Treatment For Developmental Dysplasia Of Hip 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.

Comparison of Salter innominate osteotomy and Pemberton pericapsular osteotomy combined with open reduction through medial adductor approach on acetabular development in the treatment of developmental hip dysplasia

Objective: Combined with open reduction through medial adductor approach, Salter innominate osteotomy (SIO) and Pemberton pericapsular osteotomy (PPO) methods are common procedures for the repair of incomplete acetabulum structure in patients with developmental hip dysplasia (DHD). The aim of this study is to compare the outcomes of acetabulum development in patients treated using these two methods. Patients and Methods: We retrospectively reviewed the medical records of 50 (65 hip joints) children who underwent SIO or PPO for DHD. Thirty-three patients underwent SIO and 32 patients underwent PPO as surgical treatment. The criteria of Tönnis, modified McKay, and Severin, and angles of acetabular index (AI) and acetabular center-edge (CE) angles of both groups were compared. Results: There were significant differences between two groups in the time of operation, follow-up time after operation, preoperative and postoperative AI angles, and postoperative 1styear CE angles. AI was detected as lower in the PPO group at 1stmonth postoperatively. Whereas, mean AI was detected as higher in the preoperative PPO group. In addition, the acetabular CE angle was significantly lower in the PPO group at 1styear postoperatively. However, there was no significant difference between the groups in terms of the CE angle value measured at the final follow-up. Conclusion: Salter innominate osteotomy and PPO methods used in the treatment of DHD have specific advantages and disadvantages. Preoperative and intraoperative evaluations of patients are very important in determining which procedure should be performed. When the choice is made properly, clinical and radiological results are both satisfactory.

Acetabular Dysplasia After Successful Open or Closed Treatment of Developmental Hip Dysplasia Is a Biologic Failure, Not Acetabular Deficiency.

Acetabular Dysplasia After Successful Open or Closed Treatment of Developmental Hip Dysplasia Is a Biologic Failure, Not Acetabular Deficiency.

Finite Element Analysis of Various Osteotomies Used in the Treatment of Developmental Hip Dysplasia in Children.

Late-discovered developmental hip dysplasia deformities often necessitate complex surgical treatments and meticulous preoperative planning. The selection of osteotomies is contingent upon the patient's age and the specific structural deformity of the hip. In our anatomical hip model, derived from the data of a 12-year-old patient, we performed virtual osteotomies that are commonly recommended for such cases. We precisely constructed geometric models for various osteotomies, including the Dega, Pemberton, Tönnis, Ganz, Chiari pelvic, and Pauwels femoral osteotomies. We employed Autodesk Inventor for the finite element analysis of the hip joint and the corrective osteotomies. In comparing one-stage osteotomies, we noted that the Dega and Ganz pelvic osteotomies, especially when combined with the Pauwels femoral osteotomy, yielded the most favorable outcomes. These combinations led to enhanced femoral head coverage and reduced intra-articular pressure. Furthermore, we calculated the femoral head-to-acetabulum volume ratio for both the Dega and Pauwels osteotomies. The encouraging results we obtained advocate for the integration of finite element analysis in virtual osteotomies of the pelvis and femur as a preoperative tool in the management of developmental hip dysplasia.

Early results of modified Bikini approach periacetabular osteotomy for the treatment of developmental hip dysplasia under 50 years of age

