Dega Osteotomy Research Articles

Salter versus Dega Osteotomy in Developmental Hip Dysplasia: A Systematic Review and a Meta-Analysis

Abstract Background The early treatment of developmental hip dysplasia is our goal to achieve concentric hip reduction and normal hip anatomy and function. Many osteotomies were used to achieve our goal, the most common techniques are used for maintaining this reduction, are Dega and Salter osteotomies. For this reason we have done our systematic review and meta- analysis to figure which technique has better radiological and clinical results with less complications. Aim The aim of the work is to review the difference between Dega and Salter Osteotomy according to surgical techniques, Suitable age of each technique, Advantages and disadvantages for each technique, Final clinical and radiographic outcomes and Complications. Subject and Methods This study performed a search for all published articles that evaluated Dega or Salter osteotomy in the management of developmental dysplasia of the hip. Results From a total of 879 articles, 24 with level of evidence grade IV articles were included in our review. A total of 1212 hips cases with a mean follow up of 294.5 months were included. For Severin score, we did not find significant difference after performing both techniques regarding hips with grade 1; Salter [OR = 0. 62, (95% CI = 0.47: 0.77), I2=96.46%, P < 0.001)] and Dega [OR = 0.65, (95% CI = 0.46: 0.84), I2=92.85%, P < 0.001)]. Also the proportion of hips with grade 4 was nearly similar in both groups; Salter [OR = 0. 02, (95% CI = 0.01: 0.03), I2=0%, P = 0.51)] and Dega [OR = 0.02, (95% CI = 0.003: 0.04), I2=11.61%, P = 0.34)]. For McKay score, we did not find significant difference after performing both techniques regarding hips with excellent classification; Salter [OR = 0. 50, (95% CI = 0.28: 0.72), I2=98.1%, P < 0.001)] and Dega [OR = 0.40, (95% CI = 0.16: 0.64), I2=95.56%, P < 0.001)]. In term of hips with poor classifications both techniques performed equally; Salter [OR = 0.027, (95% CI = 0.013: 0.04), I2=0%, P = 0.67)] and Dega [OR = 0.04, (95% CI = 0.003: 0.082), I2=74.78, P = 0.001)]. Conclusion Based on the information in our publication, we believe that Salter and Dega are well-established surgical treatments for hip dysplasia with comparable efficacy. Dega demonstrates marginally superior radiological and clinical data.

Avascular necrosis after surgery of developmental dysplasia of the hip in children after walking age: incidence and risk factors

Introduction Developmental dysplasia of the hip (DDH) is a common congenital anomaly in children. It includes a spectrum of anatomic abnormalities ranging from acetabular dysplasia to frank hip dislocation. Avascular necrosis (AVN) is one of the main complications associated with the treatment of DDH. It is a devastating problem that can lead to acetabular dysplasia and joint incongruity and cause premature osteoarthritis. The study aims to evaluate the incidence and risk factors of AVN after open reduction of developmental dislocation of the hip in children after walking age. Patients and methods Between the period of April 2014 and April 2019, a retrospective cohort evaluation of DDH cases was managed by surgery in the form of open reduction and pelvic osteotomy with or without femoral shortening. All grades of Tönnis classification were included. This study included 200 cases with an age range from 1 to 7 years, and the average age is 3.5 years at the time of last follow-up. The mean follow was 2.29 years, which ranged from 1 to 4 years. Plain radiography obtained in anteroposterior and frog lateral views after 1 year follow-up to diagnosis AVN as established in the literature. Results In this study, the mean time of intervention was 2.26 ± 0.97 years with an age range from 1 to 5 years. Twenty-six (13%) cases were managed only by open reduction and capsulorrhaphy, 174 (72.5%) cases had pelvic osteotomies, either Salter or Dega osteotomy, of whom 104 had femoral shortening and derotational osteotomy (59.77%). No AVN was reported in 159 (79.5%) cases, while AVN was evident in 41 (20.5%) cases. Discussion Incidence of AVN after open reduction depend on variable factor discussed in this study with total incidence of AVN 41 (20.5%) cases. This result is similar to other studies, with the incidence of AVN ranging from 15 to 30%. In the present study, the incidence of AVN increased 17 times in cases with postoperative immobilization in the hip spica more than or equal to 60° in the form of 21 cases showed AVN. Conclusion Postoperative hip immobilization in spica less than 60° as children with postoperative hip abduction more than or equal to 60° showed an increase incidence of AVN.

