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Outcome in unilateral or bilateral DDH treated with one-stage combined procedure
Mehmet Subasi1, Huseyin Arslan, Oguz Cebesoy
1Department of Orthopedic Surgery, Faculty of Medicine, Gaziantep University, Sahinbey, Gaziantep, Turkey. subasi-m@hotmail.com
Insights
Surgical outcomes for neglected developmental dysplasia of the hip (DDH) are better when treated younger. Children 5.5 years or younger (bilateral) and 8 years or younger (unilateral) showed improved results after one-stage procedures.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Developmental Dysplasia of the Hip
Background:
- Surgical treatment for neglected developmental dysplasia of the hip (DDH) remains controversial.
- Outcomes may be influenced by patient age at the time of intervention.
Purpose of the Study:
- To evaluate the effect of age on surgical outcomes in patients with neglected DDH undergoing one-stage combined procedures.
- To compare outcomes between patients with unilateral and bilateral hip dislocations.
Main Methods:
- Retrospective review of 40 patients (51 hips) with neglected DDH.
- One-stage combined procedure: open reduction, pelvic osteotomy, and femoral shortening.
- Patients divided into Group I (bilateral dislocation) and Group II (unilateral dislocation).
Main Results:
- Average age at surgery was 5.4 years (Group I) and 6.7 years (Group II).
- Modified Trevor et al. scores indicated good to excellent results in both groups.
- Younger patients (≤5.5 years in Group I, ≤8 years in Group II) demonstrated better outcomes.
- Complications included limb-length discrepancy and varying degrees of osteonecrosis.
Conclusions:
- Age is a significant factor influencing surgical outcomes in neglected DDH.
- Timely surgical intervention, particularly in younger children, may lead to improved results.
- One-stage combined procedures offer a viable treatment option for neglected DDH.
Unlabelled:
The surgical treatment of patients with neglected developmental dysplasia of the hip (DDH) has been the subject of controversy. We asked if age affected outcome in patients with neglected DDH with unilateral or bilateral dislocation who underwent one-stage combined procedures. We retrospectively reviewed the results of 40 patients (51 hips) treated with a one-stage combined procedure consisting of open reduction, pelvic osteotomy, and femoral shortening. The average age at the time of surgery was 5.4 years for Group I (bilateral dislocation, 22 hips) and 6.7 years for Group II (unilateral dislocation, 29 hips). Mean followup was 5.4 years for Group I and 6.7 years for Group II. According to the modified score system of Trevor et al, 13 hips rated excellent, three were good, and six were fair in Group I; the ratings were 14, nine, and six hips respectively in Group II. Four patients had a limb-length discrepancy of approximately 1.5 cm in Group I. Twelve hips in Group I and 18 hips in Group II had osteonecrosis of varying severity. Our data suggest the outcomes of the children who were 5.5 years or younger in Group I and 8 years or younger in Group II were better.
Level Of Evidence:
Level IV, case series. See the Guidelines for Authors for a complete description of levels of evidence.