Objective: To investigate the efficacy and safety of modified Bikini approach periacetabular osteotomy in the treatment of developmental hip dysplasia under 50 years of age. Methods: The clinical data of 39 patients with developmental hip dysplasia who underwent periacetabular osteotomy in the Department of Orthopedics, Guizhou Provincial People's Hospital from June 2016 to June 2021 were retrospectively analyzed.Among them, 20 patients (21 hips) underwent the improved Bikini approach (study group) and 19 patients (20 hips) underwent the improved Smith-Petersen approach (control group).In the study group, there were 3 males and 17 females, aged(M(IQR))27.5 (14.3) years (range:11 to 44 years).In the control group, there were 2 males and 17 females, aged 27.5 (19.3) years (range:17 to 47 years).Both groups were sutured in the same manner by the same physician.Incision length, operation time, intraoperative blood loss and complications were recorded.X-ray images, anterior central marginal angle (ACE), lateral central marginal Angle (LCE) and acetabulum tilt angle (Tonnis AI) were measured before and after the operation.The coverage rate of acetabulum to femoral head (AHI) was measured and calculated, and the healing time was observed.Harris Hip score, International Hip score (IHOT)-12 and visual analogue scale (VAS) were recorded before and after surgery.Vancouver Scar Scale (VSS) score and patient and observer scar assessment scale (POSAS) score were recorded 12 months after surgery.The independent sample t test,Wilcoxon rank sum test, χ2 test or Fisher exact test were used to compare the clinical efficacy between the two groups. Results: All patients successfully completed the operation.There was no significant difference in operation time and intraoperative blood loss between the two groups (all P>0.05).The incision length of the study group was smaller than that of the control group, and the difference was statistically significant (10.5(5.0)cm vs.15.0(3.0),W=309.000,P=0.007).Patients were followed up for (19.1±11.1) months (range:12 to 60 months).Femoral nerve stretching injury occurred in 2 cases and sciatic branch fracture occurred in 1 case in the study group, all of which recovered to normal at 3 months follow-up, while no corresponding injury occurred in the control group.Lateral femoral cutaneous nerve injury occurred in 3 cases in the study group and 2 cases in the control group.Delayed wound healing occurred in 1 case in each of the two groups, and both healed after re-operation debridement and suture.Pubic branch nonunion occurred in 4 patients in the study group and 5 patients in the control group.There were no serious complications such as sciatic nerve and femoral blood vessel injury between the 2 groups, and there was no statistical significance in the incidence of complications between the 2 groups (52.4%(11/21)vs.40.0%(8/20),χ2=0.631,P=0.427).The clinical healing time of the patient was (4.5±1.3) months after surgery (range:3.0 to 8.0 months).There were no significant differences in ACE, LCE, Tonnis AI and AHI between the 2 groups (all P>0.05).At the last follow-up, there were no significant differences in VAS,Harris hip score and IHOT-12 score between the two groups (all P>0.05).The incision scars in the study group were smaller than those in the control group, and the differences in VSS and POSAS were statistically significant (all P<0.05). Conclusion: Compared with the improved Smith-Petersen approach, the improved Bikini approach has the same early clinical efficacy in the treatment of patients with developmental hip dysplasia under the age of 50, and has the advantages of smaller postoperative incision scars, more hidden and beautiful incision, and no serious complications, which is worthy of further study and promotion.

Predictors of Total Hip Arthroplasty Following Pediatric Surgical Treatment of Developmental Hip Dysplasia at 20-Year Follow-Up.

Long-term outcomes of surgical treatment for pediatric developmental dysplasia of the hip (DDH) are not well defined. The purpose of this study was to report long-term radiographic and clinical outcomes, survivorship free of total hip arthroplasty (THA), and predictors of subsequent THA following childhood treatment of DDH. This study was a single-institution retrospective review of hips treated for DDH with closed or open reduction at a minimum 10-year follow-up. 107 patients (119 hips) were included with a mean patient age of 3.3 years at childhood treatment. At mean 30.5 years follow-up, 24 hips had undergone THA (20%). Mean patient age at time of THA was 33.5 years. None of the hips treated with closed reduction alone required THA, whereas 8 hips treated with open reduction (25%) underwent THA. Hips with patient age > 4 years at the time of treatment had lower survivorship at 35 years follow-up (50% vs. 85%; p < 0.001). Additionally, femoral osteotomy (OR 2.0, p < 0.001), and previous treatment elsewhere (27% vs. 16%; p < 0.01) were associated with subsequent THA. Early referral and appropriate intervention may prove important, as age and prior treatment were predictive of subsequent THA.

