Cenk KÖROĞLU, Emre ÖZDEMİR, MEHMET ÇOLAK, Ersin ŞENSÖZ, Fehmi Volkan ÖZTUNA

Open reduction and Salter innominate osteotomy combined with femoral osteotomy in the treatment of developmental dysplasia of the hip: Comparison of results before and after the age of 4 years

Objective: This study aimed to compare the clinical and radiological findings of radical reduction (open reduction and Salter innominateosteotomy combined with femoral osteotomy) for children of walking age, younger and older than 4 years in the treatment of with developmental dysplasia of the hip (DDH).Methods: In this retrospective study, children of walking age with DDH who underwent radical reduction between 2008 and 2014 wereidentified. They were then divided into 2 groups according to the age at which the surgery was performed: before and after the age of 4 years.Improvement in the acetabular index was examined on follow-up radiographs. The presence of avascular necrosis (AVN) was determinedand classified on the basis of the Kalamchi-MacEwen classification on final follow-up radiographs. Clinical assessment was performed withthe modified McKay criteria at the final follow-up appointment.Results: A total of 19 children (14 girls, 5 boys; mean age=37.5±21 months) (25 hips) were included. Their mean age was 27.9±4.9 and63.3±19.7 months in children operated before and after the age of 4 years, respectively. The mean follow-up time was 29.9±19 and 19.6±5months in children operated before and after the age of 4 years, respectively. No significant difference was observed in improvements inthe acetabular index between children younger than 4 years (24±6.9°) and those older than 4 years (20.7±6.7°) (p=0.25). According to themodified McKay criteria, all the children younger than 4 years exhibited excellent or good clinical results compared with those operated afterthe age of 4 years (67%) (p=0.013). At the final follow-up, 64% of all patients demonstrated no radiographical sign of AVN. The rates of AVNwere significantly higher in children operated after the age of 4 years (33%) than in those operated before the age of 4 years (19%) (p=0.049).Conclusion: Better clinical and radiographical results can be expected from radical reduction in children undergoing surgery before the ageof 4 years.Level of Evidence: level III, Therapeutic Study

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