Dega transiliac pelvic osteotomy for developmental hip dysplasia: a systematic review

A systematic review of studies reporting outcomes after Dega transiliac pelvic osteotomy (DO) in developmental dysplasia of the hip (DDH) was carried out with a meta-analysis of the pre- and postoperative acetabular index (AI) values. The MEDLINE, ClinicalKey, PubMed, and Cochrane Library databases were searched for articles published up to April 2020 (keywords: Dega, Dega osteotomy, Dega acetabuloplasty, Dega transiliac, and Dega acetabular). The reference lists of reviewed articles were manually searched. Three hundred and seventy-two articles were identified; 23 met the inclusion criteria. The difference between pre- and postoperative AI values were reported in 19 studies (636 hips); the average postoperative AI value was ≤20° in 16/19. Ten studies were included in the meta-analysis. The overall difference between the mean pre- and postoperative AI was 22.5° (95% confidence interval 20.2-24.8°). The average postoperative center-edge angle was reported in 14/23 studies (480 hips) and was normative (≥20°). Hips were assessed using the Severin classification in 11/23 studies; 81.7% of 410 hips were Severin class I-II. The clinical outcome quantified following McKay/Berkeley or other criteria in nine studies (512 hips) was good or very good in 84.8% of hips at follow-up. The incidence of avascular necrosis (AVN) of the femoral head was 18.9% (19 studies, 856 hips). The cumulative rate of reoperation of 5.8% was reported in 14 studies. DO ensures adequate correction of radiological parameters in DDH, and facilitates a good clinical outcome with low incidences of AVN and reoperation risk. Level of evidence: IV.