Reliability of the computed tomography criteria after closed reduction of developmental dislocation of the hip

BACKGROUND: Developmental dislocation of the hip includes femoral head subluxation or dislocation and/or acetabular dysplasia. Closed reduction of the hip should be performed under general anesthesia. Appropriate performance and interpretation of closed reduction are difficult and require experience. The role of computed tomography (CT) in different aspects of treatment of developmental hip dysplasia is well established. It was an accurate way to assess the adequacy of reduction of dislocated hips for patients in spica casts.&#x0D; AIM: This study aimed to assess the role of CT in the evaluation of closed reduction of developmental hip dislocation in infants and children immobilized in spica casts.&#x0D; MATERIALS AND METHODS: This study included 16 patients with 20 involved hips who presented with developmental hip dysplasia. The youngest patient was 12 months old, and the oldest was 24 months old, with a mean age of 19.62 4.27 months. There were 15 girls (93.75%) and one boy (6.25%). There were four patients with bilateral hip involvement (25%), and the right side was involved in five hips (31.25%), whereas the left side was affected in 7 (43.75%) hips.&#x0D; RESULTS: Closed reduction was performed in 20 hips, and according to the post-reduction CT evaluation, the final results were satisfactory in 16 (80%) hips and unsatisfactory in 4 (20%) hips. On the coronal CT cuts, the modified Shentons line gave a sensitivity of 75%, specificity of 81.25%, and accuracy of 80%. Second, the calculation of femoral head coverage on coronal CT cuts showed the highest sensitivity of 100%, specificity of 50%, and accuracy of 60%. Lastly, the posterior neck line identified on the axial CT cuts gave a sensitivity of 75%, specificity of 87%, and accuracy of 85%. On comparing and evaluating the three methods, the method that gave the best level of reliability for the adequacy of the reduction was the posterior neckline (82.23 %), followed by modified Shentons line (78.75%), and finally femoral head coverage (70%).&#x0D; CONCLUSIONS: The posterior neck line is the preferred method to confirm the adequacy of hip relocation on multi-slice post-reduction axial CT.

Pemberton’s acetabuloplasty without cast application for the treatment of acetabular dysplasia in older children: A case series

Objectives: To study the safety and efficacy of performing Pemberton’s acetabuloplasty (PA) in older children without application of post-operative cast to avoid the restriction and complications of cast in older children. Methods: Patients who had acetabular dysplasia and underwent Pemberton’s acetabuloplasty without cast during the period 1999-2021 were selected for the study. Cases were followed until radiographic healing of the osteotomy. Results: Twenty patients (22 hips) were included in the study. Primary acetabular dysplasia was recently discovered because of pain in 10 patients; the other 10 had residual acetabular dysplasia after treatment of developmental hip dysplasia (DDH). Most patients (19 hips in 18 patients) had a PA without internal fixation and post-operative cast. Two patients had an internal fixation with a cannulated screw because of concern about compliance with non/toe-touch weight-bearing post-operatively. The mean age on the time of surgery was 10.4 years (6.5–15.5 years). The mean body weight on the day of surgery was 42.8 Kg. (30-66 Kg.). The mean postoperative follow-up was 38 months (three months – 14 years). All patients were able to walk using a walker within five days after surgery. The follow-up radiographs showed no graft collapse and no displacement of the graft or osteotomy. Correction of the acetabular dysplasia and corrected Shenton’s line were confirmed on the last follow-up with no re-dislocation or re-subluxation of the hip. Conclusion: Performing Pemberton’s acetabuloplsty in older children without application of post-opertaive cast is efficient and safe. Complications of cast and the gross limitation it has on daily living activities and mobilization are all avoided without compromising the surgical results and healing. Care should be taken to ensure that patients and caregivers clearly understand the importance of non/toe-touch weight-bearing post-operatively and are compliant.

Petit-Morel method for hip development dysplasia in toddlers: A retrospective observational study in 34 patients

