Is the surgery safe for DDH in a walking child? Analysis of approach and medium-term outcomes of surgical management of DDH in walking children

Author(s): Dr. Rudraprasad, Dr. Kiran Rajappa, Dr. Naveen Shetty, Dr. Abhishek Bhasme and Dr. Abilash Srivatsav

Abstract: Background: Developmental dysplasia of the hip (DDH) is one of the common paediatric orthopaedic condition. Although a set protocol is in place to detect this problem during neonatal period, a majority of which goes unnoticed and present at very late age when the child is walking. The outcomes of survival of femoral head and the morphology of hip in the long term mainly depend on the time of intervention to contain the femoral head in the acetabulum. Our hospital being a tertiary referral centre often deals with late presenting DDH. We present our approach in managing untreated DDH in a walking child.
Materials and Methods: This study included a total number of 64 children with 85 hips were treated and evaluated between the periods 2006 to 2015 with a minimum follow up of one year. Children with hip dysplasia due to cerebral palsy, myopathies, connective tissue disorders and teratological dislocations were excluded from the study. All children were treated with open reduction and capsulorrhaphy through a standard anterior approach to the hip. Femoral shortening and an acetabulopalsty were done as and when needed for the coverage of the femoral head. The children were evaluated clinically and radiologically for a minimum period of one year.
Results: Open reduction with capsulorrhaphy was done in all children and this was combined with an additional acetabulopalsty in 15 children, femoral shortening osteotomy in 15 children and both procedures were done in 10 children. 75% of the patients had hip stiffness during early postoperative period which resolved in 6 months and inferior subluxation was noted in one patient. Re dislocation was seen in 4 hips, and avascular necrosis of femoral head was observed in 3 hips. Superficial wound infection was observed in 3 children which was treated conservatively.
Conclusion: DDH in a walking child can be managed with open reduction to give good functional outcome but carries more complication rates than early intervention. An additional procedure of acetabulopalsty, femoral shortening osteotomy in selected patients is necessary for good concentric reduction of the hip joint and to minimise the complications.

DOI: https://doi.org/10.22271/ortho.2022.v8.i1f.3043