Abstract

The surgical management of neglected developmental dysplasia of the hip (DDH) in walking children has always been a challenge to orthopedic surgeons. The aim of this study was to evaluate the short- to middle-term clinical and radiographic results of the management of DDH. Patients less than 6years old using two of the most commonly used osteotomies, namely, Salter innominate osteotomy and the Dega acetabuloplasty. Special attention was paid to acetabular remodeling after concentric reduction, which was monitored by the acetabular index, that, in turn, was measured preoperatively, immediately postoperatively, every 6months, and at the final follow-up examination. The final overall clinical end results were favorable (excellent or good) in 93 hips (85.3%). There was a marked improvement of the acetabular coverage during the follow-up period, which proved the good remodeling potential of the acetabulum for this particular age group after concentric reduction was achieved and maintained. Both osteotomy types were found to be adequate for the management of neglected walking DDH patients under the age of 6years.

Highlights

  • The surgical management of neglected developmental dysplasia of the hip (DDH) in walking children has always been a challenge to orthopedic surgeons

  • Special attention was paid to acetabular remodeling after concentric reduction, which was monitored by the acetabular index, that, in turn, was measured preoperatively, immediately postoperatively, every 6 months, and at the final follow-up examination

  • There was a marked improvement of the acetabular coverage during the follow-up period, which proved the good remodeling potential of the acetabulum for this particular age group after concentric reduction was achieved and maintained

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Summary

Introduction

The surgical management of neglected developmental dysplasia of the hip (DDH) in walking children has always been a challenge to orthopedic surgeons. Developmental dysplasia of the hip (DDH) is a wide spectrum of anomalies that ranges from mild acetabular dysplasia to high-riding dislocations. Salter [2], back in 1961, described one of the most commonly used osteotomies. We found a growing interest in the iliac osteotomy described by Dega in Poland in 1969 [3], as an acetabuloplasty that changes the acetabular configuration and its inclination. This study was designed to evaluate acetabular remodeling after the use of both osteotomies in walking DDH patients with high dislocation grades (Tonnis grades III and IV), under the age of 6 years

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