to classical approaches. It would be a complementary approach for DDH patients younger than 2 years old who need an open reduction.

Highlights

  • Developmental dysplasia of the hip refers to a spectrum of hip deformities, ranging from mild dysplasia to frank dislocation

  • magnetic resonance imaging (MRI) showed improved coverage but still some residual dysplasia that was in accordance with the post-operative recovery nature

  • The Bowen’s criteria were as follows: (1) the corner of the proximal femoral metaphysis was located inferior to the Hilgenreiner line, (2) the medialization ratio was greater than two thirds of the horizontal radius of the femoral head, and (3) the femoral head should maintain under the hypertrophic labrum [16]

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Summary

Introduction

Developmental dysplasia of the hip refers to a spectrum of hip deformities, ranging from mild dysplasia to frank dislocation. In early-presenting infants, a Pavlik harness may solve the problem [1, 2]. For those who failed the treatment or the early diagnosis, closed reduction (CR) or open reduction (OR) might be necessary within 24 months of age [3,4,5,6]. In order to address these concerns, some surgeons adopted the bikini incision and performed the SmithPeterson (SP) approach underneath [14, 15]. This had been reported to achieve comparable outcome with, if no better than, the traditional approaches

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