Comparison of treatment methods in patients with developmental dysplasia of the hip

This study aimed to compare the results of Pemberton osteotomy (PO), Salter innominate osteotomy (SO), open reduction (OR), and closed reduction (CR) applied in the treatment of developmental dysplasia of the hip (DDH).

Included in the study were 101 hips of 82 patients treated at our orthopedic clinic between 2017 and 2023. The patients were evaluated preoperatively, postoperatively, and at the final follow-up. The results were evaluated based on Barret's clinical and Severin's radiological classifications. Those who developed avascular necrosis (AVN) were evaluated based on Bucholz-Ogden's classification.

In terms of the preoperative acetabular angles (AAs), those for hips treated with PO were significantly higher than those of the other three, and those treated with SO were significantly higher than those of the other two (OR and CR) (p < 0.001). There was a significant difference in the final follow-up AAs of those treated with SO and PO compared to those treated with OR and CR (p < 0.001). The best corrections were achieved with PO (average: 27.94 ± 4.89°). There was a significant difference between PO and OR, and PO and CR in terms of the preoperative collodiaphyseal angles (CDAs) (p < 0.05). The greatest decrease was in those treated with PO (average: 22.44 ± 9.45°). AVN developed at various stages in 15 of 79 hips (14.85%) that were treated surgically. While AVN developed at a rate of 22.22% with PO, 18.18% with SO, and 17.85% with OR, no AVN developed in the 22 hips treated with CR.

Understanding normal and abnormal values by age is essential for selecting appropriate treatments. Acetabulum-related surgeries should be planned for patients over 1.5 years of age with an AA above 30°. Early diagnosis and CR treatments yield excellent results and low AVN rates. Various DDH treatments in our clinic have shown low AVN rates, indicating safety and efficacy.