Dega Osteotomy for the Treatment of Developmental Dysplasia of the Hip, a Clinical Evaluation and an Anatomic Study based on X-ray and CT Scan.

Dega osteotomy is becoming more widely used for the treatment of developmental dysplasia of the hip (DDH). A thorough description of this procedure is needed as many of the technical aspects are not fully defined. Moreover, more follow-up series are also needed to evaluate its outcomes. In this study, we gave a detailed anatomic description for this procedure and also presented our experience as a retrospective radiographic and case-note study. We examined the clinical and radiographic records of 44 patients (48 hips) with varying degrees of DDH. The average age of the patients was 2 months and 7 months while the average follow up period was 41 months. Clinical and radiographic assessment including CT with 3D reconstruction to examine the anatomic characteristics of the osteotomy were undertaken. We found that concentric reduction was achieved in 93.7% with excellent clinical and radiographic outcomes. Only 3 cases needed revision of the Dega osteotomy. The re-operation rate was 12.5%. CT scan revealed that the arcuate line was crossed by the osteotomy in the majority of cases. In 20.7% of cases, a bone cut that was intended to be a Dega osteotomy was found to have been inadvertently implemented as another osteotomy variant. However, this bore no significant effect on the outcome. We found that a well-implemented Dega osteotomy is a reliable tool to cope with the acetabular changes in DDH.

Comparative Study between Salter and Dega Osteotomy’s in the Management of Developmental Dysplasia of the Hip in Walking Age Children

Comparative Study between Salter and Dega Osteotomy’s in the Management of Developmental Dysplasia of the Hip in Walking Age Children

Comparative Study between Salter and Dega Osteotomy’s in the Management of Developmental Dysplasia of the Hip in Walking Age Children

Comparative Study between Salter and Dega Osteotomy’s in the Management of Developmental Dysplasia of the Hip in Walking Age Children

Low osteotomy cut of Dega procedure for older children with developmental dysplasia of the hip.

The effect on acetabular management in developmental dysplasia of the hip (DDH) patients aged 7 or older with modified low Dega osteotomy procedure was evaluated. Patients between 7 and 14 years old were managed with modified low Dega osteotomy and open reduction and concomitant procedures to evaluate whether low level osteotomy improved the clinical and radiologic outcomes after treatment. Clinical status was assessed using the modified McKay's criteria; radiologic evaluations were assessed for the modified Severin classification, the mean acetabular index (AI), Sharp angle and center-edge (CE) angle. And occurrence of triradiate cartilage injury and complications was recorded. Forty-two DDH patients (57 hips) between 7 and 14 years old were managed with modified low Dega osteotomy. The results demonstrated the latest follow-up 43 hips (75.4%) were rated excellent and 10 hips (17.5%) rated good according to the modified McKay criteria and 41 hips (71.9%) were rated excellent and 11 hips (19.3%) rated good according to Modified Severin classification, respectively. The mean Hip Score improved from 69.53 ± 7.14 before the operation to 93.17 ± 8.43 at the final follow-up. The mean AI changed from 31.9° to 20.2°, mean Sharp angle decreased from 59.3° to 38.8° and mean CE angle increased from -10.9° to 35.2°, preoperatively and at latest follow-up, respectively. The modified low Dega osteotomy combined with open reduction and concomitant procedures were found to be adequate in improving instant and sustained clinical and radiographic outcomes for the late detected pediatric walking DDH patients.

