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Bilateral developmental dysplasia of the hip: asymmetric outcome in the older child
1Department of Orthopaedic Surgery, College of Medicine, King Faisal University, Dammam, Saudi Arabia.
Insights
Bilateral developmental dysplasia of the hip (DDH) surgery in children over 5 years old carries a risk of asymmetric outcomes. Careful assessment is needed to manage potential leg length discrepancies and clinical differences post-operation.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Developmental Dysplasia of the Hip
Background:
- Developmental dysplasia of the hip (DDH) is a condition affecting hip joint development.
- Bilateral DDH requires surgical intervention, often involving open reduction and osteotomy.
- Assessing outcomes and complications is crucial for treatment optimization.
Purpose of the Study:
- To evaluate the incidence of asymmetric outcomes after surgical treatment for bilateral developmental dysplasia of the hip.
- To identify risk factors associated with asymmetric outcomes in pediatric DDH patients.
Main Methods:
- Retrospective review of 15 patients (≥2 years) with bilateral DDH.
- Surgical procedures included open reduction with pelvic and/or femoral osteotomy.
- Outcomes assessed using McKay and Severin classifications; asymmetric outcome defined by clinical/radiologic differences or leg length discrepancy.
Main Results:
- No significant pre-operative clinical or radiologic differences between hips.
- Surgical procedures were symmetric in 93% of patients.
- Asymmetric outcomes occurred in 27% of patients, predominantly in those older than 5 years.
Conclusions:
- Asymmetric outcomes are a potential risk following surgical treatment for bilateral DDH.
- Children older than 5 years with bilateral DDH are at higher risk for asymmetric outcomes.
- Further research may be needed to mitigate risks and improve symmetry in this age group.
Abstract:
Fifteen patients who were 2 years of age or older and had bilateral developmental dysplasia of the hip were reviewed. Thirty hips had required open reduction combined with osteotomy on the pelvic or femoral side or both as necessary. The results were assessed according to McKay and Severin classifications, and complications including asymmetric outcome were recorded. An asymmetric outcome existed if the clinical or radiologic result for the contralateral hip was more than one unit difference or a leg length discrepancy of more than 1 cm was observed. Before surgery, there was no significant difference clinically and radiologically between the right and left hips for all patients. Surgical procedures required for both hips also were symmetric in 14 (93%) patients. However, asymmetric outcome occurred in four (27%) patients, three of whom were older than 5 years. An asymmetric outcome as defined is a potential risk after surgical treatment of bilateral developmental dysplasia of the hip in children who are older than 5 years.
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