Surgical Treatment Of Developmental Dysplasia Research Articles

Robot-Assisted Augmented Reality (AR)-Guided Surgical Navigation for Periacetabular Osteotomy.

Periacetabular osteotomy (PAO) is an effective approach for the surgical treatment of developmental dysplasia of the hip (DDH). However, due to the complex anatomical structure around the hip joint and the limited field of view (FoV) during the surgery, it is challenging for surgeons to perform a PAO surgery. To solve this challenge, we propose a robot-assisted, augmented reality (AR)-guided surgical navigation system for PAO. The system mainly consists of a robot arm, an optical tracker, and a Microsoft HoloLens 2 headset, which is a state-of-the-art (SOTA) optical see-through (OST) head-mounted display (HMD). For AR guidance, we propose an optical marker-based AR registration method to estimate a transformation from the optical tracker coordinate system (COS) to the virtual space COS such that the virtual models can be superimposed on the corresponding physical counterparts. Furthermore, to guide the osteotomy, the developed system automatically aligns a bone saw with osteotomy planes planned in preoperative images. Then, it provides surgeons with not only virtual constraints to restrict movement of the bone saw but also AR guidance for visual feedback without sight diversion, leading to higher surgical accuracy and improved surgical safety. Comprehensive experiments were conducted to evaluate both the AR registration accuracy and osteotomy accuracy of the developed navigation system. The proposed AR registration method achieved an average mean absolute distance error (mADE) of 1.96 ± 0.43 mm. The robotic system achieved an average center translation error of 0.96 ± 0.23 mm, an average maximum distance of 1.31 ± 0.20 mm, and an average angular deviation of 3.77 ± 0.85°. Experimental results demonstrated both the AR registration accuracy and the osteotomy accuracy of the developed system.

One-Stage Combined Surgical Treatment of Developmental Dysplasia of the Hip in the Children Aged Over 18 Months

One-Stage Combined Surgical Treatment of Developmental Dysplasia of the Hip in the Children Aged Over 18 Months

Does epinephrine use reduce perioperative blood loss during pelvic and femoral osteotomy with open reduction of the patients with developmental dysplasia of the hip?

In this study, we aimed to investigate whether the use of epinephrine solution-impregnated gauzes and irrigation fluid with epinephrine could reduce perioperative blood loss during the combined surgical treatment of developmental dysplasia of the hip (DDH) patients. Between January 2018 and June 2023, a total of 68 pediatric patients (8 males, 60 females; mean age: 32.4±13.2 months; range, 18 to 98 months) who underwent combined surgery for DDH were retrospectively analyzed. The patients were divided into two groups as those who used topical epinephrine in the surgical sites during combined surgical treatment (n=34) and those who did not (n=34). Demographic and clinical characteristics and pre-, intra-, and postoperative data were recorded. To avoid transfusion complications, blood transfusion was performed in only symptomatic patients in the postoperative period. Age, sex, weight, and surgical duration were similar between the two groups (p>0.05). No statistically significant difference was found between the groups in terms of preoperative hemoglobin and hematocrit levels (p>0.05) There were statistically significantly differences between the groups in terms of postoperative hemoglobin and hematocrit levels, perioperative amount of blood loss, and postoperative length of hospital stay (p<0.001). No significant difference was found between the groups in terms of intraoperative hemodynamic parameters (p>0.05). The differences in perioperative and estimated intraoperative blood loss amounts and length of hospital stay were statistically significant between the groups (p<0.001). There was a significant relationship between the groups in terms of perioperative and estimated intraoperative blood loss, and transfusion of blood products (p<0.01). Blood transfusion was administered to five patients in the no epinephrine group. No local complications were observed in any group; however, one patient had transfusion-related fever and one patient had allergic skin lesions in the no epinephrine group. The intraoperative topical use of epinephrine irrigation solution and epinephrine solution-impregnated gauze dressings is effective and safe in reducing blood loss in DDH patients.