BackgroundThe Petit-Morel method allows the treatment of developmental hip dysplasia in toddlers by combining gradual traction to achieve reduction followed by immobilisation during which pelvic osteotomy is performed. The objective of this study was to assess the radiographic and clinical outcomes in a retrospective cohort of patients. HypothesisThe Petit-Morel method is associated with low rates of avascular necrosis and residual acetabular dysplasia at skeletal maturity, as well as with satisfactory medium-term clinical outcomes. Material and methodsWe conducted a single-centre retrospective study of 34 patients (35 hips) treated between 1997 and 2014. The radiological assessment criteria included an evaluation for avascular necrosis classified according to Kalamchi and MacEwan, the vertical centre edge (VCE) angle, femoral head sphericity according to Mose, and acetabular dysplasia at skeletal maturity according to Severin. Hip function was assessed by determining the Postel-Merle d’Aubigné (PMA) score. ResultsMean age at treatment was 19±4 months (range, 14–29). Mean follow-up was 11 years (range, 5–20). There were two failures including one case of recurrent dislocation requiring surgical reduction. Group II avascular necrosis occurred in 1 (3%) patient. Tönnis Grade IV dysplasia was significantly associated with resolving irregularity of the ossification centre, seen in 19 (54%) cases (p=0.002). In the 18 patients followed-up to skeletal maturity, with a mean follow-up of 15 years (range, 12–20 years), 17 hips were Severin Class I. The mean VCE angle was 29° (range, 15°–38°), and the head was spherical for 34 (98%) hips. The PMA score at last follow-up was excellent (17–18). The mean VCE angle was greater in all 5 patients who experienced pain during long walks (35° [range, 32°–37°]) than in the asymptomatic patients (28° [range, 15°–38°]) (p=0.009). DiscussionThe Petit-Morel method is a reliable treatment that provides good clinical and radiological outcomes. Overcorrection of the VCE angle was noted in the patients who experienced walking-related pain in adulthood. Level of evidenceIV, retrospective observational cohort study.

Comparison of the Outcomes of Salter and Pemberton Osteotomies in the Treatment of Developmental Hip Dysplasia

Comparison of the Outcomes of Salter and Pemberton Osteotomies in the Treatment of Developmental Hip Dysplasia

Comparison of Open Reduction Alone and Open Reduction Plus Pemberton Osteotomy Techniques in the Treatment of Developmental Hip Dysplasia at Walking Age.

Open reduction (OR) alone and OR plus Pemberton periacetabular osteotomy (PPO) techniques are commonly used in the treatment of developmental dysplasia of the hip at walking age. However, discussions on the timing of acetabular osteotomy are still ongoing. The aim of the present study was to compare the results of patients who underwent Ferguson OR (FOR group) and OR plus PPO group. Between 2008 and 2017, we performed surgery on the hips, which we thought were used for closed reduction but could not be reduced as closed, or that the reduction was not stable. Patient follow-up was ≥12 months. The study included 75 hips of 57 patients of which 20 (26.7%) patients with FOR and 55 (73.3%) patients with PPO. Preoperative and postoperative acetabular indices (AIs), additional surgical intervention rates, and avascular necrosis (AVN) rates were compared. The Kalamchi-McEwen classification system was used to evaluate AVN. The average age of the patients was 12.38 (9-14) months. The mean follow-up period was 38.95 (12-140) months. AVN developed in 21 (24%) hips (6 (8%) type 1, 13 (17.3%) type 2, and 2 (2.7%) type 3). AVN developed in 7 (35%) hips in the FOR group and 14 (25.5%) hips in the PPO group. No statistically significant difference was found between the two groups (p=0.416). Revision surgery was performed in 2 (3.7%) cases of the PPO group and 6 (31.5%) cases of the FOR group. Statistically, the PPO group had less revision surgery (p=0.004). The PPO group had an AI of 13.33° (5°-27°) that was significantly lower (p<0.001) than that of 27.98° (18.39°) of the FOR group. Ferguson and Pemberton techniques are current and effective in the treatment of patients with developmental hip dysplasia at walking age. There was no significant difference between the two groups when examined from the point of view of AVN, but the results of PPO surgery were found to be better with respect to AI and revision surgery.

Does Hip Arthroscopy Have a Role in the Treatment of Developmental Hip Dysplasia?

BackgroundIndications for hip arthroscopy in mildly dysplastic patients with a symptomatic hip remain controversial. MethodsThis article provides a concise review of the available literature evaluating the role of hip arthroscopy in treating symptomatic dysplasia. Potential indications for hip arthroscopy in isolation are reviewed. Emerging evidence on the role of hip arthroscopy based on patient-specific pathomorphology is highlighted. ResultsHip arthroscopy in isolation may be helpful for select dysplastic patients with dynamic impingement or microinstability. Isolated arthroscopic treatment of intra-articular pathology resulting from static overload is unlikely to be successful in the long term and may be detrimental. ConclusionArthroscopic procedures for individuals with mild dysplasia in the absence of frank instability may be effective; however, great caution should be exercised when approaching dysplastic patients with symptomatic hips.

