Does Adductor Tenotomy Need During Closed Reduction Have a Prognostic Value in the Treatment of Developmental Dysplasia of the Hip Between 6 and 12Months of Age? "Adductor Tenotomy in the Treatment of Developmental Dysplasia''.

Abstract

Adductor tenotomy is needed for clinically complex hips with soft-tissue contractures. It may be proposed that the patients who need adductor tenotomy during closed reduction would have poorer prognosis than the ones without need for adductor tenotomy. The main purposes were to compare the normalization of acetabular index angle (AI), to determine the incidence of femoral head avascular necrosis (AVN), and to predict the need for any secondary surgical intervention between the patients who need adductor tenotomy and those who do not during closed reduction for developmental dysplasia of the hip. The study group consisted of 65 hips treated between 6 and 12months of age. The mean age at the time of surgery was 8.1 ± 1.4 (6-12) months and the mean follow-up was 4.2 ± 1.5years. Improvement of AI, rate and severity of AVN, and need for secondary surgery with its predictors were evaluated. Adductor tenotomy was performed in 22 hips (Group 1), but not in 43 hips (Group 2). Normalization of the AI was - 14.8° ± 3.5° versus - 14.3° ± 3.2°. The overall incidence of AVN was 18.4%. The rate of secondary surgical intervention was higher in Group 1 (63.1% versus 36.9%) (p = 0.014). No significant difference was detected regarding the improvement of AI as well as the incidence of AVN between the groups. The need for adductor tenotomy during closed reduction was one of the main predictors of the possible secondary surgery.