Outcome of Surgical Treatment of Developmental Dysplasia of the Hip in Aden, Yemen

Background: Developmental dysplasia of hip is a common condition presenting to a pediatric orthopedic surgeon. Objective: To evaluate the outcome of surgical treatment of developmental dysplasia of the hip. Materials and Method: This retrospective study conducted at the Department of Orthopedic Surgery in Alnaqeeb private hospital in Aden. The study children were 52 who were operated in the period from January 2016 to December 2018. Patient charts were reviewed and the collected data were sex, age, side, avascular necrosis, stiffness, re-dislocations, persistent acetabular dysplasia, and infection. The operations were open reduction and Pemberton's osteotomy plus minus femoral osteotomy without rotation. Statistical analyses were performed using SPSS version 22. We expressed distribution of variables using means and standard deviation (SD). Fisher test was used and p-value ≤ 0.05 was considered as statistically significant. Results: The majority of study children were females (80.8%). The age of the children ranged between 18 – 72 months. The mean age of children at surgery was 37 ± 17.5 months. The mean age of females was 37.2 ± 18.9 months while the mean age of males was 37.5 ± 10.7 months. The most common side was in the left side (51.9%). The mean time of follow-up was 34.7 ± 6.4 (range 24-48) months. Avascular necrosis found in (5.8%) children and stiffness found in (3.8%) children. Re-dysplasia of the hip were found in (5.8%) children. Persistent acetabular dysplasia was found in (3.8%) children. Additionally, we found superficial infection in (5.8%) children. Conclusion: The open reduction approach produces a better clinical outcome. The outcome of treatment in our study was comparable to published studies. Keywords: Developmental Dysplasia, hip, surgical treatment, outcome.

RADIOLOGICAL PREDICTORS FOR CLINICAL IMPROVEMENT OF PERIACETABULAR OSTEOTOMY PERSPECTIVE STUDY

The aim of the study was to evaluate radiological and clinical outcomes of surgical treatment of developmental dysplasia of the hip (DDH) with Periacetabular Osteotomy (PAO) and to determine the values of radiological parameters allowing us to obtain an optimal clinical result.Radiological evaluation included a standardized AP digital radiograph of the hip joints. Centre edge angle (CEA), medialization, distalization, femoral head coverage (FHC) and ilioischial angle were measured. Clinical evaluation based on HHS, WOMAC, Merle d'Aubigne-Postel scales and Hip Lag Sign. Radiological and clinical evaluation was performed preoperatively and approximately 12 months after the surgery.Statistically significant (p&lt;0.05) differences in radiological measurements and all clinical scales have been observed pre- and postoperatively for all of the parameters. The results of PAO presented decreased medialization by 3.4mm (range: 3 to 3.7), distalization by 3.5mm (range: 3.2 to 3.8) and the ilioischial angle by 2.7° (range: 2.2 to 3.7). There was also an improvement in the femoral head bone coverage: CEA increased by 16.3° (range: 12.1˚ to 20.5˚) and FHC by 15.2% (range: 10.8 to 19.8). Clinically we observed an increase in HHS by 22 points (range: 15.8 to 28.2) and M. Postel d'Aubigne by 3.5 points (range: 2.0 to 4.4) and a decrease in WOMAC by 24% (range: 22.6 to 25.8). HLS improvement of gluteal muscles’ efficiency has been observed in 67% of patients postoperatively.This study revealed that the qualification of patients with DDH for an elective PAO is more justified due to the predicted optimal clinical outcomes based on three parameters: CEA &lt;25 degrees, FHC &lt;75%, and ilioischial angle &gt;85.9 degrees. Accordingly, to achieve better clinical results for all scales, it is necessary to increase the average CEA value by 11˚, the average FHC by 11%, and reduce the average ilioischial angle by 3˚.

Racial disparities in readmission rates following surgical treatment of pediatric developmental dysplasia of the hip.

Across orthopedic subspecialties, significant racial disparities have been identified with regard to postoperative outcomes. Despite these findings among adult patients, the literature assessing these disparities within pediatric orthopedics is limited. The purpose of this study was to determine the independent predictors for unplanned readmission following surgical treatment of developmental dysplasia of the hip. Pediatric patients undergoing hip dysplasia surgery from 2012 to 2019 were identified in the National Surgical Quality Improvement Program-Pediatric database. Two patient groups were defined: patients who had unplanned hospital readmission within 30days of surgery and patients who were not readmitted. Clinical characteristics assessed included gender, race, and American Society of Anesthesiologists (ASA) class. Risk factors for complications were assessed using bivariate and multivariate analysis. Of 6561 pediatric patients undergoing surgical treatment for hip dysplasia, 540 (8.2%) had unplanned readmission. On bivariate analysis, non-white race (Black, Asian, Hispanic, American Indian, and Native Hawaiian), an ASA class of III, IV, or V, pulmonary, renal, neurological, and gastrointestinal comorbidities, as well as immune disease, steroid use, and nutritional support were significantly associated with unplanned readmission (p < 0.05 for all). After controlling for confounding variables on multivariate analysis, non-white race (OR 1.46; p = 0.042) and ASA class of III-V (OR 2.21; p = 0.002) were found to be independent predictors for readmission. Clinicians should be advised of the increased readmission rates observed in non-white patients and those of higher ASA scores. Further work is needed to combat existing disparities within pediatric orthopedics.