Is Age or Surgical Approach Associated With Osteonecrosis in Patients With Developmental Dysplasia of the Hip? A Meta-analysis.

Osteonecrosis of the femoral head is a major complication that negatively impacts the clinical and radiographic long-term outcome after treatment of developmental hip dysplasia (DDH). There are conflicting results in the literature whether age at the time of closed or open reduction and a specific surgical approach are associated with osteonecrosis. Better understanding of the impact of age at reduction and surgical approach is important to reduce the risk of osteonecrosis in patients with DDH. We aimed to evaluate the association between occurrence of osteonecrosis and (1) age at closed reduction; (2) age at open reduction; and (3) medial versus anterior operative approaches. A systematic review identified studies reporting osteonecrosis occurrence after treatment of DDH and at least 2 years of followup. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Methodologic quality was assessed using the methodologic index for nonrandomized studies. Generalized logistic models were used to estimate pooled odds ratios (ORs) in the meta-analysis. Sixty-six studies were included in the systematic review and 24 in the meta-analysis. Data on 481 hips treated by closed reduction and 584 hips treated by open reduction were available to evaluate the association between osteonecrosis and age. The association between osteonecrosis and operative approach was assessed using data on 364 hips treated by medial open reduction and 220 hips treated by anterior open reduction. Age at reduction (> 12 months versus ≤ 12 months) was not associated with osteonecrosis after closed reduction (OR, 1.1; 95% confidence interval [CI], 0.4-3.2; p = 0.9) or open reduction (OR, 1.1; 95% CI, 0.7-1.9; p = 0.66). The overall, adjusted incidence of osteonecrosis (≥ Grade II) was 8.0% (95% CI, 2.8%-20.6%) among patients treated with closed reduction at or before 12 months of age and 8.4% (95% CI, 3.0%-21.5%) among those treated after 12 months. Similarly, the odds of osteonecrosis after open reduction did not differ between patients treated after the age of 12 months compared with those treated at or before 12 months (OR, 1.1; 95% CI, 0.7-1.9; p = 0.7). The incidence of osteonecrosis (≥ Grade II) was 18.3% (95% CI, 11.7%-27.4%) among patients who had index open reduction at or before 12 months of age and 20.0% (95% CI, 13.1%-29.4%) among those who had index open reduction after 12 months of age. Among hips treated with open reductions, there was no difference in osteonecrosis after medial versus anterior approaches (18.7% medial versus 19.6% anterior; OR, 1.1; 95% CI, 0.5-2.2; p = 0.9). Conclusions We did not find an association between closed or open reduction performed at or before 12 months of age and an increased risk of osteonecrosis of the femoral head. Delayed treatment past 1 year of age as a strategy to reduce the development of osteonecrosis was not supported by this meta-analysis. Open reduction through a medial or anterior approach may be recommended based on surgeon's preference, because we found no association between development of osteonecrosis and the type of surgical approach. However, many of the studies in the current literature are nonrandomized Level III or IV observational studies of inconsistent quality. Higher quality evidence is needed to better understand the effects of age at reduction and operative approach on the development of osteonecrosis after DDH treatment. Level III, therapeutic study.

Failed Pavlik harness treatment for DDH as a risk factor for avascular necrosis.

Avascular necrosis (AVN) of the femoral head is an irreversible complication seen in the treatment of developmental dysplasia of hip (DDH) with the Pavlik harness. Its incidence is reported to be low after successful reduction of the hip but high if the hip is not concentrically relocated. We aim to investigate its incidence after failed Pavlik harness treatment. We prospectively followed up a group of children who failed Pavlik harness treatment for DDH treated at our institution by the senior author between 1988 and 2001 and compared their rates of AVN with a group of children who presented late and hence were treated surgically. AVN was graded as described by Kalamchi and MacEwen and only grade 2 to 4 AVN was considered significant and included in the analysis. Thirty-seven hips were included in the failed Pavlik group (group 1) and 86 hips in the no Pavlik group (group 2). Ten hips in group 1 developed AVN (27%), whereas only 7 hips in group 2 (8%) developed AVN; the odds of developing AVN after failed Pavlik treatment was 4.7 (95% confidence interval, 1.3-14.1) (P=0.009) with a relative risk of 3.32 (range, 1.37 to 8.05). There was no statistically significant association observed with duration of splintage and severity of AVN (Spearman's correlation, -0.46; P=0.18). However, there was a positive correlation noted with age at presentation and severity of AVN. Therefore, we advise close monitoring of hips in the Pavlik harness and discontinue its use if the hips are not reduced within 3 weeks. Level III.