Are the outcomes of single-stage open reduction and Dega osteotomy the same when treating DDH in patients younger than 8 years old? A prospective cohort study

BackgroundThe primary objective was to report our early results after a one-stage procedure [open reduction (OR), Dega pelvic osteotomy (DPO), and femoral osteotomy (FO) when needed] for surgical management of a cohort of patients with developmental dysplasia of the hip (DDH). The secondary objective was to compare the functional, radiological, and complications among patients younger and older than 30 months.Materials and methodsThis prospective cohort study included 71 hips with DDH in 61 patients with a mean age of 34.3 ± 19.5 months. All patients underwent one-stage surgical procedures, including OR + DPO and FO, if needed. Functional and radiographic assessment at the last follow-up was conducted using the modified Severin grading system and the Severin classification system, respectively, in addition to assessing the acetabular index (AI), osteotomies healing, and presence of complications. We divided patients into two groups, younger than 30 months (group I) and older than 30 months (group II).ResultsWe included 35 hips in group I and 36 in group II. All hips received OR + DPO, while 25 (69.4%) hips in group II had FO. The operative time was significantly longer in group II (103.19 ± 20.74 versus 72.43 ± 11.59 min, p < 0.001). After a mean follow up of 21.3 ± 2.3 months, the functional outcomes were satisfactory in 62 (87.3%) hips (94.3% in group I and 80.6% in group II, p = 0.35). There was a significant improvement in the AI in all patients compared with preoperative values (27.2° ± 2.9 versus 37° ± 4.2, p < 0.05). Furthermore, 63 (88.7%) hips had satisfactory radiographic outcomes (94.3% in group I and 83.3% in group II, p = 0.26), and all osteotomies showed radiographic healing. The overall complications incidence was significantly lower in group I compared with group II (5.7% versus 30.6%, p < 0.05), and avascular necrosis occurred in 4 (5.6%) hips, all in group II (p = 0.06).ConclusionOne-stage procedure entailing open reduction, Dega pelvic osteotomy, and femoral osteotomy when needed for managing DDH in patients younger than eight years old revealed acceptable clinical and radiological outcomes. However, there was a higher need for a concomitant femoral osteotomy in patients older than 2.5 years, and complications were more frequent.Level of evidence III

Léčení dislokované kyčle u DMO extraartikulární intervencí

PURPOSE OF THE STUDY Hip dislocation is one of the major causes of disability in children with cerebral palsy (CP). Surgical treatment can be achieved using different techniques including proximal femoral varus derotation osteotomy (FVDRO), pelvic osteotomies, and open hip reduction (OHR). However, we claim that pathologies originating from extraarticular structures in the dislocated hip in CP can be reconstructed by extraarticular methods and OHR may not always be necessary. Therefore, this study aims to discuss the results of hip reconstruction with extraarticular intervention in patients with CP. MATERIAL AND METHODS In total, 141 hips (95 patients) were included in the study. All patients underwent FVDRO, either with or without a Dega osteotomy. Changes in the Acetabular Index (AI), Migration Index (MI), neck-shaft angle (NSA), and center-edge angle (CEA) were assessed on the preoperative, postoperative, and final follow-up anterior-posterior radiographs of the pelvis. RESULTS Median age was 8 years (range between 4-18 years). The average follow-up duration was 5 years (range between 2-9 years). Changes in AI, MI, NSA and CEA values were statistically significant for postop and follow-up periods when compared to preoperative values. Of the 141 operated hips, 8 (5.6%) hips required revision surgery due to redislocation/resubluxation detected at the follow-ups, and unilateral operation can be accepted as a risk factor for redislocation. CONCLUSIONS Our results demonstrate that reconstructive treatment consisting of FVDRO, medial capsulotomy (in the case of reduction difficulty) and transiliac osteotomy (in the case of acetabular dysplasia) provides satisfactory outcomes in hip dislocation in CP. Key words: hip displacement, cerebral palsy, hip reduction.

THE BIOMECHANICAL ANALYSIS OF PELVIC OSTEOTOMIES APPLIED FOR DDH TREATMENT IN PEDIATRIC PATIENTS.

The aim: This article aimed to evaluate biomechanical changes during the most commonly used pelvic osteotomies (Salter, Dega, Pemberton) for DDH treatment in pediatric patients. Materials and methods: Virtual pelvic models of 2- and 6-years old patients were created, material properties were assigned, pelvic osteotomies were simulated and biomechanical changes were evaluated using finite element analysis (FEA). Results: It was revealed that the patient's age impacts pelvic bones and cartilage density (in younger patients the pelvic elements are more pliable - p<0.05). Stress distribution after each of the abovementioned pelvic osteotomy was assessed in 2- and 6-year-old patients' pelvic models. The new term "restriction point" was introduced, which means a place where restriction of acetabular deformity correction occurs. Conclusions: It was found that there are no purely reshaping and reorientation pelvic osteotomies as previously believed; the pelvic ring acts as a unit in carrying out the applied load. Biomechanical overload of triradiate cartilage during Salter osteotomy in 2-year-old patients and in 2- and 6-year-old patients during Pemberton osteotomy was revealed; overload of the posterior cortical layer in the greater sciatic notch in 2-years old patient during Dega osteotomy was revealed.

