Treatment of hip dysplasia in older children with a combined one-stage procedure

This retrospective study was conducted to determine the efficacy and complication rates associated with treating children of ambulatory age with idiopathic developmental dysplasia of the hip with open reduction and combined femoral and pelvic osteotomies. Eighteen hips were reviewed in 13 patients. The average patient age at surgery was 29 months (range, 15-117 months), with an average followup of 43 months (range, 24-78 months). Preoperative Tonnis classification identified six Class II, seven Class III, and five Class IV hips. Followup Severin classification identified 16 Class 1A and two Class 2A hips. The average center edge angle on most recent followup was 47 degrees (range, 25 degrees-70 degrees), and the acetabular index was 5 degrees (range, 0 degree-20 degrees). Avascular necrosis developed in one (5.5%) patient. Clinically, all patients were pain free with ambulation and had excellent results by McKay criteria. No patient required a second surgical procedure for recurrent subluxation or persistent acetabular dysplasia. The treatment of children who are of ambulatory age with developmental dysplasia of the hip using open reduction and combined osteotomies was safe and effective.