Surgical Treatment of DDH in Older Children: Clinical and Radiological Analysis

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Surgical Treatment of DDH in Older Children
Clinical and Radiological Analysis

• Dr. Guillermo Tierno
• Dra. Milena Cruz
• Dr. José Luiz Thadeu Pedreira

Hospital Espanhol Hospital Martagão
Gesteira Salvador Bahia - Brasil
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Background

• Better results early diagnosis
• In developed countries theres a run to
  diagnosis, differently from our country, where
  patients have difficulty in healthcare access.
  For this reason, many cases of untreated DDH in
  older children are presented to us in our
  hospitals.
• These cases of untreated DDH in older children
  have complex treatment and increased number of
  complications.
• There are many possible methods of treatment
• Open reduction
• Pelvic osteotomy
• Femoral osteotomy
• COMBINED ONE-STAGED PROCEDURE

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Objective
The aim of this retrospective study was to assess
the clinical and radiographic results of
one-staged combined surgical procedure for the
treatment of DDH in older children after walking
age
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Patients Methods

• 20 patients
• 4 excluded ( 2 with follow-up lt 6 months / 2 lost
  in the follow-up )
• 11 Female / 5 Male
• 20 Hips ( aug, 1996 to sept, 2005 )
• 12 left side / 8 right side (04 bilateral)
• Mean age at surgery 60,6 months (35 a 122)
• Mean follow-up 40,8 months (7 a 85)
• Surgical technique

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Surgical Technique
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Patients Methods

• Radiological assessment
• Gage e Winter
• Acetabular index ( pre post-op)
• CE Wiberg angle ( post-op )
• Severins criteria
• Clinical assessment
• Ponsetis criteria

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Results

• Gage e Winter -1 in all the cases
• Acetabular Index
• (operated side)
• Acetabular index Post op X normal side
  p 0,1259
• Wiberg mean (operated side) 26,8o (10 46)
• Wiberg mean (normal side) 30,75o (12 44)

p lt 0,0001
p 0,3407
Paired t test (Two-tailed p value)
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Results

• Severins criteria
• Ponsetis criteria grade I 18
• grade IV - 2
• Complications
• 02 cases of AVN ( Ogden Bucholz II )
• 01 abduction contracture treated by Younts
  surgery (5m post-op)
• 01 rigid hip followed by femoral diaphyseal
  fracture after articular manipulation under
  anesthesia treated with spica cast

grade I - 12 grade II - 6 grade III - 2
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Clinical Cases
I.O.S. 5y6m F
M.S.C. 4y 4m F
N.N.J. 6y 2m F
N.N.J. 8y 6m 2y 5m PO
M.S.C. 12y 8y PO
I.O.S. 11y 5m 5y PO
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Conclusion

• The procedure is technically demanding
• We had satisfactory clinical and radiological
  results, similar to literature data
• Our patients presented few complications with
  this approach
• We conclude that this treatment is a good option
  in specialized centers, abbreviating treatment
  time
• Bibliography
• Forlin E, Munhoz da Cunha LA, Figueiredo DC.
  Treatment of developmental dysplasia of the hip
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  Orthopedic Clinics of North America 37(2)149-60,
  vi, 2006 Apr
• Tezeren G, Tukenmez M, Bulut O, Percin S, Cekin
  T. The surgical treatment of developmental
  dislocation of the hip in older children a
  comparative study. Source Acta Orthopaedica
  Belgica 71(6)678-85, 2005 Dec
• Samir B, Mahmoud S, Jalel C, Med NN, Chokri A,
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  J Bone Joint Surg Br 1996 78-B471-6