The significance of the Dega osteotomy.

Wiktor Dega has significantly impacted contemporary pediatric orthopedics by developing transiliac osteotomy - Dega's pelvic osteotomy. The global implementation of the surgery technique gained dynamism in the 2000s after being published by Ward and Grudziak. Since then, derivative operative techniques called Dega, Dega-like or Dega family osteotomies have been developed. We analyzed the original articles published by Dega between 1929 and 1974 concerning transiliac osteotomy technique development and articles about its derivatives. The epidemiological significance of developmental hip dysplasia focused Wiktor Dega's attention in the 1920s. At that time, he treated patients according to König's idea of acetabular roof plastic surgery. The osteotomy depth gradually increased, which allowed deeper graft placement to perform what we nowadays call acetabuloplasty. In 1958, Dega coined the name 'supraacetabular semicircular osteotomy'. It differed from the final concept of the transiliac osteotomy by not assuming the cut of the inner cortex of the iliac bone. The hinge for the acetabular rotation was located at the inner cortex's whole length, disallowing the excessive redirection. The final concept of osteotomy allows for simultaneous acetabuloplasty and redirection to change the shape, location and acetabular volume. Dega derivatives are Mubarak (San Diego) and high Dega osteotomies. Dega osteotomy and its derivates are routinely implemented to treat developmental hip dysplasia and spastic hip disorders. It might be considered an option in Legg-Calve-Perthes disease, congenital deficiencies, and flaccid hip displacement in neurological conditions.

Sacral-Alar-Iliac (SAI) Fixation in Patients With Previous Pelvic Osteotomy.

This was a retrospective study. The purpose of this study was to investigate the technical challenges and outcomes of sacral-alar-iliac (SAI) fixation for scoliosis in patients who had previously undergone a pelvic osteotomy for hip dysplasia. Patients with neuromuscular disease are at high risk for developing hip dislocation and scoliosis. Surgical correction of one may affect the other. We reviewed the records of patients aged 18 years and below who underwent spinal fusion using SAI screws after having undergone a pelvic osteotomy, with ≥2-year follow-up. We recorded the SAI screw dimensions, time from osteotomy to SAI fixation, type of osteotomy, and any complications performing SAI fixation due to the pelvic osteotomy. Bivariate statistics were used to analyze the data with statistical significance defined as P -value <0.05. Thirty-two patients were included. The average age was 10.3±3.2 years at pelvic osteotomy and 13.5±3.4 years at SAI fixation. Most patients had cerebral palsy (87.5%) and a unilateral Dega osteotomy (78.1%). Average screw dimensions were significantly shorter on the side of the osteotomy (66 vs. 72 mm, P <0.05). SAI screw placement was technically challenging in 8 patients (25%), due to pelvic distortion from the pelvic osteotomy. The use of a curved awl helped to find the intracortical channel. No patients had complications due to the SAI screw, and there were no significant differences in pelvic obliquity and major coronal curve correction. Two patients (6.3%) had screw lucency >2 mm around the SAI screw on the side of the pelvic osteotomy but no clinical symptoms. SAI fixation in patients with previous pelvic osteotomy is technically challenging due to pelvic morphology and prior implants. Often, a shorter SAI screw is required on the side of the osteotomy. However, outcomes in this patient population are satisfactory, with no significant complications at a 2-year follow-up. Level IV.

The Dega Osteotomy in the Treatment of Developmental and Neuromuscular Hip Pathology. Is it a Versatile Osteotomy?

The Dega Osteotomy in the Treatment of Developmental and Neuromuscular Hip Pathology. Is it a Versatile Osteotomy?

The unstable hip in children with cerebral palsy: does an acetabuloplasty add midterm stability?

