Treatment strategy and clinical outcome of developmental dislocation of the hip in children above 8 years old

Abstract

Objective To investigate the treatment and clinical outcomes in developmental dislocation of the hip in children above 8 years old. Methods We retrospectively reviewed the results of operation treatment for developmental dislocation of the hip in 94 children （112 hips） from 2006 to 2012. The age of the patients ranged from 8.2 to 13.6 years at the time of treatment, with an average age 9.8 years. In 94 patients, there are 18 males and 76 females. The patients were classified into three group based on the age at time of operation： Group 8-9 years old, Group 10-11 years old, Group 12-13 years old. The dislocation of hip was classified by Tonnis classification system： grade Ⅱ 34 hips, grade Ⅲ 29 hips, grade 1V 49 hips. Surgery was performed in all the patients. The procedures consisted of open reduction of the hip, capsulorraphy, shortening and derotational osteotomy of proximal femur, and acetabular osteotomy which include Pemberton osteotomy （66 hips）, Salter osteotomy （30 hips）, Ganz osteotomy （3 hips）, Triple osteotomy （5 hips） and Chiari osteotomy （8 hips）. McKay and Severin modified criteria were used to assess the function and radiographic results of the hip. Results The average follow-up was 2.3 years ranged from 1 to 7 years. According to McKay modified criteria at final follow-up, 75 hips （67%） had excellent （22 hips） and good （53 hips） clinical results, 32 hips （29%） were fair and 5 hips （4%） were poor. According to the Severin criteria, the outcomes of Tonnis grade IV group was significantly worse than Tonnis grade Ⅱ, Ⅲ group. There is no significant differences between Tonnis Ⅱ and m type groups. If the patients were classified by age at time of operation, the function of group 8-9 years old was significantly better than others group according to the McKay criteria; the group 12-13 years old was significantly worse than others group according to Severin criteria. Conclu- sion Open reduction with proximal femoral osteotomy and aeetabular osteotomy was an effective procedure for the treatment of developmental dislocation of the hip in children above 8 years old. The surgical results were related to the age at time of treatment and Tonnis classification system; low dislocation （TSnnis Ⅱ, Ⅲ） and young age （younger than 10 years old） had better function and radiographic results compared with high dislocation （Tonnis Ⅳ） and elder age group. Key words: Hip dislocation, congenital; Child; Osteotomy