Surgical Treatment of Mild Hip Dysplasia in Combination with Pembersal and Femoral Osteotomy

Yıl 2022, Cilt: 44 Sayı: 2, 243 - 249, 28.02.2022

Cüneyd Günay , Atalar Hakan , Coşkun Ulucaköy , Elshan Najafov , Sacit Turanlı

https://doi.org/10.20515/otd.1020776

Öz

The aim of this study was to show the clinical and radiographic mid-term results of Pembersal and femoral osteotomy without open reduction in patients with mild dysplasia of the hip joint. This case series included 13 Developmental Dysplasia of the Hip (DDH) patients (13 hips), who underwent a combination of Pembersal and femoral osteotomy without open reduction between January 2014 and June 2020. The patients comprised 12 females (93%) and 1 male (8%), with a mean age at surgery of 24.29.40 months (range: 17-51 months) and the average follow-up was 31.413.2 months (range: 12-49 months). The mean acetabular index decreased significantly from 36.604.870 (range:300- 460) preoperatively, to 1801.410 (range: 150-210) at the final follow-up examination (p<0.001). Avascular necrosis (AVN) was not seen in any patient. The results showed that this kind of surgical procedure seems to be successful at the mid-term follow-up in mild hip dysplasia patients. The most important point was that avascular necrosis was not seen in any of the patients with this technique.

Anahtar Kelimeler

Developmental hip dysplasia, Pelvic osteotomy, Avascular necrosis, Hip joint, Reduction

Hafif Kalça Displazisinin Pembersal ve Femoral Ostetomi Kombinasyonlu Cerrahi Tedavisi

Öz

Bu çalışmanın amacı kalça ekleminde hafif displazisi olan hastalarda açık redüksiyon olmadan Pembersal ve femoral osteotominin orta dönem klinik ve radyografik sonuçlarını göstermektir. Bu vaka serisi Ocak 2014 ve Haziran 2020 tarihleri arasında açık redüksiyon olmadan Pembersal ve femoral osteotomi uygulanan 13 Gelişimsel Kalça Displazisi (GKD) hastasını (13 kalça) içermektedir. Hastaların 12’ si kız (%93) ve 1’ i erkek (%8), cerrahi sırasındaki ortalama yaş 24.29.40 ay (aralık: 17-51 ay) ve ortalama takip süresi ise 31.413.2 ay idi (aralık: 12-49 ay). Ortalama asetabular indeks son takipte 36.604.870 (aralık: 300- 460) den önemli derecede düşerek 1801.410 (aralık: 150-210) geriledi (p<0.001). Hiçbir hastada avasküler nekroz görülmedi. Elde edilen bu sonuçlar bu tarz cerrahi girişimin hafif kalça displazili hastalarda orta dönem takiplerde başarılı olduğunu göstermektedir. En önemli nokta ise bu teknikle hiçbir hastada avasküler nekroz görülmemiş olmasıdır.

Anahtar Kelimeler

Gelişimsel kalça displazisi, Pelvik osteotomi, Avasküler nekroz, Kalça eklemi, Redüksiyon