PurposeThis study addresses whether an additional pelvic procedure is superior to a varus derotation osteotomy femur (VDRO) alone in unstable hips in children with cerebral palsy (CP).MethodsAll patients had unstable hips utilising the Melbourne Cerebral Palsy Hip Classification System (MCPHCS). We compared one group that underwent VDRO alone with one that had a combination of VDRO and Dega osteotomy (VDRO+). Measurements were taken before surgery, postoperatively, two years after surgery and at latest follow-up. Generalised estimating equations were used to account for known and unknown correlations between hips from bilateral cases.ResultsIn total, 74 hips in 57 children fulfilled the inclusion criteria. There was no outcome difference between Gross Motor Function Classification System levels III, IV and V. Age at time of operation ranged from three to 16 years (mean 9.8 years). Mean follow-up was 49.1 months. In the VDRO group (28 hips) migration percentage (MP) changed from 61% preoperative to a final value of 35.7%. In the VDRO+ group (46 hips) the MP changed from 64.4% to 19.3%. At final follow-up 15 hips (54%) were stable in the VDRO group, 37 hips (83%) in the VDRO+ group. The odds ratio (OR) of hip stability at final follow-up was 3.5-times higher in the VDRO+ group versus the VDRO group (OR = 3.9; 95% confidence interval = 1.5 to 9.7; p = 0.004).ConclusionReconstruction of unstable hips via VDRO + Dega in children with CP provides a higher likelihood of long-term stability than an isolated VDRO.Level of EvidenceLevel III, retrospective comparative study

Is capsulorrhaphy a necessary step during open reduction of developmental dysplasia of the hip? A randomized controlled trial.

To investigate the necessity of performing capsulorrhaphy during open reduction of DDH. A single-centre, prospective,randomized controlled trial was conducted between 2015 and 2020. The study included 82 hips in 67 patients with developmental dysplasia of the hip (DDH) who were treated with open reduction via the anterior approach. Patients were randomized into two equal groups (41 hips in each group); group A (capsulorrhaphy was done) and group B (capsulorrhaphy was not done). Dega osteotomy was performed in all cases, while femoral derotation shortening osteotomy was performed only in four hips in group A and four hips in group B. The mean age at the time of surgery was 33 ± 22.3months. The follow-up period was 24months for all patients. At the final follow-up, maintenance of reduction was chosen as the primary outcome and was assessed radiologically by the Severin's grading system. Secondary outcome measures were functional evaluation (by using the modified McKay's criteria), Shenton line assessment, acetabular index measurement, and complications. According to the Severin's grading system, concentric reduction was achieved in 36 hips in group A and 37 hips in group B, subluxation occurred in three hips in each group, and redislocation was encountered in two hips in group A and one hip in group B. There was no statistically significant difference between both groups (p-value = 0.239). According to the modified McKay's criteria, the results were satisfactory (excellent and good) in 34 hips (82.9%) in group A and 36 hips (87.8%) in group B. The difference was statistically insignificant (p-value = 0.352). The rate of complications was higher in group A (17.1%) than group B (12.2%) (p-value = 0.532). The stability of the hip joint after open reduction depends mainly on adequate removal of soft tissue obstacles that impede reduction and proper correction of the bony configuration of the hip using pelvic and/or femoral osteotomy. So, the authors believe that capsulorrhaphy is not necessary in the surgical management of DDH, provided that adequate soft tissue and bony gestures are combined.

Simulation of pelvic osteotomies applied for DDH treatment in pediatric patients using piglet models.

