A modified surgical approach of the hip in children: is it safe and reliable in patients with developmental hip dysplasia?

Author:

Iyetin Yusuf1,Turkmen Ismail2,Saglam Yavuz3,Akcal Mehmet Akif4,Unay Koray5,Unsac Bahattin5

Affiliation:

1. Department of Orthopedics and Traumatology, Istanbul Pendik Bolge Hospital, Istanbul Turkey

2. Department of Orthopedics and Traumatology, Beykoz State Hospital, Istanbul Turkey

3. Department of Orthopedics and Traumatology, Bahcelievler State Hospital, Atakoy 4. Kisim, TO 109, Daire: 18, Bakirkoy, Istanbul Turkey

4. Department of Orthopedics and Traumatology, Antalya Atatürk State Hospital, Istanbul Turkey

5. Department of Orthopedics and Traumatology, Istanbul Medeniyet University Göztepe Training and Research Hospital, Istanbul Turkey

Abstract

Purpose Treatment is easier and complications are less likely to occur if developmental dysplasia of the hip (DDH) is diagnosed early. In this study, we examined the early results of open reduction using a medial approach which we had modified for DDH and analyzed the success of this technique and the associated complication rates, with a focus on avascular necrosis (AVN). Methods This is an Institutional Review Board-approved retrospective review of all patients diagnosed with DDH and treated with a modified medial approach at a single institution from July 1999 to December 2010. The patients' charts were analyzed for clinical and radiographic features. Results Fifty-five hips of 41 patients, all of whom were treated by open reduction using a modified medial approach due to DDH, were evaluated retrospectively. The mean age of the patients at surgery was 19 (range 11–28) months, and the average follow-up was 5.5 (range 3–9.5) years. AVN was the most important complication in terms of radiological outcomes as assessed according to the Kalamchi–McEwen classification. Radiologic results were excellent or good in 51 hips (92.7 %) and fair–plus in four (7.3 %). Type 1 temporary AVN was detected in only two hips (3.6 %), and the lesions had disappeared completely in the final control graphs of these two patients. A secondary intervention was needed for two hips (3.6 %) of the same patients who were operated on due to bilateral DDH. No other complications, such as infection, re-dislocation, or subluxation, were seen in the operated patients. Conclusions We believe that treatment for DDH using a modified medial approach during early childhood is an effective and reliable method with low AVN rates. As shown here, this method achieves great success in radiological and clinical outcomes after a minimum 3-year follow-up.

Publisher

SAGE Publications

Subject

Orthopedics and Sports Medicine,Pediatrics, Perinatology and Child Health

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