Pelvic osteotomies for DDH treatment in pediatric patients: assessment of risk factors.

Abstract

Developmental Dysplasia of the Hip (DDH) is the common hip pathology in pediatric orthopedist’s practice. Without treatment, DDH leads to early-onset hip arthritis. In non-walking patients, excellent results may be achieved with non-surgical treatment, but in walking patients, surgical treatment is considered usually. Among all surgical options, applications of pelvic osteotomies give predictably better results. Few pelvic osteotomies (Salter, Dega, and Pemberton osteotomies) are widely used for DDH treatment in pediatric patients, but a better one hasn’t been determined. Suggested risk factors that may lead to unsatisfactory results are the patient's age and the preoperative acetabular deformity’s degree. Avascular necrosis (AVN) of the femoral head is the commonest and most harmful complication. It is supposed that adding the proximal femoral shortening osteotomy may decrease it. This systematic review aimed to 1) to reveal the better one pelvic osteotomy in terms of results; 2) to establish the impact of patient’s age and preoperative acetabular deformity’s degree on results after the abovementioned pelvic osteotomies; 3) to reveal the impact of additional proximal femoral shortening osteotomy on postoperative AVN rate. Methods: 51 articles were selected for analysis; patient information was extracted from these articles; statistical processing of these data was performed. Results: in terms of postoperative results, better one pelvic osteotomy wasn't determined; older patient’s age (older than 3-4 years old) may lead to worse results after Salter and Dega osteotomies; larger preoperative acetabular deformity’s degree may lead to worse results after Pemberton osteotomy; the impact of additional proximal femoral shortening osteotomy on postoperative AVN rate exists but is low and statistically insignificant. Level of Evidence – Level III, therapeutic study.