Developmental dysplasia of the hip (DDH) is a common hip joint pathology seen in the pediatric orthopedist's practice. Pelvic osteotomies are the reliable surgical option for DDH treatment in walking patients, and 3 osteotomies (Salter, Dega and Pemberton) are widely used in patients under 6 years of age. Plastic changes in hinge points occur during iliac fragment movement, after the performed osteotomy. The locations of these points are described in the literature, but some debate still exists about their true positions. To reveal hinge point locations during a simulation of pelvic osteotomies on biological models. Eighteen piglet pelvis complexes were obtained and separated according to their age. Pelvic osteotomies were simulated, and bone changes were assessed on computed tomography (CT) scans after the performed surgeries. No bone changes were found after Salter osteotomy in younger piglets, while contralateral pubic bone metaphyseal fractures were found in older animals. After Pemberton osteotomy, greenstick fractures in iliac and pubic bones metaphyses in the triradiate cartilage area were revealed in younger and older piglets. After Dega osteotomy, a posterior medial cortical layer fracture of the uncut iliac bone in the greater sciatic notch was found in all piglets. In older piglets, an additional hinge point was detected in the ipsilateral pubic bone metaphysis. It was found that the age of the piglets has an impact on hinge point number and location, and this may be explained by an age-related decrease in pelvic bone and cartilage plasticity. The results of this study may help surgeons to decrease the number of preventable complications during pelvic osteotomies.

Evaluation of high cut Dega osteotomy for management of developmental hip dysplasia in children

Background: Developmental dysplasia of the hip (DDH) is a spectrum of pathologic changes affect the developing hip. Dega acetabuloplasty is considered one of the favorable reshaping procedures and it is most valuable in severe dysplasia without need for internal fixation. High cut Dega osteotomy is a modification for the typical Dega procedure by making the osteotomy at a higher level close to salter osteotomy. So, it facilitates the basic Dega procedure and produces a Salter-like effect. Objectives: to evaluate theclinical and radiological outcomes of the management of DDH by high cut Dega osteotomy. Patients and Methods: This prospective study included 20 patients with 25 involved hips who presented with DDH between walking age and under 3 years of age, High cut Dega osteotomy were conducted in 13 patients in Abo-Elreesh-Hospital and 7 patients in Qena University Hospital between March 2017 and March 2021. Clinical status was assessed using modified McKay criteria; radiological evaluations were assessed using the modified Severinclassification, the mean acetabular index (AI),and centeredge (CE) angles. Results: The final clinical resultswere satisfactory in 24 hips (96%) and unsatisfactory in one (4%), there was a statistically significant improvement in acetabular index and center edge at the final follow up. Conclusions: Our modified technique gives similar results to the Dega procedure but avoid iatrogenic insults to the acetabulum and rare early closure of the triradiated cartilage, which might lead to acetabular dysplasia.

Acetabular volume and femoral coverage change following Dega-like osteotomy in treatment of developmental dysplasia of the hip.

Although Dega's acetabuloplasty has become a commonly used osteotomy, there is still an ongoing debate regarding its impact on the volume and depth of the acetabulum. The purpose of our study was to assess the postoperative images of the transverse acetabular plane and version obtained from developmental dysplasia of the hip (DDH) patients after a modified Dega osteotomy. We performed a retrospective study of the morphologic indices obtained from the pelvic X-rays and computer tomography (CT) scans of patients with DDH, who were operated in our institution between July 2005 and October 2013, using the modified Dega osteotomy. Preoperative and postoperative pelvic X-rays were used to measure the acetabular index and the acetabular (ACM) angle. The postoperative CT scans were used to measure the acetabular anteversion angle (AAA), acetabular depth and depth of acetabular coverage [total acetabular index (TAI)]. The contralateral unaffected hips served as control. The postoperative acetabular indices and ACMs showed a significant improvement, with near-normal values measured 1 year after the surgery. Comparing the CT scan parameters (AAA, TAI and the depth of acetabulum) showed that TAI and the depth of acetabulum were not significantly different between the groups (TAI: P = 0.423; depth of acetabulum: P = 0.132), whereas AAA comparison implied a slight advantage of the DDH hips (17.6° DDH vs. 13.3° contralateral, P = 0.001). On the basis of images set of acetabular morphometric parameters, our study substantiates previous reports on an increase of acetabular volume and a significant improvement of femoral head coverage for patients with DDH who underwent Dega acetabuloplasty. Level of evidence: Level III - retrospective comparative study.

A short-term magnetic resonance imaging analysis of acetabular adaptation in developmental dysplasia of the hip by open reduction or open reduction combined with Dega osteotomy.

A short-term magnetic resonance imaging analysis of acetabular adaptation in developmental dysplasia of the hip by open reduction or open reduction combined with Dega osteotomy.

