Single-stage surgical treatment for late presenting developmental dysplasia of the hip in children older than 7 years of age: a midterm results

Abstract

Background Treatment of late presenting developmental dysplasia of the hip (DDH) in older children is a challenge due to adaptive shortening of the surrounding soft tissues, acetabular dysplasia (1). This study aims to evaluate the outcome of surgical treatment for DDH presenting in children older than 7 years. Patients and methods Twenty-five patients (32 hips) a mean age at the time of surgery was 9.5 years (range 7.3–14.9 years) were treated using Dega osteotomy, or triple pelvic osteotomy. Femoral shortening and derotation osteotomy were done for all patients. A spica cast was applied postoperative for 6 weeks, and allowed mobilization exercises of the hip joint 2 weeks after the cast removal. All patients were followed for an average of 5.9 years (range 4.5–9.9 years) after surgery. According to the McKay criteria and Severin criteria, the satisfactory results were 67 and 53%, respectively. There was one case of postoperative stiffness managed by physical. A green stick supracondylar femoral fracture occurred in one case. The results revealed improvement in Sharp’s acetabular angle and centre edge angle. Avascular necrosis of the femoral head was observed in two cases. Conclusion Reconstruction for late presenting DDH in children older than 7 years can give a satisfactory result both clinical and radiological. Although the concern of postoperative stiffness and avascular necrosis is still there but this can be managed with prolonged physical therapy and prevented with shortening of the femur, respectively.