Surgical Treatment of Neglected Developmental Dysplasia of the Hip

The choice for treatment of Developmental dysplasia of the hip (DDH) include open reduction in conjunction with acetabular and or femoral procedures, however there is still debate about when, why and what type of these procedures should be done. 25 hips with neglected DDH in 19 patients were operated upon. Their age at the time of the presentation ranged between 2 and 10.5 years (mean 4.2 years).DDH was bilateral in 6 patients (31.5%), unilateral in 13 patients (68.5%). In unilateral DDH, the right side was affected in 7 patients (37%) and the left side affected in 6 patients (31.5%). 11 patients were delivered by normal delivery with cephalic presentation, 3 with breech presentation and five delivered by a caesarian section. There were no other associated anomalies. Adductor tenotomy was performed in all cases except 2 cases. Open reduction was performed in all cases.Depending on the pre-operative evaluation and the intra-operative finding, several techniques were used: open reduction and Salter osteotomy (10 hips), open reduction and Pemberton osteotomy (2 hips), open reduction and Dega osteotomy (2 hips), open reduction and Salter osteotomy with femoral shortening (1 hip), open reduction and Dega osteotomy with femoral shortening (2 hips), open reduction and Dega osteot¬omy with varus derotation osteotomy of the femur (1 hip), open reduction and femoral shortening with varus derotation osteotomy (2 hips), open reduction and varus derotation osteotomy (1 hip), open reduction and Salter osteotomy with femoral shortening with varus derotation osteotomy (2 hips), open reduction and Shelf acetabulasty (1 hip), open reduction and Chiari osteotomy with femoral shortening and varus derotation osteotomy (1 hip).The follow-up period ranged from 6 to 15 months (mean 11.8 months). Clinicaly, according to modified Mckay criteria 4 hips (16%) were rated as excellent, 17 hips (68%) as good, 3 hips (12%) as fair and one hip (4%) as poor. Excellent and good results were considered satisfactory and represent 84%. Fair and poor results were considered unsatisfactory and represents 16%. Radiologicaly, according to Severin s radiological criteria 19 hips (76%) were rated as Severin s grade 1, 4 hips (16%) as grade 2, 1 hip (4%) as grade 3 and 1 hip (4%) as grade 4. Grade 1 and 2 were considered satisfactory and represents 92%.