Single-Center Experience of Surgical Treatment of Subjects with Late-Presenting Developmental Dysplasia of the Hip

Year 2024, Volume: 34 Issue: 1, 71 - 77, 29.02.2024

Serdar Menekşe , Ahmet Yılmaz , Fırat Seyfettinoğlu

https://doi.org/10.54005/geneltip.1347722

Abstract

Aim: This study aimed to delineate the single-center experience surrounding the long-term consequences of surgical reconstruction in subjects with late-presenting DDH (developmental dysplasia of the hip).
Methods: We analyzed 23 hips of 21 subjects aged >6 years who underwent surgical interventions, such as pelvic osteotomy, open reduction, femoral shortening, and derotation, for developmental hip dysplasia.
Results: After a median follow-up of 23.34 (8–120) months, there were no noteworthy alterations in the Harris score and anteversion. Nevertheless, significant improvements were observed in SHARP, CE angle, and depth and width index over the follow-up duration. Using Sever’s radiological criteria, 87.1% of subjects achieved excellent and good results. Assessment of femoral head avascular necrosis, based on Bucholz and Ogden’s classification, produced the subsequent findings: 52% of hips were Type I; 13% were Type II; 22% were Type III; and 13% were categorized as Type IV.
Conclusion: Despite achieving favorable postoperative radiological outcomes, there's a noticeable decline in clinical success in these subjects, especially as their age increases. Additionally, they face an elevated risk of avascular necrosis. The juxtaposition of a 75% radiological success rate with a 50% clinical success rate accentuates this contrast. Crucially, the success rate of surgical corrections in late-presenting DDH is tied to the age of the patient, with the success rate decreasing as age progresses.

Keywords

developmental dysplasia of the hip, triple pelvic osteotomy, femoral osteotomy, hip joint, hip preservation

Geç Dönem Tedavi Edilen Gelişimsel Kalça Displazisi Olan Olguların Cerrahi Tedavisinde Tek Merkez Deneyimi

Abstract

Amaç: Bu çalışma, geç ortaya çıkan GKD'li (gelişimsel kalça displazisi) olgularda cerrahi rekonstrüksiyonun uzun vadeli sonuçlarına ilişkin tek merkez deneyimini tanımlamayı amaçlamıştır.
Yöntemler: Gelişimsel kalça displazisi nedeniyle pelvik osteotomi, açık redüksiyon, femoral kısaltma ve derotasyon gibi cerrahi girişimler uygulanan 6 yaşından büyük 21 olgunun 23 kalçası analiz edildi.
bulgular: Ortanca 23.34 (8-120) aylık takip sonrasında, Harris skoru ve anteversiyonda kayda değer bir değişiklik olmadı. Bununla birlikte, SHARP, CE açısı ve derinlik ve genişlik indeksinde takip süresi boyunca anlamlı iyileşmeler gözlendi. Sever'in radyolojik kriterleri kullanılarak, olguların %87.1'inde mükemmel ve iyi sonuçlar elde edildi. Bucholz ve Ogden'in sınıflandırmasına göre femur başı avasküler nekrozu değerlendirildiğinde aşağıdaki bulgular elde edildi: Kalçaların %52'si Tip I; %13'ü Tip II; %22'si Tip III ve %13'ü Tip IV olarak kategorize edildi.
Sonuçlar: Ameliyat sonrası olumlu radyolojik sonuçlar elde edilmesine rağmen, bu olgularda, özellikle yaşları arttıkça, klinik başarıda gözle görülür bir düşüş vardır. Ayrıca, bu kişiler yüksek avasküler nekroz riskiyle karşı karşıyadır. 75'lik radyolojik başarı oranı ile %50'lik klinik başarı oranının yan yana gelmesi bu zıtlığı vurgulamaktadır. Daha da önemlisi, geç ortaya çıkan GKD'de cerrahi düzeltmelerin başarı oranı hastanın yaşına bağlıdır ve yaş ilerledikçe başarı oranı düşmektedir.

Keywords

gelişimsel kalça displazisi, üçlü pelvik osteotomi, femoral osteotomi, kalça eklemi, kalça koruma

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