Functional Treatment of Developmental Hip Dysplasia with the Tübingen Hip Flexion Splint

Developmental dysplasia of the hip (DDH) is a deformity that may cause to serious disability. Early diagnosis and early treatment are very important. Our aim is to report the outcomes of infants with DDH who were treated with the Tübingen hip flexion splint. Retrospectively, 49 patients (45 female, four male; 60 hips) diagnosed with DDH were included in the study. For diagnosis, all patients underwent ultrasonography of the hip performed according to the Graf method. Infants whose hips were Graf type 2b or worse underwent orthotic treatment. Treatment success was defined as development into a mature hip (Graf type 1 on ultrasonography and no acetabular dysplasia apparent on the latest radiograph). Overall median age at the start of treatment was 18 weeks (14-25). Median total treatment time (from initial application of the splint to the end of weaning) was 17 weeks (14-20). Median duration of follow up was 13.5 months (8.5-31.5). Treatment was successful in 56/60 hips (93.3%). Of the 56 successfully treated patients, acetabular dysplasia was present early in follow up but later resolved in 4 patients. No complications were encountered in any patients in the study. The Tübingen splint provides abduction, but due to its different design it offers the advantages of preventing hip adduction and leaving the knee and ankle joints free. Our findings suggest that in infants with DDH, the Tübingen hip flexion splint is an effective form of treatment.

Correction: Incidence and Treatment of Developmental Hip Dysplasia in Mongolia: A Prospective Cohort Study

An error in the production process caused the incidence risk ratios in the rightmost column of Table 3 to be displayed incorrectly. Please see the corrected Table 3 here:

Incidence and Treatment of Developmental Hip Dysplasia in Mongolia: A Prospective Cohort Study

BackgroundIn Mongolia, adequate early diagnosis and treatment of developmental hip dysplasia (DDH) have been unavailable and its incidence was unknown. We determined the incidence of ultrasonographic DDH in newborns and established adequate procedures for diagnosis and treatment of DDH at the largest maternity hospital in Ulaanbaatar, Mongolia.Methodology/Principal FindingsDuring one year (Sept 2010 – Aug 2011) we assessed the hips newborns using ultrasound and Graf’s classification of DDH. 8,356 newborns were screened; median age at screening was 1 day. We identified 14,873 Type 1 (89.0%), 1715 Type 2a (10.3%), 36 Type 2c (0.2%), 70 Type D (0.4%), 14 Type 3 (0.08%), and 4 Type 4 hips (0.02%). Children with Type 1 hips (normal) were discharged. Children with Type 2a hips (physiologically immature) received follow-up ultrasounds at monthly intervals. Children with Type 2c to 4 (DDH; deformed or misaligned hip joint) hips were treated with a Tubingen hip flexion splint and also followed up. The hip abnormalities resolved to mature hips in all children who were followed up. There was no evidence for severe treatment related complications.Conclusion/SignificanceThis study suggests that the incidence of DDH in Mongolian neonates is comparable to that in neonates in Europe. Early ultrasound-based assessment and splinting treatment of DDH led to mature hips in all children followed up. Procedures are feasible and will be continued.

