The aim of this study was to evaluate the correlation between
Salter’s criteria and Kalamchi’s classification of avascular necrosis
in patients treated for developmental dysphasia of the hip (DDH). The study involved a retrospective analysis of 123 patients (123
hips) with DDH treated by operative and non-operative reduction
before the age of two years, with a minimum follow-up of ten years.
Salter’s criteria (S1 to S4) were determined from radiographs obtained
at one to two years post-reduction, whilst the Kalamchi grade was determined
from radiographs obtained at ten or more years of age. Early post-reduction
radiographs were also used to evaluate the centre-head distance
discrepancy (CHDD) and the occurrence of a dome-shaped deformity
of the proximal femoral metaphysis (D-shaped metaphysis). The prognosis was described as good (Kalamchi grade K0 or KI),
fair (Kalamchi grade KII) or poor (Kalamchi grade KIII or KIV) for
analysis and correlation with the early Salter criteria, CHDD and
D-shaped metaphysis.Aims
Patients and Methods
The term developmental dysplasia of the hip (DDH)
describes a spectrum of disorders that results in abnormal development
of the hip joint. If not treated successfully in childhood, these
patients may go on to develop hip symptoms and/or secondary osteoarthritis
in adulthood. In this review we describe the altered anatomy encountered
in adults with DDH along with the management options, and the challenges
associated with hip arthroscopy, osteotomies and arthroplasty for
the treatment of DDH in young adults. Cite this article:
In late developmental dysplasia of the hip in childhood, the deformed dysplastic acetabulum is malaligned and has lost its shape due to pressure from the subluxed femoral head. The outer part of the acetabulum involves the upper part of the original acetabulum, thereby giving a bipartite appearance. A clear edge separates the outer from inner part which represents the lower part of the original acetabulum and has no direct contact with the femoral head. Combined pelvic osteotomy (CPO) using a Lance acetabuloplasty with either a Salter or a Pemberton procedure restores the original shape and realigns the acetabulum. A total of 20 children (22 hips), with a mean age of 46 months (28 to 94) at primary operation underwent CPO with follow-up for between 12 and 132 months. In each case concentric stable reduction with good acetabular cover was achieved and maintained throughout the period of follow-up.
Over the last several years, triple pelvic osteotomy has become our preferred method for surgical containment in Perthes disease. Since 1995, seventeen patients with Perthes disease have been treated with triple pelvic oste-otomy at our institution. Fourteen of seventeen patients (82%) had a good or excellent clinical result at latest follow-up. According to Sundt’s criteria, radiographic outcome was rated as good in fourteen patients (82%), fair in one patient and poor in two patients. Experience with the technical aspects of the procedure is necessary to avoid pseudarthrosis and iatrogenic external rotation of the acetabular fragment. To evaluate the efficacy of triple pelvic osteotomy as a method of surgical containment in Perthes disease. Recent trends point to surgery as the method of choice for containment in older children with Perthes disease. Over the last several years, triple pelvic osteotomy has become our preferred method for surgical containment in Perthes disease. Since 1995, seventeen patients (seventeen hips) with Perthes disease classified as either lateral pillar B or C have been treated with triple pelvic osteotomy at our institution. The average age at surgery was 8.5 years with an average follow-up of 4.3 years. Outcome was assessed using clinical as well as multiple radiographic criteria. Fourteen of seventeen patients (82%) had a good or excellent clinical result at latest follow-up. No patients had a residual limp or limb length inequality. Two patients had a minor postoperative complication (transient peroneal nerve palsy, meralgia paresthetica). According to Sundt’s criteria, radiographic outcome was rated as good in fourteen patients (82%), fair in one patient and poor in two patients. Triple pelvic osteotomy minimizes potential complications associated with other surgical methods such as Trendelenberg gait and shortening with proximal femoral osteotomy or hinge abduction following a
The
We reviewed the medical records of 115 patients with 130 hips with developmental dysplasia with complete dislocation in the absence of a neuromuscular disorder, spontaneous reduction with a Pavlik harness, and a minimum of 14 years’ follow-up. The mean age at the time of harness application was 4.8 months (1 to 12) and the mean time spent in the harness was 6.1 months (3 to 12). A total of 108 hips (83.1%) were treated with the harness alone and supplementary surgery for residual acetabular dysplasia, as defined by an acetabular index >
30°, was performed in 22 hips (16.9%). An overall satisfactory outcome (Severin grade I or II) was achieved in 119 hips (91.5%) at a mean follow-up of 16 years (14 to 32) with a follow-up rate of 75%. Avascular necrosis of the femoral head was noted in 16 hips (12.3%), seven of which (44%) underwent supplementary surgery and nine (56%) of which were classified as satisfactory. The acetabular index was the most reliable predictor of residual acetabular dysplasia.