Radiologic Predictors for Clinical Improvement in PAO-A Perspective Study.

The aim of this study was to evaluate the results of surgical treatment of developmental dysplasia of the hip (DDH) with periacetabular osteotomy (PAO) and determine the values of radiological parameters that would allow us to obtain an optimal clinical result. Radiological evaluation included determining the center-edge angle (CEA), medialization, distalization, femoral head coverage (FHC), and ilioischial angle as measured on a standardized AP radiograph of the hip joints. Clinical evaluation was based on the HHS, WOMAC, Merle d'Aubigne-Postel scales and Hip Lag Sign. The results of PAO presented decreased medialization (mean 3.4 mm), distalization (mean 3.5 mm), and ilioischial angle (mean 2.7°); improvement in femoral head bone cover; an increased CEA (mean 16.3°) and FHC (mean 15.2%); clinically increased HHS (mean 22 points) and M. Postel-d'Aubigne (mean 3.5 points) scores; and a decrease in WOMAC (mean 24%). HLS improved in 67% of patients after surgery. Qualification of patients with DDH for PAO should be based on the following values of three parameters: CEA < 26°, FHC < 75%, and ilioischial angle >85.9°. To achieve better clinical results, it is necessary to increase the average CEA value by 11° and the average FHC by 11% and reduce the average ilioischial angle by 3°.

Racial Disparities in Postoperative Outcomes Following Operative Management of Pediatric Developmental Dysplasia of the Hip.

Developmental dysplasia of the hip in pediatric patients can be managed conservatively or operatively. Understanding patient risk factors is important to optimize outcomes following surgical treatment of developmental dysplasia of the hip. Racial disparities in procedural outcomes have been studied, however, there is scarce literature on an association between race and complications following pediatric orthopaedic surgery. Our study aimed to determine the association between pediatric patients' race and outcomes following operative management of hip dysplasia by investigating 30-day postoperative complications and length of hospital stay. The National Surgical Quality Improvement Program-Pediatric database was utilized from the years 2012 to 2019 to identify all pediatric patients undergoing surgical treatment for hip dysplasia. Patients were stratified into 2 groups: patients who were White and patients from underrepresented minority (URM) groups. URM groups included those who were Black or African American, Hispanic, Native American or Alaskan, and Native Hawaiian or Pacific Islander. Differences in patient demographics, comorbidities, and postoperative outcomes were compared between the 2 cohorts using bivariate and multivariate analyses. Of the 9159 pediatric patients who underwent surgical treatment for hip dysplasia between 2012 and 2019, 6057 patients (66.1%) were White and 3102 (33.9%) were from URM groups. In the bivariate analysis, compared with White patients, patients from URM groups were more likely to experience deep wound dehiscence, pneumonia, unplanned reintubation, cardiac arrest, and extended length of hospital stay. Following multivariate analysis, patients from URM groups had an increased risk of unplanned reintubation (odds ratio: 3.583; P=0.018). Understanding which patient factors impact surgical outcomes allows health care teams to be more aware of at-risk patient groups. Our study found that pediatric patients from URM groups who underwent surgery for correction of hip dysplasia had greater odds of unplanned reintubation when compared with patients who were White. Further research should investigate the relationship between multiple variables including race, low socioeconomic status, and language barriers on surgical outcomes following pediatric orthopaedic procedures. Level III-retrospective cohort analysis.

Surgical treatment of developmental dysplasia of the hip in children - A monocentric study about 414 hips.

