Developmental disorders of the hip treated at the Clinic for Orthopaedic Diseases – in a period of 10 years (2009-2018)

Abstract

Developmental hip dysplasia includes a wide range of conditions such as subluxation, dislocation, hip instability, and teratological hip. The diagnosis  was confirmed by clinical examination, ultrasound  examination and anterior-posterior view radiograph  (AP). Treatment  varied  depending on the patient's age and the degree of dysplasia: Pavlik harness, closed reduction, open reduction  and corrective osteotomies. In this  study 242 patients were included, of whom  198 were female  patients and 44 male. All of the patients were treated with conservative treatment- closed reducation and spica casting. Left-sided dislocations were  more common than right sided dislocations with predominance in the female patients. The main treatment in follow-up patients was closed reduction with or without adductor muscle tenotomy   (m. add. longus). In cases with  unsuccessful attempt  of closed reduction, open reduction  was performed with or without adductor muscle tenotomy. Depending on the residual dysplasia, patients were additionally treated with pelvic osteotomies    (Salter 's inominate  osteotomy), varus derotation osteotomy, valgus osteotomy, proximal femoral resection, and  trochanter major  transposition. 167 patients were treated with closed reduction  and 3 with open reduction. The remaining patients were treated with closed reduction and additional surgery or with open reduction and additional surgery. Out of all treated patients, only 10 patients had recurrent dislocation of the hip, 7 female and 3 male patients. Closed reduction was performed again on two patients, and open reduction of the hip was performed on one patient. The average  age  of  patients was  21.5 months. By presenting the cases in a period of 10 years, it was conclud  that most  cases were  diagnosed later. Also, the standard closed reduction treatment  was successful even after the first year in said  patients. Depending on the residual dysplasia of the hip, in order to achieve better congruence of the joint, additional surgeries were  performed.