THE OUTCOME OF OPERATIVE TREATMENT OF DEVELOPMENTAL DISLOCATION OF THE HIP (DDH) IN OLDER CHILDREN

Abstract

Unrecognised DDH may present late in older children. The problems lie in reducing the femoral head into the acetabulum, obtaining concentric reduction and obtaining a functional hip. The aim of this paper is to describe our early results with operative reduction, femoral shortening and derotation in older children with DDH.

Ten hips in 9 girls, aged 3–9 years, with DDH, seen over a 10 year period, underwent operative treatment. Pre-operative traction was not used. The femoral head was exposed through an anterior oblique incision, and femoral shortening and varus derotation osteotomy was performed through a separate lateral approach. The hip was fixed with a plate (6 cases) and cross K wires (4 cases) and immobilized in a spica cast for 6 weeks. A neck shaft angle of 90⁰–130⁰ was obtained.

The osteotomies healed in all hips. Minor skin problems were pin tract sepsis and pressure effects from the cast in 2 patients. Follow up ranged from 6 months to 5 years. Functional and radiological assessment was done to assess the outcome. Pain with avascular necrosis occurred in one patient and another had subluxation of the hip. The CE angle ranged from 0⁰–30⁰, neck shaft angle 90⁰–130⁰, leg length discrepancy from 1cm 2.5cm. The results were good in 6, satisfactory in 2 and poor in 2 children. Remodeling of the neck shaft and acetabulum was seen in the majority. Although the follow up period is short, the results of open reduction and femoral shortening in late DDH is encouraging.

The author concludes that the combination of open reduction, femoral shortening and varus derotation osteotomy gave good to satisfactory results in the majority of patients.