Introduction: No consensus exists about the open reduction of developmental dysplasia of the hip (DDH; age of surgery and the need for additional bone surgery). We report clinical and radiological outcomes of a large monocentric study. The objectives are to analyze outcomes and to give recommendations. Materials and methods: This was a retrospective review of 414 hips (301 patients) operated on for DDH between 2010 and 2018. The mean age at the time of surgery was 34.6 months (14–96 months). In all, 72 hips had open reduction (OR) alone, 130 had OR with femoral osteotomy, 37 had OR with pelvic osteotomy, and 175 hips OR was associated with femoral and pelvic osteotomy. The mean follow-up was 6.5 years (3–10 years). Clinical outcomes were evaluated according to Mckay’s classification. The acetabular index was measured, and Severin classification was used for radiological outcomes. Reduction failure and residual dysplasia were noted, and avascular necrosis of femoral head (AVN) was assessed according to Kalamchi and MacEwen classification. Results: At the last follow-up, 331 hips (80.2%) had good clinical results, and 319 (77%) had satisfactory radiological results. The AI measured on the last follow-up radiograph was ≤25° in 350 hips. AVN was noted in 83 hips (20%). Redislocation was founded in 53 hips (12%). Overall: 293 hips (72%) had stable reduction without AVN with good clinical and radiological outcomes. Discussion: Clinical outcomes are better and the risk of AVN decreases significantly when a femoral osteotomy is performed. There were better radiological results when pelvic osteotomy was performed. The rate of residual dysplasia was higher when pelvic osteotomy was not performed. We recommend a femoral shortening osteotomy for high dislocations (Tönnis 3 or 4) for children over 18 months and a pelvic osteotomy for children over 36 months or over 18 months with an acetabular index > 25°.

Epidemiology and costs of surgical treatment of developmental dysplasia of hip in the Brazilian Public Health System in a decade.

ABSTRACTObjective:To describe and analyze the epidemiology and costs of surgical treatment of hip dysplasia in the Brazilian Public Health System.Methods:An ecological analytical study that evaluated a time series and the geographic distribution of surgical treatment of hip dysplasia in Brazil. Frequencies of cases, number of cases and associated factors were analyzed. Correlations, frequency maps and flow maps are presented and discussed.Results:During the study, 14,584 patients with dysplasia were admitted to hospitals according to Information Technology Department of the Public Health System. Patients underwent hospital treatment specific for dysplasia in 8,592 cases (at an average cost of R$ 2.225,50, total cost of R$ 19.124.086,25– updated values). In this group, mortality rate was 0.046% and mean hospitalization time was 4.41 days (standard deviation of 2,39 days). Age between 1 and 4 years (37.7%), female sex (64.5%) and white race (46%) were more frequent. Greater rates of specialists (R²=0.82; p<0.001), greater proportion of counties with high/very high human development index (R²=0.79; p<0.001), and higher per capita income (R²=0.68; p<0.001) correlated to greater rates of treatments undertaken per 1,000 live births (as per State of treatment). The factor most related to treatment rate per 1,000 live births (as per State of residence) was white race (R²=0.90; p<0.001). Southern states had higher treatment rates (as per State of residence, rate of 0.73/1,000), and Southeast states had greater absolute frequency of cases (46.7%) and greater flow of patients.Conclusion:The surgical treatment of hip dysplasia in Brazil occurs frequently, at relevant costs, and is distributed in a heterogenous and unequal fashion in the Public Health System. Southern states have a higher incidence of cases, and there is an association with racial and socioeconomic factors. There was no large variation in the incidence of cases over time.

Morscher Osteotomy Through Surgical Dislocation Approach for True Femoral Neck Lengthening with Greater Trochanter Transposition.

