Should routine pelvic osteotomy be added to the treatment of DDH after 18 months?

The treatment of developmental dysplasia of the hip (DDH) between ages 1-3 years is controversial. Particularly controversial is the age after which pelvic osteotomy should be added to the treatment. In the present study, the outcomes of DDH patients aged 1-3 years treated with anterior open reduction alone were evaluated, and the relationship between inadequate acetabular development, the need for secondary pelvic osteotomy, and age was investigated. A total of 53 patients (70 hips) who had begun walking, who had undergone open reduction through an anterolateral approach, who had a follow-up period of at least 2 years, and who had Tönnis grade III and IV hip dysplasia were included in the study. They were grouped according to treatment age (pre-18 months: Group I; post-18 months: Group II), and the two groups were compared with regard to radiological and functional outcomes and the need for a secondary acetabular procedure. In Group I there were 29 hips (mean age: 16.09 months) and in group II there were 41 hips (mean age: 23.1 months), and the mean follow-up period was 48.9 months. According to the modified Trevor score, in Group I outcomes were excellent in 23 hips (79.3%) and good in 6 hips (20.7%), while in group II outcomes were excellent in 30 hips (73.2%), good in 10 hips (24.4%), and fair in 1 hip (2.1%). The difference between outcomes was not significant (P > 0.05). Inadequate acetabular development was determined in 11 hips in group I (37.9%) and in 16 hips in group II (39%). There was no difference between groups in terms of inadequate acetabular development or the need for acetabular prodecures (p > 0.05). No significant difference was determined between DDH patients treated before 18 months and those treated after 18 months with regard to unsatisfactory acetabular development or the need for secondary acetabular procedures. According to these results, reduction prior to 18 months does not always achieve satisfactory acetabular development, and secondary acetabular procedures are not always necessary in patients who undergo reduction after 18 months. In the treatment of DDH, the decision to perform primary pelvic osteotomy in addition to open reduction should be made not according to whether the patient is older or younger than 18 months, but according to stability, and all patients should be followed closely with regard to the need for pelvic osteotomy.