Kaynakça

• 1. Akagi S, Tanabe T, Ogawa R. Acetabular development after open reduction for developmental dislocation of the hip: 15-year follow-up of 22 hips without additional surgery. Acta Orthop Scand. 1998;69:17-20.
• 2. Huang S-C, Wang J-H. A comparative study of nonoperative versus operative treatment of developmental dysplasia of the hip in patients of walking age. J Pediatr Orthop. 1997;17:181-8.
• 3. Berkeley ME, Dickson JH, Cain TE, Donovan MM. Surgical therapy for congenital dysplasia of the hip in patients who are twelve to thirty-six months old. J Bone Joint Surg (Am). 1984;66-A:412-20.
• 4. Tönnis D. Normal values of the hip joint for the evaluation of X-rays in children and adults. Clin Orthop Relat Res. 1976;119:39-47.
• 5. Herring J. Developmental dysplasia of the hip. In: Herring J (editor). Tachdjian’s pediatric orthopaedics. Philadelphia, WB Saunders, 2008, pp 637–770.
• 6. Pospischill R, Weninger J, Ganger R, Altenhuber J, Grill F. Does open reduction of the developmental dislocated hip increase the risk of osteonecrosis? Clin Orthop Relat Res. 2012;470:250-60.
• 7. Roposch A, Ridout D, Protopapa E, Nicolaou N, Gelfer Y. Osteonecrosis complicating developmental dysplasia of the hip compromises subsequent acetabular remodeling. Clin Orthop Relat Res. 2013;471:2318-26.
• 8. Li Y, Guo Y, Shen X, Liu H, Mei H, Xu H, Canavese F; Chinese Multi-center Pediatric Orthopedic Study Group (CMPOS). Radiographic outcome of children older than twenty-four months with developmental dysplasia of the hip treated by closed reduction and spica cast immobilization in human position: a review of fifty-one hips. Int Orthop. 2019;43:1405-11.
• 9. Roposch A, Liu LQ, Offiah AC, Wedge JH. Functional outcomes in children with osteonecrosis secondary to developmental dysplasia of the hip. J Bone Joint Surg Am. 2011;93:e145.
• 10. Schoenecker PL, Strecker WB. Congenital dislocation of hip in the children. Comparison of the effects of femoral shortening and of skeletal traction in the treatment. J Bone Joint Surg Am. 1984;66:21-7.
• 11. Karakaş ES, Baktir A, Argün M, Türk CY. One-stage treatment of congenital dislocation of the hip in older children. J Pediatric Orthop. 1995;15:330-6.
• 12. Klisic P, Jankovic L, Basara V. Long-term results of combined operative reduction of the hip in older children. J Pediatric Orthop. 1988;8:532-4.
• 13. Agarwal A, Rastogi P. Clinicoradiological outcomes following pembersal acetabular osteotomy for developmental dysplasia of hip in young children: A series of 16 cases followed minimum 2 years. J Clin Orthop Trauma. 2021;23:101669.
• 14. Stuart L. Weinstein, Scott J. Mubarak and Dennis R. Wenger. Developmental Hip Dysplasia and Dislocation: Part I J Bone Joint Surg Am. 2003;85:1824-32.
• 15. Lindstrom JR, Ponseti IV, Wenger DR. Acetabular development after reduction in congenital dislocation of the hip. J Bone Joint Surg Am. 1979;61:112–8.
• 16. Salter RB. Role of innominate osteotomy in the treatment of congenital dislocation and subluxation of the hip in the older child. J Bone Joint Surg Am. 1966;48:1413–39.
• 17. Salter RB. The classic: innominate osteotomy in the treatment of congenital dislocation and subluxation of the hip by Robert B. Salter, J Bone Joint Surg (Brit) 43B:3:518, 1961. Clin Orthop Relat Res. 1978;137:2–14.
• 18. Carvalho Filho G, Chueire AG, Ignácio H, Carneiro MO, Neto JF, Canesin AC. Tratamento cirúrgico da luxac¸ãocongênita do quadril pós marcha: reduc¸ão aberta e osteotomia de Salter. Acta Ortop Bras. 2003;11:42–7.
• 19. Rocha VL, Thomé AL, Castro DL, Oliveria LZ, Moraes FB. Avaliac¸ão clínica e radiológica após procedimento de Salter e Ombrédanne na displasia de desenvolvimento do quadril. Rev Bras Ortop. 2011;46:650–5.
• 20. Yagmurlu MF, Bayhan IA, Tuhanioglu U, Kilinc AS, Karakas ES. Clinical and radiological outcomes are correlated with the age of the child in single-stage surgical treatment of developmental dysplasia of the hip. Acta Orthop Belg. 2013;79:159–65.
• 21. Abdullah ES, Razzak MY, Hussein HT, El-Adwar KL, Youssef AA. Evaluation of the results of operative treatment of hip dysplasia in children after the walking age. Alexandria J Med. 2012;48:115–22.
• 22. Chang CH, Kao HK, Yang WE, Shih CH. Surgical results and complications of developmental dysplasia of the hip – one stage open reduction and Salter’s osteotomy for patients between 1 and 3 years old. Chang Gung Med J. 2011;34:84–92.
• 23. Kotzias Neto A, Ferraz A, Bayer Foresti F, Barreiros Hoffmann R. Bilateral developmental dysplasia of the hip treated with open reduction and Salter osteotomy: analysis on the radiographic results. Rev Bras Ortop. 2014;49:350-8.
• 24. El-Sayed M, Ahmed T, Fathy S, Zyton H. The effect of Dega acetabuloplasty and Salter innominate osteotomy on acetabular remodeling monitored by the acetabular index in walking DDH patients between 2 and 6 years of age: short- to middle-term follow-up. J Child Orthop. 2012;6:471-7.
• 25. Arrest NA, Ramachandran M, Paterson MJMH, Barry M. Paediatric orthopaedics in clinical practice. London, Springer-Verlag, 2016.
• 26. Kelly DM. Congenital and developmental anomalies of the hip and pelvis. In: Canale ST, Beaty JH (ed). 12th edn. Campbell’s operative orthopaedics. Elsevier Mosby, Philadelphia, 2013, pp 1079–117.
• 27. Firth GB, Robertson AJ, Schepers A, Fatti L. Developmental dysplasia of the hip: open reduction as a risk factor for substantial osteonecrosis. Clin Orthop Relat Res. 2010;468:2485–94.
• 28. Wang YJ, Yang F, Wu QJ, Pan SN, Li LY. Association between open or closed reduction and avascular necrosis in developmental dysplasia of the hip: a PRISMA-compliant meta-analysis of observational studies. Medicine. 2016;95:e4276.
• 29. Kothari A, Grammatopoulos G, Hopewell S, Theologis T. How Does Bony Surgery Affect Results of Anterior Open Reduction in Walking-age Children With Developmental Hip Dysplasia? Clin Orthop Relat Res. 2016;474:1199-208.
• 30. Kim HW, Morcuende JA, Dolan LA, Weinstein SL. Acetabular development in developmental dysplasia of the hip complicated by lateral growth disturbance of the capital femoral epiphysis. J Bone Joint Surg Am. 2000;82-A:1692–700.