Bilateral developmental dysplasia of the hip: setting an upper age limit for open reduction

Abstract

Background Salter innominate osteotomy and Dega acetabuloplasty are considered as two of the most commonly used osteotomies for the management of developmental dysplasia of the hip (DDH) in walking children. Bilateral DDH patients add to the complexity of the problem. There is a worldwide debate about the upper age limit for open reduction, especially in bilateral cases. This study was designed as a trial to set an upper age limit for reduction of bilateral DDH hips, and to show the results of management of such cases using the two main osteotomies at an academic supervised referral university hospital. Patients and methods A total of 58 hips in 29 bilateral DDH cases were managed by a team of orthopedic surgeons. The cases were grouped into a Salter and a Dega group and were followed up for a mean of 10 ± 9 years. The same surgeons operated both sides in each case using the same osteotomy to limit the variables. The cases were evaluated clinically and radiographically. Results Radiographic and clinical evaluations were compared during and at the final follow-up visit. Favorable end results were found in 69% of cases (75% Dega and 66.6% Salter). Nevertheless, there were major complications encountered, including redislocation, avascular necrosis, pain, limb-length discrepancy (LLD), and the need for another surgery during the follow-up period. Conclusion Both Salter and Dega osteotomies provided good clinical and radiographic results when a good preoperative assessment and skillful open reduction performed by an experienced surgeon was executed. However, more complications and unfavorable results are expected despite all precautious if performed in children older than 6 years. Level of evidence: IV.