Treatment of developmental dysplasia of the hip with periacetabular osteotomy.

Abstract

Objective To report the preliminary results of treatment of developmental dysplasia of the hip (DDH) with periacetabular osteotomy. Methods From February 2002 to February 2008, 53 patients (55 hips) with DDH were treated with periacetabular osteotomy. 51 patients were females, 2 were males, with the average age of 25.5 years (ranged, 13 to 51 years). The hip pain period before surgery varied from 1 month to 6 years (mean 16 months). 6 patients had the history of hip surgery. The mean Wiberg CE angle was 3°(range, -20°to 15°). According to Tonnis osteoarthritis classification, there were 16 cases in grade Ⅰ, 1 in grade Ⅱ. 25 patients had Shenton's line broken. The ilioinguinal approach was used in former 13 cases. The modified Smith-Petersen approach was used in later 40 cases. Intertrachanteric varus osteotomy was done simultaneously in 6 cases. Results The mean follow-up period was 28 months (ranged, 12 to 60 months). Bone union was achieved in 3 months after surgery. The pain relieved in most of patients. The Har-ris hip score increased from 77.4 points (ranged, 68 to 87 points) preoperatively to 94.6 points (ranged, 70 to 100 points) post-operatively. The range of motion of the hip decreased 20°-60° after surgery. The mean CE angle increased to 29°(ranged, 20° to 50°) postoperatively. 5 patients had limp after surgery, mostly due to dysfunction of gluteus medius, and recovered after 6 months of exercises. 18 patients got lateral femoral cu-taneous nerve injury. Two patients suffered pelvic ring broken and healed without affecting on hip function.No complication such as infection, vascular injury, sciatic neve injury happened in this series. Conclusion Satisfactory results can be obtained through periacetabular osteotomy in young patients with DDH. Periac-etabular osteotomy can correct the acetabular deformity in multiplanar. No vascular impair in acetabular fragment. The stability of the pelvic can be reserved. Early rehabilitation is allowed after surgery. Key words: Hip dislocation; congenital; Osteotomy; Acetabulum