Abstract
We reviewed the medical records of 101 patients with developmental dysplasia of the hip who were treated with Dega’s (102 hips), or Salter’s (42 hips) osteotomy preceded by open reduction and femoral intertrochanteric osteotomy. The minimal follow-up was 17 years. At the last follow-up, there were proximal femoral growth disturbances in 52 hips (36%). In 20 hips, the disturbances were graded as mild and in six as severe. We found significantly better clinical and radiological results in hips without avascular changes. Risk factors for the development of avascular necrosis were: involvement of the left side and surgical treatment initiated after 2 years of age without pre-operative traction and without femoral shaft shortening. We found that the incidence of avascular necrosis increased with the length of follow-up. The avascular necrosis influenced both clinical and radiological results.
Résumé
Nous avons examiné les registres médicaux de 101 malades avec une dysplasie congénitale de la hanche qui ont été traitée par ostéotomie de Dega (102 hanches) ou Salter (42 hanches) précédé par réduction ouverte et ostéotomie fémorale intertrochantérienne. Le suivi minimal était de 17 ans. Àu dernier recul il y avait des troubles de croissance des fémurs proximaux dans 52 hanches (36%). Dans 20 hanches les troubles ont été notés comme discrets et en six comme sévères. Nous avons trouvé des résultats cliniques et radiologiques bien meilleurs dans les hanches sans troubles vasculaires. Les facteurs du risque pour le développement d’une nécrose avasculaire étaient: l’affection du côté gauche, le traitement chirurgical commencé après l’âge de 2 ans sans traction préopératoire et sans raccourcissement de la diaphyse fémorale. Nous avons trouvé que la fréquence des nécroses avasculaires a augmenté avec la durée d’observation. La nécrose avasculaire a influencé les résultats cliniques et radiologiques.
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Acknowledgments
This paper was supported by Grant no. 502-11-712(59)
Footnotes
First presented at the SICOT Congress in San Diego, CA, USA, 2002.
References
- 1.Barret W, Staheli L, Chew D (1986) The effectiveness of the Salter innominate osteotomy in the treatment of congenital dislocation of the hip. J Bone Joint Surg [Am] 68:79–87 [PubMed]
- 2.Berkeley ME, Dickson JH, Cain TE, Donovan MM (1984) Surgical therapy for congenital dislocation of the hip in patients who are twelve to thirty-six months old. J Bone Joint Surg [Am] 66:412–420 [PubMed]
- 3.Brougham DI, Broughton NS, Cole WG, Menelaus MB (1990) Avascular necrosis following closed reduction of congenital dislocation of the hip. Review of influencing factors and long-term follow-up. J Bone Joint Surg [Br] 72: 557–562 [DOI] [PubMed]
- 4.Bucholz In The. 1978;Hip:Proceedings. [Google Scholar]
- 5.Crego CH, Schwartzmann JR (1948) Follow-up study of the early treatment of congenital dislocation of the hip. J Bone Joint Surg [Am] 30:428–453 [PubMed]
- 6.Esteve R (1960) Congenital dislocation of the hip. A review and assessment of results of treatment with special reference to frame reduction as compared with manipulative reduction. J Bone Joint Surg [Br] 42:253–263 [DOI] [PubMed]
- 7.Fogarty J Pediatr Orthop. 1981;1:307. doi: 10.1097/01241398-198111000-00011. [DOI] [PubMed] [Google Scholar]
- 8.Gage JR, Winter RB (1972) Avascular necrosis of the capital femoral epiphysis as a complication of closed reduction of congenital dislocation of the hip. A critical review of twenty years’ experience at Gillette Children’s Hospital. J Bone Joint Surg [Am] 54:373–388 [PubMed]
- 9.Gore DR (1974) Iatrogenic avascular necrosis of the hip in young children. A review of six cases. J Bone Joint Surg [Am] 56:493–502 [PubMed]
- 10.Gregosiewicz J Pediatr Orthop. 1988;8:17. doi: 10.1097/01241398-198801000-00004. [DOI] [PubMed] [Google Scholar]
- 11.Kalamchi A, MacEwen GD (1980) Avascular necrosis following treatment of congenital dislocation of the hip. J Bone Joint Surg [Am] 62:876–888 [PubMed]
- 12.Koizumi W, Moriya H, Tsuchiya K, Takeuchi T, Kamegaya M, Akita T (1996) Ludloff’s medial approach for open reduction of congenital dislocation of the hip. A 20-year follow-up. J Bone Joint Surg [Br] 78:924–929 [DOI] [PubMed]
- 13.Langenskiold A, Paavilainen T (1982) The effect of traction treatment on the results of closed or open reduction for congenital dislocation of the hip: a preliminary report. In: Tachdjian, MO (ed), Congenital dislocation of the hip, Churchill Livingstone, New York, pp 365–371
- 14.Malvitz TA, Weinstein SL (1994) Closed reduction for congenital dysplasia of the hip. Functional and radiographic results after an average of thirty years. J Bone Joint Surg [Am] 76:1777–1792 [DOI] [PubMed]
- 15.Mau H, Dorr WM, Henkel L, Lutsche J (1971) Open reduction of congenital dislocation of the hip by Ludloff’s method. J Bone Joint Surg [Am] 53:1281–88 [PubMed]
- 16.McKayClin Orthop 1974981244817221 [Google Scholar]
- 17.Mose Clin Orthop. 1980;150:103. [PubMed] [Google Scholar]
- 18.SalterCan J Surg 196912445762671 [Google Scholar]
- 19.Schoenecker PL, Strecker WB (1984) Congenital dislocation of the hip in children. Comparison of the effects of femoral shortening and of skeletal traction in treatment. J Bone Joint Surg [Am] 66:21–27 [PubMed]
- 20.Severin Acta Chir Scand Suppl. 1941;63:1. [Google Scholar]
- 21.Thomas CL, Gage JR, Ogden JA (1982) Treatment concepts for proximal femoral ischemic necrosis complicating congenital hip disease. J Bone Joint Surg [Am] 64:817–828 [PubMed]
- 22.Thomas J Pediatr Orthop. 1989;9:525. doi: 10.1097/01241398-198909010-00005. [DOI] [PubMed] [Google Scholar]
- 23.TonnisClin Orthop 197611939954321 [Google Scholar]
- 24.Weiner DS, Hoyt WA Jr, O’ Dell HW (1977) Congenital dislocation of the hip. The relationship of premanipulation traction and age to avascular necrosis of the femoral head. J Bone Joint Surg [Am] 59:306–311 [PubMed]
- 25.Zionts LE, MacEwen GD (1986) Treatment of congenital dislocation of the hip in children between the ages of one and three years. J Bone Joint Surg [Am] 68:829–846 [PubMed]