Table 2.
Studies reporting treatment of late presenting DDH
| No. | Study [References] | No. of patients (hips) | Mean age (range) in months | Mean Follow up (range) in months | Surgical Protocol | Surgical procedure done | Outcome measures used | Final outcome | MINORS score/(LOE) | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Only OR | OR + AO | OR + FO | OR + FO + AO | |||||||||
| 1 | Mootha et al. [20] | 15 (15) | 23.9 (12–48) | 21.2 (Min. 18) |
Anterior approach Test of stability used intra-op Post-op: 6 weeks spica + 6 weeks brace |
0 | 12 = OR + Salter | 0 | 3 = OR + FSO + Salter |
Clinical evaluation with McKay’s criteria Acetabular index on X-ray |
McKay: Excellent = 8, Good = 7 | 10 (4) |
| 2 | Bhuyan et al. [24] | 25 (30) | 46.8 (19–96) | 48 (24–91) |
a. One-stage triple procedure OR + FDRO + Salter b. Post-op: 6 weeks spica + 4 weeks abduction splint |
0 | 0 | 0 | 30 = OR + FSDRO + Salter |
Clinical stability AI on X-ray McKay’s criteria Severin & Bucholz |
McKay: Excellent = 13, Good = 14, Fair = 2, Poor = 1 |
5 (4) |
| 3 | Narasimhan et al. [25] | 35 (35) | (18–24) | (24–84) |
Standard anterior approach Intra-op ‘Test of stability’ used 6 + 6 weeks spica, No Bracing |
26 | 9 (Dega) | 0 | 0 |
Clinical stability Residual acetabular dysplasia (RAD) |
No re-dislocation. 7 cases with RAD (only OR group)—advised for acetabuloplasty | 7 (4) |
| 4 | Bhaskar et al. [28] | 55 (60) | 16 (6–36) | 28 (24–36) |
In OR Group: 4 hips = Medial approach Remaining 24 hips = Anterior approach Intra-op stability to decide FO/AO 6 + 6 weeks spica, No Brace |
28 | 5 (Salter) | 10 (FDRO / FSO) | - |
Clinical AI, Tonnis, Bucholz on X-ray MacKay’s for function |
McKay: Excellent = 36, Good = 11, Fair = 4. Re-dislocations = 5 hips | 10 (4) |
| 5 | Jagadesh et al. [68] | 21 (21) | 66.8 (25–96) | 15.1 |
Lateral approach used for OR 3 months of spica No Brace |
0 | 9 (Pemberton) | 0 | 12 (5 = OR + VDRO + Pemberton) (7 = OR + FS + VDRO + Pemberton) |
Clinical & radiographs AI, CEA, Tonnis, Severin classification on X-ray McKay’s for functional outcome |
McKay: Excellent = 8, Good = 11, Fair = 1, Poor = 1 Re-dislocation = 1 | 10 (4) |
| 6 | Manimaran et al. [64] | 10 (12) | 84 (36–180) | 44.4 (30–60) |
One-stage procedure: OR + VDRO + FSO + Dega/Salter Anterior approach Hip spica = 6–8 weeks No brace |
0 | 0 | 0 | 12 = OR + VDRO + Pelvic Osteotomy (Salter = 6, Dega = 6) |
Clinical AI on X-rays and Mckay’s criteria used |
McKay: Excellent = 3, Good = 2, Fair = 5, Poor = 2 Re-dislocation = 1 | 10 (4) |
| 7 | Tej et al. [63] | 34 (41) | 34.7 | 36 (13–65) |
Anterior approach 3 month hip spica Brace case to case basis |
15 | 16 (Pemberton) | 0 | 10 (3 = OR + VDRO + Pemberton) (7 = OR + VDRO + FSO + Pemberton) | AVN rate as per Kalamchi classification at mean follow-up of 3 year (44% AVN rate noted) |
AVN as per Kalamchi: No AVN = 23, Type 1 = 12, Type 2 = 3, Type 3 = 3 |
9 (4) |
OR open reduction, FDRO femoral derotation osteotomy, FO femoral osteotomy, FSO femoral shortening osteotomy, VDRO varus derotation osteotomy, FSDRO femoral shortening derotation osteotomy, AO acetabular osteotomy, AVN avascular necrosis, LOE level of evidence, AI acetabular index, CEA center edge angle