The outcomes of open reduction by the medial approach for developmental dysplasia of the hip in the 3-18 months old patients

This study has aimed to evaluate the outcomes of open reduction technique by the medial approach performed in the 3-18 months old infants. The patients who underwent an open reduction by the medial approach for typical dysplasia of hip between the years 20072011 were screened retrospectively. The study included 28 hips of 19 patients. The correction percentage of acetabular index was calculated by acetabular angle measurements performed prior to operation and at the last control examination. Avascular necrosis (AVN) was classified by the criteria of Kalamchi-MacEwen while radiological and clinical evaluations were performed using Severin and McKay criteria. The mean age at surgery was 12.1 months (3-18 months) while mean follow-up period duration was found 18.6 months (648 months). According to Severin radiological criteria, 9 (32.1%) and 9 (32.1%) hips were evaluated as excellent and good, respectively. Whereas, according to the evaluation based on McKay criteria, 22 (78.6%) and 6 (21.4%) hips were found excellent and good, respectively. Avascular necrosis (AVN) of the femoral head was encountered in 3 (10.7%) of the 28 hips. According to the criteria of Kalamchi-MacEwen Classification; 2 and 1 hips revealed Type I and Type 4 avascular necrosis, respectively. We have encountered according to outcomes data of this study that open reduction technique by the medial approach for treatment of developmental dysplasia of the hip (DDH) presented more successful clinical and radiological outcomes in the 3-12 months old infants compared with its application in the 13-18 months old infants.

Kaynakça

1. Ferguson AB. Primary open reduction of congenital dislocation of the hip using a median adduktor approach. J Bone Joint Surg Am 1973; 55: 671-689.

2. Mergen E, Adyaman S, Omeroglu H, Erdemli B, Isiklar U. Medial approach open reduction for congenital dislocation of the hip using the Ferguson procedure. A review of 31 hips. Arch Orthop Trauma Surg 1991; 110: 169-172.

3. Pişkin A, Karaismailoğlu TN, Sığırcı A. Gelişimsel Kalça Displazili Çocuklarda Medial Yaklaşımla açık Redüksiyon; 40 Kalçanın Orta Dönem Sonuçları O.M.U. Tıp Dergisi 2005; 22: 18-24.

4. Severin E. Congenital dislocation of the hip; Development of the joint after closed reduction. J Bone Joint Surg Am 1950; 32-A: 507-518.

5. Mckay DW. A comparison of the innominate and pericapsuler osteotomy in treatment of congenital dislocation of the hip. Clin Orthop Relat Res 1974; 98: 124-132.

6. Kalamachi A, Schmidt TL, MacEwen GD. Congenital dislocation of the hip. Open reduction by medial approach. Clin Orthop Relat Res 1982; 169: 127-132.

7. Di Mascio L, Carey-Smıth R, Tucker K. Open reduction of developmental hip dysplasia using a medial approach: A review of 24 hips. Acta Orthop Belg 2008; 74,3: 343-348.

8. Castillo R, Sherman FC. Medial adductor open reduction for congenital dislocation of the hip. J Pediatr Orthop 1990; 10: 335-340.

9. Konigsberg DE, Karol LA, Colby S, O'Brien S. Results of medial open reduction of the hip in infants with developmental dislocation of the hip. J Pediatr Orthop 2003; 23: 1-9.

10. Weinstein SL, Ponseti IV. Congenital dislocation of the hip. Open reduction through a medial approach. J Bone Joint Surg Am 1979; 61: 119-124

11. Roose PE, Chingren GL, Klaaren HE, Broock G. Open reduction for congenital dislocation of the hip using the Ferguson procedure. A review of twenty-six cases. J Bone Joint Surg Am, 1979; 61: 915-921.

12. Sener M, Baki C, Aydin H, Yildiz M, Saruhan S. The results of open reduction through a medial approach for developmental dysplasia of the hip in children above 18 months of age. Acta Orthop Traumatol Turc 2004; 38: 247-251.

13. Kiely N, Younis U, Day JB, Meadows TM. The ferguson medial approach for open reduction of developmental dysplasia of the hip. A clinical and radiological review of 49 hips. J Bone Joint Surg Br 2004; 86: 430-433.

14. Sosna A, Rejholec M. Ludloff's open reduction of the hip: long-term results. J Pediatr. Orthop 1992; 12: 603-606.

15. Matsushita T, Miyake Y, Akazawa H, Eguchi S, Takahashi Y. Open reduction for congenital dislocation of the hip: comparison of the long-term results of the wide exposure method and Ludloff's method. J Orthop Sci 1999; 4: 333-341.

16. Danielsson L. Late-diagnosed DDH: a prospective 11-year follow-up of 71 consecutive patients (75 hips). Acta Orthop. Scand 2000; 71: 232-242.

17. Ucar DH, Isiklar ZU, Stanitski CL, Kandemir U, Tumer Y. Open reduction through a medial approach in developmental dislocation of the hip: a follow-up study to skeletal maturity. J Pediatr. Orthop 2004; 24: 493-500.

Kaynak Göster