Young adults presenting with hip pain can be affected by proximal femoral growth disturbances as seen in Legg-Calvé-Perthes disease (LCPD) or as a complication of surgical treatment of developmental dysplasia of the hip (DDH). In 1988, Morscher proposed a novel femoral neck lengthening osteotomy to address these issues. The purpose of this study was to evaluate the effectiveness and safety of the Morscher osteotomy as a procedure to complement the well-documented surgical hip dislocation, to increase femoral offset, to distalize the greater trochanter, and to increase the overall limb length. This study was a retrospective case series from 3 hip-preservation-expert surgeons. Morscher osteotomies performed through a surgical dislocation approach by 3 surgeons between January 2008 and September 2019 were reviewed. Fifteen patients with a median age at surgery of 17 years (range, 13 to 28 years) and a minimum follow-up of 3 months (until union) were included. Surgical indications, clinical findings, comparative radiographic analyses including the change in horizontal femoral offset and the position of the greater trochanter, and complications were assessed. Surgical indications included DDH and LCPD. The horizontal femoral offset improved in all patients, to a median of 32.5 mm (range, 4 to 46.4 mm). The articular-trochanteric distance increased to >5 mm in all patients. Limb length improved by a median of 11.5 mm (range, 3 to 30 mm). Complementary periacetabular osteotomy was performed in 14 patients. The lateral center-edge angle and the acetabular index improved in patients with an associated periacetabular osteotomy, to a median of 28.2° (range, 9° to 37.7°) and 7.9° (range, 0° to 20°), respectively. Two patients demonstrated osteoarthritis progression from Tönnis stage 0 to stage 1, and 6 patients had a decrease of the joint space. Complications included 1 pulmonary embolism, 1 case of asymptomatic fibrous union of the greater trochanter, and 1 transient sciatic nerve palsy. The time-tested Morscher osteotomy indicated for complex proximal femoral reconstruction is effective in increasing horizontal femoral offset, distalization of the greater trochanter, and limb length. Combining the Morscher osteotomy with the versatility of surgical hip dislocation and the improved coverage capacity of periacetabular osteotomy proved complementary in the arsenal of hip preservation. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Surgical Treatment of Developmental Dysplasia of the Hip in Children Three to Five Years of Age

Surgical Treatment of Developmental Dysplasia of the Hip in Children Three to Five Years of Age

Open treatment of dysplasia-other than PAO: does it have to be a PAO?

Hip dysplasia is a developmental disorder that results in anatomic abnormalities in which the acetabular coverage is insufficient. In the absence of severe degenerative changes, younger active patients with these symptomatic structural abnormalities are increasingly managed with joint-preserving operations. Historically there have been numerous reconstructive pelvic osteotomies. In recent years, the Bernese periacetabular osteotomy (PAO) has become the preferred osteotomy by many surgeons. Even so, as our understanding of the hip advances and new diagnostic and treatment techniques are developed, we sought to put a focus on the long-term results of augmental osteotomies and pelvic osteotomies other than the PAO, to see if any of these surgeries still have a place in the current algorithm of treatment for the dysplastic hip. As the longevity of the treatment is the focal point for joint preservation surgeries for the dysplastic hip, these authors have searched databases for articles in the English literature that reported results of long-term follow-up with a minimum of 11-year survivorship after surgical treatment of developmental dysplasia of the hip. Reconstruction osteotomies for the dysplastic hip are intended to restore normal hip anatomy and biomechanics, improve symptoms and prevent degenerative changes, in this manuscript each procedure is independently assessed on the ability to achieve these important characteristics.

Clinical and radiographic medium‐term evaluation on patients with developmental dysplasia of the hip, who were submitted to open reduction, capsuloplasty and Salter osteotomy

Objectiveto evaluate the clinical and radiographic medium‐term results from surgical treatment of developmental dysplasia through open reduction, Salter et al.’s osteotomy and capsuloplasty. Methods13 patients were evaluated, 13 hips treated surgically by the proposed technique between 2004 and 2011. A clinical and radiographic evaluation was conducted by Dutoit et al. and Severin et al. criteria, respectively. Resultsthe acetabular preoperative index for the 13 surgically treated hips ranged from 27° to 50° (average of 36), and after surgical correction to 18.5° (10–28°), so that the evaluations of preoperative and postoperative acetabular indexes showed up significant statistic reduction (p<0.05). Regarding the postoperative clinical evaluation, it was found: nine excellent hips (69.2%), three good ones (23.1%), no fair hips (0%) and a poor one (7.7%). In radiographic evaluation, it was found: six excellent hips (46.1%), three good ones (23.1%), no fair hips (0%) and four poor ones (30.8%). Therefore, favorable results were obtained (92.3%), with grouped hips with excellent and good ratings as satisfactory and with fair and bad ratings as unsatisfactory. It is also important to notice that there was no significance among occurrence of complications, the patient's age, the time of surgery and the preoperative acetabular index (p>0.05). As complications occurred, it was found that three subluxations and a subluxation associated with avascular necrosis of the femoral head. Conclusionopen reduction, Salter et al.’s osteotomy and capsuloplasty are seen to be a viable option for the treatment of developmental dysplasia of the hip, according to clinical and radiological medium‐term evaluations.

