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Revision of Failed Open Reduction of Developmental Dysplasia of the Hip
Mohamed Mansour Elzohairy1, Mohamed Mahmoud Elhefnawy1, Hosam Mohamed Khairy1
1Faculty of Human Medicine, Zagazig University, Zagazig, Egypt.
Insights
Revision surgery for developmental dysplasia of the hip (DDH) can yield good outcomes. Addressing causes of failure in initial open reduction is key to achieving stable hip reduction in children.
Area of Science:
- Pediatric Orthopedics
- Surgical Techniques
- Hip Dysplasia Research
Background:
- Inadequate surgical exposure and incomplete soft-tissue release are primary causes of re-dislocation after open reduction for hip dysplasia.
- Developmental dysplasia of the hip (DDH) can necessitate revision surgery when initial treatments fail.
Purpose of the Study:
- To evaluate the outcomes of revision surgery in children with developmental dysplasia of the hip (DDH) following failed open reduction.
- To identify common causes of failure in primary open reduction procedures for DDH.
Main Methods:
- A clinical study involving 33 children (34 hips) who underwent revision surgery for developmental dysplasia of the hip (DDH).
- Assessment of clinical outcomes using McKay criteria and radiological outcomes using modified Severin criteria.
Main Results:
- Good clinical results were achieved in 82.4% of cases (McKay criteria).
- Radiological evaluation showed 82.4% of hips were classified as good (modified Severin category 2).
- Poor outcomes, including re-dislocation, occurred in 5.9% of cases.
Conclusions:
- Revision surgery for DDH, while challenging, can lead to successful stable and concentric hip reduction.
- Addressing acetabulum remodeling and ensuring adequate soft-tissue release are crucial to prevent primary operation failure.
- The study indicates a favorable outcome for revision surgery in cases of failed open reduction for DDH.
Background:
The most common causes of re-dislocation after open reduction are inadequate exposure and failure to release the obstructing soft tissues inside and around the hip.
Methods:
This clinical study included 33 consecutive children (34 hips) who underwent a revision surgery after failed open reduction of developmental dysplasia of the hip (DDH).
Results:
According to the McKay clinical criteria, the results were good in 28 cases (82.4%), fair in 4 cases (11.8%), and poor in 2 cases with re-dislocation (5.9%). Radiological results according to the modified Severin criteria were as follows: 28 hips (82.4%) were identified as category 2 (good), 4 hips (11.8%) category 4 (fair), and 2 hips (5.9%) category 5 (poor).
Conclusions:
Revision surgery for DDH is demanding and the long-term consequences are usually serious, but stable, concentric reduction should be obtained either at the first or second open reduction by addressing the causes of failure. Failed acetabulum remodeling and technical errors with inadequate soft-tissue release were the most common causes of failure in the primary operation. Based on the results, the outcome of revision surgery after failed open reduction for DDH was good.
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