We report the long-term results of 51 pelvic osteotomies in 43 patients with a mean follow-up of 15 years (13 to 20). The mean age of the patients was 28 years (14 to 46). At review three patients were lost to follow-up, and six had received a total hip arthroplasty. Of 48 hips, 42 (88%) were preserved, with good to excellent clinical results in 27 (64%). Pre-operatively, 41 (80%) of the treated hips had shown no sign of osteoarthritis. Thirty-one (65%) hips showed no progression of osteoarthritis after follow-up for 15 years. Significant negative factors for good long-term results were the presence of osteoarthritic changes and a fair or poor clinical score pre-operatively. Pelvic reorientation osteotomy for symptomatic hip dysplasia can give satisfactory and reproducible long-term clinical results.
We present simple but effective retractors used in pairs to expose the sciatic notch during
Preoperative positioning and the incision Psoas tenotomy, capsular exposure and the capsulotomy Facilitation of the Gigli saw osteotomy Sizing and procurement of the graft Displacement and fixation of the osteotomy Application of the hip spica Some questions are worthy of debate:- Can the osteotomy be safely combined with open reduction of the high dislocation? Should the osteotomy be fixed before reducing the femoral head? Are there alternatives to autogenous bone graft and K-wire fixation? Is minimally invasive surgery an option? Are the contraindications and alternatives to the Salter osteotomy fully appreciated?
We treated 15 hips (15 patients) with developmental dysplasia by a single-stage combination of open reduction through a medial approach and innominate osteotomy. The mean age of the patients at the time of operation was 20 months (13 to 30). The mean follow-up period was 9.6 years (4 to 14). At the final follow-up, 14 hips were assessed clinically as excellent and one hip as good. Radiologically, ten hips were rated as class I, four as class II and one as class III according to the criteria of Severin. No avascular necrosis was seen. No patient required subsequent surgery. Our results indicate that satisfactory results can be obtained with the single-stage combination of open reduction by the medial approach and innominate osteotomy for developmental dysplasia of the hip in a selected group of children older than 12 months. To our knowledge, no similar combined technique has been previously reported.
Clinical and radiographic data on 47 hips in 45 patients with Developmental Hip Dysplasia who underwent either a Salters Innominate Osteotomy or a Femoral Derotation Varus Osteotomy by a single operator were reviewed. The average age of patients at the time of osteotomy was 21 months (range 12–108 months). Clinical evaluation was performed with use of the lowa hip rating score and the Harris hip score. Radiographs were evaluated pre=operatively, post-operatively and at final review. The mean duration of follow-up was 15 years 9 months (range 10–21 years). Thirty-five patients had a
Treatment of residual acetabular dysplasia is still controversial regarding the timing of Surgery, and the type of surgical procedur. Material and Methods: We analyzed 70 patients (83 hips) operated between 1980–1988 year, in which
The vertical configuration open MRI Scanner (Signa SPIO, General Electric) has been used to assess the place of interventional MR in the management of developmental dysplasia of the hip over the last four years. Twenty-six patients have been studied. In static mode, coronal and axial T1 – weighted spin echo images are initially obtained to assess the anatomy of the hip, followed by dynamic imaging in near-real time. In all cases, dynamic imaging was very good for assessing and demonstrating stability. The best position for containment can be assessed and a hip spica applied. Scanning in two planes gives more information and allows more accurate positioning than an arthrogram. Confirmation of location of the hip after application of the spica can be easily demonstrated. Adductor tenotomies have been performed within the imaging volume, and in two cases, this enabled planning of femoral osteotomies. All patients have had a satisfactory outcome, but five have required open reduction and a
We compared the clinical and radiological effects of the Salter and the Chiari pelvic osteotomy on congruent dysplastic adolescent hips with mild symptoms and free of degenerative changes. The
We have studied retrospectively 37 hips in 36 children at an average of 91 months after simultaneous open reduction and
We used hydroxyapatite blocks to keep open
The transiliac method of leg lengthening uses a modification of
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