Avaliação clínica e radiológica em médio prazo dos pacientes portadores de displasia do desenvolvimento do quadril submetidos a redução aberta, capsuloplastia e osteotomia de Salter

Objectiveto evaluate the clinical and radiographic medium-term results from surgical treatment of developmental dysplasia through open reduction, Salter et al.’s osteotomy and capsuloplasty. Methodswere evaluated 13 patients, 13 hips treated surgically by the proposed technique between 2004 and 2011. A clinical and radiographic evaluation was conducted by Dutoit et al. and Severin et al. criteria, respectively. Resultsthe acetabular preoperative index for the 13 surgically treated hips ranged from 27° to 50° (average of 36), and after surgical correction to 18.5° (10° to 28°), so that the evaluations of preoperative and postoperative acetabular indexes showed up significant statistic reduction (p < 0.05). Regarding the postoperative clinical evaluation, it was found: nine excellent hips (69.2%), three good ones (23.1%), no fair hips (0%) and a poor one (7.7%). In radiographic evaluation, it was found: six excellent hips (46.1%), three good ones (23.1%), no fair hips (0%) and four poor ones (30.8%). Therefore, favorable results were obtained (92.3%), with grouped hips with excellent and good ratings as satisfactory and with fair and bad ratings as unsatisfactory. It is also important to notice that there was no significance among occurrence of complications, the patient's age, the time of surgery and the preoperative acetabular index (p > 0.05). As complications occurred, it was found: three subluxations and a subluxation associated with avascular necrosis of the femoral head. Conclusionopen reduction, Salter et al.’s osteotomy and capsuloplasty are seen to be a viable option for the treatment of developmental dysplasia of the hip, according to clinical and radiological medium-term evaluations.

Evaluation of Surgical Treatment of Developmental Dysplasia of Hip for Avascular Necrosis of Femoral Head in Children

Developmental Dysplasia of the Hip (DDH) is a common congenital malformation. Avascular necrosis of femoral head is the major complication of both close and open reduction of the dislocated joint. Aim of this study was to determine the incidence and influencing factors in different types of a vascular necrosis of femoral head, following surgical treatment of developmental dysplasia of hip in 1-7 years patients. In this study, 120 patients aged from 1 to 7 years old with DDH who had been undergone open surgery, entered to the study. All of these patients followed up for at least 1 year. Surgery procedures divided to 4 groups: open reduction, open reduction+salter osteotomy, open reduction+femur shortening and open reduction+salter osteotomy+femur shortening. The presence of Avascular Necrosis (AVN) had been appraised. 27.5% of surgeries performed on male and 72.5 on female patients. 35.0% of DDH cases were unilateral and remaining was bilateral. 36 patients (30%) shows radiologic findings of AVN, although all of them placed at group I of Bucholz-Ogden classification. 40% of group A patients, 25% of group B, 14.3% of group C and 36.4% of group D patients developed this findings. Open reduction of DDH in older children is effective in the management of DDH and if all of the contrivance considered in the surgery, the rate of AVN would be low and mild (at least in short term follow ups).

A study on the complications of surgical treatment for bilateral developmental dysplasia of the hip and a comparison of two osteotomy techniques.

This study aims to present a review about complications of surgical treatment of Developmental Dysplasia of the Hip and comparing the kinds and ratios of two osteotomy technique (Salter Innominate Osteotomy and Pemberton Pericapsular Osteotomy). Fifty-seven patients of 126 that had bilateral developmental dysplasia of the hip are the case series that had undewent to Salter Innominate Osteotomy for one hip and Pemberton Pericapsular Osteotomy for other hip by one surgeon in one stage. Avascular Necrosis ratio was 19.29% on hips with Salter Innominate Osteotomy, and 8.77% on hips with Pemberton Pericapsular Osteotomy. Salter Innominate Osteotomy made lower limb discrepency with 0.47 cm mean in all patients. There were 17 general complications on hips with Salter Innominate Osteotomy (SIO) (14.91%) and 9 general complications on hip with Pemberton Pericapsular Osteotomy (PPO) (7.89%). As looking for general complications, SIO/PPO ratio were 1.8 (17/9). By the comparing two osteotomy technique for complication ratios, SIO had two-fold of complications than PPO. SIO had 65% more complications as to PPO.

