Mid- and long-term outcome of Salter's, Pemberton's and Dega's osteotomy for treatment of developmental dysplasia of the hip: a systematic review and meta-analysis

Quality of life in adult patients with developmental dysplasia of the hip who were treated for hip dislocation during childhood

Developmental dysplasia of the hip (DDH) can lead to premature loss of hip function if not properly treated; however, few studies have focused on the long-term outcomes of DDH. We conducted a survey of health-related quality of life in adult patients with DDH who were treated for hip dislocation during childhood. We sent a questionnaire to 287 adult patients with DDH who were treated for hip dislocation during childhood in our institutions. We examined patient demographics, disease-specific medical history, and health-related quality of life using the short form-36. Physical component summary (PCS), mental component summary (MCS) and role/social component summary (RCS) were compared between the patients and Japanese standard values. Sixty-eight patients were evaluated after exclusion. The overall mean PCS, MCS and RCS scores of the patients were comparable to the standard values. The PCS was maintained until the age of 50, but it was significantly decreased in 10 patients over 50 years old. In addition, PCS was significantly lower in patients who underwent open reduction than in those who were conservatively reduced. The MCS and RCS of the patients did not differ from the standard values in each age and treatment group. Additionally, the PCS, MCS and RCS did not differ according to bilaterality, age at diagnosis, or requirement for additional surgeries. Physical quality of life was maintained until the age of 50 but rapidly declined thereafter in patients with DDH, especially in those who required open reduction during childhood.

Bernese periacetabular osteotomy (PAO): from its local inception to its worldwide adoption

The development of the Bernese periacetabular osteotomy (PAO) is based on a structured approach starting with an analysis of the preexisting procedures to improve the coverage of the femoral head and was followed by a list of additional goals and improvements. Cadaveric dissections with a detailed description of the vascular supply of acetabulum and periacetabular bone set the stage for an intrapelvic approach, which offered the largest acetabular correction possible combined with safe intracapsular access. The final composition of osteotomies required the development of several instruments and cutting devices before the feasibility could be tested on a series of cadaveric hips.While the sequence of the osteotomies remained largely unchanged over time (except for the pubic and ischial osteotomies), several propositions for an easier/less invasive approach have been discussed; some made it into standard practice. Efforts were undertaken to optimize the learning curve and minimize failures using video-clips, hands-on courses, fellowships, publications, and ongoing mentoring programs. In retrospect, with almost 40 years of experience, such efforts have promoted a worldwide adoption of the Bernese periacetabular osteotomy.

Smith c/b ratio and teardrop figure measurements; Can it be used in the follow-up of patients who underwent salter innominate osteotomy?

BACKGROUND

This study aimed to investigate the effectiveness of radiological parameters used in the follow-up of patients who underwent salter innominate osteotomy (SIO) for the treatment of developmental dysplasia of the hip.

METHODS

Acetabular index, c/b ratio, teardrop width, femoral head teardrop distance (TDD), and acetabular teardrop angle were measured on anteroposterior pelvic radiographs of patients who underwent SIO between 2017 and 2020. The patients were divided into 2 groups according to their preoperative Tönnis stage. Twenty-five (51%) hips of 23 patients with Tönnis stage 2 were classified into group 1, and 24 (49%) of 17 patients with Tönnis stages 3 and 4 were classified into group 2. Changes in radiologic parameters over time and between the groups were statistically evaluated.

RESULTS

The study included 49 hips of 40 patients (37 female and 3 male). The age at surgery was 26.53 (18-53) months. After a mean follow-up period of 33.7 ± 12.8 months, there was no statistically significant difference between Groups 1 and 2 in terms of clinical, radiological and femoral head avascular necrosis results (P = .591, P = 956, P = .492). The changes in radiological parameters over time and between groups were statistically significant. (P < .001). Only the TDD and c/b ratio were significantly different between groups 1 and 2 (P = .002 and P < .001, respectively).

CONCLUSION

In our study, along with acetabular index, the c/b ratio, teardrop width, TDD, and acetabular teardrop angle significantly changed after SIO and could be used as a guide for patient follow-up.

Clinicoradiological outcomes following pembersal acetabular osteotomy for developmental dysplasia of hip in young children: A series of 16 cases followed minimum 2 years

PURPOSE

Pembersal acetabular osteotomy is a relatively less practised procedure for developmental dysplasia of hip in young children. We retrospectively studied the acetabular correction and clinico-radiological outcome with this osteotomy in 16 children (16 hips) aged less than 4 years.

METHODS

Postoperative correction of acetabular dysplasia was measured by acetabular index (AI). At follow up, following radiological parameters were documented: Centre edge angle (CEA), Reimer's index (RI) and acetabular depth to width ratio (D/W ratio). Avascular necrosis of hip, stability, and premature fusion of triradiate cartilage (TRC) were also recorded. Overall containment was assessed by modified Severin classification and function by Mckay clinical grade.

RESULTS

The mean age at time of surgery was 25 months. Mean follow up was 54 months. The postoperative AI (17.6 ± 5.6°) improved significantly from preoperative values (37.5 ± 5.0°) (p < 0.0001). Mean follow up AI on the operated side was 15.3 ± 6.9° as compared to 14.7 ± 4.4° on the normal side (p = 0.78). Follow up CEA (24.9 ± 11.3°), Reimer's index (14.3%), D/W ratio (40.9%) did not differ significantly from the normal side. Early closure of TRC was not found in any of hips. All hips were clinically stable. As per modified Severin's classification, 7 hips were Type Ia, 7 Type IIa and 2 had residual dysplasia. Twelve (75%) hips had excellent clinical outcome, 2 (12.5%) good outcome and 2 (12.5%) had fair outcome.

CONCLUSIONS

Pembersal osteotomy is a safe and effective option for correction of acetabular dysplasia during open reduction of DDH in young children. It improves the AI and femoral head coverage, and promotes formation of a congruent and stable hip joint.