Open reduction, Dega osteotomy and proximal femoral osteotomy in delayed diagnosis of developmental hip dislocation: outcome at 40-year follow-up.

PurposeLate-diagnosed dislocated hips underwent open reduction, Dega osteotomy, and proximal femoral osteotomy between 1968 and 1988. The objectives of this study are to assess the survival of hips into adulthood, clinical and radiological outcome, patients’ life perspectives and the risk factors of failure.MethodsAn assessment of 67 hips treated when younger than five years (<age 5yr. group) and 71 hips in the group aged older than five years (+age 5yr.) was performed. All cases were evaluated clinically and radiographically, and survival was assessed, considering hip replacement as endpoints for failure (abbreviation HR+ refers to hips that underwent hip replacement surgery; HR- refers to hips that have not been replaced at the follow-up). The fertility rate and the social security disability benefits (SSDB) recipiency percentage were calculated.ResultsThe 40-year survival rates were 73% (95% confidence (CI) 71% to 76%) in the <age 5yr. group, 54% (95% CI 51% to 57%) in the +age 5yr. group, 70% (95% CI 67% to 73%) in one-sided dislocations and 57% (95% CI 54% to 60%) in bilateral dislocations. At follow-up, the median Harris hip and Western Ontario and McMaster Universities Osteoarthritis scores were 90.0 and 13.0 (<age 5yr. group, HR-), 74.0 and 28.0 (+age 5yr. group, HR-), 90.0 and 16.0 (<age 5yr. group, HR+) and 84.5 and 11.5 (+age 5yr. group, HR+), respectively. The operation normalized the radiological parameters. The correlation between the grade of femoral head avascular necrosis (AVN) at a median 2.6 years after the operation and the grade of osteoarthritis at follow-up was 0.38 (p < 0.001). The fertility rate was 1.54. In total, 16.0% (aged under five years) and 38.5% (aged over five years) of patients were receiving SSDB (p = 0.003).ConclusionEarly failure risk factors are older age at the surgical procedure, high AVN grade and bilateral hip involvement. Still, the results facilitate hip reposition whenever technically manageable, even in teenagers.Level of evidenceIII

Blood Loss and Related Laboratory Changes after Single-Event Multilevel Surgery and Hip Reconstructive Surgery in Patients with Cerebral Palsy.

BackgroudSingle-event multilevel surgery (SEMLS) and hip reconstructive surgery (HRS) often cause intraoperative bleeding, consequently increasing the probability of transfusion and postoperative laboratory changes. Therefore, it is important to assess risk factors to predict the amount of blood loss. This study aimed to evaluate blood loss, its influencing factors, and the related laboratory changes during SEMLS and HRS in patients with cerebral palsy (CP).MethodsWe retrospectively examined consecutive CP patients who underwent SEMLS and HRS. Surrogate markers of blood loss, including preoperative and postoperative hemoglobin (Hb), hematocrit, and changes in Hb concentration, were assessed. Albumin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and creatine levels were also analyzed for related laboratory changes. Risk factors were analyzed using multiple regression and logistic regression models.ResultsThe overall cohort comprised 1,188 patients. Of them, 1,007 and 181 underwent SEMLS and HRS, respectively. Furthermore, 72 of 181 patients underwent a concomitant Dega osteotomy. The regression model showed that low preoperative Hb concentration (p < 0.001), high albumin level (p = 0.007), low body mass index (BMI) (p = 0.002), and bilateral HRS (p < 0.001) were significant risk factors of postoperative anemia. Valproate medication was associated with Hb drop, and the risk factors for Hb level < 8 g/dL on postoperative day 2 were bilateral HRS and Dega osteotomy in the HRS subgroup. In total, 21.6% had elevated AST levels on postoperative day 2, and bilateral HRS (p < 0.001), Gross Motor Function Classification System (GMFCS) level V (p = 0.041), Dega osteotomy (p < 0.001), and high preoperative AST level (p < 0.001) increased the risk of AST elevation.ConclusionsWe have summarized the estimated blood loss and related laboratory changes after SEMLS and HRS in patients with CP and identified the risk factors. Clinical guidelines should be accordingly developed to include assessment of these risk factors and their impact in the outcomes of CP patients undergoing SEMLS and HRS.