Surgical treatment of developmental dysplasia of the hip presenting in children above 10 years

BackgroundManagement of developmental dysplasia of the hip in older children remains controversial. The objective of this study was to evaluate the results of surgical treatment of developmental dysplasia of the hip in children older than 10 years. MethodSixty-three patients (75 hips) whose mean age at the time of surgery was 11.5 years (range 10–19 years) were treated using Salter osteotomy, Pemberton acetabuloplasty, Dega osteotomy, or Westin osteotomy. Subtrochanter transverse femoral shortening and derotation osteotomy were performed for all patients. A long leg cast, rather than a spica cast, was applied postoperation, and progressive flexion and extension exercises of the hip joint were initiated 2 weeks after the surgery. ResultAll 63 patients (75 hips) were followed for an average of 7.6 years (range 5–10 years) after surgery. According to the McKay criteria and Severin X-ray criteria, the fineness ratios were 82.7 and 82.6%, respectively. After surgery, there were 4 cases of semiluxation (6.3%); 4 of femoral head ischemia necrosis (6.3%), and 9 of hip joint stiffness (14.3%). ConclusionWe believe that preoperation overall evaluation and personalized operation plans, experience with the surgical procedure, and commencement of functional exercise soon after the operation are the main reasons for the satisfactory therapeutic effects achieved in this study after surgery for developmental dysplasia of the hip presenting in children older than 10 years.

Results of surgical treatment of developmental dysplasia of hip considering child’s age

Developmental dysplasia of the hip (DDH) represents one of common diseases of the locomotor system. Late discovery and inadequate healing of this defect leads to serious disability in the best years of human life. The aim of this study was to analyse the quality of functional and anatomic restitution of the diseased hip, depending on the age of the patient at the time of surgery. Our retrospective study was developed on 78 children surgically treated for DDH. The examiners were distributed in three groups according to age in which they had been operated. The data were produced on the basis of full-scale medical documents for each patient. We analysed and compared anatomic and functional results of surgeries treating DDH in the group of examiners. On examination, we got data that the most prevalent were distorted gait, inequality of the legs and positive Trendelendburg's sign in the group of children who had been operated in the oldest age. The patients who were surgically treated in older age had worse postoperative results in aspect value angle of flexion and abduction in treated hip, higher frequency in manifesting pain and asymmetric gait. Better corrective results on aspect of dimension of the colodiaphyseal and Hilgenrainer's angle will be obtained if DDH treatment is conducted in younger age of patients. In 94.95%, the patients were treated with Salter innominate osteotomy of pelvis with osteotomy of the femur involving its shortening and reverse rotation. Preoperative treatment with Pavliks harness was provided in 44.02% children, with abduction of Hilgenrainer's apparatus in 2.6%, with abductions "Niva" slips in 2.6% and preoperative extension in 28.2%. The surgical treatment of DDH in the observed patients done at the earlier age of growth resulted in the evidently better anatomical and functional results at postoperative observation.

Análise radiográfica dos fatores prognósticos no tratamento do quadril displásico inveterado

OBJETIVO: Avaliar os resultados do tratamento cirúrgico da Displasia do Desenvolvimento do Quadril na idade da marcha. MÉTODOS: Avaliamos 33 quadris operados entre novembro de 1992 e setembro de 1997. A média de idade foi 4 anos e 5 meses na ocasião da cirurgia e 11 anos e 7 meses quando avaliamos os resultados. O seguimento médio foi de 10 anos e 2 meses. Realizamos o encurtamento femoral, redução cruenta e osteotomia pélvica (Salter ou Chiari). Radiograficamente avaliamos: grau da luxação, índice acetabular; ângulo acetabular; arco de Shenton; linha de Hilgenheiner; coeficientes c/b, c/h, centro-acetábulo e cabeça-acetábulo; largura da cartilagem trirradiada; relação cabeça trocânter; esfericidade da epífise femoral; ângulo de Wiberg; necrose avascular e anisomelia. Os parâmetros radiográficos foram avaliados nos períodos pré-operatório, pós-operatório imediato e tardio. RESULTADOS: Verificamos estatisticamente melhora significante destes no momento pré-operatório para o pós-operatório imediato (p=0,0001) porém não houve variação significante entre o pós-operatório imediato e o tardio (p=0.5958). CONCLUSÃO: Pela classificação utilizada para avaliação dos resultados observamos 23 (69,70%) bons, 5 (15,15%) regulares e 5 (15,15%) maus resultados.