The high osteotomy cut of Dega procedure for developmental dysplasia of the hip in children under 6years of age.

Abstract

Dega osteotomy has gained popularity for the acetabular reconstruction of developmental dysplasia of the hip (DDH). Ahigh-level Dega osteotomy combining the typical Dega procedure with an age limit of under 6years and the higher pelvic cut height of the Salter osteotomy for walking DDH patients aged 6or younger was advocated in our department. The purpose of this retrospective study is to introduce this modified Dega procedure and report the preliminary clinical and radiological results in DDH patients under 6. From September2000 to September2010, atotal of 162patients with 191 dysplastic hips between 1.5 and 6years old were managed with this high-level Dega osteotomy. From each patient's record, clinical status was retrospectively assessed using modified McKay criteria; radiological evaluations were assessed according to the modified Severin classification, the mean acetabular index (AI), Sharp angle and center-edge (CE) angle. Any occurrence of complications was recorded postoperatively. The average age at surgery was 3.6 years (range 1.5 to 6.0), mean duration of follow-up 11.3 years (range 5.0 to 16.9). The latest follow-up fineness (favorable and good) rate in clinical and radiological evaluations was 92.7 % and 91.1 % respectively. There was amarked trend toward normalization of radiographic indices during the follow-up period: the mean AI changed from 38.0° to 20.8°, the mean Sharp's angle decreased from 59.9° to 39.2°, and the mean CE angle increased from -10.7° to 29.4°, preoperatively and at the latest follow-up respectively. No major complications were recorded during follow-up. The high osteotomy cut Dega procedure for patients between 1.5 and 6years of age was found to be sufficient for improving clinical and radiographic outcomes and inducing little morbidity and few complications for late-detected pediatric walking DDH patients.