Arthroscopic-assisted surgical treatment for developmental dislocation of the hip before the age of 18 months

The purpose of this study is to evaluate the results of arthroscopy assisted surgical treatment of developmental dislocation of the hip (DDH). Arthroscopic assisted surgical treatment was performed on nine hips of nine female children with DDH using our method, published previously, between January 2001 and December 2005. Their ages ranged from 9 to 16months. Percutaneous adductor tenotomies were performed in seven cases. A spica cast and abduction splint were used for 11-17weeks postoperatively. Acetabular index and Shenton line were used for preoperative and postoperative radiologic evaluation. Also, the cases were evaluated postoperatively with respect to range of motion restriction, and the leg length discrepancy. The average follow-up was 47.7months (range 22-79months). Acetabular index measurements of cases in the preoperative/postoperative periods were as follows: preoperative mean angle 39.9° (range 34°-52°)/postoperative mean angle 26° (range 22°-34°). Hip joint restriction and leg length discrepancy were not observed postoperatively. However, two patients had acetabular dysplasia. Acetabular dysplasia was completely resolved in one patient in the third year of follow-up, whereas Salter innominate osteotomy, required in another patient, was in the second year of follow-up. The latter patient was the oldest case (16-month-old) in our series. Based on the results of this study, treatment of developmental hip dysplasia with arthroscopic-assisted surgical treatment technique may be safe and effective method. Further clinical studies will be required to confirm this study.

The results of Pemberton’s pericapsular osteotomy in patients with developmental hip dysplasia

The aim of this study was to investigate the radiological and clinical outcomes of Pemberton's pericapsular osteotomy in toddlers and preschool children with developmental hip dysplasia. Ninety-one hips of 86 patients (81 girls, 5 boys) with developmental hip dysplasia who underwent Pemberton's pericapsular osteotomy were included in this study. The mean age of the patients was 34 (range: 18 to 96) months. The mean duration of follow-up was 60 (range: 24 to 158) months. All patients underwent open reduction and Pemberton's pericapsular osteotomy, including 12 hips in which proximal femur osteotomy had been performed earlier. Clinical results were evaluated according to McKay's clinical evaluation criteria, radiological results according to Sever's radiological evaluation criteria, and the presence of avascular necrosis according to Kalamchi-MacEwen's classification criteria. At the final examinations the mean acetabular index was 12.04° (range: 5° to 24°) and the mean Wiberg's center-edge angle was 35.5° (range: 20° to 52°). Clinically, excellent results were obtained in 81 (89.0%) hips, good results were obtained in 2 (2.2%) hips, and fair results in 8 (8.8%) hips. Radiologically, excellent results were obtained in 79 (86.8%) hips, good results in 7 (7.7%) and fair results in 5 (5.5%) hips. Clinically and radiologically no poor results were noted. Type 1 avascular necrosis was detected in 9 (9.9%) hips, Type 2 in 7 (7.7%) hips, and Type 3 in one (1.1%) hip. There were no cases with Type 4 avascular necrosis. Pemberton's pericapsular osteotomy is a safe and effective procedure for the surgical treatment of developmental hip dysplasia in toddlers and preschool children.

CLINICAL AND RADIOLOGICAL EVALUATION ON DEVELOPMENTAL HIP DYSPLASIA AFTER SALTER AND OMBRÉDANNE PROCEDURE

Objective: To evaluate the clinical and radiological medium-term results from surgical treatment of developmental hip dysplasia through Salter innominate bone osteotomy and Ombrédanne femoral shortening. Methods: Fourteen patients were evaluated, with surgical treatment on 18 hips (seven right-side hips and eleven left-side hips) using the proposal technique, performed between 1998 and 2008. The Dutoit and Severin criteria were used respectively for clinical and radiographic evaluations. Results: The average preoperative index for the seven right-side hips was 43.3° (40° to 50°), and this was corrected through surgery to an average of 31.57° (24° to 42°). The average preoperative index for the eleven left-side hips was 42.1° (36° to 56°), and this was corrected through surgery to an average of 30.36° (20° to 44°). There was a statistically significant difference between the preoperative and postoperative acetabular indexes, with P > 0.05. The clinical evaluation showed that there were seven excellent hips (38.9%), eight good ones (44.4%), three fair hips (16.7%) and no poor ones (0%). By grouping the hips rated good and excellent as satisfactory and those rated poor and fair as unsatisfactory, 83.3% of the results were seen to be favorable. There were no statistically significant correlations between occurrences of complications and patient age at the time of surgery or between complications and the preoperative acetabular index (p > 0.05). The complications observed consisted of one case each of subluxation, osteonecrosis and osteonecrosis together with subluxation. Conclusion: The combined procedure of Salter and Ombrédanne is a viable option for treating developmental hip dysplasia after patients have started to walk.