Preliminary Results after Reduction of DDH via Medial Approach

Jung Yun Bae; Do-Hoon Kim; Tae-Joon Cho; Won Joon Yoo; Chin Youb Chung; Moon Seok Park; In Ho Choi

doi:10.4055/jkoa.2009.44.6.627

Journal List > J Korean Orthop Assoc > v.44(6) > 1012958

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Bae, Kim, Cho, Yoo, Chung, Park, and Choi: Preliminary Results after Reduction of DDH via Medial Approach

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2009; 44(6): 627-633.

Published online: 21 December 2009

DOI: https://doi.org/10.4055/jkoa.2009.44.6.627

Preliminary Results after Reduction of DDH via Medial Approach

Jung Yun Bae, M.D., Do-Hoon Kim, M.D., Tae-Joon Cho, M.D., Won Joon Yoo, M.D., Chin Youb Chung, M.D., Moon Seok Park, M.D., In Ho Choi, M.D.

Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea.

Correspondence to Tae-Joon Cho, M.D. Department of Orthopedic Surgery, Seoul National University Children's Hospital, 101, Daehak-ro, Jongno-gu, Seoul 110-744, Korea. Tel: +82.2-2072-2878, Fax: +82.2-745-3367, tjcho@snu.ac.kr

Received 28 August 2009 Accepted 8 October 2009

Abstract

Purpose

We report the outcomes of medial open reduction for developmental dysplasia of the hip (DDH).

Materials and Methods

This study reviewed the medical records and radiographs of 33 DDH cases treated by a medial open reduction and followed for at least two years. The mean age at surgery and follow-up duration was 11.4 months (range, 4 to 22) and 88 months (range, 24 to 168), respectively. The perioperative parameters, maintenance of reduction, and postoperative changes in the acetabular index and center-edge angle were recorded.

Results

The acetabular index decreased from a preoperative average of 35° to 16° at the latest follow-up. The center-edge angle improved from an average of 7° at postoperative 1 year to 22° at the latest follow-up. A secondary bony procedure was performed in 15 cases at average age of 4.4 years. Avascular necrosis was noted in 8 cases, all of whom belonged to Kalamchi group I. Among the 21 patients over 6 years-old at the latest follow-up, 18 belonged to Severin groups I or II and the remaining 3 to group III. Redislocation occurred in one case.

Conclusion

A medial open reduction is a minimal surgical procedure that can effectively release the structures obstructing a femoral head reduction. It should be a useful treatment modality for selected cases with DDH.

Keywords: Developmental dysplasia of the hip, Medial open reduction

Figures and Tables

Fig. 1

Schematic drawing of medial open reduction approaches for DDH (AL, adductor longus; AB, adductor brevis; AM, adductor magnus; EO, obturator externus; QF, quadratus femoris; P, pectineus; I, iliopsoas; VM, vastus medialis; VI, vastus intermedius; RF, rectus femoris; S, sartorius) (Modified from Choi IH, et al. Duk Young Lee's Pediatric Orthopedics. Seoul: Goonja; 2009.).

Fig. 2

An illustrative case. In a 14-month-old girl with left DDH (A), the femoral head could be reduced deep into the acetabulum due to narrow acetabular introitus (B). On the first cast change, arthrogram showed deep reduction of the femoral head (C). The left hip joint developed well in 4 year follow-up (D).

Table 1

Pertinent Data of Patients Under 12 Months

na, not applicable; FVDO, femoral varus derotational osteotomy; FS, femoral shortening. ^*according to Severin classification; ^†according to Kalamchi classification.

Table 2

Pertinent Data of Patients Aged 12 Months or Older

na, not applicable; FVDO, femoral varus derotational osteotomy; FS, femoral shortening. ^*according to Severin classification; ^†according to Kalamchi classification.

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