Mini Direct Anterior Approach for Open Reduction and Capsulorrhaphy of Developmental Dysplasia of Hip (DDH): Preliminary Report

This preliminary report introduces a new mini approach for open reduction and capsulorrhaphy without the need for splitting the iliac apophysis and avoiding excessive blood loss.Twenty hips in 14 patients (6 bilateral and 8 unilateral) have been operated upon by this new approach, the average age were 12 months (range, 9 to 22 months). The incision is started 1 cm distal and medial to the anterior superior iliac spine, extending parallel to the inguinal ligament for 5 cm. Deep dissection is carried out inbetween the Sartorius and Iliopsoas muscles. Intramuscular tenotomy of the iliopsoas tendon and tenotomy of the rectus femoris muscle allow direct access to the hip capsule. Through this plane, classic open reduction and capsulorrhaphy was achieved. All patients were maintained in hip spica in human position for 3 months.Concentric reduction was achieved in all cases and maintained for an average follow-up of 14 months (range, 12 to 20 months) with progressive radiological evidence of acetabular development.The operative time ranged from 30 to 40 minutes, blood loss during the procedure ranged from 15 to 20 ml, the scars were nearly invisible, the patients regained full range of motion 2 to 4 weeks after removal of the spica and all were walker without limp at the end of their follow-up.This approach allows satisfactory reduction of the hips, it alleviates the need for splitting the iliac apophysis thus avoiding its morbidity. However, it needs previous experience and orientation with DDH surgery.