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Surgical results of developmental dysplasia of the hip in older children based on using three-dimensional computed
Xiong Zhao1, Ya-Bo Yan1, Peng-Chong Cao1
1Department of Orthopeadics, Xijing Hospital, The Fourth Military Medical University, Xi'an, P.R. China.
Insights
This study shows that personalized surgical plans using 3D CT scans lead to good outcomes for older children with developmental dysplasia of the hip (DDH). Careful planning and surgical experience are key to successful treatment.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Radiology
Background:
- Developmental dysplasia of the hip (DDH) management in older children remains controversial.
- Neglected DDH cases present unique surgical challenges.
- Three-dimensional computed tomography (3D CT) offers advanced imaging for surgical planning.
Purpose of the Study:
- To evaluate the outcomes of surgical interventions for neglected DDH in older children.
- To assess the efficacy of individualized surgical procedures guided by 3D CT.
- To analyze the results of Pemberton osteotomy and Dega osteotomy combined with femoral osteotomy.
Main Methods:
- Retrospective analysis of 47 patients (59 hips) with neglected DDH.
- Surgical procedures included Pemberton osteotomy or Dega plus Pemberton osteotomy.
- All patients underwent subtrochanteric transverse femoral shortening and derotation osteotomy.
Main Results:
- Excellent or good outcomes were achieved in 87.5% of hips in group 1 (bilateral) and 85.7% in group 2 (unilateral).
- Complications included limb length discrepancy in 5 patients and varying degrees of osteonecrosis in 13 hips.
- The average age at surgery was over 10 years, with a mean follow-up of approximately 5.5 years.
Conclusions:
- Preoperative 3D CT evaluation is crucial for personalized surgical planning in DDH.
- Experience with specific surgical techniques contributes to satisfactory therapeutic effects.
- Individualized surgical approaches can yield positive results in older children with neglected DDH.
Background:
The surgical management of developmental dysplasia of the hip (DDH) in older children has been the subject of controversy. The purpose of this study was to evaluate the outcome in patients with neglected DDH who underwent individual procedures based on using three-dimensional computed tomography.
Methods:
Forty-seven patients (59 hips) were treated using Pemberton osteotomy or Dega plus Pemberton osteotomy. Subtrochanteric transverse femoral shortening and derotation osteotomy were performed for all patients. The average age at the time of surgery was 10.5 y for group 1 (bilateral dislocation, 24 hips) and 11.2 y for group 2 (unilateral dislocation, 35 hips). Mean follow-up was 5.3 y for group 1 and 5.8 y for group 2.
Results:
At the end of follow-up, 13 hips (54.2%) were rated excellent, eight hips (33.3%) were good, and three hips (12.5%) were fair in group 1. In group 2, 20 hips (57.1%) were rated excellent, 10 hips (28.6%) were good, and five hips (14.3%) were fair. There were five patients who had a limb length discrepancy of approximately 1.5 cm in group 2. Six hips in group 1 and seven hips in group 2 had osteonecrosis of varying severity.
Conclusions:
We believe that preoperation three-dimensional computed tomography evaluation, personalized operation plans, and experience with the surgical procedure are the main reasons for the satisfactory therapeutic effects achieved in this study in older children with DDH.
