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Combined Femoral and Acetabular Osteotomy in Children of Walking Age for Treatment of DDH; A Five Years Follow-Up Report.

Mazloumi M, Omidi-Kashani F, Ebrahimzadeh MH, Makhmalbaf H, Hoseinayee MM - Iran J Med Sci (2015)

Bottom Line: From the 30 cases, six patients excluded in the course of the study and among the remaining patients, 12 had bilateral involvement.The mean follow-up period was 7.6±0.8 (range: 5.1-11.3) years.During the last visit, radiographic status of the operated joints, according to Severin classification was as follows: Class I: 12 patients; Class II: 20 patients; Class III: 3 patients; Class IV: 1 patient; and Class VI: 1 patient.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Orthopedic Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.

ABSTRACT

Background: The prevalence of neglected developmental dysplasia of the hip (DDH) has been decreasing. Nowadays, the disease is rarely seen in walking age children. The purpose of this study is to assess the results of simultaneous osteotomy of femur and pelvic bones in such children.

Method: We performed a retrospective study on 30 children aged 3.8±0.9 (range: 1.5-7) years old, with DDH who underwent surgical operation in our hospital from August 2001 to September 2006. Tönnis and Severin grading systems were used to classify the radiographic status of the hip in pre- and postoperative era, respectively. Improvement in function and limp was also evaluated by the modified McKay's classification.

Results: From the 30 cases, six patients excluded in the course of the study and among the remaining patients, 12 had bilateral involvement. The mean follow-up period was 7.6±0.8 (range: 5.1-11.3) years. During the last visit, radiographic status of the operated joints, according to Severin classification was as follows: Class I: 12 patients; Class II: 20 patients; Class III: 3 patients; Class IV: 1 patient; and Class VI: 1 patient.

Conclusion: Although through the follow-up, two hips subluxated, necrosis happened in three and one joint was re-dislocated, simultaneous femoral and innominate osteotomy in the walking age children with DDH has relatively good clinical outcomes.

No MeSH data available.


Related in: MedlinePlus

Intra-operative picture showing the dislocated hip and the round ligament just before resection.
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Figure 1: Intra-operative picture showing the dislocated hip and the round ligament just before resection.

Mentions: At first, adductor tenotomy was performed to release muscle contractures in the adductor muscles group. Hip arthrotomy was performed using the iliofemoral approach and then the iliac crest apophysis was divided into two halves in order to gain access to the joint capsule, followed by the exposure of the hip joint for direct joint reduction (figure 1). We performed proximal femoral rotational osteotomy in cases with excessive anteversion or tension on the head, especially in older age groups. This osteotomy was carried out through the proximal femoral posterolateral approach. After appropriate femoral shortening and derotating, fixation of the osteotomy site was performed by a simple 4-hole plate. After that, iliac osteotomy by the Salter or Pemberton method (depend upon the femoral head size and acetabular capacity) through the previous hip approach was carried out. Open reduction of the femoral head in the acetabulum was achieved, then the joint capsule was reefed, and finally the wound closed in anatomical layers. Reduction was cheeked by flouroscopy and hip spica cast applied while the operated joint immobilized in the reduced position. The spica cast was removed after 1.5 months and radiographic control study was repeated every 6 months until the final visit.


Combined Femoral and Acetabular Osteotomy in Children of Walking Age for Treatment of DDH; A Five Years Follow-Up Report.

Mazloumi M, Omidi-Kashani F, Ebrahimzadeh MH, Makhmalbaf H, Hoseinayee MM - Iran J Med Sci (2015)

Intra-operative picture showing the dislocated hip and the round ligament just before resection.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4300474&req=5

Figure 1: Intra-operative picture showing the dislocated hip and the round ligament just before resection.
Mentions: At first, adductor tenotomy was performed to release muscle contractures in the adductor muscles group. Hip arthrotomy was performed using the iliofemoral approach and then the iliac crest apophysis was divided into two halves in order to gain access to the joint capsule, followed by the exposure of the hip joint for direct joint reduction (figure 1). We performed proximal femoral rotational osteotomy in cases with excessive anteversion or tension on the head, especially in older age groups. This osteotomy was carried out through the proximal femoral posterolateral approach. After appropriate femoral shortening and derotating, fixation of the osteotomy site was performed by a simple 4-hole plate. After that, iliac osteotomy by the Salter or Pemberton method (depend upon the femoral head size and acetabular capacity) through the previous hip approach was carried out. Open reduction of the femoral head in the acetabulum was achieved, then the joint capsule was reefed, and finally the wound closed in anatomical layers. Reduction was cheeked by flouroscopy and hip spica cast applied while the operated joint immobilized in the reduced position. The spica cast was removed after 1.5 months and radiographic control study was repeated every 6 months until the final visit.

Bottom Line: From the 30 cases, six patients excluded in the course of the study and among the remaining patients, 12 had bilateral involvement.The mean follow-up period was 7.6±0.8 (range: 5.1-11.3) years.During the last visit, radiographic status of the operated joints, according to Severin classification was as follows: Class I: 12 patients; Class II: 20 patients; Class III: 3 patients; Class IV: 1 patient; and Class VI: 1 patient.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Orthopedic Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.

ABSTRACT

Background: The prevalence of neglected developmental dysplasia of the hip (DDH) has been decreasing. Nowadays, the disease is rarely seen in walking age children. The purpose of this study is to assess the results of simultaneous osteotomy of femur and pelvic bones in such children.

Method: We performed a retrospective study on 30 children aged 3.8±0.9 (range: 1.5-7) years old, with DDH who underwent surgical operation in our hospital from August 2001 to September 2006. Tönnis and Severin grading systems were used to classify the radiographic status of the hip in pre- and postoperative era, respectively. Improvement in function and limp was also evaluated by the modified McKay's classification.

Results: From the 30 cases, six patients excluded in the course of the study and among the remaining patients, 12 had bilateral involvement. The mean follow-up period was 7.6±0.8 (range: 5.1-11.3) years. During the last visit, radiographic status of the operated joints, according to Severin classification was as follows: Class I: 12 patients; Class II: 20 patients; Class III: 3 patients; Class IV: 1 patient; and Class VI: 1 patient.

Conclusion: Although through the follow-up, two hips subluxated, necrosis happened in three and one joint was re-dislocated, simultaneous femoral and innominate osteotomy in the walking age children with DDH has relatively good clinical outcomes.

No MeSH data available.


Related in: MedlinePlus